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Southward MW, Wilson AC, Cheavens JS. On what do therapists agree? Assessing therapist evaluations of emotion regulation strategy effectiveness. Psychol Psychother 2021; 94:231-246. [PMID: 32853449 DOI: 10.1111/papt.12302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/30/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To develop more unified, process-based, and disseminable psychotherapy treatments, it is important to determine whether there is consensus among therapists regarding intervention strategies. DESIGN Because emotion regulation is a cornerstone of modern treatments and a thriving area of clinical research, we assessed therapists' ratings of the effectiveness of commonly studied emotion regulation strategies. METHODS Therapists (n = 582) read eleven vignettes describing stressful scenarios and rated the effectiveness of ten emotion regulation strategies in each scenario. RESULTS Across therapists, we found general consensus regarding the most (i.e., problem-solving) and least (i.e., concealing emotions) effective strategies. Cognitive/behavioural/third-wave therapists rated acceptance and distraction as more effective, and emotional expression and gathering information as less effective, than other therapists, Fs> 4.20, ps < .05, whereas hours of clinical experience were generally unrelated to strategy effectiveness ratings. CONCLUSIONS We discuss what these points of agreement and relative disagreement among therapists reveal about a more unified, process-based treatment approach and how these results can guide emotion regulation research. PRACTITIONER POINTS There is general consensus among practising therapists that problem-solving is the most effective emotion regulation strategy and expressive suppression is the least effective. However, CBT-oriented therapists rated acceptance and distraction as more effective than non-CBT-oriented therapists. Non-CBT-oriented therapists rated emotional expression and gathering information as more effective than CBT-oriented therapists. Years of experience were unrelated to ratings of emotion regulation strategy effectiveness.
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Affiliation(s)
- Matthew W Southward
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA.,Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Anne C Wilson
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA.,Department of Psychiatry and Behavioral Sciences, University of California - Davis, California, USA
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Ametaj AA, Wilner Tirpak J, Cassiello-Robbins C, Snow R, Rassaby MM, Beer K, Sauer-Zavala S. A Preliminary Investigation of Provider Attitudes Toward a Transdiagnostic Treatment: Outcomes from Training Workshops with the Unified Protocol. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:668-682. [PMID: 33538945 DOI: 10.1007/s10488-020-01101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
Evidence-based psychological treatments (EBPTs) for common mental health conditions are efficacious but remain underutilized in clinical service settings. Novel transdiagnostic and modular approaches that treat several disorders simultaneously promise to address common barriers to the dissemination and implementation of traditional EBPTs. Despite the promise that transdiagnostic treatments hold, the claims that these interventions can be more easily disseminated and implemented have not been widely tested. The present study examined whether a transdiagnostic treatment, the Unified Protocol (UP), addresses some barriers to dissemination and implementation for clinicians. Exploratory aims of the current study were to examine the effects of a UP introductory training workshop on clinician attitudes and behaviors by: (1) evaluating UP knowledge and treatment delivery, (2) determining relationships between clinician characteristics and their knowledge acquisition, satisfaction with UP, and UP penetration, and (3) exploring clinicians' perceptions of the UP's characteristics utilizing mixed methods. Workshop participants showed a good understanding of UP treatment concepts following training, and over a third of survey respondents reported use of the intervention 6-months after training. Positive attitudes toward EBPTs and fewer years of clinical practice were associated with greater satisfaction with the UP. Clinicians held positive views of the UP's flexibility and relative advantage over standard EBPTs but held negative views toward the manual's design and packaging. Overall, our findings suggest that clinicians may view transdiagnostic treatments such as the UP favorably and may consider them appealing over standard EBPTs. However, barriers associated with traditional EBPTs may extend to transdiagnostic treatments like the UP.
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Affiliation(s)
- Amantia A Ametaj
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA. .,Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02215, USA.
| | | | - Clair Cassiello-Robbins
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Rachel Snow
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Madeleine M Rassaby
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Kelsey Beer
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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Lussier-Valade M, Ngô TL, Leblanc J. www.psychopap.com : améliorer l’accès à la psychothérapie par le transfert des connaissances aux patients et aux futurs thérapeutes. SANTE MENTALE AU QUEBEC 2020. [DOI: 10.7202/1073525ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
La psychothérapie est un traitement efficace pour plusieurs troubles mentaux. Elle est, toutefois, peu accessible pour différentes raisons, dont son coût, la façon de l’offrir et la disponibilité locale des thérapeutes. Par ailleurs, l’accès à la formation en psychothérapie pour les futurs thérapeutes peut être compliqué par différents facteurs incluant le manque de ressources adaptées à différents contextes de pratique et la difficulté à obtenir une supervision. Dans ce contexte, un site web offrant des documents d’autothérapie aux patients, des miniguides de formation dans différents types de psychothérapies basées sur des données probantes, des suggestions d’articles et livres phares, des capsules vidéo expliquant les principes sous-tendant différents modèles théoriques et démontrant des techniques de psychothérapie, pourrait bénéficier autant aux patients qu’aux psychothérapeutes débutants.
L’Hôpital en santé mentale Albert-Prévost (HSMAP), impliqué dès ses origines dans la formation et la pratique de la psychothérapie, conçoit un tel outil pour célébrer son centenaire, le site www.psychopap.com. Le présent article propose de décrire la genèse et le déploiement de ce projet de transmission de connaissances en psychothérapie en décrivant d’abord le contexte et l’implication des membres de l’HSMAP dans l’enseignement de la psychothérapie puis une brève recension des écrits concernant l’autothérapie pour les troubles mentaux, l’utilisation des ordinateurs/Internet pour l’enseignement de la psychothérapie et comment ces données ont été appliquées dans la création de www.psychopap.com.
