A randomized controlled dismantling trial of post-workshop consultation strategies to increase effectiveness and fidelity to an evidence-based psychotherapy for Posttraumatic stress disorder

Abstract

BackgroundPosttraumatic Stress Disorder (PTSD) is a serious mental health condition with substantial costs to individuals and society. Among military veterans, the lifetime prevalence of PTSD has been estimated to be as high as 20%. Numerous research studies have demonstrated that short-term cognitive-behavioral psychotherapies, such as Cognitive Processing Therapy (CPT), lead to substantial and sustained improvements in PTSD symptoms. Despite known benefits, only a minority of clinicians provide these therapies. Transferring this research knowledge into clinical settings remains one of the largest hurdles to improving the health of veterans with PTSD. Attending a workshop alone is insufficient to promote adequate knowledge transfer and sustained skill; however, relatively little research has been conducted to identify effective post-training support strategies.MethodsThe current study investigates whether clinicians receiving post-workshop support (six-month duration) will deliver CPT with greater fidelity (i.e., psychotherapy adherence and competence) and have improved patient outcomes compared with clinicians receiving no formal post-workshop support. The study conditions are: technology-enhanced group tele-consultation; standard group tele-consultation; and fidelity assessment with no consultation. The primary outcome is independent assessment (via audio-recordings) of the clinicians’ adherence and competence in delivering CPT. The secondary outcome is observed changes in patient symptoms during and following treatment as a function of clinician fidelity. Post-consultation interviews with clinicians will help identify facilitators and barriers to psychotherapy skill acquisition. The study results will inform how best to implement and transfer evidence-based psychotherapy (e.g., CPT) to clinical settings to attain comparable outcomes to those observed in research settings.DiscussionFindings will deepen our understanding of how much and what type of support is needed following a workshop to help clinicians become proficient in delivering a new protocol. Several influences on clinician learning and patient outcomes will be discussed. An evidence-based model of clinical consultation will be developed, with the ultimate goal of informing policy and influencing best practice in clinical consultation.Trial registrationClinicalTrials.gov: NCT01861769

Maintenance and Reach of Exposure Psychotherapy for Posttraumatic Stress Disorder 18 Months After Training

“…Some contextual variables assessed prior to training (e.g., the use of group therapy) may have changed by the 18‐month follow‐up, obscuring the impact of those factors. We did not assess the fidelity with which PE was delivered (Wiltsey‐Stirman et al., ). Finally, we examined the penetration of PE within each trained clinician's caseload, but not how reach of PE to the veteran population is changing over time as more clinicians are trained in PE.…”

Evaluating the effects of mindfulness-based stress reduction on cognitive function and well-being in caregivers of persons with dementia and related neurodegenerative diseases

“…Feedback Questionnaire At the end of the follow-up testing session, all participants were asked to complete a feedback questionnaire, consisting of a facilitator component and an intervention component (see Appendix G). The facilitator feedback component instructed participants to rate their group facilitator on a variety of domains in order to determine whether the facilitators of each intervention were comparable in terms of therapist effects (adapted from the Cognitive Processing Therapy: Therapist Adherence and Competence protocol; Stirman et al, 2013). The intervention feedback component asked participants to describe their thoughts about the program (e.g., whether they enjoyed it, which aspects they found helpful, if they could recommend any changes, etc.…”

Advancing the state-level tracking of evidence-based practices: a case study

“…The same complication applies to the length of consultation available to therapists following training, with some models requiring indefinite consultation and some not requiring or offering any. While waiting for more empirical guidance in this area [32], we opted for not specifying any specific length of training time. Instead, the guides indicate the need for interactivity and some objective assessment of skill.…”