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Research

Expanding the vital work of the STRONG STAR Consortium, our research focuses on improving the effectiveness of EBTs with all trauma-exposed populations. We conduct research to inform efficient and effective training methods for mental health clinicians. We are particularly interested in the use of technology in the delivery of EBTs and training.

Conference Presentations

Current Research Studies

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Telehealth 2.0: Evaluating Effectiveness and Engagement Strategies for CPT-Text for PTSD

Funder: National Institute of Mental Health

Principal Investigators: Shannon Wiltsey-Stirman, PhD, Stanford University & Katy Dondanville, PsyD, ABPP, UT Health San Antonio.

Brief Summary:
There is a pressing need to increase capacity to treat PTSD related to or exacerbated by the COVID-19 pandemic. Texting-based therapy holds promise to increase capacity and reduce barriers to delivering evidence-based treatments (EBTs), but ongoing engagement in digital mental health interventions is low. This study will compare a texting-based EBT for PTSD to culturally-informed texting-based treatment for PTSD as usual, and it will also compare a unique incentive strategy to typical platform reminders aimed to prevent early discontinuation in therapy.

Clinical Trial Overview

 

Free messaging-based counseling for trauma with a licensed therapist. Click here if to see if you qualify for the study.

 

Selected Research Publications

Launching a Competency‑Based Training Program in Evidence‑Based Treatments for PTSD: Supporting Veteran‑Serving Mental Health Providers in Texas

Community mental health providers play an essential role in delivering services to veterans who either have limited access to U.S. Department of Veterans Affairs (VA) facilities or who prefer to seek care outside of the VA. However, there are limited training opportunities in evidence-based treatments for posttraumatic stress disorder (PTSD) outside of the VA. In 2017, the STRONG STAR Training Initiative was established to develop competency-based training in two evidence-based therapies for PTSD and to provide that training for mental health providers serving veterans and their families in community settings in Texas. This article describes the program’s development and implementation, baseline characteristics of participating clinicians, and lessons learned toward the scale-up and extension of this competency-based training effort to include other interventions and locations.

Reference:

Dondanville, K.A., Fina, B.A., Straud, C.L. et al. (2021). Launching a Competency-Based Training Program in Evidence-Based Treatments for PTSD: Supporting Veteran-Serving Mental Health Providers in Texas. Community Ment Health J 57, 910–919. https://doi.org/10.1007/s10597-020-00676-7

Evaluating a Community-Based Training Program for Evidence-Based Treatments for PTSD Using the RE-AIM Framework

Community mental health providers increasingly serve veterans with posttraumatic stress disorder (PTSD). However, recent surveys find that less than 20% of community providers are adequately trained to implement evidence-based treatments (EBTs) for PTSD. Since 2017, the STRONG STAR Training Initiative (SSTI) model has adapted traditional learning collaboratives aimed at increasing availability of EBTs for PTSD in community settings. This study reports on STRONG STAR program evaluation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to assess dissemination and implementation outcomes. Between January 2018 and January 2020, 280 mental health providers from 25 states participated. Providers initiating EBTs for PTSD with 930 patients, reaching 29% who had PTSD among their caseload. Overall, 238 of patients who initiated EBT completed treatment. Patients who completed treatment demonstrated a 32.51-point decrease, t(237) = 25.27, p < .001, in PTSD symptom severity and an 8.73-point decrease, t(231) = 19.95, p < .001, in depression symptom severity following treatment. High rates of SSTI providers continued implementing EBT for PTSD at 6 months (cognitive processing therapy [CPT]: 95%; prolonged exposure [PE]: 72%) and 1-year (CPT: 87%; PE: 77%) posttraining, similar to outcomes reported by community and Department of Veterans Affairs providers. In reporting on the first evaluation of a National Training Program for community-based mental health providers, we look ahead to continued work in refining scalable models for building provider competence in delivery of EBTs.

