Uniformity of evidence-based treatments in practice? Therapist effects in the delivery of cognitive processing therapy for PTSD.

2013 ◽  
Vol 60 (1) ◽  
pp. 31-41 ◽  
Author(s):  
Kevin M. Laska ◽  
Tracey L. Smith ◽  
Andrew P. Wislocki ◽  
Takuya Minami ◽  
Bruce E. Wampold
Keyword(s):  
Cognitive Processing ◽  
Cognitive Processing Therapy ◽  
Evidence Based ◽  
Therapist Effects ◽  
Evidence Based Treatments

scholarly journals Predictors of Quality of Life Following Cognitive Processing Therapy Among Women and Men With Post-Traumatic Stress Disorder

2020 ◽  
Vol 185 (5-6) ◽  
pp. e579-e585 ◽  
Author(s):  
Lisa H Glassman ◽  
Margaret-Anne Mackintosh ◽  
Stephanie Y Wells ◽  
Induni Wickramasinghe ◽  
Kristen H Walter ◽  
...  
Keyword(s):  
Cognitive Processing ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Post Treatment ◽  
Cognitive Processing Therapy ◽  
Evidence Based ◽  
Post Traumatic Stress ◽  
Post Traumatic

Abstract Introduction The effect of evidence-based post-traumatic stress disorder (PTSD) treatments on quality of life (QOL) is not well understood. In light of mixed findings on QOL after PTSD interventions, little is known about why some individuals experience functional and QOL improvements while others do not. This study examined treatment-related changes in depression, anger, and PTSD following cognitive processing therapy (CPT) as potential predictors of QOL change. Materials and Methods Data from two randomized controlled trials, one examining CPT among female civilians and veterans (women’s study NCT02362477; n = 126) and the other on CPT delivered to male veterans (men’s study NCT00879255; n = 125), were used to test study aims. Linear mixed modeling examined changes in depression, anger, and PTSD as predictors of post-treatment QOL while controlling for baseline QOL. The VA Pacific Island Health Care System’s Institutional Review Board approved all study procedures. Results Among women, reductions in depression from pre- to post-treatment had the strongest predictive value of post-treatment QOL (B = −1.15, 95% confidence interval (−1.71, −0.60), t = −4.07, P < .001). For men, reductions in trait anger from pre- to post-treatment predicted post-treatment QOL (B = −0.55, 95% confidence interval (−0.90, −0.19), t = −3.00, P = .003). Conclusions Improvements in QOL may be predicted by different symptoms for men and women following evidence-based PTSD treatment. Our findings suggest that change in depression symptoms is an important predictor of post-treatment QOL among women, while anger symptoms are more influential for men. QOL and functioning is underresearched within the context of PTSD treatment, and this study suggests that these domains should be examined within the context of gender.

Quality of life following treatment for PTSD: Comparison of videoconferencing and in-person modalities

2017 ◽  
Vol 25 (2) ◽  
pp. 123-127 ◽  
Author(s):  
Lisa H Glassman ◽  
Margaret-Anne Mackintosh ◽  
Alexander Talkovsky ◽  
Stephanie Y Wells ◽  
Kristen H Walter ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cognitive Processing ◽  
Treatment Modality ◽  
Treatment Modalities ◽  
Cognitive Processing Therapy ◽  
Modality Effect ◽  
Evidence Based ◽  
Over Time