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Affiliation(s)
| | - Thanh-Lan Ngô
- M.D., M. Sc. FRCPC, psychiatre, CIUSSS du Nord-de-l’Île-de-Montréal - Professeur agrégé de clinique, Département de psychiatrie et d’addictologie, Université de Montréal
| | - Jean Leblanc
- M.D., FRCPC, psychiatre, HSMAP - Professeur agrégé de clinique, Département de psychiatrie et d’addictologie, Université de Montréal
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Bryl K, Goodill S. Development, Execution and Acceptance of a Manualized Dance/Movement Therapy Treatment Protocol for the Clinical Trial in the Treatment of Negative Symptoms and Psychosocial Functioning in Schizophrenia. AMERICAN JOURNAL OF DANCE THERAPY 2019. [DOI: 10.1007/s10465-019-09312-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Flaherty HB, Bornheimer LA, Hamovitch E, Garay E, Mini De Zitella ML, Acri M, Mckay M. Examining Provider Factors Supporting the Adoption and Use of Research-Supported Interventions. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2019; 16:615-625. [PMID: 32459158 DOI: 10.1080/26408066.2019.1666768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose: The purpose of this study was to examine the factors associated with the adoption of research-supported interventions (RSIs) in outpatient mental health clinics serving youth in order to inform implementation efforts and ultimately improve treatment outcomes. Method: This explanatory cross-sectional study includes secondary data from a clinical trial of an innovative group-based RSI in public mental health clinics for youth in New York City. Structural Equation Modeling examined the relationships between attitudes toward and beliefs of RSIs and uptake/use of RSIs in practice among providers in mental health settings. Results: As providers attitudes toward and beliefs about RSIs became more favorable, on average, RSIs were used more in practice in mental health settings serving youth. Conclusion: These findings indicate attitudes toward, and beliefs about innovation can be a precursor to the decision whether or not to use an innovative RSI in clinical practice in these settings. Implications and future directions are discussed.
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Affiliation(s)
- Hanni B Flaherty
- Wurzweiler School of Social Work, Yeshiva University, New York, NY, USA
| | | | - Emily Hamovitch
- Silver School of Social Work, McSilver Institute for Poverty Policy & Research, New York University, New York, NY, USA
| | - Elene Garay
- Silver School of Social Work, McSilver Institute for Poverty Policy & Research, New York University, New York, NY, USA
| | - Maria L Mini De Zitella
- Silver School of Social Work, McSilver Institute for Poverty Policy & Research, New York University, New York, NY, USA
| | - Mary Acri
- McSilver Institute for Poverty Policy & Research, New York University Medical Center, New York, NY, USA
| | - Mary Mckay
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
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Whiteside SPH, Dammann JE, Tiede MS, Biggs BK, Hillson Jensen A. Increasing Availability of Exposure Therapy Through Intensive Group Treatment for Childhood Anxiety and OCD. Behav Modif 2017; 42:707-728. [PMID: 28918645 DOI: 10.1177/0145445517730831] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Archival data were used to examine the feasibility of a 5-day, clinic-based, intensive exposure-based cognitive-behavioral group therapy for childhood anxiety disorders (CADs) and obsessive-compulsive disorder (OCD). Participants were 143 children (82 girls) aged 6 to 19 years ( M = 13.93 years, SD = 2.9 years) with CADs or OCD (or both) in 28 consecutive groups. Repeated-measures ANOVA in the subsample ( n = 57) with complete treatment data indicated positive change on all variables from pretreatment to posttreatment with few differences between CADs and OCD patients. Effect sizes were moderate to large for anxiety symptoms (parent reported = 0.74, child reported = 0.65) and impairment (parent reported = 1.02, child reported = 0.69). The intensive group protocol required fewer sessions and 36% fewer therapist-hours per patient than the individually administered protocol. The program increased treatment availability for families from diverse geographic areas ( M distance traveled to clinic = 407 miles, SD = 786.4 miles). These findings support further, well-controlled examination of the 5-day intensive group treatment protocol's efficacy and potential to increase availability of evidence-based exposure therapy.
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Stahmer AC, Aranbarri A, Drahota A, Rieth S. Toward a more collaborative research culture: Extending translational science from research to community and back again. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2017; 21:259-261. [DOI: 10.1177/1362361317692950] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Aubyn C Stahmer
- Department of Psychiatry and Behavioral Sciences, The MIND Institute, University of California Davis, CA, USA
| | - Aritz Aranbarri
- Department of Psychiatry and Behavioral Sciences, The MIND Institute, University of California Davis, CA, USA
| | - Amy Drahota
- Department of Psychology, Michigan State University, MI, USA
| | - Sarah Rieth
- Department of Child and Family Development, San Diego State University, CA, USA
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Whiteside SPH, Ale CM, Young B, Olsen MW, Biggs BK, Gregg MS, Geske JR, Homan K. The Length of Child Anxiety Treatment in a Regional Health System. Child Psychiatry Hum Dev 2016; 47:985-992. [PMID: 26852405 DOI: 10.1007/s10578-016-0628-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Anxiety disorders are often undertreated due to unsuccessful dissemination of evidence-based treatments (EBTs). Lack of empirical data regarding the typical length of treatment in clinical settings may hamper the development of clinically relevant protocols. The current study examined billing records for 335 children ages 7-17 years to quantify the treatment received for newly diagnosed anxiety disorders within a regional health system. The vast majority of patients did not receive a sufficient number of appointments to complete the typical cognitive behavioral therapy protocol or reach the sessions introducing exposure. Although half of the sample received pharmacotherapy, the vast majority received fewer follow-up appointments than participants in pharmacotherapy research studies. Further, the type of treatment (i.e., number of sessions and medication) differed depending on utilization of specialty care. These results underscore the need to develop brief and flexible EBT protocols that can be standardized and implemented in community practice.
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Affiliation(s)
- Stephen P H Whiteside
- Department of Psychiatry and Psychology, Mayo Clinic, Mayo Bldg West 11, 200 First St., SW, Rochester, MN, 55905, USA.
