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Ragnarsson EH, Reinebo G, Ingvarsson S, Lindgren A, Beckman M, Alfonsson S, Hedman-Lagerlöf M, Rahm C, Sahlin H, Stenfors T, Sörman K, Jansson-Fröjmark M, Lundgren T. Effects of Training in Cognitive Behavioural Therapy and Motivational Interviewing on Mental Health Practitioner Behaviour: A Systematic Review and Meta-Analysis. Clin Psychol Psychother 2024; 31:e3003. [PMID: 38855846 DOI: 10.1002/cpp.3003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 06/11/2024]
Abstract
Effective training of mental health professionals is crucial for bridging the gap between research and practice when delivering cognitive behavioural therapy (CBT) and motivational interviewing (MI) within community settings. However, previous research has provided inconclusive evidence regarding the impact of training efforts. The current study aimed to systematically search, review and synthesize the literature on CBT and MI training to assess its effect on practitioner behavioural outcomes. Following prospective registration, a literature search was conducted for studies where mental health practitioners were exposed to training in face-to-face CBT or MI, reporting on at least one quantitative practitioner behavioural outcome. A total of 116 studies were eligible for the systematic review, and 20 studies were included in four meta-analyses. The systematic review highlights the need to establish psychometrically valid outcome measures for practitioner behaviour. Results of the meta-analyses suggest that training has a greater effect on practitioner behaviour change compared to receiving no training or reading a treatment manual. Training combined with consultation/supervision was found to be more effective than training alone, and no differences were found between face-to-face and online training. Results should be interpreted with caution due to methodological limitations in the primary studies, large heterogeneity, and small samples in the meta-analyses. Future directions are discussed.
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Affiliation(s)
- Emma Högberg Ragnarsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Gustaf Reinebo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Sara Ingvarsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Annika Lindgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Maria Beckman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Sven Alfonsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Maria Hedman-Lagerlöf
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Christoffer Rahm
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Hanna Sahlin
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Terese Stenfors
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Karolina Sörman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
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2
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Baumann BL, McGuier EA, Rounds JL, Rumbarger KM, Kolko DJ. Comparing In-Person and Synchronous Online Training for an Evidence-Based Treatment. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:936-945. [PMID: 37634176 DOI: 10.1007/s10488-023-01294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
Online trainings in evidence-based treatments (EBT) can be effective platforms and may provide better access to community providers as compared with traditional in-person trainings. However, questions remain as to whether online trainings can achieve similar rates of training engagement and model application to traditional in-person trainings. We compared training engagement and model application (e.g., extent of use, fidelity) between participants attending in-person (n = 127) and synchronous online (n = 277) trainings for an EBT (Alternatives for Families: a Cognitive Behavioral Therapy; AF-CBT). Data were collected through pre- and post-training questionnaires and trainers' records. Chi-square analyses and t-tests were used to test for differences between groups. Engagement regarding attendance at workshops and consultation calls was high for both groups, with no significant differences. A total of 81% and 76% presented at least one case and submitted at least one audio recording of an actual AF-CBT session, respectively. Participants rated the training workshop as high quality (M > 4.5/5), and the consultation calls as medium-to-high quality (M > 4/5) across both modalities, indicating good training engagement. In-person training participants were significantly more likely to submit two or more audio recorded sessions than online training participants. This was the only training requirement outcome that differed between the two groups. In examining model application, there were no significant differences between in-person and online training participants in self-reported delivery of AF-CBT, the number of clients with whom it was implemented, the extent they used the model, or the fidelity with which they delivered it. Both groups reported similar improvements in comfort when working with aggressive families, being directive, and using learning techniques like role plays. Online evidence-based treatment skills training appears to be feasible, efficient, and beneficial, with engagement and performance comparable to in-person training. We discuss potential advantages of online training (e.g., fewer costs, greater flexibility for staff from independent practices) and disadvantages (e.g., less satisfaction).
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Affiliation(s)
- Barbara L Baumann
- University of Pittsburgh, 3811 O'Hara Street, BT 540, Pittsburgh, PA, 15213, USA.
| | - Elizabeth A McGuier
- University of Pittsburgh, 3811 O'Hara Street, BT 540, Pittsburgh, PA, 15213, USA
| | | | | | - David J Kolko
- University of Pittsburgh, 3811 O'Hara Street, BT 540, Pittsburgh, PA, 15213, USA
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3
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Roosenschoon BJ, van Weeghel J, Deen ML, van Esveld EW, Kamperman AM, Mulder CL. Fidelity and Clinical Competence in Providing Illness Management and Recovery: An Explorative Study. Community Ment Health J 2023; 59:1508-1520. [PMID: 37253901 PMCID: PMC10598171 DOI: 10.1007/s10597-023-01137-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 05/07/2023] [Indexed: 06/01/2023]
Abstract
Illness Management and Recovery (IMR) is a psychosocial intervention supporting people with serious mental illnesses. In this study, 15 IMR groups were assessed for fidelity and clinician competency to establish the implementation level of all IMR elements and explore complementarity of the IMR Treatment Integrity Scale (IT-IS) to the standard IMR Fidelity Scale. Use of the IT-IS was adapted, similar to the IMR Fidelity Scale. Descriptive statistics were applied. Implementation success of IMR elements varied widely on the IMR Fidelity Scale and IT-IS (M = 3.94, SD = 1.13, and M = 3.29, SD = 1.05, respectively). Twelve IMR elements (60%) were well-implemented, whereas eight (40%) were implemented insufficiently, including some critical cognitive-behavioral techniques (e.g., role-playing). The scales appeared largely complementary, though strongly correlated (r (13) = 0.74, p = 0.002). Providing all IMR elements adequately requires a variety of clinical skills. Specific additional training and supervision may be necessary.
