Use of reflective journaling to understand decision making regarding two evidence-based psychotherapies for PTSD: Practice implications.

Abstract

As part of a longitudinal investigation on implementation of 2 evidence-based psychotherapies (EBPs) for posttraumatic stress disorder, psychotherapists from 38 Department of Veterans Affairs residential treatment programs across the United States were asked to complete reflective journals every 4 months for a 1-year time period in regard to their successes and challenges in using prolonged exposure and cognitive processing therapy. This paper provides content analysis on the reflective journals of 24 of these providers. Five main themes were identified: EBPs are great but not sufficient for patients in residential treatment with chronic posttraumatic stress disorder and complicated life circumstances, and thus, more treatment is necessary after discharge. Modifications were made or thought needed for optimal outcome and successful delivery of these 2 EBPs; some providers blended aspects of prolonged exposure and cognitive processing therapy; what happens when providers and patients do not agree on choice of which EBP to first implement; and provider concerns on when to discontinue an EBP. Reflective journaling appears to be a promising way for trainers and treatment developers to gather important information about the clinical application and decision-making process for front-line providers, which may offer insight into how to improve EBP implementation and sustainability. Incorporating reflective journaling and strategies for accomplishing this into training, supervision, and consultation may also be 1 strategy for increasing feedback, expanding implementation, and informing ways to increase sustainability of EBPs in populations with multiple clinical and psychosocial needs.

Barriers and facilitators of healthcare provider uptake of clinical practice guideline recommendations for the management of common mental health concerns: A qualitative evidence synthesis.

“…Five studies with three unique datasets that included 515 providers (265 psychologists, 138 social workers, 23 psychiatrists, 39 nurses, 2 counselors, 1 peer support worker, and 47 other) reported that limited generalizability and rigidity of PE and CPT treatment protocols were barriers to implementation primarily among veterans who experience PTSD (Cook et al, 2013(Cook et al, , 2018Finley et al, 2020;Marques et al, 2016;Simiola et al, 2019). Providers noted that: (a) clients often need more than just 12 sessions of CPT to see improvement; (b) rigidity of protocols does not allow for administration with clients with limited cognitive function, low education, or complex PTSD; (c) structured sessions and amount of homework were barriers; and (d) certain portions of the protocol often do not fit with their clientele.…”

Exposure therapy training and supervision: Research-informed strategies for addressing barriers to adoption and dissemination.

“…Research has demonstrated that therapists will contradict their training in exposure therapy by modifying evidence-based protocols in ways that are not supported by research because of evaluating the protocol as inadequate for unique patient characteristics. (Cook et al, 2018). Perhaps one of the best supervision approaches to this concern is MICHAEL, BLAKEY, SHERRILL, AND AOSVED experiencing first hand how exposure is adaptable and, in fact, often the only treatment many patients will need.…”

“…Clinicians may cite psychiatric comorbidity as a reason against delivering exposure, despite numerous studies demonstrating that comorbidities generally do not preclude benefit from exposure (Meyer et al, 2014). Clinicians and clinicians-in-training sometimes think their patients are the exception to empirical findings based on unique patient factors and that these factors the patient exhibits are rule-outs for offering exposure therapy (Cook, Simiola, McCarthy, Ellis, & Wiltsey Stirman, 2018; Feeny, Hembree, & Zoellner, 2003).…”

Interactive Activities to Aid in a Comprehensive Understanding of Mental Health Within the Professional Athletic Training Curriculum

“…Reflective journaling has been used as an educational strategy in nursing and psychology 31 education programs to support the development of critical thinking and to enhance decisionmaking. Reflective journaling has been touted as an effective way for teachers to gather important information about the clinical application and decision-making process for frontline providers.…”

“…Reflective journaling has been touted as an effective way for teachers to gather important information about the clinical application and decision-making process for frontline providers. 31 Purposefully engaging in critical thinking dispositions may help prevent negative patient outcomes. 32 Specific to mental health clinical education, students have reported that reflective journaling provided them opportunities for selfreflection, leading to increased understanding of patients' perspectives and mental health competency.…”