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Background Implementation strategies are necessary to ensure that evidence-based practices are successfully incorporated into routine clinical practice. Such strategies, however, are frequently modified to fit local populations, settings, and contexts. While such modifications can be crucial to implementation success, the literature on documenting and evaluating them is virtually nonexistent. In this paper, we therefore describe the development of a new framework for documenting modifications to implementation strategies. Discussion We employed a multifaceted approach to developing the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS), incorporating multiple stakeholder perspectives. Development steps included presentations of initial versions of the FRAME-IS to solicit structured feedback from individual implementation scientists (“think-aloud” exercises) and larger, international groups of researchers. The FRAME-IS includes core and supplementary modules to document modifications to implementation strategies: what is modified, the nature of the modification (including the relationship to core elements or functions), the primary goal and rationale for the modification, timing of the modification, participants in the modification decision-making process, and how widespread the modification is. We provide an example of application of the FRAME-IS to an implementation project and provide guidance on how it may be used in future work. Conclusion Increasing attention is being given to modifications to evidence-based practices, but little work has investigated modifications to the implementation strategies used to implement such practices. To fill this gap, the FRAME-IS is meant to be a flexible, practical tool for documenting modifications to implementation strategies. Its use may help illuminate the pivotal processes and mechanisms by which implementation strategies exert their effects.

D-cycloserine is associated with a small augmentation effect on exposure-based therapy. This effect is not moderated by the concurrent use of antidepressants. Further research is needed to identify patient and/or therapy characteristics associated with DCS response.

BackgroundClinicians often modify evidence-based psychotherapies (EBPs) when delivering them in routine care settings. There has been little study of factors associated with or implications of modifications to EBP protocols. This paper differentiates between fidelity-consistent and fidelity-inconsistent modifications and it examines the potential influence of two clinician characteristics, training outcomes, and attitudes toward EBPs on fidelity-consistent and fidelity-inconsistent modifications of cognitive behavioral therapy in a sample of clinicians who had been trained to deliver these treatments for children or adults.MethodsSurvey and coded interview data collected 2 years after completion of training programs in cognitive behavioral therapy were used to examine associations between successful or unsuccessful completion of training, clinician attitudes, and modifications. Modifications endorsed by clinicians were categorized as fidelity-consistent or fidelity-inconsistent and entered as outcomes into separate regression models, with training success and attitudes entered as independent variables.ResultsSuccessful completion of a training program was associated with subsequent fidelity-inconsistent modifications but not fidelity-consistent modifications. Therapists who reported greater openness to using EBPs prior to training reported more fidelity-consistent modifications at follow-up, and those who reported greater willingness to adopt EBPs if they found them appealing were more likely to make fidelity-inconsistent modifications.ConclusionsImplications of these findings for training, implementation, EBP sustainment, and future studies are discussed. Research on contextual and protocol-related factors that may impact decisions to modify EBPs will be an important future direction of study to complement to this research.

Sleep disturbance is a core component in posttraumatic stress disorder (PTSD). Although cognitive-behavioral treatments for PTSD reduce the severity of sleep symptoms, they do not lead to complete remission. The present study examines the impact of Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) on subjective measures of sleep disturbance from treatment randomization through long-term follow-up (LTFU). Participants were 171 female rape victims with PTSD who were randomly assigned to CPT, PE, or Minimal Attention (MA). After 6-weeks, the MA group was randomized to CPT or PE. Sleep symptoms were assessed at baseline, post-MA, post-treatment, 3-months, 9-months and LTFU using the Pittsburgh Sleep Quality Index (PSQI) and nightmare and insomnia items from the Clinician Administered PTSD Scale. Change in sleep during MA, from pre- to post-treatment for CPT and PE, and from post-treatment through LTFU was assessed using piecewise hierarchical linear modeling with the intent-to-treat sample. Controlling for medication, sleep improved during CPT and PE compared to MA, and treatment gains were maintained through LTFU. CPT and PE were equally efficacious and improvements persist over LTFU, yet, neither produced remission of sleep disturbance. Overall, sleep symptoms do not remit and may warrant sleep-specific treatments.