Introduction Quality of life (QOL) is significantly impaired among individuals with post-traumatic stress disorder (PTSD); however, few treatment outcome studies examine QOL following treatment. Furthermore, the use of videoconferencing to deliver evidence-based treatments for PTSD is increasing dramatically. Although videoconferencing has demonstrated non-inferiority to in-person treatment modalities for improving PTSD symptom severity, no studies to date have directly compared QOL outcomes of an evidence-based intervention delivered via videoconferencing to one delivered in-person. Methods This study presents a secondary data analysis of two randomized controlled trials comparing cognitive processing therapy (CPT) delivered via videoconferencing or a traditional in-person modality. The Men’s study delivered group CPT to 125 male veterans with PTSD, whereas the Women’s study delivered individuals CPT to 126 female civilians and veterans. Multigroup latent growth curve models were used to model changes in QOL Inventory (QOLI) scores over time. Results There was no effect of treatment modality on changes in QOLI scores over time (modality effect on slope estimate = 0.004 (–0.60, 0.61) and on quadratic estimate = 0.001 (–0.18, 0.20); all ps > 0.33). Model fit was the same for both genders (Δ χ2 (2) = 2.28, p = 0.32) and for the gender × treatment modality interaction (Δ χ2 (2) = 2.87, p = 0.24). QOLI scores improved at post-treatment and three-month follow-up assessments, but declined at the six-month follow-up assessment. Discussion This secondary analysis extends the findings of the parent studies by establishing the efficacy of the videoconferencing platform in improving QOL. Clinical implications of findings are discussed.

Evidence-based treatments for PTSD and VHA provider burnout: The impact of cognitive processing and prolonged exposure therapies.

2015 ◽  
Vol 21 (1) ◽  
pp. 7-13 ◽  
Author(s):  
Hector A. Garcia ◽  
Cindy A. McGeary ◽  
Erin P. Finley ◽  
Norma S. Ketchum ◽  
Donald D. McGeary ◽  
...  
Keyword(s):  
Cognitive Processing ◽  
Prolonged Exposure ◽  
Evidence Based ◽  
Evidence Based Treatments ◽  
The Impact

Dissemination and Implementation of Evidence-Based Interventions for Adults with PTSD

2020 ◽  
Author(s):  
Heidi La Bash ◽  
Shannon Wiltsey Stirman
Keyword(s):  
Cognitive Processing ◽  
Cultural Context ◽  
Prolonged Exposure ◽  
Empirical Support ◽  
The Body ◽  
Cognitive Processing Therapy ◽  
Dissemination And Implementation ◽  
Evidence Based ◽  
Initial Stage ◽  
Active Implementation

This chapter reviews current efforts to disseminate and implement evidence-based interventions (EBIs) for adult posttraumatic stress disorder (PTSD), like cognitive processing therapy and prolonged exposure. As the body of empirical support for EBIs has been amassed and best practices identified, concerted efforts are being made to integrate EBIs for PTSD into behavioral health organizations. However, implementation is a complex, multi-faceted process, with a range of factors that can benefit or hinder efforts to diffuse an innovation. Working through each stage of implementation, these factors are reviewed from the initial stage of a needs assessment, through the preparation, active implementation, and finally sustained delivery stages. Factors discussed include those related to the broader sociopolitical and cultural context, the organization, the individuals providing and receiving treatment, as well as those specific to the characteristics of the intervention. Strategies to address these barriers and to amplify the effects of factors that facilitate implementation are also discussed. Finally, the chapter discusses future directions and remaining pressing issues for the field.

scholarly journals Developing a model of post-workshop consultation for clinicians learning to deliver Cognitive Processing Therapy for posttraumatic stress disorder

2021 ◽  
Author(s):  
Meredith Sara Herman Landy
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Clinical Supervision ◽  
Cognitive Processing ◽  
Best Practice ◽  
Stress Disorder ◽  
Kappa Statistic ◽  
Cognitive Processing Therapy ◽  
Evidence Based ◽  
Clinical Consultation