| | - Chelsea M Ale
- Department of Psychiatry and Psychology, Mayo Clinic, Mayo Bldg West 11, 200 First St., SW, Rochester, MN, 55905, USA
| | - Brennan Young
- Department of Child and Adolescent Psychology, Marshfield Clinic, Eau Claire, WI, USA
| | - Mark W Olsen
- Department of Psychiatry and Psychology, Mayo Clinic, Mayo Bldg West 11, 200 First St., SW, Rochester, MN, 55905, USA
| | - Bridget K Biggs
- Department of Psychiatry and Psychology, Mayo Clinic, Mayo Bldg West 11, 200 First St., SW, Rochester, MN, 55905, USA
| | - Melissa S Gregg
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Jennifer R Geske
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Kendra Homan
- Department of Psychiatry and Psychology, Mayo Clinic, Mayo Bldg West 11, 200 First St., SW, Rochester, MN, 55905, USA
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Meza R, Drahota A, Spurgeon E. Community-Academic Partnership Participation. Community Ment Health J 2016; 52:793-8. [PMID: 25976376 PMCID: PMC4653088 DOI: 10.1007/s10597-015-9890-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Abstract
Community-academic partnerships (CAPs) improve the research process, outcomes, and yield benefits for the community and researchers. This exploratory study examined factors important in community stakeholders' decision to participate in CAPs. Autism spectrum disorder (ASD) community stakeholders, previously contacted to participate in a CAP (n = 18), completed the 15-item Decision to Participate Questionnaire (DPQ). The DPQ assessed reasons for participating or declining participation in the ASD CAP. CAP participants rated networking with other providers, fit of collaboration with agency philosophy, and opportunity for future training/consultations as factors more important in their decision to participate in the ASD CAP than nonparticipants. Nonparticipants reported the number of requests to participate in research as more important in their decision to decline participation than participants. Findings reveal important factors in community stakeholders' decision to participate in CAPs that may provide guidance on increasing community engagement in CAPs and help close the science-to-service gap.
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Affiliation(s)
- Rosemary Meza
- Child and Adolescent Services Research Center, San Diego State University, 3020 Children's Way MC 5033, San Diego, CA, 92123-4282, USA.
| | - Amy Drahota
- Child and Adolescent Services Research Center, San Diego State University, 3020 Children's Way MC 5033, San Diego, CA, 92123-4282, USA
| | - Emily Spurgeon
- Child and Adolescent Services Research Center, San Diego State University, 3020 Children's Way MC 5033, San Diego, CA, 92123-4282, USA
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Design, development, and evaluation of printed educational materials for evidence-based practice dissemination. INT J EVID-BASED HEA 2016; 14:84-94. [PMID: 26735568 DOI: 10.1097/xeb.0000000000000072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Printed educational materials (PEMs) are one of the most common dissemination strategies for communicating information about evidence-based practices (EBPs) to healthcare professionals and organizations; however, evidence is conflicting regarding the conditions and circumstances in which PEMs are effective in achieving desired outcomes. The effectiveness of PEMs is largely dependent on the manner in which they are developed. This article reports on the findings from a comprehensive review of the literature regarding best practices for creating PEMs for health professionals and illustrates how these practices were used to design, develop, and evaluate an informational packet to disseminate information about motivational interviewing. METHODS The informational packet was disseminated to 92 community health organizations not currently implementing motivational interviewing. Evaluation surveys were completed by 212 healthcare directors and providers to examine quality and perceived helpfulness of the packets, intention to use information from the packet, and sharing of the packet with others. Associations between these and individual and organizational characteristics were also assessed. RESULTS Overall, the packet was perceived as appropriate and helpful in making a decision to implement motivational interviewing. For example, 84.9% of participants stated that the content was 'about right'. Three-quarters (75.9%) of participants reported plans to use the information in the packet and almost half (46.7%) reported talking about the packet with others in the organizations. Higher levels of baseline interest in motivational interviewing adoption were significantly related to packet use and wanting to utilize additional resources presented in the packet. Positive attitudes toward EBPs were also significantly related to the desire to obtain resources in the packet. Perceptions of the packet did not differ by type of community health organization (i.e., community health center, community behavioral health organization) or whether the individual was a director or provider. CONCLUSION Results indicated that PEMs can be a useful tool to disseminate EBP information to healthcare professionals particularly if they have a prior interest in the EBP and have general attitudes supportive of EBPs. Recommendations for the improvement of future PEMs are discussed.
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Heck NC, Saunders BE, Smith DW. Web-Based Training for an Evidence-Supported Treatment: Training Completion and Knowledge Acquisition in a Global Sample of Learners. CHILD MALTREATMENT 2015; 20:183-192. [PMID: 26092441 DOI: 10.1177/1077559515586569] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this investigation is to describe the characteristics of professional and preprofessional learners who registered for and completed TF-CBTWeb, a modular, web-based training program designed to promote the dissemination of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and to demonstrate the feasibility of this method of dissemination. Between October 1, 2005, and October 1, 2012, a total of 123,848 learners registered for TF-CBTWeb, of whom 98,646 (79.7%) initiated the learning activities by beginning the first module pretest. Of those, 67,201 (68.1%) completed the full training. Registrants hailed from 130 countries worldwide, and they had varied educational backgrounds, professional identities (both professional and preprofessional), and a range of experience working with child trauma victims. Learners who were from the United States, students, those with master's degrees, and those with fewer years of experience working with child trauma victims tended to have the highest course completion rates. Learners displayed significant increases in knowledge about each component of TF-CBT, based on module pretest and posttest scores. The advantages and limitations of this web-based training program evaluation are discussed, while important implications for the use of web-based trainings are reviewed.
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Affiliation(s)
- Nicholas C Heck
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Benjamin E Saunders
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel W Smith
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
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Foa EB, Gillihan SJ, Bryant RA. Challenges and Successes in Dissemination of Evidence-Based Treatments for Posttraumatic Stress: Lessons Learned From Prolonged Exposure Therapy for PTSD. Psychol Sci Public Interest 2015; 14:65-111. [PMID: 25722657 DOI: 10.1177/1529100612468841] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Posttraumatic stress disorder (PTSD) poses monumental public health challenges because of its contribution to mental health, physical health, and both interpersonal and social problems. Recent military engagements in Iraq and Afghanistan and the multitude of resulting cases of PTSD have highlighted the public health significance of these conditions. There are now psychological treatments that can effectively treat most individuals with PTSD, including active duty military personnel, veterans, and civilians. We begin by reviewing the effectiveness of these treatments, with a focus on prolonged exposure (PE), a cognitive-behavioral therapy (CBT) for PTSD. Many studies conducted in independent research labs have demonstrated that PE is highly efficacious in treating PTSD across a wide range of trauma types, survivor characteristics, and cultures. Furthermore, therapists without prior CBT experience can readily learn and implement the treatment successfully. Despite the existence of highly effective treatments like PE, the majority of individuals with PTSD receive treatments of unknown efficacy. Thus, it is crucial to identify the barriers and challenges that must be addressed in order to promote the widespread dissemination of effective treatments for PTSD. In this review, we first discuss some of the major challenges, such as a professional culture that often is antagonistic to evidence-based treatments (EBTs), a lack of clinician training in EBTs, limited effectiveness of commonly used dissemination techniques, and the significant cost associated with effective dissemination models. Next, we review local, national, and international efforts to disseminate PE and similar treatments and illustrate the challenges and successes involved in promoting the adoption of EBTs in mental health systems. We then consider ways in which the barriers discussed earlier can be overcome, as well as the difficulties involved in effecting sustained organizational change in mental health systems. We also present examples of efforts to disseminate PE in developing countries and the attendant challenges when mental health systems are severely underdeveloped. Finally, we present future directions for the dissemination of EBTs for PTSD, including the use of newer technologies such as web-based therapy and telemedicine. We conclude by discussing the need for concerted action among multiple interacting systems in order to overcome existing barriers to dissemination and promote widespread access to effective treatment for PTSD. These systems include graduate training programs, government agencies, health insurers, professional organizations, healthcare delivery systems, clinical researchers, and public education systems like the media. Each of these entities can play a major role in reducing the personal suffering and public health burden associated with posttraumatic stress.