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Affiliation(s)
- Bert-Jan Roosenschoon
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands.
- Parnassia Academy, Parnassia Psychiatric Institute, Kiwistraat 32, Den Haag, 2552 DH, The Netherlands.
| | - Jaap van Weeghel
- Department of TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, Tilburg, 5000 LE, The Netherlands
| | - Mathijs L Deen
- Parnassia Academy, Parnassia Psychiatric Institute, Kiwistraat 32, Den Haag, 2552 DH, The Netherlands
- Faculty of Social and Behavioral Sciences, Institute of Psychology, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, The Netherlands
| | | | - Astrid M Kamperman
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - Cornelis L Mulder
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
- ANTES Mental Health Care, Parnassia Psychiatric Institute, Albrandswaardsedijk 74, Poortugaal, 3172 AA, The Netherlands
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4
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Ng LC, Miller AN, Bowers G, Cheng Y, Brigham R, Him Tai M, Smith AM, Mueser KT, Fortuna LR, Coles M. A pragmatic feasibility trial of the Primary Care Intervention for PTSD: A health service delivery model to reduce health disparities for low-income and BIPOC youth. Behav Res Ther 2023; 165:104310. [PMID: 37040669 DOI: 10.1016/j.brat.2023.104310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/27/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE This study is a non-randomized pragmatic trial to assess the feasibility and acceptability of the Primary Care Intervention for Posttraumatic stress disorder (PCIP) (Srivastava et al., 2021), an Integrated Behavioral Health Care treatment for PTSD in adolescents. METHOD Following routine clinic procedures, youth who were suspected of having trauma-related mental health symptoms were referred by their primary care providers to integrated care social workers for evaluation. The integrated care social workers referred the first 23 youth whom they suspected of having PTSD to the research study. Twenty youth consented to the study and 19 completed the pre-assessment (17 female; mean age = 19.32, SD = 2.11; range 14-22 years). More than 40% identified as Black and a third as Hispanic/Latinx. PCIP mechanisms and clinical outcomes were assessed pre- and post-treatment, and at one-month follow-up. Participants and therapists completed post-treatment qualitative interviews to assess feasibility and acceptability, and treatment sessions were audio recorded to assess fidelity. RESULTS Findings suggest high acceptability, satisfaction, and feasibility of the PCIP delivered in "real-life" safety net pediatric primary care. Integrated care social workers had high treatment fidelity. Despite the small sample size, there was significant improvement in symptom scores of anxiety (g = 0.68, p = 0.02) and substance use (g = 0.36, p = 0.04) from pre to post, and depression symptoms (g = 0.38, p = 0.04) from pre to follow-up. Qualitative data from patients who completed exit interviews and integrated social workers indicated high satisfaction with the treatment, with some participants reporting that the integrated intervention was more acceptable and less stigmatizing than seeking mental health care outside of primary care. CONCLUSIONS The PCIP may improve treatment engagement and access for vulnerable youth. Promising findings of high acceptability, feasibility, and initial clinical effectiveness suggest that PCIP warrants larger-scale study as part of routine care in pediatric integrated care.
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5
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Brown WJ, Saulnier KG, Allan NP, Wojtalik JA, Zampogna AM, Grubaugh AL. Dropout from prolonged exposure among individuals with posttraumatic stress disorder and comorbid severe mental illness. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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6
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Khan A, Ullah F, Abid O, Awan KH. "Efficacy of Cognitive Behavioral Therapy in Post-traumatic Stress Disorder
Among Spinal Cord Injury Patients: A Randomized Controlled Pilot Study". JOURNAL OF EVIDENCE-BASED PSYCHOTHERAPIES 2021. [DOI: 10.24193/jebp.2021.2.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
"Post-Traumatic Stress Disorder (PTSD) develops after exposure to or
witnessing traumatic events. PTSD is very common among the Spinal Cord
Injury (SCI) patients. PTSD can be successfully treated with the Cognitive
Behavioral Therapy (CBT). However, CBT is mostly used in the western
countries, so its efficacy in the eastern culture is still not fully known.
Keeping this in view, the current study has determined the efficacy of CBT
in the treatment of PTSD among the SCI patients in Pakistan. Using a
Randomized Controlled Pilot Study design, data were collected through the
Clinician-Administered PTSD Scale for DSM-5 from thirty patients
admitted to the Paraplegic Center. Trauma-focused CBT(TF-CBT) protocol
was applied through fourteen sessions. Data were analyzed by descriptive
and multivariate statistics. Findings show that the level of PTSD symptoms
gradually decreased from high at baseline (CAPS-5 Mean Scores μ= 3.6) to
low during follow-up stage (CAPS-5 Mean Scores μ= 0.89). Results obtained
from the present study on the efficacy of CBT are in concurrence with the
research findings in other countries. This study supports the efficiency CBT
intervention among Pakistani patients who had developed PTSD symptoms
after suffering from SCI. Therefore, CBT can be widely used in the
management of PTSD in Pakistan."