Best practice in training clinicians to deliver evidence-based psychotherapies includes workshop attendance followed by post-workshop consultation. Although previous research highlights the importance of consultation, little is known about what makes for effective consultation, and no model of clinical consultation currently exists. The primary aims of this study were to identify the primary elements of consultation, and develop a model of consultation in a sample of clinicians learning to deliver Cognitive Processing Therapy (CPT; Resick, Monson, & Chard, 2014), an evidence-based psychotherapy for posttraumatic stress disorder. The study was conducted from a realist perspective, a paradigm that is particularly useful for theory building. The study involved the participation of mental health clinicians (N = 41) who attended one of five CPT workshops, and CPT consultants (N = 6) who provided the clinicians with post-workshop consultation for six months following the workshop. Thirty audio recorded consultation calls were randomly selected and transcribed. The data was coded and analyzed using thematic analysis. The kappa statistic measuring inter-rater reliability was .80. The following contextual factors were identified: access to group support, clinicians joining late, clinicians not having content to discuss, study participation, and technological disruptions. Knowledge consolidation and case conceptualization were identified as the overarching functions of consultation. The remaining elements of consultation were classified into the following themes: Organization, Asking for Help, Directive Instruction, Non-Directive Instruction, and Provision of Feedback. Two hypothesized mechanisms of consultation, reflection and connectedness, wereidentified. A comprehensive model positing how consultation works was presented. Additionally, three sets of context-mechanism-outcome configurations were presented. The model of consultation was compared to the model of clinical supervision proposed by Milne and colleagues (2008). Finally, the usefulness of Kolb’s (1984) model of experiential learning was explored as a framework for understanding the learning that occurs during clinical consultation. Based on the study’s findings, several recommendations for clinical practice were made. An important next step is to test the proposed theory, and to assess the relationship between the use of various elements of consultation and the development of proficiency in delivering CPT.

scholarly journals Drivers of Preference for Evidence-Based PTSD Treatment: A Qualitative Assessment

2020 ◽  
Vol 185 (Supplement_1) ◽  
pp. 303-310
Author(s):  
Bella Etingen ◽  
Kathleen M Grubbs ◽  
Juliette M Harik
Keyword(s):  
Cognitive Processing ◽  
Mental Health Treatment ◽  
Online Survey ◽  
Prolonged Exposure ◽  
Qualitative Assessment ◽  
Cognitive Processing Therapy ◽  
Stress Inoculation ◽  
Free Text ◽  
Evidence Based ◽  
Ptsd Treatment

ABSTRACT Introduction Mental health treatment utilization among persons with posttraumatic stress disorder (PTSD) tends to be low but may be improved by aligning treatment with patient preferences. Our objective was to characterize the reasons that drive a person’s selection of a specific evidence-based PTSD treatment. Materials and Methods Data were collected using an online survey of adults who screened positive for PTSD. Participants viewed descriptions of five evidence-based PTSD treatments (cognitive processing therapy, prolonged exposure, eye movement desensitization and reprocessing, stress inoculation training, antidepressant medication) and identified their most preferred treatment. Participants then explained why they selected their top choice. These free-text responses (n = 249) were analyzed using thematic coding and constant comparative methods. Results Identified themes included (1) perceived effectiveness, (2) perceived suitability, (3) requirements of participation, (4) familiarity with the modality, (5) perception of the option as ‘better than alternatives,’ (6) perception of the option as ‘not harmful,’ (7) accessibility, and (8) delivery format. Differences in themes were also examined by treatment modality. Conclusions By highlighting which pieces of information may be most important to detail when presenting different treatment options, these results can help guide treatment planning conversations, as well as the development of shared decision-making tools.

scholarly journals Study protocol for a non-inferiority randomised controlled trial of SKY breathing meditation versus cognitive processing therapy for PTSD among veterans

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e027150 ◽  
Author(s):  
Danielle C Mathersul ◽  
Julia S Tang ◽  
R Jay Schulz-Heik ◽  
Timothy J Avery ◽  
Emma M Seppälä ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Cognitive Processing ◽  
Controlled Trial ◽  
Self Report ◽  
Cognitive Processing Therapy ◽  
Symptom Improvement ◽  
Evidence Based ◽  
Post Traumatic Stress ◽  
Randomised Controlled ◽  
Breathing Meditation