Reference:

Dondanville, K. A., Fina, B. A., Straud, C. L., Tyler, H., Jacoby, V., Blount, T. H., Moring, J. C., Blankenship, A. E., & Finley, E. P. (2021, October 25). Evaluating a Community-Based Training Program for Evidence-Based Treatments for PTSD Using the RE-AIM Framework. Psychological Services. Advance online publication. http://dx.doi.org/10.1037/ser0000567

The Impact of Prior Head Injury on Outcomes Following Group and Individual Cognitive Processing Therapy Among Military Personnel

This study examined the impact of a history of head injury (HHI) on posttraumatic stress disorder (PTSD) and depression symptoms in active duty military personnel following group and individual cognitive processing therapy (CPT). Data for these secondary analyses were drawn from a clinical trial comparing group and individual CPT. Service members (N = 268, 91.0% male) were randomized to 12 sessions of group (n = 133) or individual (n = 135) CPT. Most participants (57.1%) endorsed a deployment-related HHI, 92.8% of whom reported currently experiencing symptoms (CES) related to the head injury (i.e., HHI/CES). Patients classified as non-HHI/CES demonstrated large, significant improvements in PTSD symptom severity in both individual and group therapy, ds = 1.1, p < .001. Patients with HHI/CES status showed similar significant improvements when randomized to individual CPT, d = 1.4, p < .001, but did not demonstrate significant improvements when randomized to group CPT, d = 0.4, p = .060. For participants classified as HHI/CES, individual CPT was significantly superior to group CPT, d = 0.98, p = .003. Symptoms of depression improved following treatment, with no significant differences by treatment delivery format or HHI/CES status. The findings of this clinical trial subgroup study demonstrate evidence that group CPT is less effective than individual CPT for service members classified as HHI/CES. The results suggest that HHI/CES status may be important to consider in selecting patients for group or individual CPT; additional research is needed to confirm the clinical implications of these findings.

Reference:

Wachen, J. S., Mintz, J., LoSavio, S. T., Kennedy, J. E., Hale, W. J., Straud, C. L., Dondanville, K. A., Moring, J., Blankenship, A. E., Vandiver, R., Young-McCaughan, S., Yarvis, J. S., Peterson, A. L., Resick, P. A., & STRONG STAR Consortium (2022). The impact of prior head injury on outcomes following group and individual cognitive processing therapy among military personnel. Journal of traumatic stress, 10.1002/jts.22870. Advance online publication. https://doi.org/10.1002/jts.22870

Treatment responder status and time to response as a function of hazardous drinking among active duty military receiving variable-length cognitive processing therapy for posttraumatic stress disorder

Objective: A common concern is whether individuals with posttraumatic stress disorder (PTSD) and hazardous drinking will respond to PTSD treatment or need a higher dose. In a sample of active-duty military, we examined the impact of hazardous drinking on cognitive processing therapy (CPT) outcomes and whether number of sessions to reach good end-state or dropout differed by drinking status.

Method: Participants included 127 service members participating in a clinical trial of variable-length CPT. The Quick Drinking Screen was used to characterize drinking. Participants were categorized as treatment responders when they reached good end-state (<20 on the PTSD Checklist for DSM-5) or nonresponders if they completed 24 sessions or 18 weeks of treatment without good end-state. Survival analyses were used to compare time to dropout or good end-state between those with and without hazardous drinking.

Results: Those with hazardous drinking were as likely as those without to reach good end-state and no more likely to drop out. There were no differences in number of sessions to reach good end-state or dropout. On a gold-standard assessment, those with hazardous drinking evidenced more PTSD symptom reduction than those without. The overall proportion of participants with hazardous drinking decreased (30.7% to 18.6%), as did mean number of drinks per drinking day and drinks on the heaviest drinking day among those initially drinking hazardously.

Conclusions: Results support using CPT for military personnel with PTSD and hazardous drinking and indicate that those with hazardous drinking can benefit from PTSD treatment without additional treatment sessions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Reference:

LoSavio, S. T., Straud, C. L., Dondanville, K. A., Fridling, N. R., Wachen, J. S., McMahon, C. J., Mintz, J., Young-McCaughan, S., Yarvis, J. S., Peterson, A. L., & Resick, P. A. (2022). Treatment responder status and time to response as a function of hazardous drinking among active-duty military receiving variable-length cognitive processing therapy for posttraumatic stress disorder. Psychological trauma : theory, research, practice and policy, 10.1037/tra0001268. Advance online publication. https://doi.org/10.1037/tra0001268