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Affiliation(s)
- Anwar Khan
- Department of Psychology and Management Sciences, Khushal Khan Khattak University, Karak, Khyber Pakhtunkhwa, Pakistan
| | - Faseeh Ullah
- Paraplegic Centre Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Omer Abid
- Category-D Government Hospital, Badaber, Peshawar District, Khyber Pakhtunkhwa, Pakistan
| | - Khizra Hafeez Awan
- The Indus Hospital, University Town, Peshawar, Khyber Pakhtunkhwa, Pakistan
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7
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Sijercic I, Lane JEM, Gutner CA, Monson CM, Stirman SW. The Association Between Clinician and Perceived Organizational Factors with Early Fidelity to Cognitive Processing Therapy for Posttraumatic Stress Disorder in a Randomized Controlled Implementation Trial. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:8-18. [PMID: 31463667 DOI: 10.1007/s10488-019-00966-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A common metric for determining implementation success is the measurement of clinician adherence to, and competence in, delivering a psychotherapy. The present study examined clinician and organizational factors as predictors of early adherence and competence among 78 clinicians delivering cognitive processing therapy (CPT), an evidence-based psychotherapy (EBP) for posttraumatic stress disorder, in a randomized controlled implementation trial. Results indicated that clinicians' willingness to adopt an EBP if required to do so was significantly associated with early adherence and competence in CPT delivery. Level of clinician education was significantly associated with early competence in delivering CPT. Organizational factors did not predict early adherence or competence. Implications of the findings are discussed.
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Affiliation(s)
| | | | | | | | - Shannon Wiltsey Stirman
- National Center for PTSD, VA Palo Alto Healthcare System & Stanford University, 795 Willow Road, NC-PTSD 334, Menlo Park, CA, 94025, USA.
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8
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Mallard Swanson K, Song J, Beristianos M, Aajmain S, Lane JE, Landy MS, Suvak MK, Shields N, Monson CM, Stirman SW. A Glimpse into the "Black Box": Which Elements of Consultation in an EBP are Associated with Client Symptom Change and Therapist Fidelity? IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211051791. [PMID: 37090000 PMCID: PMC9978606 DOI: 10.1177/26334895211051791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Consultation is an implementation strategy that improves delivery and clinical outcomes for Cognitive Processing Therapy (CPT), an evidence-based practice (EBP) for posttraumatic stress disorder (PTSD). However, little is known about the specific components of consultation that influence the fidelity of treatment delivery or clinical outcomes. Methods: The current study examined whether specific activities performed during CPT consultation meetings were associated with better fidelity to the CPT protocol among 60 newly trained therapists or improved clinical outcomes among 135 clients treated by these therapists. Consultation activities that fall under three broad categories (discussion of the application of CPT to individual cases, review/feedback on fidelity, and technical difficulties) were measured by consultant checklists for each consultation session. Treatment fidelity (adherence to the protocol and competence of delivery) was rated by trained observers for a random sample of therapists' CPT sessions following consultation. The self-reported PTSD Checklist-IV assessed PTSD symptom change. Results: Multilevel regression analyses indicated that higher therapist consultation attendance predicted a greater decrease in their clients' PTSD symptoms and that attendance was not associated with observer-rated treatment fidelity. Discussion of the application of specific CPT strategies was the only consultation activity that was significantly associated with greater improvement in PTSD symptoms. Lastly, no consultation activities were significantly associated with treatment fidelity. Conclusions: Our findings suggest that specific consultation strategies such as emphasizing the discussion of the application of specific CPT strategies to individual cases during consultation meetings may be effective in improving the clinical outcomes of CPT.
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Affiliation(s)
| | - Jiyoung Song
- National Center for PTSD and Stanford University, Menlo Park, CA,
USA
| | | | - Syed Aajmain
- National Center for PTSD and Stanford University, Menlo Park, CA,
USA
| | - Jeanine E.M. Lane
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | | | | | - Norman Shields
- Royal Canadian Mounted
Police, Divisional Psychologist Occupational Health and Safety
Services, Ottawa, Ontario, Canada
| | - Candice M. Monson
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
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Frank HE, Becker-Haimes EM, Kendall PC. Therapist training in evidence-based interventions for mental health: A systematic review of training approaches and outcomes. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2020; 27:e12330. [PMID: 34092941 PMCID: PMC8174802 DOI: 10.1111/cpsp.12330] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/07/2020] [Indexed: 12/20/2022]
Abstract
A lack of effective therapist training is a major barrier to evidence-based intervention (EBI) delivery in the community. Systematic reviews published nearly a decade ago suggested that traditional EBI training leads to higher knowledge but not more EBI use, indicating that more work is needed to optimize EBI training and implementation. This systematic review synthesizes the training literature published since 2010 to evaluate how different training models (workshop, workshop with consultation, online training, train-the-trainer, and intensive training) affect therapists' knowledge, beliefs, and behaviors. Results and limitations for each approach are discussed. Findings show that training has advanced beyond provision of manuals and brief workshops; more intensive training models show promise for changing therapist behavior. However, methodological issues persist, limiting conclusions and pointing to important areas for future research.
