A Pilot Study Comparing Peer Supported Web-Based CBT to Self-Managed Web CBT for Primary Care Veterans With PTSD and Hazardous Alcohol Use

Kyle Possemato, Emily M. Johnson, J. Bronte Emery, Michael Wade, Michelle C. Acosta, Lisa A. Marsch, Andrew Rosenblum, Stephen A. Maisto

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Objective: Many combat veterans struggle with posttraumatic stress disorder (PTSD) and hazardous alcohol use and are hesitant to engage in behavioral health services. Combining peer support with an eHealth intervention may overcome many barriers to care. This pilot study investigated the feasibility of adding peer support to a web-based cognitive behavior therapy (CBT) targeting PTSD symptoms and hazardous drinking, called Thinking Forward. Method: Thirty primary care patients with PTSD and hazardous alcohol use were randomized to receive Thinking Forward with or without peer support. Participants were assessed at pretreatment, posttreatment, and 24-week follow-up. Feasibility was analyzed with descriptive statistics. Preliminary outcomes were analyzed with multilevel modeling and effect sizes are presented. Results: Peer support specialists can be feasibly trained to support the Thinking Forward intervention with good fidelity. Both participants and peers reported good satisfaction with the protocol; although peers discussed a mismatch between the philosophies of peer support and diagnostically focused CBT. All participants experienced significant improvements in PTSD, quality of life, resiliency, and coping from pre to posttreatment, with no differences between conditions. Pretreatment patient activation predicted outcomes regardless of whether participants received peer support. Conclusions and Implications for Practice: Peer support interventions to facilitate eHealth programs should strive to be consistent with the person-centered, recovery orientation of peer support, explicitly focus on patient activation, and consider characteristics of the patients, such as their level of problem recognition and willingness to engage in traditional behavioral health modalities.

Original languageEnglish (US)
Pages (from-to)305-313
Number of pages9
JournalPsychiatric Rehabilitation Journal
Issue number3
StatePublished - 2019


  • PTSD
  • eHealth
  • hazardous alcohol use
  • peer support
  • primary care-mental health integration

ASJC Scopus subject areas

  • Health Professions (miscellaneous)
  • Rehabilitation
  • Psychiatry and Mental health


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