Treatment Outcomes for Adolescents Versus Adults Receiving Cognitive Processing Therapy for Posttraumatic Stress Disorder During Community Training

Cognitive processing therapy (CPT) is a gold-standard treatment for adults with posttraumatic stress disorder (PTSD). However, adolescents may also benefit from CPT, particularly when existing evidence-based treatments for adolescents are unavailable or not a good fit. In this program evaluation study, community-based therapists participating in training delivered a modular version of CPT to 32 adolescents (age range: 14–17 years) and 174 adults recruited at their sites (overall sample: 81.1% female, 59.7% White, 31.6% Black, 21.6% Hispanic, 2.9% American Indian/Alaskan Native, 1.9% Asian, and 9.7% other race). The same protocol was used for adolescents as adults. Treatment outcomes, including treatment completion status, number of sessions needed, and PTSD and depression symptom change, were compared between groups. In total, 47.1% of adults versus 71.9% of adolescents completed treatment. Among completers, there was no between-group difference in the number of attended sessions, RR = 1.04, 95% CI [0.88, 1.23], p = .576. Overall, in the full intent-to-treat sample (i.e., completers and noncompleters), large symptom reductions were observed for PTSD, b = −3.27, SE = 0.17, p < .001, d = 1.22; and depression, b = −0.82, SE = 0.07, p < .001, d = 0.84. There were no differences in the rate of change for adolescents versus adults regarding PTSD, b = −0.15, SE = 0.48, p = .759; or depression, b = −0.20, SE = 0.14, p = .181. These findings suggest that CPT is a viable treatment option for adolescents, who benefited from treatment and completed treatment at a high rate.

Reference:

LoSavio, S.T., Murphy, R.A. and Resick, P.A. (2021), Treatment Outcomes for Adolescents Versus Adults Receiving Cognitive Processing Therapy for Posttraumatic Stress Disorder During Community Training. Journal of Traumatic Stress, 34: 757-763. https://doi.org/10.1002/jts.22668

Efficacy of Individual and Group Cognitive Processing Therapy for Military Personnel With and Without Child Abuse Histories

Objective: Many clinicians question whether patients with a history of childhood trauma will benefit from trauma-focused treatment. In this secondary analysis, we examined whether reports of childhood abuse moderated the efficacy of cognitive processing therapy (CPT) for active-duty military with posttraumatic stress disorder (PTSD). Methods: Service members (N = 254, mean age 33.11 years, 91% male, 41% Caucasian) were randomized to receive individual or group CPT (n= 106 endorsing and n = 148 not endorsing history of childhood abuse). Outcomes included baseline cognitive-emotional characteristics [Posttraumatic Cognitions Inventory (PTCI), Trauma-Related Guilt Inventory (TRGI), Cognitive Emotion Regulation Questionnaire-Short Form (CERQ)], treatment completion, and symptom outcome (PTSD Checklist, Beck Depression Inventory-II). We predicted participants endorsing childhood abuse would have higher scores on the PTCI, TRGI, and CERQ at baseline, but be noninferior on treatment completion and change in PTSD and depression symptoms. We also predicted those endorsing childhood abuse would do better in individual CPT than those not endorsing abuse. Results: Those endorsing childhood abuse primarily experienced physical abuse. There were no baseline differences between service members with and without a history of childhood abuse (all p ≥ .07). Collapsed across treatment arms, treatment completion and symptom reduction were within the noninferiority margins for those endorsing versus not endorsing childhood abuse. History of abuse did not moderate response to individual versus group CPT. Conclusions: In this primarily male, primarily physically abused sample, active-duty military personnel with PTSD who endorsed childhood abuse benefitted as much as those who did not endorse abuse. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Reference:

LoSavio, S. T., Hale, W. J., Moring, J. C., Blankenship, A. E., Dondanville, K. A., Wachen, J. S., Mintz, J., Peterson, A. L., Litz, B. T., Young-McCaughan, S., Yarvis, J. S., & Resick, P. A. (2021). Efficacy of individual and group cognitive processing therapy for military personnel with and without child abuse histories. Journal of consulting and clinical psychology, 89(5), 476–482. https://doi.org/10.1037/ccp0000641