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Affiliation(s)
- Hannah E. Frank
- Psychology Department, Temple University, Philadelphia, Pennsylvania
| | - Emily M. Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Hall Mercer Community Mental Health, Philadelphia, Pennsylvania
| | - Philip C. Kendall
- Psychology Department, Temple University, Philadelphia, Pennsylvania
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10
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The Family Psychoeducation Fidelity Scale: Psychometric Properties. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:894-900. [PMID: 32323217 PMCID: PMC7547979 DOI: 10.1007/s10488-020-01040-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined psychometric properties and feasibility of the Family Psychoeducation (FPE) Fidelity Scale. Fidelity assessors conducted reviews using the FPE fidelity scale four times over 18 months at five sites in Norway. After completing fidelity reviews, assessors rated feasibility of the fidelity review process. The FPE fidelity scale showed excellent interrater reliability (.99), interrater item agreement (88%), and internal consistency (mean = .84 across four time points). By the 18-month follow-up, all five sites increased fidelity and three reached adequate fidelity. Fidelity assessors rated feasibility as excellent. The FPE fidelity scale has good psychometric properties and is feasible for evaluating the implementation of FPE programs. Trial registration ClinicalTrials.gov Identifier: NCT03271242.
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11
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Dimitropoulos G, Lock JD, Agras WS, Brandt H, Halmi KA, Jo B, Kaye WH, Pinhas L, Wilfley DE, Woodside DB. Therapist adherence to family-based treatment for adolescents with anorexia nervosa: A multi-site exploratory study. EUROPEAN EATING DISORDERS REVIEW 2020; 28:55-65. [PMID: 31297906 PMCID: PMC6925617 DOI: 10.1002/erv.2695] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 05/16/2019] [Accepted: 05/27/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This exploratory study is the first to examine family-based treatment (FBT) adherence and association to treatment outcome in the context of a large-scale, multi-centre study for the treatment of adolescents with anorexia nervosa. METHOD One hundred and ninety recorded FBT sessions from 68 adolescents with anorexia nervosa and their families were recruited across multiple sites (N = 6). Each site provided 1-4 tapes per family over four treatment time points, and each was independently rated for therapist adherence. RESULTS There were differences in adherence scores within and between sites. ANOVA produced a main effect for site, F(5, 46) = 8.6, p < .001, and phase, F(3, 42) = 12.7, p < .001, with adherence decreasing in later phases. Adherence was not associated to end of treatment percent ideal body weight after controlling for baseline percent ideal body weight (r = .088, p = .48). CONCLUSIONS Results suggest that FBT can be delivered with adherence in phase one of treatment. Adherence was not associated with treatment outcome as determined using percent ideal body weight.
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Affiliation(s)
| | - James D Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | | | - Harry Brandt
- The Center for Eating Disorders, Sheppard Pratt Health System, Baltimore, MD
| | - Katherine A Halmi
- Department of Psychiatry, Weill Medical College, Cornell University, New York, NY
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Walter H Kaye
- Centre for Eating Disorders, Department of Psychiatry, University of California, San Diego, CA
| | - Leora Pinhas
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - D Blake Woodside
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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12
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Kühne F, Maas J, Wiesenthal S, Weck F. Empirical research in clinical supervision: a systematic review and suggestions for future studies. BMC Psychol 2019; 7:54. [PMID: 31439041 PMCID: PMC6706910 DOI: 10.1186/s40359-019-0327-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/18/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although clinical supervision is considered to be a major component of the development and maintenance of psychotherapeutic competencies, and despite an increase in supervision research, the empirical evidence on the topic remains sparse. METHODS Because most previous reviews lack methodological rigor, we aimed to review the status and quality of the empirical literature on clinical supervision, and to provide suggestions for future research. MEDLINE, PsycInfo and the Web of Science Core Collection were searched and the review was conducted according to current guidelines. From the review results, we derived suggestions for future research on clinical supervision. RESULTS The systematic literature search identified 19 publications from 15 empirical studies. Taking into account the review results, the following suggestions for further research emerged: Supervision research would benefit from proper descriptions of how studies are conducted according to current guidelines, more methodologically rigorous empirical studies, the investigation of active supervision interventions, from taking diverse outcome domains into account, and from investigating supervision from a meta-theoretical perspective. CONCLUSIONS In all, the systematic review supported the notion that supervision research often lags behind psychotherapy research in general. Still, the results offer detailed starting points for further supervision research. TRIAL REGISTRATION PROSPERO; CRD42017072606 , registered on June 20, 2017.