IntroductionPost-traumatic stress disorder (PTSD) is a debilitating, highly prevalent condition. Current clinical practice guidelines recommend trauma-focused psychotherapy (eg, cognitive processing therapy; CPT) as the first-line treatment for PTSD. However, while these treatments show clinically meaningful symptom improvement, the majority of those who begin treatment retain a diagnosis of PTSD post-treatment. Perhaps for this reason, many individuals with PTSD have sought more holistic, mind–body, complementary and integrative health (CIH) interventions. However, there remains a paucity of high-quality, active controlled efficacy studies of CIH interventions for PTSD, which precludes their formal recommendation.Methods and analysesWe present the protocol for an ongoing non-inferiority parallel group randomised controlled trial (RCT) comparing the efficacy of a breathing meditation intervention (Sudarshan Kriya Yoga [SKY]) to a recommended evidence-based psychotherapy (CPT) for PTSD among veterans. Assessors are blinded to treatment group. The primary outcome measure is the PTSD Checklist-Civilian Version and a combination of clinical, self-report, experimental and physiological outcome measures assess treatment-related changes across each of the four PTSD symptom clusters (re-experiencing, avoidance, negative cognitions or mood and hyperarousal/reactivity). Once the RCT is completed, analyses will use both an intent-to-treat (using the ‘last observation carried forward’ for missing data) and a per-protocol or ‘treatment completers’ procedure, which is the most rigorous approach to non-inferiority designs.Ethics and disseminationTo the best of our knowledge, this is this first non-inferiority RCT of SKY versus CPT for PTSD among veterans. The protocol is approved by the Stanford University Institutional Review Board. All participants provided written informed consent prior to participation. Results from this RCT will inform future studies including larger multi-site efficacy RCTs of SKY for PTSD and other mental health conditions, as well as exploration of cost-effectiveness and evaluation of implementation issues. Results will also inform evidence-based formal recommendations regarding CIH interventions for PTSD.Trial registration numberNCT02366403; Pre-results.

scholarly journals Developing a model of post-workshop consultation for clinicians learning to deliver Cognitive Processing Therapy for posttraumatic stress disorder

2021 ◽  
Author(s):  
Meredith Sara Herman Landy
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Clinical Supervision ◽  
Cognitive Processing ◽  
Best Practice ◽  
Stress Disorder ◽  
Kappa Statistic ◽  
Cognitive Processing Therapy ◽  
Evidence Based ◽  
Clinical Consultation

Best practice in training clinicians to deliver evidence-based psychotherapies includes workshop attendance followed by post-workshop consultation. Although previous research highlights the importance of consultation, little is known about what makes for effective consultation, and no model of clinical consultation currently exists. The primary aims of this study were to identify the primary elements of consultation, and develop a model of consultation in a sample of clinicians learning to deliver Cognitive Processing Therapy (CPT; Resick, Monson, & Chard, 2014), an evidence-based psychotherapy for posttraumatic stress disorder. The study was conducted from a realist perspective, a paradigm that is particularly useful for theory building. The study involved the participation of mental health clinicians (N = 41) who attended one of five CPT workshops, and CPT consultants (N = 6) who provided the clinicians with post-workshop consultation for six months following the workshop. Thirty audio recorded consultation calls were randomly selected and transcribed. The data was coded and analyzed using thematic analysis. The kappa statistic measuring inter-rater reliability was .80. The following contextual factors were identified: access to group support, clinicians joining late, clinicians not having content to discuss, study participation, and technological disruptions. Knowledge consolidation and case conceptualization were identified as the overarching functions of consultation. The remaining elements of consultation were classified into the following themes: Organization, Asking for Help, Directive Instruction, Non-Directive Instruction, and Provision of Feedback. Two hypothesized mechanisms of consultation, reflection and connectedness, wereidentified. A comprehensive model positing how consultation works was presented. Additionally, three sets of context-mechanism-outcome configurations were presented. The model of consultation was compared to the model of clinical supervision proposed by Milne and colleagues (2008). Finally, the usefulness of Kolb’s (1984) model of experiential learning was explored as a framework for understanding the learning that occurs during clinical consultation. Based on the study’s findings, several recommendations for clinical practice were made. An important next step is to test the proposed theory, and to assess the relationship between the use of various elements of consultation and the development of proficiency in delivering CPT.

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