Clinical effectiveness study of a treatment to prepare for trauma-focused evidence-based psychotherapies at a veterans affairs specialty posttraumatic stress disorder clinic

Posttraumatic stress disorder (PTSD) clinics in the Department of Veterans Affairs (VA) often provide psychoeducational or skill-building groups to prepare veterans for trauma-focused PTSD treatments. However, there has been limited evaluation of the effectiveness of this phase-based approach for treatment engagement and symptom reduction. Participants included 575 veterans seeking treatment for PTSD whose treatment outcomes were assessed in a VA outpatient PTSD clinic staffed by mental health professionals and trainees. Participants completed self-report measures of baseline characteristics and psychiatric symptoms as part of routine PTSD clinic treatment. We tested the association of preparatory group treatment with engagement in and treatment response to subsequent trauma-focused psychotherapies, cognitive processing therapy (CPT) and prolonged exposure therapy (PE), which are designated by VA as evidence-based psychotherapies (EBP). Following participation in preparatory treatments, 94/391 (24%) of veterans engaged in a subsequent trauma-focused EBP (CPT or PE). Relative to patients who had previously completed a preparatory group, patients initiating a trauma-focused EBP without having first attended preparatory PTSD treatment had similar rates of trauma-focused EBP completion and better treatment response, as measured by decreases on the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5; PCL-5), F(1, 3009) = 10.89, p = .001, and Patient Health Questionnaire 9 measure of depressive symptoms F(1, 3688) = 6.74, p = .010. Overall, veterans reported greater symptom reduction when engaging in trauma-focused EBP directly, without having previously attended a preparatory group. These data support veteran engagement in trauma-focused EBPs for PTSD without first being encouraged to complete psychoeducational or skill-building groups. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Reference:

Dedert, E. A., LoSavio, S. T., Wells, S. Y., Steel, A. L., Reinhardt, K., Deming, C. A., Ruffin, R. A., Berlin, K. L., Kimbrel, N. A., Wilson, S. M., Boeding, S. E., & Clancy, C. P. (2021). Clinical effectiveness study of a treatment to prepare for trauma-focused evidence-based psychotherapies at a veterans affairs specialty posttraumatic stress disorder clinic. Psychological services, 18(4), 651–662. https://doi.org/10.1037/ser0000425

Variable-length Cognitive Processing Therapy for posttraumatic stress disorder in active duty military: Outcomes and predictors

Cognitive Processing Therapy (CPT) is an evidence-based therapy recommended for posttraumatic stress disorder (PTSD). However, rates of improvement and remission are lower in veterans and active duty military compared to civilians. Although CPT was developed as a 12-session therapy, varying the number of sessions based on patient response has improved outcomes in a civilian study. This paper describes outcomes of a clinical trial of variable-length CPT among an active duty sample. Aims were to determine if service members would benefit from varying the dose of treatment and identify predictors of treatment length needed to reach good end-state (PTSD Checklist-5 ≤ 19). This was a within-subjects trial in which all participants received CPT (N = 127). Predictor variables included demographic, symptom, and trauma-related variables; internalizing/externalizing personality traits; and readiness for change. Varying treatment length resulted in more patients achieving good end-state. Best predictors of nonresponse or needing longer treatment were pretreatment depression and PTSD severity, internalizing temperament, being in precontemplation stage of readiness for change, and African American race. Controlling for differences in demographics and initial PTSD symptom severity, the outcomes using a variable-length CPT protocol were superior to the outcomes of a prior study using a fixed, 12-session CPT protocol. CLINICALTRIALS.GOV IDENTIFIER: NCT023818.

Reference:

Resick, P. A., Wachen, J. S., Dondanville, K. A., LoSavio, S. T., Young-McCaughan, S., Yarvis, J. S., Pruiksma, K. E., Blankenship, A., Jacoby, V., Peterson, A. L., Mintz, J., & STRONG STAR Consortium (2021). Variable-length Cognitive Processing Therapy for posttraumatic stress disorder in active duty military: Outcomes and predictors. Behaviour research and therapy, 141, 103846. https://doi.org/10.1016/j.brat.2021.103846
Predictors of Treatment Outcome in Group or Individual Cognitive Processing Therapy for Posttraumatic Stress Disorder Among Active Duty Military

Background: The purpose of this study was to examine demographic, psychological, military, and deployment variables that might predict posttraumatic stress disorder (PTSD) symptom improvement in a sample of active duty service members who received either group or individual cognitive processing therapy (CPT).

