A randomized controlled effectiveness trial of training strategies in cognitive processing therapy for posttraumatic stress disorder: Impact on patient outcomes

Monson, Candice M.; Shields, Norman; Suvak, Michael K.; Lane, Jeanine E. M.; Shnaider, Philippe; Landy, Meredith S. H.; Wagner, Anne Catherine; Sijercic, Iris; Masina, Tasoula; Wanklyn, Sonya G.; Stirman, Shannon Wiltsey

doi:10.1016/j.brat.2018.08.007

Cited by 68 publications

(88 citation statements)

References 39 publications

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“…Consultation may also impact patient outcomes. For example, Monson et al [15] found that consultation in cognitive processing therapy (CPT), including discussion of cases and conceptualization without audio review, resulted in significantly greater reductions in patients' PTSD outcomes relative to no consultation in a VA setting. This study also found that audio review was not a necessary component for consultation to improve patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…This is an important gap in the literature, as therapists sometimes express reluctance to utilize exposure therapy, particularly in the presence of comorbid conditions [19]. Furthermore, whereas Monson et al's [15] study was conducted in the VA, there may be important organizational factors within the military that alter the impact of consultation on provider and patient outcomes in this setting. We are not aware of any controlled trials of consultation as an implementation strategy for improving provider and patient outcomes within military clinics.…”

Section: Introductionmentioning

confidence: 99%

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The effects of a prolonged exposure workshop with and without consultation on provider and patient outcomes: a randomized implementation trial

et al. 2020

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Background: Prolonged exposure therapy (PE) is an evidence-based treatment for posttraumatic stress disorder (PTSD) that is underutilized in the military health system. Standard workshop training in PE may not be sufficient to alter provider behavior, but post-workshop consultation requires significant resources. Therefore, it is important to determine the incremental utility of post-workshop consultation. Methods: This study used a hybrid type III randomized implementation trial at 3 US Army installations. Providers were randomized to receive a 4-day prolonged exposure workshop (Standard training condition, n = 60), or the prolonged exposure workshop followed by 6-8 months of post-workshop expert case consultation (Extended training condition, n = 43). The effects training condition were examined on provider attitudes (self-efficacy in delivering PE, expectations for patient improvement, and beliefs about PE), use of PE and PE components, and clinical outcomes of patients with PTSD (using the Clinician-Administered PTSD Scale (CAPS-5)). Results: Extended condition providers reported greater improvements in self-efficacy, b = .83, 95% CI [.38, 1.27], t(79) = 3.71, p = .001, and d = .63. A greater proportion of patients in the Extended condition (44%) than in the Standard condition (27%) received at least 1 PE session, b = .76, t(233) = 2.53, p = .012, and OR = 2.13. Extended condition providers used more PE components (M = .9/session) than did Standard condition providers (M = .5/session), b = .54, 95% CI [.15, .93], t(68) = 2.70, p = .007, and d = .68. Finally, decrease in patients' PTSD symptoms was faster for patients of Extended condition providers than for patients of Standard condition providers, b = − 1.81, 95% CI [− 3.57, − .04], t(263) = − 2.02, p = .045, and d = .66, and their symptoms were lower at the second assessment, b = − 5.47, 95% CI [− 9.30, − 1.63], t(210) = − 2.81, p = .005, and d = .66.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The effects of a prolonged exposure workshop with and without consultation on provider and patient outcomes: a randomized implementation trial

et al. 2020

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“…Functioning-related concepts, classifications and measurements play a central role in clinical practice, teaching and research 1 . In addition, functioning is considered a Clinical Outcome Assessment (COA), which means that it can be used as a clinical assessment to measure patient outcome in a clinical trial 2 , as we can see in some papers already published 3,4,5,6,7 . As a COA, functioning has been used in several health fields, e.g.…”