A substantial minority of people dropout of cognitive behavioral therapies (CBT) for posttraumatic stress disorder (PTSD). There has been considerable research investigating who drops out of PTSD treatment, however, the question of dropout occurs has received far less attention. The purpose of the current study was to examine when individuals drop out of CBT for PTSD. Women participants (N = 321) were randomized to one of several PTSD treatment conditions. The conditions included Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), CPT-cognitive only (CPT-C), and written accounts (WA). Survival analysis was used to examine temporal pattern of treatment dropout. Thirty-nine percent of participants dropped out of treatment, and those that dropped out tended to do so by mid treatment. Moreover, the pattern of treatment dropout was consistent across CBT conditions. Additional research is needed to examine if treatment dropout patterns are consistent across treatment modalities and settings.

This study examined the relationship between changes in coping and posttraumatic stress disorder (PTSD) symptomatology among recent female rape and physical assault victims as a function of assault type and perpetrator status. Participants were assessed within 1 month after trauma and again at 3 months after trauma. Results indicate that changes in coping strategies over time are associated with the severity of the PTSD symptoms. Assault type was not a significant factor in the association between changes in coping and PTSD, but perpetrator status was. Victims with known perpetrators, who coped more by social withdrawal, had more severe PTSD symptoms over time. The importance of examining the dynamic nature of coping in the development of PTSD is discussed.Posttraumatic stress disorder (PTSD) frequently occurs in female rape and physical assault victims. Within one week of these traumas, female sexual assault victims (up to 94%) and physical assault victims (71%) have been found to meet the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R; American Psychiatric Association, 1987) symptom criteria for PTSD (omitting Criterion E, which requires >1 month duration of symptoms; Riggs, Rothbaum, & Foa, 1995;Rothbaum, Foa, Riggs, Murdock, & Walsh, 1992). By 3 months after the assault, these numbers diminish to 47% of sexual assault victims and 21% of physical assault victims, indicating that although PTSD exists at high rates for these types of victims, a large percentage of people naturally recover from traumatic events. This research indicates that the presence of a trauma alone is not sufficient for a person to develop PTSD; instead, it is likely that a range of factors contribute to the failure of recovery. Factors such as personality characteristics of the victim (Schnurr, Friedman, & Rosenberg, 1993), the relationship between the perpetrator and the victim (Leahy, Pretty, & Tenenbaum, Correspondence concerning this article should be addressed to Patricia A. Resick, National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, 150 South Huntington Avenue (116B), Boston, MA 02130. Patricia.Resick@med.va.gov. Lucenko, Gold, & Cott, 2000), peritraumatic reactions such as dissociation and other responses (Birmes et al., 2003;Kaysen, Morris, Rizvi, & Resick, 2005), as well as different approaches to managing the effects of trauma (for a review, see Resick, 2001) have all been shown to play a role in the maintenance of PTSD symptomatology. NIH Public AccessHow one copes and responds after a trauma may provide valuable information on risk and resiliency factors in PTSD, although research in this area is surprisingly limited. Coping strategies utilized to deal with the effects of a trauma can be broadly categorized as cognitive or behavioral (Waldrop & Resick, 2004), as well as effective or ineffective in reducing distress (Resick, 2001). Cognitive strategies involve attempts to change the way one thinks about a situation, such as cognitive rest...

Objective First line treatments for posttraumatic stress disorder (PTSD) are often implemented twice per week in efficacy trials. However, there is considerable variability in the frequency of treatment sessions (e.g., once per week or twice per week) in clinical practice. Moreover, clients often cancel or reschedule treatment sessions leading to even greater variability in treatment session timing. The goal of the current study is to investigate the impact of PTSD treatment session frequency on treatment outcome. Method 136 women [Mage = 32.16 (9.90)] with PTSD were randomized to receive cognitive processing therapy (CPT) or prolonged exposure (PE). PTSD symptom outcome was measured using the Clinician Administered PTSD Scale, and session frequency and consistency were measured using dates of treatment session attendance. Session frequency was operationalized using average days between session and consistency was defined by the standard deviation of the number of days between treatment sessions. Results Piecewise growth curve modeling revealed that higher average days between sessions was associated with significantly smaller PTSD symptom reduction with more frequent sessions yielding greater PTSD symptom reduction (p < .001, d = .82). Higher consistency was also associated with significantly greater PTSD symptom reduction (p < .01, d = .48). The substantially larger effect size for frequency suggests that average days between treatment sessions impacts treatment outcome more than consistency. Follow-up analyses revealed a longer time interval between sessions 4 and 5 was associated with smaller reductions in PTSD treatment outcome. Conclusions More frequent scheduling of sessions may maximize PTSD treatment outcomes.