Methods: Data were analyzed from 165 active duty service members with pre- and posttreatment data participating in a randomized controlled trial comparing group with individual CPT. Pretreatment variables were examined as predictors of change in PTSD severity from baseline to posttreatment, assessed using the PTSD Symptom Scale-Interview Version (PSS-I). Predictors of PSS-I change were first evaluated using Pearson correlations, followed by partial and multiple correlations to clarify which associations remained when effects of other predictors were controlled. Multiple regression analyses were used to test for interactions between pretreatment variables and treatment format.

Results: Only age was a significant predictor of PTSD symptom change after controlling for other variables and statisitically correcting for testing multiple variables. There was also an interaction between age and treatment format.

Conclusions: Younger participants had greater symptom improvement, particularly if they received individual treatment. Other pretreatment variables did not predict outcome. CPT appears to be robust across most pretreatment variables, such that comorbid disorders, baseline symptom severity, and suicidal ideation do not interfere with application of CPT. However, individual CPT may be a better option particularly for younger service members.

Reference:

Resick, P. A., LoSavio, S. T., Wachen, J. S., Dillon, K. H., Nason, E. E., Dondanville, K. A., Young-McCaughan, S., Peterson, A. L., Yarvis, J. S., Mintz, J., & STRONG STAR Consortium (2020). Predictors of Treatment Outcome in Group or Individual Cognitive Processing Therapy for Posttraumatic Stress Disorder Among Active Duty Military. Cognitive therapy and research, 44(3), 611–620. https://doi.org/10.1007/s10608-020-10085-5

Weekly changes in blame and PTSD among active duty military receiving cognitive processing therapy

Both negative posttraumatic cognitions and posttraumatic stress disorder (PTSD) symptoms decrease over the course of cognitive-behavior therapy for PTSD; however, further research is needed to determine whether cognitive change precedes and predicts symptom change. The present study examined whether weekly changes in blame predicted subsequent changes in PTSD symptoms over the course of cognitive processing therapy (CPT). Participants consisted of 321 active duty U.S. Army soldiers with PTSD who received CPT in one of two clinical trials. Symptoms of PTSD and blame were assessed at baseline and weekly throughout treatment. Bivariate latent difference score modeling was used to examine temporal sequential dependencies between the constructs. Results indicated that changes in self-blame and PTSD symptoms were dynamically linked: When examining cross-construct predictors, changes in PTSD symptoms were predicted by prior changes in self-blame, but changes in self-blame were also predicted by both prior levels of and prior changes in PTSD. Changes in other-blame were predicted by prior levels of PTSD, but changes in other-blame did not predict changes in PTSD symptoms. Findings highlight the dynamic relationship between self-blame and PTSD symptoms during treatment in this active military sample.

Reference:

Dillon, K. H., Hale, W. J., LoSavio, S. T., Wachen, J. S., Pruiksma, K. E., Yarvis, J. S., Mintz, J., Litz, B. T., Peterson, A. L., Resick, P. A., & STRONG STAR Consortium (2020). Weekly Changes in Blame and PTSD Among Active-Duty Military Personnel Receiving Cognitive Processing Therapy. Behavior therapy, 51(3), 386–400. https://doi.org/10.1016/j.beth.2019.06.008
Evidence-based posttraumatic stress disorder treatment in a community sample: Military-affiliated versus civilian patient outcomes