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Affiliation(s)
- Franziska Kühne
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany.
| | - Jana Maas
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany
| | - Sophia Wiesenthal
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany
| | - Florian Weck
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany
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13
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Back SE, Killeen T, Badour CL, Flanagan JC, Allan NP, Ana ES, Lozano B, Korte KJ, Foa EB, Brady KT. Concurrent treatment of substance use disorders and PTSD using prolonged exposure: A randomized clinical trial in military veterans. Addict Behav 2019; 90:369-377. [PMID: 30529244 DOI: 10.1016/j.addbeh.2018.11.032] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/17/2018] [Accepted: 11/22/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE A substantial amount of individuals with substance use disorders (SUD) also meet criteria for posttraumatic stress disorder (PTSD). Prolonged Exposure (PE) is an effective, evidence-based treatment for PTSD, but there is limited data on its use among individuals with current alcohol or drug use disorders. This study evaluated the efficacy of an integrated treatment that incorporates PE (Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure or COPE) among veterans. METHOD Military veterans (N = 81, 90.1% male) with current SUD and PTSD were randomized to 12 sessions of COPE or Relapse Prevention (RP). Primary outcomes included the Clinician Administered PTSD Scale (CAPS), PTSD Checklist-Military version (PCL-M), and the Timeline Follow-back (TLFB). RESULTS On average, participants attended 8 out of 12 sessions and there were no group differences in retention. Intent-to-treat analyses revealed that COPE, in comparison to RP, resulted in significantly greater reductions in CAPS (d = 1.4, p < .001) and PCL-M scores (d = 1.3, p = .01), as well as higher rates of PTSD diagnostic remission (OR = 5.3, p < .01). Both groups evidenced significant and comparable reductions in SUD severity during treatment. At 6-months follow-up, participants in COPE evidenced significantly fewer drinks per drinking day than participants in RP (p = .05). CONCLUSIONS This study is the first to report on the use of an integrated, exposure-based treatment for co-occurring SUD and PTSD in a veteran sample. The findings demonstrate that integrated, exposure-based treatments are feasible and effective for military veterans with SUD and PTSD. Implications for clinical practice are discussed.
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Affiliation(s)
- Sudie E Back
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA.
| | - Therese Killeen
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Christal L Badour
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Julianne C Flanagan
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | - Elizabeth Santa Ana
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Brian Lozano
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Kristina J Korte
- Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Edna B Foa
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathleen T Brady
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
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Mueser KT, Meyer-Kalos PS, Glynn SM, Lynde DW, Robinson DG, Gingerich S, Penn DL, Cather C, Gottlieb JD, Marcy P, Wiseman JL, Potretzke S, Brunette MF, Schooler NR, Addington J, Rosenheck RA, Estroff SE, Kane JM. Implementation and fidelity assessment of the NAVIGATE treatment program for first episode psychosis in a multi-site study. Schizophr Res 2019; 204:271-281. [PMID: 30139553 PMCID: PMC6382606 DOI: 10.1016/j.schres.2018.08.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/18/2018] [Accepted: 08/12/2018] [Indexed: 11/19/2022]
Abstract
The NAVIGATE program was developed for the Recovery After Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study, which compared NAVIGATE to usual Community Care in a cluster randomized design involving 34 sites and 404 patients. This article describes the approach to training and implementing the NAVIGATE program at the 17 sites (including 134 practitioners) randomized to provide it, and to evaluating the fidelity of service delivery to the NAVIGATE model. Fidelity was evaluated to five different components of the program, all of which were standardized in manuals in advance of implementation. The components included four interventions (Individualized Resiliency Training, Family Education Program, Supported Employment and Education, Personalized Medication Management) and the overall organization (staffing and structure) of the NAVIGATE team. Most of the sites demonstrated acceptable or higher levels of fidelity in their implementation of the four interventions and the organization of the program, with all 17 sites demonstrating at least acceptable overall fidelity to the NAVIGATE program. The results indicate that the NAVIGATE program can be implemented with good fidelity to the treatment model in a diverse array of community mental health care settings serving persons with a first episode psychosis.
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Affiliation(s)
- Kim T Mueser
- Boston University, Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychiatry, and Psychology, Boston, MA, USA.
| | - Piper S Meyer-Kalos
- University of Minnesota, School of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul, MN, USA.
| | - Shirley M Glynn
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - David W Lynde
- Geisel School of Medicine at Dartmouth, Department of Psychiatry, Lebanon, NH, USA
| | - Delbert G Robinson
- Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Medical Center, Glen Oaks, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY, USA
| | | | - David L Penn
- University of North Carolina-Chapel Hill, Department of Psychology, Chapel Hill, NC, USA; Australian Catholic University, School of Psychology, Melbourne, VIC, Australia
| | | | - Jennifer D Gottlieb
- Boston University, Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychiatry, and Psychology, Boston, MA, USA
| | | | - Jennifer L Wiseman
- University of Minnesota, Minnesota Center for Chemical and Mental Health, St. Paul, MN, USA
| | - Sheena Potretzke
- Oregon Health and Science University, Department of Behavioral Neuroscience, Portland, OR, USA
| | - Mary F Brunette
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Bureau of Mental Health Services, Department of Health and Human Services, Concord, NH, USA
| | - Nina R Schooler
- Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Medical Center, Glen Oaks, NY, USA; SUNY Downstate Medical Center, Department of Psychiatry, Brooklyn, NY, USA
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Canada
| | | | - Sue E Estroff
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - John M Kane
- Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Medical Center, Glen Oaks, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY, USA
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15
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Slade EP, Gottlieb JD, Lu W, Yanos PT, Rosenberg S, Silverstein SM, Minsky SK, Mueser KT. Cost-Effectiveness of a PTSD Intervention Tailored for Individuals With Severe Mental Illness. Psychiatr Serv 2017; 68:1225-1231. [PMID: 28712353 PMCID: PMC5711573 DOI: 10.1176/appi.ps.201600474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined the cost-effectiveness of a cognitive-behavioral therapy (CBT) intervention for posttraumatic stress disorder (PTSD) that is tailored for adults with a co-occurring severe mental illness. METHODS Data were from a randomized trial involving 183 adult clients of two outpatient clinics and three partial hospitalization programs. All had a severe mental illness diagnosis (major mood disorder, schizophrenia, or schizoaffective disorder) and severe PTSD. Participants were randomly assigned to the tailored 12- to 16-session CBT intervention for PTSD (CBT-P) or a three-session breathing retraining and psychoeducation intervention (BRF). Cost estimates included intervention costs for training, supervision, fidelity assessment, personnel, and overhead and related mental health care costs for outpatient, inpatient, and emergency department services and for medications. The incremental cost-effectiveness ratio comparing CBT-P with BRF measured the added cost or savings per remission from PTSD at 12 months postintervention. Generalized linear models were used to estimate intervention effects on annual mental health care costs and the likelihood of a remission from PTSD. Ten thousand bootstrap replications were used to assess uncertainty. RESULTS Annual mean mental health care costs were $25,539 per client (in 2010 dollars) for BRF participants and $29,530 per client for CBT-P participants, a nonsignificant difference. The mean incremental cost-effectiveness ratio was $36,893 per additional PTSD remission yielded by CBT-P compared with BRF (95% confidence interval=-$33,523 to $158,914). Remissions were associated with improvements in quality of life and functioning. CONCLUSIONS An effective CBT intervention tailored for adults with severe mental illness and PTSD was not found to be more cost-effective than a brief three-session intervention.
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Affiliation(s)
- Eric P Slade
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Jennifer D Gottlieb
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Weili Lu
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Philip T Yanos
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Stanley Rosenberg
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Steven M Silverstein
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Shula K Minsky
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
| | - Kim T Mueser
- Dr. Slade is with the Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, and the U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network 5) Mental Illness Research, Education, and Clinical Center. Dr. Gottlieb and Dr. Mueser are with the Center for Psychiatric Rehabilitation, Boston University, Boston. Dr. Lu is with the Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University School of Health Professions, Newark, New Jersey. Dr. Yanos is with the Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York. Dr. Rosenberg is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire. Dr. Silverstein is with the Division of Schizophrenia Research and Dr. Minsky is with the Department of Quality Improvement and the Department of Psychiatry, Rutgers University Behavioral Health Care, Piscataway, New Jersey
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Kredlow MA, Szuhany KL, Lo S, Xie H, Gottlieb JD, Rosenberg SD, Mueser KT. Cognitive behavioral therapy for posttraumatic stress disorder in individuals with severe mental illness and borderline personality disorder. Psychiatry Res 2017; 249:86-93. [PMID: 28086181 PMCID: PMC5325773 DOI: 10.1016/j.psychres.2016.12.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/19/2016] [Accepted: 12/29/2016] [Indexed: 11/30/2022]
Abstract
Secondary analyses were performed on data from two randomized controlled trials of a cognitive behavioral therapy (CBT) program for posttraumatic stress disorder (PTSD) in individuals with severe mental illness (SMI) to examine the feasibility, tolerability, and effectiveness for individuals with borderline personality disorder (BPD). In Study 1, 27 participants received CBT or treatment as usual. In Study 2, 55 participants received CBT or a Brief treatment. Feasibility and tolerability of CBT, PTSD symptoms, and other mental health and functional outcomes were examined, with assessments at baseline, post-treatment, and two follow-up time points. CBT was feasible and tolerable in this population. Study 1 participants in CBT improved significantly more in PTSD symptoms, depression, and self-reported physical health. Study 2 participants in both CBT and Brief improved significantly in PTSD symptoms, posttraumatic cognitions, depression, and overall functioning, with those in CBT acquiring significantly more PTSD knowledge, and having marginally significantly greater improvement in PTSD symptoms. CBT for PTSD was feasible and tolerated in individuals with SMI, BPD, and PTSD, and associated with improvements in PTSD symptoms and related outcomes. Prospective research is needed to evaluate CBT in individuals with BPD, including comparing it with staged interventions for this population.
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Affiliation(s)
- M Alexandra Kredlow
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, United States
| | - Kristin L Szuhany
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, United States
| | - Stephen Lo
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, United States
| | - Haiyi Xie
- Geisel School of Medicine at Dartmouth, Hanover, NH 03755, United States
| | - Jennifer D Gottlieb
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA 02215, United States
| | | | - Kim T Mueser
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, United States; Center for Psychiatric Rehabilitation, Boston University, Boston, MA 02215, United States.