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Affiliation(s)
- Edna B Foa
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Seth J Gillihan
- Department of Psychiatry, University of Pennsylvania, Philadelphia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
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Montero-Marín J, Prado-Abril J, Botella C, Mayoral-Cleries F, Baños R, Herrera-Mercadal P, Romero-Sanchiz P, Gili M, Castro A, Nogueira R, García-Campayo J. Expectations among patients and health professionals regarding Web-based interventions for depression in primary care: a qualitative study. J Med Internet Res 2015; 17:e67. [PMID: 25757358 PMCID: PMC4376189 DOI: 10.2196/jmir.3985] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/26/2015] [Accepted: 02/12/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND One-quarter of the world's population will suffer from depression symptoms at some point in their lives. Mental health services in developed countries are overburdened. Therefore, cost-effective interventions that provide mental health care solutions such as Web-based psychotherapy programs have been proposed. OBJECTIVE The intent of the study was to identify expectations regarding Web-based psychotherapy for the treatment of depression in primary care among patients and health professionals that might facilitate or hinder its effects. METHODS The expectations of untreated patients and health professionals were examined by means of interviews and focus groups. There were 43 participants (20 patients with mild and moderate levels of depression, 11 primary care physicians, and 12 managers; 22 of them for interviews and 21 for groups). A thematic content analysis from the grounded theory for interviews, and an analysis of the discursive positions of participants based on the sociological model for groups were performed. Interpretations were achieved by agreement between three independent analysts. RESULTS All participants showed a good general acceptance of Web-based psychotherapy, appreciating possible advantages and improvements. Patients, physicians, and managers shared the same conceptualization of their expectations, although highlighting different aspects. Patients focused on the need for individualized and personalized interaction, while professionals highlighted the need for the standardization of the program. Physicians were concerned with extra workload, while managers were worried about optimizing cost-effectiveness. CONCLUSIONS Expectations of the different participants can conflict with each other. Finding a balanced position among them is needed if we are to harmoniously implement effective Web-based interventions for depression in routine clinical practice.
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McKay D, Whiteside SPH. Introduction to the special issue: new methods in exposure therapy. Behav Modif 2014; 37:163-9. [PMID: 23671911 DOI: 10.1177/0145445513478156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Exposure-based interventions have been shown to significantly reduce anxiety and avoidance. The efficacy of the approach is robust, and recent efforts have been made to expand the use of exposure as well as identify more effective ways to implement the procedure. This article introduces the special issue devoted to recent novel approaches to the dissemination and implementation of exposure.
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Affiliation(s)
- Dean McKay
- Fordham University, 441 East Fordham Road, Bronx, NY 10458, USA.
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Cloitre M, Henn-Haase C, Herman JL, Jackson C, Kaslow N, Klein C, Mendelsohn M, Petkova E. A multi-site single-blind clinical study to compare the effects of STAIR Narrative Therapy to treatment as usual among women with PTSD in public sector mental health settings: study protocol for a randomized controlled trial. Trials 2014; 15:197. [PMID: 24886235 PMCID: PMC4071147 DOI: 10.1186/1745-6215-15-197] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 04/17/2014] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND This article provides a description of the rationale, design, and methods of a multisite clinical trial which evaluates the potential benefits of an evidence-based psychosocial treatment, STAIR Narrative Therapy, among women with posttraumatic stress disorder (PTSD) related to interpersonal violence who are seeking services in public sector community mental health clinics. This is the first large multisite trial of an evidence-based treatment for PTSD provided in the context of community settings that are dedicated to the treatment of poverty-level patient populations. METHODS The study is enrolling 352 participants in a minimum of 4 community clinics. Participants are randomized into either STAIR Narrative Therapy or Treatment As Usual (TAU). Primary outcomes are PTSD, emotion management and interpersonal problems. The study will allow a flexible application of the protocol determined by patient need and preferences. Secondary analyses will assess the relationship of outcomes to different patterns of treatment implementation for different levels of baseline symptom severity. DISCUSSION The article discusses the rationale and study issues related to the use of a flexible delivery of a protocol treatment and of the selection of treatment as it is actually practiced in the community as the comparator. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01488539.
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Affiliation(s)
- Marylene Cloitre
- VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA.
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Stephens TN, McGuire-Schwartz M, Rotko L, Fuss A, McKay MM. A learning collaborative supporting the implementation of an evidence-informed program, the "4Rs and 2Ss for children with conduct difficulties and their families". JOURNAL OF EVIDENCE-BASED SOCIAL WORK 2014; 11:511-523. [PMID: 25491005 PMCID: PMC4369766 DOI: 10.1080/15433714.2013.831007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In this qualitative study the authors examine factors associated with the successful implementation and plans for continued use of an evidence-informed intervention, the 4Rs and 2Ss Program for Strengthening Families, in a sample of 29 New York State, Office of Mental Health licensed child mental health clinics. A learning collaborative (LC) approach was used as a vehicle for supporting training and implementation of the program. The PRISM theoretical framework ( Feldstein & Glasgow, 2008 ) was used to guide the data analysis. Data were analyzed using a multi-phase iterative process, identifying influences on implementation at multiple levels: the program (intervention), the external environment, implementation and sustainability infrastructure, and recipient characteristics. Clinics that were more proactive evidenced staff with advanced organizational skills were able to take advantage of the trainings and supports offered by the LC and fared better in their ability to adopt the intervention. The ability to adapt the intervention to the specific constraints of the clinics was a strong influence on continued use following the end of the LC. These preliminary results suggest that the supports provided by the LC are useful in consolidating information about the process of implementing evidence-informed interventions in community mental health settings. The impact of these supports is also based on their interactions with specific clinic contextual factors.