Posttraumatic stress disorder (PTSD) is a significant mental health issue among military service members and veterans. Although the U.S. Department of Veterans Affairs (VA) provides crucial resources for behavioral health care, many veterans seek mental health services through community clinics. Previous research illustrates that military and veteran patients benefit less from evidence-based treatments (EBTs) for PTSD than civilians. However, most PTSD treatment outcome research on military and veteran populations is conducted in VA or military settings. Little is known about outcomes among military-affiliated patients in community settings. The primary aim of this study was to directly compare civilian versus military-affiliated patient outcomes on PTSD and depression symptoms using the PTSD Checklist for DSM-5 (PCL-5) and the nine-item Patient Health Questionnaire (PHQ-9) in a community setting. Participants (N = 502) included military-affiliated (veteran, Guard/Reservist, active duty) and civilian patients who engaged in cognitive processing therapy (CPT) or prolonged exposure (PE) for PTSD in community clinics. Both groups demonstrated significant reductions on the PCL-5, military-affiliated: d = −0.91, civilian: d = -1.18; and PHQ-9, military-affiliated: d = -0.65, civilian: d = -0.88, following treatment. However, military-affiliated patients demonstrated smaller posttreatment reductions on the PCL-5, Mdiff = 5.75, p = .003, and PHQ-9, Mdiff = 1.71, p = .011,

Reference:

Jacoby, V. M., Straud, C. L., Bagley, J. M., Tyler, H., Baker, S. N., Denejkina, A., Sippel, L. M., Kaya, R., Rozek, D. C., Fina, B. A., Dondanville, K. A., & STRONG STAR Training Initiative (2022). Evidence-based posttraumatic stress disorder treatment in a community sample: Military-affiliated versus civilian patient outcomes. Journal of traumatic stress, 35(4), 1072–1086. https://doi.org/10.1002/jts.22812

How often do community-based mental health providers educate and initiate PTSD treatment following training? Answering the question of reach

Background: Posttraumatic stress disorder (PTSD) is a significant problem. Clinical practice guidelines recommend evidence-based treatments (EBTs) including cognitive processing therapy (CPT) and prolonged exposure (PE) as firstline treatments. Training in EBTs for PTSD has often been limited to large-scale systems (e.g., U.S. Department ofVeterans Affairs). Research has shown that veteran-serving community-based mental health providers have low rates of training and supervision in EBTs for PTSD, suggesting that training initiatives for these community providers are critical to increase accessibility. This study aimed to examine the reach of education about EBTs for PTSD and the initiation of EBT for PTSD treatment among veteran-serving community-based providers participating in a large-scale training initiative.

Methods: Participants (N = 280) were community-based, licensed mental health providers who received training in CPT (67%) or PE (33%). Provider attitudes toward EBTs were measured with the Perceived Characteristics of Intervention Scale. Reach was calculated from provider self-reported follow-up survey data, including caseload total number of patients with PTSD, number of patients provided education on EBTs for PTSD, and patient initiation of EBT for PTSD Reach was calculated for both education and EBT initiation.

Results: Providers reported positive attitudes toward CPT and PE. Rates of education reach for EBTs for PTSD ranged from 30% to 76%, and rates of EBTs for PTSD initiation ranged from 11% to 35% over the 5-month follow-up period. CPT providers had higher rates of education and initiation earlier in the follow-up period, although differences in initiation rates diminished after 3 months posttraining.

Conclusion: Overall, this study examined how large-scale, training programs can be used to increase the education reach and initiation reach of EBTs for PTSD among veteran-serving community-based providers. Future work should examine how best to augment these training programs to reduce the gap between education and implementation of EBTs for PTSD.

Reference:

Dondanville, K. A., Fina, B. A., Steigerwald, V. L., McCarthy, K. D., Worley, C., Straud, C. L., Moring, J. C., & Rozek, D. C. (2021). How often do community-based mental health providers educate and initiate PTSD treatment following training? Answering the question of reach. Implementation Research and Practice, 2. https://doi.org/10.1177/26334895211011771

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Therapist stuck points during training in cognitive processing therapy: Changes over time and associations with training outcomes