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McGuire AB, Bartholomew T, Anderson AI, Bauer SM, McGrew JH, White DA, Luther L, Rollins A, Pereira A, Salyers MP, Roudebush RL, Pereira A, Salyers MP. Illness management and recovery in community practice. Psychiatr Rehabil J 2016; 39:343-351. [PMID: 27505349 PMCID: PMC5125841 DOI: 10.1037/prj0000200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine provider competence in providing Illness Management and Recovery (IMR), an evidence-based self-management program for people with severe mental illness, and the association between implementation supports and IMR competence. METHOD IMR session recordings, provided by 43 providers/provider pairs, were analyzed for IMR competence using the IMR Treatment Integrity Scale. Providers also reported on receipt of commonly available implementation supports (e.g., training, consultation). RESULTS Average IMR competence scores were in the "needs improvement" range. Clinicians demonstrated low competence in several IMR elements: significant other involvement, weekly action planning, action plan follow-up, cognitive-behavioral techniques, and behavioral tailoring for medication management. These elements were commonly absent from IMR sessions. Competence in motivational enhancement strategies and cognitive-behavioral techniques differed based on the module topic covered in a session. Generally, receipt of implementation supports was not associated with increased competence; however, motivational interviewing training was associated with increased competence in action planning and review. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE IMR, as implemented in the community, may lack adequate competence and commonly available implementation supports do not appear to be adequate. Additional implementation supports that target clinician growth areas are needed. (PsycINFO Database Record
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Affiliation(s)
- Alan B McGuire
- Health Services Research and Development, Richard L. Roudebush VA Medical Center
| | - Tom Bartholomew
- Psychiatric Rehabilitation and Counseling Professions, Rutgers University
| | | | - Sarah M Bauer
- Department of Psychology, Indiana University Purdue-University Indianapolis
| | - John H McGrew
- Department of Psychology, Indiana University Purdue-University Indianapolis
| | - Dominique A White
- Department of Psychology, Indiana University Purdue-University Indianapolis
| | - Lauren Luther
- Department of Psychology, Indiana University Purdue-University Indianapolis
| | - Angela Rollins
- Health Services Research and Development, Richard L. Roudebush VA Medical Center
| | - Angela Pereira
- Psychiatric Rehabilitation and Counseling Professions, Rutgers University
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Stirman SW, Gutner CA, Langdon K, Graham JR. Bridging the Gap Between Research and Practice in Mental Health Service Settings: An Overview of Developments in Implementation Theory and Research. Behav Ther 2016; 47:920-936. [PMID: 27993341 DOI: 10.1016/j.beth.2015.12.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 12/09/2015] [Accepted: 12/12/2015] [Indexed: 10/22/2022]
Abstract
Twenty years after Sobell's (1996) influential call to integrate advances in behavior therapy into clinical settings, significant progress has been made in implementation science. In this narrative review, we provide an overview of implementation research findings and highlight recent findings that can inform efforts to bridge the gap between research and practice in mental health service settings. Key findings are summarized, organized according to levels of influence described in two implementation frameworks: The Exploration, Planning, Implementation, and Sustainment Framework (EPIS; Aarons et al., 2011) and the Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009). Important levels of influence to consider when implementing new treatments include the outer context, inner context, characteristics of the individual, and characteristics of the innovation. Research on strategies to prepare clinicians to deliver evidence-based psychosocial treatments (EBPTs) and to address contextual barriers to implementation at each level is described, with discussion of implications for the implementation of EBPTs and next steps for research.
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Affiliation(s)
| | - Cassidy A Gutner
- National Center for PTSD, VA Boston Healthcare System; Boston University
| | - Kirsten Langdon
- Department of Psychiatry, Rhode Island Hospital, Providence, RI
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Abstract
This study sought to clarify the contribution of posttraumatic stress disorder (PTSD) to interpersonal and occupational functioning in people with schizophrenia. Self-report questionnaires and semistructured interviews were used to evaluate PTSD and brain injury, positive symptoms, depression, substance abuse, occupational and social functioning, and intelligence. Multiple regressions assessed the relationship between predictors and functional impairment. Posttraumatic stress disorder symptoms were present in 76% of participants, with 12% of participants meeting diagnostic criteria for PTSD. Participants with PTSD had higher rates of depression and more severe positive symptoms. Results of multiple regressions indicated that PTSD symptoms were the only significant predictor of patient-rated interpersonal and occupational functioning. Posttraumatic stress disorder symptoms were not associated with interviewer-rated interpersonal or occupational functioning or employment. While more research is needed, screening and treatment for exposure to traumatic events and PTSD symptoms might be indicated for individuals with schizophrenia. Availability of PTSD assessment and evidence-based treatments for people with schizophrenia is a crucial and often unmet health service need.
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Meier A, McGovern MP, Lambert-Harris C, McLeman B, Franklin A, Saunders EC, Xie H. Adherence and competence in two manual-guided therapies for co-occurring substance use and posttraumatic stress disorders: clinician factors and patient outcomes. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:527-34. [PMID: 26286351 PMCID: PMC4698972 DOI: 10.3109/00952990.2015.1062894] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The challenges of implementing and sustaining evidence-based therapies into routine practice have been well-documented. OBJECTIVES This study examines the relationship among clinician factors, quality of therapy delivery, and patient outcomes. METHODS Within a randomized controlled trial, 121 patients with current co-occurring substance use and posttraumatic stress disorders were allocated to receive either manualized Integrated Cognitive Behavioral Therapy (ICBT) or Individual Addiction Counseling (IAC). Twenty-two clinicians from seven addiction treatment programs were trained and supervised to deliver both therapies. Clinician characteristics were assessed at baseline; clinician adherence and competence were assessed over the course of delivering both therapies; and patient outcomes were measured at baseline and 6-month follow-up. RESULTS Although ICBT was delivered at acceptable levels, clinicians were significantly more adherent to IAC (p < 0.05). At session 1, clinical female gender (p < 0.05) and lower education level (p < 0.05) were predictive of increased clinician adherence and competence across both therapies. Adherence and competence at session 1 in either therapy were significantly predictive of positive patient outcomes. ICBT adherence (p < 0.05) and competence (p < 0.01) were predictive of PTSD symptom reduction, whereas IAC adherence (p < 0.01) and competence (p < 0.01) were associated with decreased drug problem severity. CONCLUSIONS The differential impact of adherence and competence for both therapy types is consistent with their purported primary target: ICBT for PTSD and IAC for substance use. These findings also suggest the benefits of considering clinician factors when implementing manual-guided therapies. Future research should focus on diverse clinician samples, randomization of clinicians to therapy type, and prospective designs to evaluate models of supervision and quality monitoring.