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Affiliation(s)
- Tricia N Stephens
- a Silver School of Social Work, New York University , New York , New York , USA
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Herbert JD, Gaudiano BA, Forman EM. The importance of theory in cognitive behavior therapy: a perspective of contextual behavioral science. Behav Ther 2013; 44:580-91. [PMID: 24094783 DOI: 10.1016/j.beth.2013.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 02/23/2013] [Accepted: 03/01/2013] [Indexed: 12/19/2022]
Abstract
For the past 30 years, generations of scholars of cognitive behavior therapy (CBT) have expressed concern that clinical practice has abandoned the close links with theory that characterized the earliest days of the field. There is also a widespread assumption that a greater working knowledge of theory will lead to better clinical outcomes, although there is currently very little hard evidence to support this claim. We suggest that the rise of so-called "third generation" models of CBT over the past decade, along with the dissemination of statistical innovations among psychotherapy researchers, have given new life to this old issue. We argue that theory likely does matter to clinical outcomes, and we outline the future research that would be needed to address this conjecture.
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Becker EM, Jensen-Doss A. Computer-assisted therapies: examination of therapist-level barriers to their use. Behav Ther 2013; 44:614-24. [PMID: 24094787 DOI: 10.1016/j.beth.2013.05.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 04/11/2013] [Accepted: 05/27/2013] [Indexed: 10/26/2022]
Abstract
Despite enthusiasm in the field for their potential ease of dissemination, little work has examined whether practicing clinicians are willing and able to use computer-assisted therapies (i.e., computerized treatments designed to be administered with therapist support). For therapists to use these tools, they require access to computer equipment, the skills needed to use the equipment, and willingness to adopt the technology in treatment. This study examined these three factors using survey data from a national sample of mental health clinicians (N=1,067). Respondents reported on their access to technology and computer fluency, in addition to completing the Computer-Assisted Therapy Attitudes Scale (CATAS), a measure of therapist attitudes designed for this study. Overall, the majority of therapists (90.7%) reported access to at least one computer at work and self-reported computer fluency levels were high. On average, therapists held positive attitudes towards computer-assisted therapies, although expressed concern that these technologies might damage rapport and did not feel that these technologies would improve treatment outcomes. Predictors of positive attitudes included greater general openness toward new treatments, greater comfort with computers, and easier access to technology at work (all ps<.01). Results suggested that, on the whole, therapists may be likely to integrate computer-assisted therapies into their clinical practice. However, therapists vary both in their ability and willingness to use these tools. Implications for the dissemination of computer-assisted therapies are discussed.
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Abstract
Collaborative partnerships between community-based clinicians and academic researchers have the potential to improve the relevance, utility, and feasibility of research, as well as the effectiveness of practice. Collaborative partnership research from a variety of fields can inform the development and maintenance of effective partnerships. In this paper we present a conceptual model of research-community practice partnership derived from literature across disciplines and then illustrate application of this model to one case example. The case example is a multi-year partnership between an interdisciplinary group of community-based psychotherapists and a team of mental health researchers. This partnership was initiated to support federally funded research on community-based outpatient mental health care for children with disruptive behavior problems, but it has evolved to drive and support new intervention studies with different clinical foci. Lessons learned from this partnership process will be shared and interpreted in the context of the presented research-practice partnership model.
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Affiliation(s)
- Ann F Garland
- a School, Family & Mental Health Professions , University of San Diego , San Diego , CA , USA
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Lundgren L, Amodeo M, Chassler D, Krull I, Sullivan L. Organizational readiness for change in community-based addiction treatment programs and adherence in implementing evidence-based practices: a national study. J Subst Abuse Treat 2013; 45:457-65. [DOI: 10.1016/j.jsat.2013.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 06/11/2013] [Accepted: 06/25/2013] [Indexed: 10/26/2022]
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Henggeler SW, Chapman JE, Rowland MD, Sheidow AJ, Cunningham PB. Evaluating training methods for transporting contingency management to therapists. J Subst Abuse Treat 2013; 45:466-74. [PMID: 23910392 PMCID: PMC3805110 DOI: 10.1016/j.jsat.2013.06.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 06/20/2013] [Accepted: 06/25/2013] [Indexed: 11/19/2022]
Abstract
The effects of three increasingly intensive training methods on therapist use, knowledge, and implementation adherence of contingency management (CM) with substance abusing adolescents were evaluated. Ten public sector substance abuse or mental health provider organizations were randomized to one of three training conditions: workshop and resources (WS+), WS+and computer assisted training (WS+/CAT), or WS+/CAT and supervisory support (WS+/CAT/SS). Across conditions, 161 therapists participated in the training experiences, and measures were obtained at baseline and 2-month intervals for 12 months following workshop participation. Across training conditions, therapists reported increased CM use, knowledge, and implementation adherence through the 12-month follow-up. The findings show that community-based practitioners are amenable to the adoption of evidence-based treatments when provided access to useful resources. Moreover, high quality workshops in combination with resource access can increase knowledge of the evidence-based treatment and might enhance intervention adherence to a level needed to improve youth outcomes.
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Affiliation(s)
- Scott W Henggeler
- Family Services Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29407, USA.