Posttraumatic stress disorder (PTSD) is a significant mental health issue among military service members and veterans. Although the U.S. Department of Veterans Affairs (VA) provides crucial resources for behavioral health care, many veterans seek mental health services through community clinics. Previous research illustrates that military and veteran patients benefit less from evidence-based treatments (EBTs) for PTSD than civilians. However, most PTSD treatment outcome research on military and veteran populations is conducted in VA or military settings. Little is known about outcomes among military-affiliated patients in community settings. The primary aim of this study was to directly compare civilian versus military-affiliated patient outcomes on PTSD and depression symptoms using the PTSD Checklist for DSM-5 (PCL-5) and the nine-item Patient Health Questionnaire (PHQ-9) in a community setting. Participants (N = 502) included military-affiliated (veteran, Guard/Reservist, active duty) and civilian patients who engaged in cognitive processing therapy (CPT) or prolonged exposure (PE) for PTSD in community clinics. Both groups demonstrated significant reductions on the PCL-5, military-affiliated: d = −0.91, civilian: d = -1.18; and PHQ-9, military-affiliated: d = -0.65, civilian: d = -0.88, following treatment. However, military-affiliated patients demonstrated smaller posttreatment reductions on the PCL-5, Mdiff = 5.75, p = .003, and PHQ-9, Mdiff = 1.71, p = .011,

Reference:

LoSavio, S. T., Dillon, K. H., Murphy, R. A., & Resick, P. A. (2019). Therapist stuck points during training in cognitive processing therapy: Changes over time and associations with training outcomes. Professional Psychology: Research and Practice, 50(4), 255–263. https://doi.org/10.1037/pro0000224

The Impact of Military Status on Cognitive Processing Therapy Outcomes in the Community

Military-affiliated individuals (i.e., active duty personnel and veterans) exhibit high rates of posttraumatic stress disorder (PTSD). Although existing evidence-based treatments for PTSD, such as cognitive processing therapy (CPT), have demonstrated effectiveness with military-affiliated patients, there is evidence to suggest these individuals do not benefit as much as civilians. However, few studies have directly compared the effects of PTSD treatment between civilian and military-affiliated participants. The current study compared treatment outcomes of military-affiliated and civilian patients receiving CPT. Participants with PTSD who were either civilians (n = 136) or military-affiliated (n = 63) received CPT from community-based providers in training for CPT. Results indicated that military-affiliated participants were equally likely to complete treatment, Log odds ratio (OR) = 0.14, p = .648. Although military-affiliated participants exhibited reductions in PTSD, B = −2.53, p < .001; and depression symptoms, B = −0.65, p < .001, they experienced smaller reductions in symptoms relative to civilians: B = 1.15, p = .015 for PTSD symptoms and B = 0.29, p = .029 for depression symptoms. Furthermore, variability estimates indicated there was more variability in providers’ treatment of military-affiliated versus civilian participants (i.e., completion rates and symptom reduction). These findings suggest that military-affiliated patients can be successfully retained in trauma-focused treatment in the community at the same rate as civilian patients, and they significantly improve in PTSD and depression symptoms although not as much as civilians. These findings also highlight community providers’ variability in treatment of military-affiliated patients, providing support for more military-cultural training.

Reference:

Dillon, K. H., LoSavio, S. T., Henry, T. R., Murphy, R. A., & Resick, P. A. (2019). The impact of military status on cognitive processing therapy outcomes in the community. Journal of Traumatic Stress, 32, 330-336.

 

In-person vs Synchronous Virtual Provider Workshops for Evidence-Based Therapies for Posttraumatic Stress Disorder (PTSD)

In response to the novel coronavirus (COVID-19), many mental health provider trainings for evidence-based therapies (EBTs) shifted to virtual rather than in-person formats. The purpose of this paper is to compare workshops in EBTs for posttraumatic stress disorder (PTSD) that were formerly conducted in person to workshops conducted virtually during the pandemic. Providers reported similar ratings for learning objective achievements between in-person and virtual trainings. Providers and trainers reported facilitators and barriers to learning in virtual training and provided recommendations for virtual trainings. Both provider participants and trainers identified a loss of networking opportunities as the primary drawback of virtual training.

