VA residential provider perceptions of dissuading factors to the use of two evidence-based PTSD treatments.

Cook, Joan M.; Dinnen, Stephanie; Simiola, Vanessa; Thompson, Richard; Schnurr, Paula P.

doi:10.1037/a0036183

Cited by 86 publications

(111 citation statements)

References 39 publications

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“…Our results suggest that giving clients a sense of control in treatment by allowing them choice over how and when their trauma memories are shared is a good first step in moving towards more traumainformed early psychosis services (SAMHSA, 2012). More specifically, the importance of readiness to talk about trauma in both the current and in previous studies suggest that motivational enhancement strategies such as motivational interviewing (MI) may play a role in traumaspecific treatments (Cigrang & Peterson, 2017;Cook et al, 2014). MI is designed to explore and resolve ambivalence about behavioural change, and its effectiveness in the treatment of substance abuse is well known (Smedslund et al, 2011).…”

Section: Discussionmentioning

confidence: 96%

“…This ambivalence also has been described in participants' experience of the exposure component of trauma‐focused CBT (Shearing, Lee, & Clohessy, ). Lack of motivation to engage fully or ambivalence in relation to a behavioural change (ie, talking about trauma) has been conceptualized as a problem of readiness (Cook, Dinnen, Simiola, Thompson, & Schnurr, ; Osei‐Bonsu et al, ).…”

Section: Discussionmentioning

confidence: 99%

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Talking about trauma in therapy: Perspectives from young people with post‐traumatic stress symptoms and first episode psychosis

Tong

Simpson

Álvarez‐Jiménez

et al. 2018

Early Intervention Psych

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Aim: Despite recommendations from national guidelines, individuals with first episode psychosis (FEP) are currently unlikely to have the effects of their traumatic experiences assessed and treated within psychosis treatment. This may be due to the mismatch between the objectives of trauma-specific treatments (directly targeting post-traumatic stress symptoms by talking about the trauma) and trauma-informed care (limiting practices that may retraumatise clients). We aimed to gain an understanding of what it was like for young people to talk about trauma in FEP treatment, and how their experiences related to the broad conceptualisations of trauma-informed and trauma-specific treatment approaches. Methods: Semi-structured interviews were conducted with eleven participants (18-27 years) with FEP and post-traumatic stress disorder (PTSD) symptoms after the completion of an intervention for the effects of trauma. Transcripts were analysed using an interpretative phenomenological approach. Results: Two superordinate themes were identified, each with subordinate themes. 1. Reluctance to approach the trauma memory: 1a. Not wanting to talk about trauma; 1b. Difficulty acknowledging that the trauma had occurred; 1c. Not wanting to re-experience emotions associated with trauma. 2. Factors aiding the process: 2a. Desire for change; 2b. Not being pushed to talk; 2c. Valuing the case manager; 2d. Time. Conclusions: A majority of participants in the study experienced reluctance when recounting their trauma memories. Being in control of how trauma memories are shared and having time for the therapeutic relationship to develop enhanced participants' readiness for talking about trauma. Incorporating trauma-informed principles and motivational interviewing could aid in facilitating the processes around talking about trauma. K E Y W O R D S childhood trauma, cognitive behavioural therapy, first episode psychosis, motivational interviewing, post-traumatic stress disorder

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Talking about trauma in therapy: Perspectives from young people with post‐traumatic stress symptoms and first episode psychosis

Tong

Simpson

Álvarez‐Jiménez

et al. 2018

Early Intervention Psych

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“…Of a group of 38 programs, 39% reported delivering CPT or PE to many or all their patients (Cook, Dinnen, Thompson, Simiola, & Schnurr, 2014). In an earlier wave of data collection, many providers indicated that they did not perceive any patient factors that dissuaded their use of either EBT but some noted three broad patient categories they believed might contribute to patients being less suitable candidates for the treatments: the presence of psychiatric comorbidities, cognitive limitations, and low levels of patient motivation (Cook, Dinnen, Simiola, Thompson, & Schnurr, 2014). …”

mentioning

confidence: 99%

The influence of patient readiness on implementation of evidence-based PTSD treatments in Veterans Affairs residential programs.

Cook¹,

Simiola²,

Hamblen³

et al. 2017

Psychological Trauma: Theory, Research, Practice, and Policy

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Objective Mental health provider perceptions of patient readiness for trauma-focused evidence-based treatments (EBTs) for posttraumatic stress disorder (PTSD) have been found to impact outpatient care in the Department of Veterans Affairs (VA). Method One hundred and seventy two mental health directors and providers from 36 VA residential PTSD treatment programs completed qualitative interviews regarding implementation of two EBTs, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). Perceptions of patients’ “readiness” for PE and CPT, including how to define and assess this construct and how it influences implementation of these EBTs, were discussed. Results Patient readiness was identified as having three components: psychological and psychiatric stability, general readiness to change, and specific skills to manage trauma-focused EBTs (e.g., distress tolerance, affect regulation skills). Providers indicated that some patients who are deemed not ready are either screened out prior to entry or helped to get ready prior to or during their residential stay. Providers expressed difficulties predicting who is actually ready and described what they saw as differences between readiness for PE as compared to CPT. Conclusions The concept of readiness for trauma-focused EBTs impacted admission and access to services in the programs. Future research directions, such as empirically measuring readiness and formally assessing veterans’ perceptions of and willingness to participate in these EBTs, are considered.

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“…Given this nonequivalence, providers must make costbenefit determinations regarding which patients to triage to the more resource-intensive individual psychotherapy rather than to group therapy. Although there have been no direct evaluations of VA PTSD providers' decision-making processes regarding therapy referral decisions, qualitative studies of referrals to the (mostly individual) traumafocused evidence-based psychotherapies have shown that providers are reluctant to refer patients to these treatments if they do not deem the patients to be appropriate candidates for psychotherapy or if they do not consider the patients to be "ready" for the treatment (7)(8)(9). The concept of readiness or appropriateness for psychotherapy is not new or unique to evidence-based manualized psychotherapies; mental health providers commonly make determinations about patient appropriateness for psychotherapy (9)(10)(11).…”

mentioning

confidence: 99%

A Prospective Study of Racial and Ethnic Variation in VA Psychotherapy Services for PTSD

Spoont

Sayer

Kehle‐Forbes

et al. 2017

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VA residential provider perceptions of dissuading factors to the use of two evidence-based PTSD treatments.

Cited by 86 publications

References 39 publications

Talking about trauma in therapy: Perspectives from young people with post‐traumatic stress symptoms and first episode psychosis

Talking about trauma in therapy: Perspectives from young people with post‐traumatic stress symptoms and first episode psychosis

The influence of patient readiness on implementation of evidence-based PTSD treatments in Veterans Affairs residential programs.

A Prospective Study of Racial and Ethnic Variation in VA Psychotherapy Services for PTSD

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