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22
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Woo SM, Hepner KA, Gilbert EA, Osilla KC, Hunter SB, Muñoz RF, Watkins KE. Training Addiction Counselors to Implement an Evidence-Based Intervention: Strategies for Increasing Organizational and Provider Acceptance. COGNITIVE AND BEHAVIORAL PRACTICE 2013; 20:232-244. [PMID: 23734072 DOI: 10.1016/j.cbpra.2012.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
One barrier to widespread public access to empirically supported treatments (ESTs) is the limited availability and high cost of professionals trained to deliver them. Our earlier work from two clinical trials demonstrated that front-line addiction counselors could be trained to deliver a manualized, group-based cognitive behavioral therapy (GCBT) for depression, a prototypic example of an EST, with a high level of adherence and competence. This follow-up article provides specific recommendations for the selection and initial training of counselors, and for the structure and process of their ongoing clinical supervision. Unique challenges in working with counselors unaccustomed to traditional clinical supervision are highlighted. The recommendations are based on comprehensive feedback derived from clinician notes taken throughout the clinical trials, a focus group with counselors conducted one year following implementation, and interviews with key organization executives and administrators.
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Gryczkowski MR, Tiede MS, Dammann JE, Jacobsen AB, Hale LR, Whiteside SPH. The Timing of Exposure in Clinic-Based Treatment for Childhood Anxiety Disorders. Behav Modif 2013; 37:211-25. [DOI: 10.1177/0145445513482394] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The present study examines treatment length and timing of exposure from two child anxiety disorders clinics. Data regarding symptoms and treatment characteristics for 28 youth were prospectively obtained through self, parent, and therapist report at each session. Information regarding length of treatment, timing of exposure initiation, and drop-out rates were compared with those obtained through efficacy and effectiveness trials of manualized treatment for anxious youth. Findings from the authors’ clinical data revealed significantly shorter treatment duration with exposures implemented sooner than in the previous studies. Dropout rates were significantly higher than in the efficacy trial but comparable with the effectiveness trial. Outcome data from a subset of eight patients revealed large effect sizes. These findings suggest that effective treatment can be shorter and more focused on exposure than is often outlined in manuals and have important implications for outcome research and dissemination.
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Affiliation(s)
| | | | | | - Amy Brown Jacobsen
- Kansas City Center for Anxiety Treatment, KS, USA
- University of Missouri-Kansas City, MO, USA
| | - Lisa R. Hale
- Kansas City Center for Anxiety Treatment, KS, USA
- University of Missouri-Kansas City, MO, USA
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24
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Goldstein NES, Kemp KA, Leff SS, Lochman JE. Guidelines for Adapting Manualized Interventions for New Target Populations: A Step-Wise Approach Using Anger Management as a Model. ACTA ACUST UNITED AC 2012; 19:385-401. [PMID: 25110403 DOI: 10.1111/cpsp.12011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The use of manual-based interventions tends to improve client outcomes and promote replicability. With an increasingly strong link between funding and the use of empirically supported prevention and intervention programs, manual development and adaptation have become research priorities. As a result, researchers and scholars have generated guidelines for developing manuals from scratch, but there are no extant guidelines for adapting empirically supported, manualized prevention and intervention programs for use with new populations. Thus, this article proposes step-by-step guidelines for the manual adaptation process. It also describes two adaptations of an extensively researched anger management intervention to exemplify how an empirically supported program was systematically and efficiently adapted to achieve similar outcomes with vastly different populations in unique settings.
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Affiliation(s)
| | | | - Stephen S Leff
- The Children's Hospital of Pennsylvania, University of Pennsylvania School of Medicine, The Philadelphia Collaborative Violence Prevention Center
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Gryczkowski MR, Tiede MS, Dammann JE, Brown Jacobsen A, Hale LR, Whiteside SPH. The Timing of Exposure in Clinic-Based Treatment for Childhood Anxiety Disorders. Behav Modif 2012; 37:113-27. [DOI: 10.1177/0145445512456546] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study examines treatment length and timing of exposure from two child anxiety disorders clinics. Data regarding symptoms and treatment characteristics for 28 youth were prospectively obtained through self, parent, and therapist report at each session. Information regarding length of treatment, timing of exposure initiation, and drop-out rates were compared with those obtained through efficacy and effectiveness trials of manualized treatment for anxious youth. Findings from the authors’ clinical data revealed significantly shorter treatment duration with exposures implemented sooner than in the previous studies. Dropout rates were significantly higher than in the efficacy trial but comparable with the effectiveness trial. Outcome data from a subset of eight patients revealed large effect sizes. These findings suggest that effective treatment can be shorter and more focused on exposure than is often outlined in manuals and have important implications for outcome research and dissemination.
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Affiliation(s)
| | | | | | - Amy Brown Jacobsen
- Kansas City Center for Anxiety Treatment, KS, USA
- University of Missouri-Kansas City, MO, USA
| | - Lisa R. Hale
- Kansas City Center for Anxiety Treatment, KS, USA
- University of Missouri-Kansas City, MO, USA
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26
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Self-Brown S, Whitaker D, Berliner L, Kolko D. Disseminating child maltreatment interventions: research on implementing evidence-based programs. CHILD MALTREATMENT 2012; 17:5-10. [PMID: 22353672 PMCID: PMC3814165 DOI: 10.1177/1077559511436211] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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27
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Cruz M. Mental Health Services Research and Community Psychiatry. HANDBOOK OF COMMUNITY PSYCHIATRY 2012:561-573. [DOI: 10.1007/978-1-4614-3149-7_46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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28
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Gaudiano BA, Brown LA, Miller IW. Let your intuition be your guide? Individual differences in the evidence-based practice attitudes of psychotherapists. J Eval Clin Pract 2011; 17:628-34. [PMID: 21255200 DOI: 10.1111/j.1365-2753.2010.01508.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Despite increasing dissemination efforts, many psychotherapists still do not use treatments that are supported by research. Some have claimed that psychotherapists rely more on their clinical intuition than scientific evidence when making treatment decisions, but there is a paucity of research on this topic. The aim of the study was to examine the relationship between intuition and therapists' attitudes towards evidence-based practices (EBPs). METHODS Psychotherapists from diverse professional backgrounds completed an Internet-based survey that assessed EBP attitudes, reliance on an intuitive thinking style, attitudes about alternative therapies and endorsement of erroneous health beliefs that are not supported by scientific evidence. RESULTS Regression analyses showed that an intuitive thinking style was associated with several dimensions of EBP attitudes, including more negative attitudes towards research, less openness to research-based treatments, and less willingness to use evidence-based treatments if required to do so, even after controlling for background factors such as education level. Furthermore, a tendency to rely on intuition was associated with more positive attitudes towards alternative therapies and the endorsement of erroneous health beliefs. CONCLUSIONS Most dissemination efforts targeted at psychotherapists focus only on education about EBPs. However, results of this study suggest that dissemination efforts may need to more directly address the potential barriers to using EBPs (i.e. reliance on intuition) to be optimally effective in changing therapists' attitudes and behaviours.
