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Rauch SA, Venners MR, Ragin C, Ruhe G, Lamp K, Burton M, Pomerantz A, Bernardy N, Schnurr PP, Hamblen JL, Possemato K, Sripada R, Wray LO, Dollar K, Wade M, Astin MC, Cigrang JA. Treatment of posttraumatic stress disorder with prolonged exposure for primary care (PE-PC): Effectiveness and patient and therapist factors related to symptom change and retention. Psychol Serv 2023; 20:745-755. [PMID: 37326566 PMCID: PMC10721715 DOI: 10.1037/ser0000783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Prolonged exposure (PE) is a first-line treatment for posttraumatic stress disorder (PTSD) available in specialty mental health. PE for primary care (PE-PC) is a brief version of PE adapted for primary care mental health integration, composed of four-eight, 30-min sessions. Using retrospective data of PE-PC training cases from 155 Veterans Health Administration (VHA) providers in 99 VHA clinics who participated in a 4- to 6-month PE-PC training and consultation program, we examined patients' PTSD and depression severity across sessions via mixed effects multilevel linear modeling. Additionally, hierarchical logistic regression analysis was conducted to assess predictors of treatment dropout. Among 737 veterans, medium-to-large reductions in PTSD (intent-to-treat, Cohen's d = 0.63; completers, Cohen's d = 0.79) and small-to-medium reductions in depression (intent-to-treat, Cohen's d = 0.40; completers, Cohen's d = 0.51) were observed. The modal number of PE-PC sessions was five (SD = 1.98). Providers previously trained in both PE and cognitive processing therapy (CPT) were more likely than providers who were not trained in either PE or CPT to have veterans complete PE-PC (OR = 1.54). Veterans with military sexual trauma were less likely to complete PE-PC than veterans with combat trauma (OR = 0.42). Asian American and Pacific Islander veterans were more likely than White veterans to complete treatment (OR = 2.93). Older veterans were more likely than younger veterans to complete treatment (OR = 1.11). (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Sheila A.M. Rauch
- Research Service Line, Atlanta VA Medical Center, Decatur, GA, 30033
- Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, 30033
- Emory University School of Medicine, Atlanta, GA, 30029
| | - Margaret R. Venners
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, 94025
| | - Carly Ragin
- Research Service Line, Atlanta VA Medical Center, Decatur, GA, 30033
| | - Gretchen Ruhe
- Research Service Line, Atlanta VA Medical Center, Decatur, GA, 30033
| | - Kristen Lamp
- Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, 30033
| | - Mark Burton
- Emory University School of Medicine, Atlanta, GA, 30029
| | - Andrew Pomerantz
- Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington DC
| | - Nancy Bernardy
- National Center for PTSD, White River Junction VA Medical Center, White River Junction, VT, 05009
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755
| | - Paula P. Schnurr
- National Center for PTSD, White River Junction VA Medical Center, White River Junction, VT, 05009
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755
| | - Jessica L. Hamblen
- National Center for PTSD, White River Junction VA Medical Center, White River Junction, VT, 05009
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, 03755
| | - Kyle Possemato
- VA Center for Integrated Healthcare, VA Medical Center, Syracuse, NY 13204
- Department of Psychology, Syracuse University, Syracuse, NY, 13244
| | - Rebecca Sripada
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, 48105
| | - Laura O. Wray
- VA Center for Integrated Healthcare, VA Medical Center, Syracuse, NY 13204
- Department of Psychology, Syracuse University, Syracuse, NY, 13244
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY
| | - Katherine Dollar
- VA Center for Integrated Healthcare, VA Medical Center, Syracuse, NY 13204
- Department of Psychology, Syracuse University, Syracuse, NY, 13244
| | - Michael Wade
- VA Center for Integrated Healthcare, VA Medical Center, Syracuse, NY 13204
| | - Millie C. Astin
- Research Service Line, Atlanta VA Medical Center, Decatur, GA, 30033
- Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, 30033
| | - Jeffrey A. Cigrang
- School of Professional Psychology, Wright State University, Dayton, OH, 45402
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Jobes DA, Comtois KA, Gutierrez PM, Brenner LA, Huh D, Chalker SA, Ruhe G, Kerbrat AH, Atkins DC, Jennings K, Crumlish J, Corona CD, Connor SO, Hendricks KE, Schembari B, Singer B, Crow B. A Randomized Controlled Trial of the Collaborative Assessment and Management of Suicidality versus Enhanced Care as Usual With Suicidal Soldiers. Psychiatry 2017; 80:339-356. [PMID: 29466107 DOI: 10.1080/00332747.2017.1354607] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study describes a randomized controlled trial called "Operation Worth Living" (OWL) which compared the use of the Collaborative Assessment and Management of Suicidality (CAMS) to enhanced care as usual (E-CAU). We hypothesized that CAMS would be more effective than E-CAU for reducing suicidal ideation (SI) and suicide attempts (SA), along with secondary behavioral health and health care utilization markers for U.S. Army Soldier outpatients with significant SI (i.e., > 13 on Beck's Scale for Suicide Ideation). METHOD Study participants were 148 Soldiers who presented to a military outpatient behavioral health clinic. There were 73 Soldiers in the experimental arm of the trial who received adherent CAMS; 75 Soldiers received E-CAU. Nine a-priori treatment outcomes (SI, past year SA, suicide-related emergency department (ED) admits, behavioral health-related ED admits, suicide-related inpatient psychiatric unit (IPU) days, behavioral health-related IPU days, mental health, psychiatric distress, resiliency) were measured through assessments at Baseline and at 1, 3, 6, and 12 months post-Baseline (with a 78% retention of intent-to-treat participants at 12 months). RESULTS Soldiers in both arms of the trial responded to study treatments in terms of all primary and secondary outcomes (effect sizes ranged from 0.63 to 12.04). CAMS participants were significantly less likely to have any suicidal thoughts by 3 months in comparison to those in E-CAU (Cohen's d = 0.93, p=.028). CONCLUSIONS Soldiers receiving CAMS and E-CAU significantly improved post-treatment. Those who received CAMS were less likely to report SI at 3 months; further group differences were not otherwise seen.
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