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Affiliation(s)
- Andrea Meier
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
| | - Mark P. McGovern
- Departments of Psychiatry and of Community & Family Medicine, Geisel School of Medicine at Dartmouth, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
| | - Chantal Lambert-Harris
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
| | - Bethany McLeman
- Dartmouth Psychiatric Research Center, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
| | - Anna Franklin
- Dartmouth College, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
| | - Elizabeth C. Saunders
- Dartmouth Psychiatric Research Center, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
| | - Haiyi Xie
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, 85 Mechanic Street, Suite B4-1, Lebanon, New Hampshire, USA
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Mueser KT, Gottlieb JD, Xie H, Lu W, Yanos PT, Rosenberg SD, Silverstein SM, Duva SM, Minsky S, Wolfe RS, McHugo GJ. Evaluation of cognitive restructuring for post-traumatic stress disorder in people with severe mental illness. Br J Psychiatry 2015; 206:501-8. [PMID: 25858178 PMCID: PMC4450219 DOI: 10.1192/bjp.bp.114.147926] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 10/06/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND A cognitive-behavioural therapy (CBT) programme designed for post-traumatic stress disorder (PTSD) in people with severe mental illness, including breathing retraining, education and cognitive restructuring, was shown to be more effective than usual services. AIMS To evaluate the incremental benefit of adding cognitive restructuring to the breathing retraining and education components of the CBT programme (trial registration: clinicaltrials.gov identifier: NCT00494650). METHOD In all, 201 people with severe mental illness and PTSD were randomised to 12- to 16-session CBT or a 3-session brief treatment programme (breathing retraining and education). The primary outcome was PTSD symptom severity. Secondary outcomes were PTSD diagnosis, other symptoms, functioning and quality of life. RESULTS There was greater improvement in PTSD symptoms and functioning in the CBT group than in the brief treatment group, with both groups improving on other outcomes and effects maintained 1-year post-treatment. CONCLUSIONS Cognitive restructuring has a significant impact beyond breathing retraining and education in the CBT programme, reducing PTSD symptoms and improving functioning in people with severe mental illness.
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Young-Wolff KC, Fromont SC, Delucchi K, Hall SE, Hall SM, Prochaska JJ. PTSD symptomatology and readiness to quit smoking among women with serious mental illness. Addict Behav 2014; 39:1231-4. [PMID: 24813548 DOI: 10.1016/j.addbeh.2014.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/23/2014] [Accepted: 03/27/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Posttraumatic stress disorder (PTSD) is a risk factor for tobacco addiction. The majority of research on PTSD and smoking has been conducted with men, particularly combat veterans, and little is known about the association among women. In a clinical sample of women civilian smokers with serious mental illness (SMI), we examined the prevalence of PTSD symptomatology and associations with physical and mental health functioning, co-occurring substance use, nicotine dependence, and readiness to quit smoking. METHODS 376 adult women smokers aged 18-73 were recruited from 7 acute inpatient psychiatry units and screened by diagnostic interview for current PTSD symptomatology (PTSD(+)). In multiple regressions, we examined the associations of screening PTSD(+) with physical and mental health functioning; past-month drug use; past-year substance use disorders; nicotine dependence and readiness to quit smoking. RESULTS Nearly half the sample (43%) screened PTSD(+), which was significantly associated with the use of stimulants (OR=1.26) and opiates (OR=1.98), drug use disorders (OR=2.01), and poorer mental health (B=-2.78) but not physical health functioning. PTSD(+) status was unrelated to nicotine dependence, but predicted greater desire to quit smoking (B=2.13) and intention to stop smoking in the next month (OR=2.21). In multivariate models that adjusted for substance use disorders, physical and mental health functioning, and nicotine dependence, screening PTSD(+) remained predictive of greater desire and intention to quit smoking. CONCLUSION PTSD symptomatology was common in our sample of women smokers with SMI and associated with not only worse substance use and mental health, but also greater readiness to quit smoking, suggesting the need for and potential interest in integrative PTSD-addiction treatment among women.
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Green CA, Estroff SE, Yarborough BJH, Spofford M, Solloway MR, Kitson RS, Perrin NA. Directions for future patient-centered and comparative effectiveness research for people with serious mental illness in a learning mental health care system. Schizophr Bull 2014; 40 Suppl 1:S1-S94. [PMID: 24489078 PMCID: PMC3911266 DOI: 10.1093/schbul/sbt170] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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