Reference:

Pruiksma, K. E., Blankenship A. E., Choi, H., Yoo, G., Wolfe, L., Fina B. A., & Dondanville, K. A., for the STRONG STAR Training Initiative (2021). Professional Development: The International Journal of Continuing Social Work Education, 25(2), 113-126.
Cognitive Processing Therapy for Posttraumatic Stress Disorder via Telehealth: Practical Considerations During the COVID-19 Pandemic

The global outbreak of COVID-19 has required mental health providers to rapidly rethink and adapt how they provide care. Cognitive processing therapy (CPT) is a trauma-focused, evidence-based treatment for posttraumatic stress disorder that is effective when delivered in-person or via telehealth. Given current limitations on the provision of in-person mental health treatment during the COVID-19 pandemic, this article presents guidelines and treatment considerations when implementing CPT via telehealth. Based on lessons learned from prior studies and clinical delivery of CPT via telehealth, recommendations are made with regard to overall strategies for adapting CPT to a telehealth format, including how to conduct routine assessments and ensure treatment fidelity.

Reference:

Moring, J. C., Dondanville, K. A., Fina, B. A., Hassija, C., Chard, K., Monson, C., LoSavio, S. T., Wells, S. Y., Morland, L. A., Kaysen, D., Galovski, T. E., & Resick, P. A. (2020). Cognitive Processing Therapy for Posttraumatic Stress Disorder via Telehealth: Practical Considerations During the COVID-19 Pandemic. Journal of traumatic stress, 33(4), 371–379. https://doi.org/10.1002/jts.22544

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Conducting Prolonged Exposure for PTSD During the COVID-19 Pandemic: Considerations for Treatment

The unprecedented effects and duration of the COVID-19 crisis are likely to elevate the population’s level of anxiety due to psychological stress, economic hardship, and social isolation. This effect may be especially potent for individuals with preexisting mental health conditions, such as posttraumatic stress disorder (PTSD). Prolonged Exposure (PE) therapy is a highly effective treatment for PTSD across trauma-exposed populations, and has been implemented effectively via telehealth. Nevertheless, PE implementation via telehealth may require specific adaptations during the COVID-19 crisis due to public health mandates calling for sheltering in place and physical distancing. This paper discusses strategiesfor implementing PE for PTSD during the COVID-19 pandemic, which may also be applied to other situations in which physical distancing must be considered.

Reference:

Fina, B. A., Wright, E. C., Rauch, S., Norman, S. B., Acierno, R., Cuccurullo, L. J., Dondanville, K. A., Moring, J. C., Brown, L. A., & Foa, E. B. (2021). Conducting Prolonged Exposure for PTSD During the COVID-19 Pandemic: Considerations for Treatment. Cognitive and behavioral practice, 28(4), 532–542. https://doi.org/10.1016/j.cbpra.2020.09.003
Examination of Treatment Effects on Hazardous Drinking Among Service Members with Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) and alcohol use disorder are frequently comorbid and present significant treatment challenges. Unfortunately, since the September 11, 2001, terrorist attacks in the United States, the rates of PTSD and hazardous drinking among active duty service members have increased significantly. Previous research on PTSD has typically excluded participants with current substance abuse. However, there is some research examining independent treatments for PTSD and substance abuse provided consecutively, concurrently, or as enhancements to other treatment. The current study examined the association between current hazardous drinking and PTSD treatment among 108 active duty service members with PTSD in a randomized controlled trial of group cognitive processing therapy and group present‐centered therapy. Total scores above 8 on the Alcohol Use Disorders Identification Test defined hazardous alcohol use. At baseline, 25.0% of the sample was categorized as hazardous drinkers, and the hazardous and nonhazardous drinking groups did not differ in PTSD symptom severity, F(1, 106) = 0.08, p = .777, d = 0.06. Over the course of treatment, the two groups also did not differ significantly in PTSD symptom severity change on the PTSD Checklist, F(1, 106) = 1.20, p = .280, d = 0.33. Treatment for PTSD did not exacerbate hazardous drinking, and the hazardous drinking group showed significant reductions in drinking following PTSD treatment. Limitations and implications for treatment considerations are discussed.

Reference:

Dondanville, K. A., Wachen, J. S., Hale, W. J., Mintz, J., Roache, J. D., Carson, C., Litz, B. T., Yarvis, J. S., Young-McCaughan, S., Peterson, A. L., & Resick, P. A.; for the STRONG STAR Consortium (2019). Examination of Treatment Effects on Hazardous Drinking Among Service Members with Posttraumatic Stress Disorder. Journal of Traumatic Stress. 32(2), 310-316. https://doi.org/ 10.1002/jts.22393

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