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29
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Integrating Triple P into Existing Family Support Services: A Case Study on Program Implementation. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2011; 12:411-22. [DOI: 10.1007/s11121-011-0233-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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30
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Vande Voort JL, Svecova J, Jacobson AB, Whiteside SP. A Retrospective Examination of the Similarity Between Clinical Practice and Manualized Treatment for Childhood Anxiety Disorders. COGNITIVE AND BEHAVIORAL PRACTICE 2010. [DOI: 10.1016/j.cbpra.2009.12.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Proctor EK, Landsverk J, Aarons G, Chambers D, Glisson C, Mittman B. Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2009; 36:24-34. [PMID: 19104929 PMCID: PMC3808121 DOI: 10.1007/s10488-008-0197-4] [Citation(s) in RCA: 1005] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 11/28/2008] [Indexed: 10/21/2022]
Abstract
One of the most critical issues in mental health services research is the gap between what is known about effective treatment and what is provided to consumers in routine care. Concerted efforts are required to advance implementation science and produce skilled implementation researchers. This paper seeks to advance implementation science in mental health services by over viewing the emergence of implementation as an issue for research, by addressing key issues of language and conceptualization, by presenting a heuristic skeleton model for the study of implementation processes, and by identifying the implications for research and training in this emerging field.
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Affiliation(s)
- Enola K Proctor
- George Warren Brown School of Social Work, Washington University, 1 Brookings Drive, St Louis, MO 63130, USA.
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32
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Friedberg RD, Gorman AA, Beidel DC. Training psychologists for cognitive-behavioral therapy in the raw world: a rubric for supervisors. Behav Modif 2008; 33:104-23. [PMID: 18768930 DOI: 10.1177/0145445508322609] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Empirically supported treatments (EST) hold much promise in relieving psychological distress and dysfunction. However, various obstacles to effective training and clinical practice have truncated dissemination efforts. One such obstacle is the perceived applicability of EST procedures to raw world clinical practice. This article proposes a rubric for supervision that emphasizes case conceptualization, the use of immediacy in session, tolerating negative affect, harvesting open attitudes, cultural responsiveness, and technical proficiency. Several specific training strategies and supervisory processes are recommended.
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Affiliation(s)
- Robert D Friedberg
- Penn State Milton Hershey Medical Center/College of Medicine, Hershey, PA 17033, USA.
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33
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Frueh BC, Grubaugh AL, Cusack KJ, Elhai JD. Disseminating evidence-based practices for adults with PTSD and severe mental illness in public-sector mental health agencies. Behav Modif 2008; 33:66-81. [PMID: 18723837 DOI: 10.1177/0145445508322619] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Posttraumatic stress disorder (PTSD) remains largely untreated among adults with severe mental illnesses (SMI). The treatment of psychotic symptoms usually takes precedence in the care of adults with SMI. Such oversight is problematic in that PTSD in SMI populations is common (19%-43%), contributes a significant illness burden, and hinders mental health care. Yet few public-sector mental health agencies routinely provide specialized services for PTSD. The purpose of the article is to describe strategies and efforts to disseminate trauma-focused empirically based practices in a public-sector mental health system. Identified challenges include limited resources and commitment; knowledge deficits, attitudes, and biases; and limited practice accountability at provider, facility, and system levels. Proposed strategies for overcoming these challenges are to set clear goals, nurture broad-based organizational commitment and key stakeholder involvement, implement specialty training efforts to provide information and change attitudes, provide ongoing supervision, conduct fidelity monitoring, and ensure accountability to the extent possible.
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34
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Proctor EK, Rosen A. From Knowledge Production to Implementation: Research Challenges and Imperatives. RESEARCH ON SOCIAL WORK PRACTICE 2008; 18:285-291. [PMID: 24089591 PMCID: PMC3786596 DOI: 10.1177/1049731507302263] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
As evidence-based practice is increasingly accepted in social work, the challenges associated with its actual implementation become more apparent and pressing. This article identifies implementation as a critical issue for research; implementation itself must be better understood if evidence-based practices are to be used and resultant improvements to practice are to be realized. Social work needs to engage more fully in (a) service system research and (b) implementation research, each of which complements and has potential to extend the benefits of efficacy and effectiveness research. Service system research can enhance the fit of empirically supported treatments to the needs of real-world practice and thus facilitate their implementation. Implementation studies examine the acceptability of evidence-based interventions, the feasibility and likelihood of their sustained use, and the decision-support procedures that can help practitioners apply probabilistically based, empirically supported treatments to the individual case in real-world practice.
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35
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Translating Empirically Supported Strategies Into Accessible Interventions: The Potential Utility of Exercise for the Treatment of Panic Disorder. COGNITIVE AND BEHAVIORAL PRACTICE 2007. [DOI: 10.1016/j.cbpra.2006.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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36
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Abstract
Whither, or wither, empirically supported therapies? Increasingly rigorous research in behavioral therapies has yielded a large number of effective therapies, but comparatively little work, demonstrating that integrating empirically supported therapies (ESTs) into standard practice results in meaningful improvements in patient outcomes. Methodology and strategies for evaluating ESTs and their effectiveness in clinical practice is a fairly recent innovation, and a host of unanswered questions remain regarding issues such as selection among different ESTs and what type of ESTs should be emphasized in dissemination efforts, what type of clinicians should be trained in what type of ESTs, the most effective training strategies for various types of clinicians, the need for ongoing supervision to maintain minimum levels of treatment fidelity and skill. In this review, we call for broader use of new research strategies and methods relevant to dissemination of ESTs; these may include adaptive designs, identification of mechanisms of action to foster greater emphasis on effective change principles, training and adoption trials, as well as novel implementation strategies including computer-assisted therapy and computer-assisted training.
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Affiliation(s)
- Kathleen M Carroll
- Division of Substance Abuse, Yale University School of Medicine, West Haven, CT 06516, USA.