Section: Introductionmentioning

confidence: 99%

The World Health Organization Disability Assessment Schedule 2 (WHODAS 2.0): remarks on the need to revise the WHODAS

et al. 2019

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Functioning and disability are concepts in increasing use in clinical settings and in public health. From the public health perspective, the use of functioning as a third health indicator could show more than the frequency of a disease and its death rates, offering information on how the population performs its activities and participation. Clinically, the functioning assessment can provide information for patient-centered health care and specific clinical interventions according to their functioning profile. WHODAS 2.0 is a generic tool to assess health and functioning according to the ICF functioning model. It is an alternative to assess functioning in a less time-consuming way, whereas the duration of the application is one of the main ICF critiques. This paper aims to present some of WHODAS 2.0 inconsistencies and weaknesses as well as strategies to cope with them. In this paper, we present some weaknesses related to the WHODAS layout; wording and scoring process. Some suggestions for strategies to correct these weaknesses are presented, as well.

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“…The clients in the current sample attended sessions more frequently but less consistently compared with other clients receiving CPT in community settings,16 which may account for the lack of differences in treatment outcome. The effects of clients’ inconsistent treatment attendance may have been mitigated by the fact that the providers in the study were receiving 6 months of rigorous CPT consultation, which previous studies have shown impact treatment outcome 39. However, ongoing consultation and feedback is not a feasible solution in routine clinical care in community settings, where resources and clinicians’ time are limited 40.…”

Section: Discussionmentioning

confidence: 99%

Client-level predictors of treatment engagement, outcome and dropout: moving beyond demographics

et al. 2019

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BackgroundDespite the availability of evidence-based treatments for posttraumatic stress disorder (PTSD), significant heterogeneity in the effectiveness of PTSD treatment persists, especially in community settings. Client demographics used to understand this variability in treatment outcome and dropout have yielded mixed results. Despite increasing evidence for the importance of attending to treatment engagement in community settings, few studies have explored client-level predictors.AimThe purpose of this study is to explore client-level predictors of treatment outcome and dropout beyond client demographics, and to identify client-level predictors of treatment engagement in community settings.MethodSecondary data analysis was conducted with data collected as part of an implementation-effectiveness hybrid study of cognitive processing therapy (CPT) for PTSD in a diverse community health centre. Providers (n=19) treated (n=52) clients as part of their routine clinical care. Non-demographic client-level predictors included barriers to treatment, quality of life, session-level language and employment history assessed at baseline. Treatment engagement included number of weeks in the study, number of sessions with repeated CPT content, number of unique CPT sessions attended, frequency of session attendance and consistency of session attendance.ResultsResults showed language as a significant predictor of treatment engagement. There were significant differences between Spanish and English-speaking clients, with the former having a tendency to repeat more session content than the latter (β=1.4 sessions, p=0.003), and also less likely to attend treatment frequently (r=0.62, p=0.009) and consistently (r=0.57, p=0.027) if high logistical and financial barriers were endorsed. Irrespective of language, clients who reported high quality of life at baseline were less likely to repeat CPT session content (β=−0.3, p=0.04), and those with increased baseline barriers to treatment had deceleration in PTSD symptom improvement over time (β=−0.62, p<0.05). In terms of treatment engagement moderators impacting treatment outcome, clients who repeated more session content were more likely to complete treatment (OR=1.84, p=0.037).ConclusionIdentification of client-level predictors of treatment engagement, outcome and dropout is essential to optimise treatment, particularly in community settings.

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A randomized controlled effectiveness trial of training strategies in cognitive processing therapy for posttraumatic stress disorder: Impact on patient outcomes

Cited by 68 publications

References 39 publications

The effects of a prolonged exposure workshop with and without consultation on provider and patient outcomes: a randomized implementation trial

The effects of a prolonged exposure workshop with and without consultation on provider and patient outcomes: a randomized implementation trial

The World Health Organization Disability Assessment Schedule 2 (WHODAS 2.0): remarks on the need to revise the WHODAS

Client-level predictors of treatment engagement, outcome and dropout: moving beyond demographics

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