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Symposia

Adult Depression

COVID Crashed My Clinical Study!: Surprising Results, New Paths, and Lessons in Resilience

2 - (SYM 59) In-person to Zoom Overnight: High Levels of Adherence, Retention, and Efficacy in Remotely Delivered Mind-body Group Interventions for Posttraumatuic Stress Disorder in a Community Sample

Sunday, November 23, 2025
12:27 PM - 12:48 PM CST
Location: Strand 10 A&B, Level 2
Keywords: Clinical Trial, Mood, Technology / Mobile Health
Recommended Readings: Rohan, K. J., Franzen, P. L., Roeckelin, K. A., Siegle, G. J., Kolko, D. J., Postolache, T. T., & Vacek, P. M. (2022). Elucidating treatment targets and mediators within a confirmatory efficacy trial: Study protocol for a randomized controlled trial of cognitive-behavioral therapy vs. light therapy for winter depression. Trials, 23, 383. https://doi.org/10.1186/s13063-022-06330-9,   King, A. P., Block, S. R., Sripada, R. K., Rauch, S. A., Porter, K. E., Favorite, T. K., Giardino, N., & Liberzon, I. (2016). A Pilot Study of Mindfulness-Based Exposure Therapy in OEF/OIF Combat Veterans with PTSD: Altered Medial Frontal Cortex and Amygdala Responses in Social-Emotional Processing. Frontiers in psychiatry, 7, 154. https://doi.org/10.3389/fpsyt.2016.00154,   Liu, T., Meyerhoff, J., Mohr, D. C., Ungar, L. H., & Kording, K. P. (2020). COVID-19 pandemic: Every day feels like a weekday to most. medRxiv, 2020-05.,   Price, M., Legrand, A. C., Brier, Z. M., van Stolk-Cooke, K., Peck, K., Dodds, P. S., ... & Adams, Z. W. (2022). Doomscrolling during COVID-19: The negative association between daily social and traditional media consumption and mental health symptoms during the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy, 14(8), 1338. https://doi.org/10.1037/tra0001202,  
Abstract Body

Posttraumatic stress disorder (PTSD) is common, debilitating, and associated with considerable distress. Trauma exposure-based psychotherapies show high efficacy, but 30-50% of PTSD patients treated do not show clinically meaningful improvement, suggesting “one size may not fit all.”  We have previously shown Mindfulness-based Cognitive Therapy (MBCT) group intervention is acceptable to male Veteran PTSD patients and has efficacy (effect sizes g = 0.7 - 0.9).

In October 2019, we started an RCT with community members meeting DSM-5 criteria for PTSD that compared MBCT to a structurally similar mind-body group (Progressive Muscular Relaxation, PMR) without mindfulness instruction and used cluster randomization.   PTSD assessments (CAPS-5) were conducted by blinded assessors, and self-report measures (PCL-5) were collected using web-based REDCap. Functional MRI (3T GE scanner) scans were also collected at intake and post-treatment.

Due to the COVID pandemic, all interventions and interviews were shifted to remote (by “Zoom”) during the second treatment group.  A total of 357 community members expressed interest, 161 met initial eligibility and consented, 114 had PTSD assessment, and 81 met PTSD eligibility and were enrolled into the study, 61 of whom had intake fMRI scans.  65 participants completed the RCT with pre- and post-therapy PCL-5, and 41 with CAPS-5 and fMRI scan.  Both MBCT and PMR led to improvements in PTSD in intent-to-treat (ITT) analysis (MBCT - mean 22 point PCL-5 reduction, Hedge’s g=1.2, p< .001, PMR - mean 24 point PCL-5 reduction, g=1.2, p < .001), with no significant between treatment effect.  Both interventions appeared well-tolerated and had completion rates (5+ sessions) >80%. Rates of “treatment responders” (CGI-I 1–very much or 2-much improved) were 48% MBCT and 50% PMR.  In self-report scales added in Nov 2020, participants in both remote group interventions reported client satisfaction (CSQ8 6.6 / 7.0), treatment credibility (TCI 5.4 / 7.0), and working alliance (WAI-R 3.7 / 5.0). 

These remotely delivered group PTSD therapies had high levels of adherence, completion, and efficacy, as well as high satisfaction and moderately high treatment credibility and working alliance from the client perspective.