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37
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Byrne DG, Davenport SC. Contemporary profiles of clinical and health psychologists in Australia. AUSTRALIAN PSYCHOLOGIST 2006. [DOI: 10.1080/00050060500243434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- D. G. Byrne
- School of Psychology, The Australian National University, Canberra, ACT, Australia
| | - S. C. Davenport
- School of Psychology, The Australian National University, Canberra, ACT, Australia
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38
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Addis ME, Hatgis C, Cardemil E, Jacob K, Krasnow AD, Mansfield A. Effectiveness of cognitive-behavioral treatment for panic disorder versus treatment as usual in a managed care setting: 2-year follow-up. J Consult Clin Psychol 2006; 74:377-85. [PMID: 16649882 DOI: 10.1037/0022-006x.74.2.377] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Eighty clients meeting criteria for panic disorder and receiving either panic control therapy (PCT; M. G. Craske, E. Meadows, & D. H. Barlow, 1994) or treatment as usual (TAU) in a managed care setting were assessed 1 and 2 years following acute treatment. PCT was provided by therapists with little or no previous exposure to cognitive-behavioral therapies. Analyses of the full intent-to-treat sample revealed no significant differences between the treatments across the follow-up period. However, when treatment completer status was added as a moderator, those receiving PCT showed lower levels of panic severity and phobic avoidance and a greater likelihood of achieving and maintaining clinically significant change. Benzodiazepine use during follow-up was associated with greater panic severity for those clients who received PCT, but no such relationship was found for TAU clients. Results are discussed in relation to the dissemination and effectiveness of PCT as well as evidence-based psychotherapies more generally.
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Affiliation(s)
- Michael E Addis
- Department of Psychology, Clark University, Worcester, MA 01610, USA.
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Lipsitz JD, Gur M, Miller NL, Forand N, Vermes D, Fyer AJ. An open pilot study of interpersonal psychotherapy for panic disorder (IPT-PD). J Nerv Ment Dis 2006; 194:440-5. [PMID: 16772862 DOI: 10.1097/01.nmd.0000221302.42073.a1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Interpersonal psychotherapy (IPT) is a time-limited psychotherapy initially developed to treat depression. It has yet to be studied systematically for treatment of panic disorder. We modified IPT for the treatment of panic disorder and tested this treatment in an open clinical trial with 12 patients seeking treatment of DSM-IV panic disorder. Patients were assessed before during and after treatment. At completion of treatment, nine patients (75%) were independently categorized as responders (i.e., rated as much improved or very much improved on the Clinical Global Impression-Change Scale). Substantial improvement was found for panic symptoms, associated anxiety and depressive symptoms, and physical and emotional well-being. Degree of change in this sample approximated that obtained in studies using established treatments such as cognitive behavioral therapy. Results, though preliminary, suggest that IPT may have efficacy as a primary treatment of panic disorder. Further study is warranted.
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Affiliation(s)
- Joshua D Lipsitz
- Columbia University, Department of Psychiatry, Anxiety Disorders Clinic, New York State Psychiatric Institute, New York, New York, USA
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40
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Sukhodolsky DG, Ruchkin V. Evidence-based psychosocial treatments in the juvenile justice system. Child Adolesc Psychiatr Clin N Am 2006; 15:501-16, x. [PMID: 16527668 DOI: 10.1016/j.chc.2005.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
During the past three decades, considerable progress has been made in the development, implementation, and evaluation of psychosocial treatments focused on alleviation of risk factors of delinquency, reduction of juvenile crime, and prevention of recidivism. This article reviews selected youth-, family-, and community-based psychosocial treatments for delinquent behavior that are likely to be used in the juvenile justice system and evidence-based psychosocial treatments for internalizing disorders that have a potential for being successfully implemented in the juvenile justice system. The authors discuss the practical issues in dissemination and implementation of evidence-based psychosocial treatments in the juvenile justice system.
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Affiliation(s)
- Denis G Sukhodolsky
- Child Study Center, Yale University School of Medicine, New Haven, CT 06520, USA.
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41
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Tyrrell J, Poussin G. Quelques réflexions sur l'avenir en France des traitements psychologiques appuyés empiriquement. PSYCHOLOGIE FRANCAISE 2005. [DOI: 10.1016/j.psfr.2005.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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42
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Ruzek JI, Friedman MJ, Murray S. Toward a Knowledge Management System for Posttraumatic Stress Disorder Treatment in Veterans Healthcare. Psychiatr Ann 2005. [DOI: 10.3928/00485713-20051101-06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Riemer M, Rosof-Williams J, Bickman L. Theories related to changing clinician practice. Child Adolesc Psychiatr Clin N Am 2005; 14:241-54, viii. [PMID: 15694784 DOI: 10.1016/j.chc.2004.05.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article provides a theoretic exploration of the microprocesses of clinician practice change in the context of adopting and implementing evidence-based treatments. The two most important internal clinician or microlevel factors involved in behavior change are identified as motivation and ability. The authors focus on factors related to motivation and present their own theory of the cognitive-affective processes for motivation to change. In the discussion of their theory, the authors highlight leverage points for possible interventions. Finally, the authors show how their microlevel theory relates to other prominent, more macrolevel-oriented theories of clinician practice change.
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Affiliation(s)
- Manuel Riemer
- Department of Psychology and Human Development, Vanderbilt University, 1818 South Ave Drive, Nashville, TN 37203, USA.
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Addis ME, Hatgis C, Krasnow AD, Jacob K, Bourne L, Mansfield A. Effectiveness of cognitive--behavioral treatment for panic disorder versus treatment as usual in a managed care setting. J Consult Clin Psychol 2004; 72:625-35. [PMID: 15301647 DOI: 10.1037/0022-006x.72.4.625] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Eighty clients enrolled in a managed care health plan who identified panic disorder as their primary presenting problem were randomly assigned to treatment by a therapist recently trained in a manual-based empirically supported psychotherapy or a therapist conducting treatment as usual (TAU). Participants in both conditions showed significant change from pre- to posttreatment on a number of measures. Those receiving panic control therapy (PCT) showed greater levels of change than those receiving TAU. Among treatment completers, an average of 42.9% of those in PCT and 18.8% in TAU achieved clinically significant change across measures. The results are discussed with reference to the dissemination of PCT and other evidence-based psychotherapies to clinical practice settings.
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Affiliation(s)
- Michael E Addis
- Department of Psychology, Clark University, Worcester, MA 01610, USA.
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