Competence in Delivering Cognitive Processing Therapy and the Therapeutic Alliance Both Predict PTSD Symptom Outcomes.

Cognitive Processing Therapy (CPT) is efficacious in treating PTSD, but there remains a need to improve outcomes for individuals who do not fully respond to treatment. Differences between patient-therapist dyads in the fidelity (i.e.

A Glimpse into the "Black Box": Which Elements of Consultation in an EBP are Associated with Client Symptom Change and Therapist Fidelity?

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. 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.

Changes in Community Clinicians' Attitudes and Competence following a Transdiagnostic Cognitive Behavioral Therapy Training.

Background: Although the literature suggest that attitudes toward evidence-based practices (EBPs) are associated with provider use of EBPs, less is known about the association between attitudes and how competently EBPs are delivered. This study examined how initial attitudes and competence relate to improvements in attitudes and competence following EBP training.

Methods: Program evaluation data was collected during implementation of an EBP in a large community mental health network.

A personalized index to inform selection of a trauma-focused or non-trauma-focused treatment for PTSD.

PTSD treatment guidelines recommend several treatments with extensive empirical support, including Prolonged Exposure (PE), a trauma-focused treatment and Present-Centered Therapy (PCT), a non-trauma-focused therapy. Research to inform treatment selection has yielded inconsistent findings with single prognostic variables that are difficult to integrate into clinical decision-making. We examined whether a combination of prognostic factors can predict different benefits in a trauma-focused vs.

Towards a comprehensive model for understanding adaptations' impact: the model for adaptation design and impact (MADI).

Background: Implementation science is shifting from qualifying adaptations as good or bad towards understanding adaptations and their impact. Existing adaptation classification frameworks are largely descriptive (e.g.

Stakeholder Preferences on Transdiagnostic Psychosocial Treatment for Trauma-Exposed Veterans.

While modular and transdiagnostic approaches may address implementation challenges, there remains limited investigation into the fit within large healthcare systems. The current study examines qualitative interviews from patients, clinicians and administrative stakeholders in the Veterans Administration about experiences with, and views of, the Unified Protocol (UP; Barlow et al. in The unified protocol for transdiagnostic treatment of emotional disorders: therapist guide, Oxford University Press, New York, 2011) to understand potential for implementation.

The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions.

Background: This paper describes the process and results of a refinement of a framework to characterize modifications to interventions. The original version did not fully capture several aspects of modification and adaptation that may be important to document and report. Additionally, the earlier framework did not include a way to differentiate cultural adaptation from adaptations made for other reasons.

Homework Completion, Patient Characteristics, and Symptom Change in Cognitive Processing Therapy for PTSD.

We evaluated the impact of homework completion on change in PTSD symptoms in the context of two randomized controlled trials of Cognitive Processing Therapy for PTSD (CPT). Female participants (n = 140) diagnosed with PTSD attended at least one CPT session and were assigned homework at each session. The frequency of homework completion was assessed at the beginning of each session and PTSD symptoms were assessed every other session.

Empirical Examinations of Modifications and Adaptations to Evidence-Based Psychotherapies: Methodologies, Impact, and Future Directions.

This review describes methods used to examine the modifications and adaptations to evidence-based psychological treatments (EBPTs), assesses what is known about the impact of modifications and adaptations to EBPTs, and makes recommendations for future research and clinical care. One hundred eight primary studies and three meta-analyses were identified. All studies examined planned adaptations, and many simultaneously investigated multiple types of adaptations.

Decision making and the use of evidence based practice: Is the three-legged stool balanced?

This article presents the results of a qualitative analysis of interviews with 25 psychologists in independent practice, with a focus on decision making with a selected patient. We endeavored to examine how clinical decision making intersected with the principles of evidence based practice (EBP) as laid out by Spring (2007). Clinicians reported that diagnostic impressions were generally formulated through unstructured assessment rather than validated instruments, and that treatment selection was based on therapists' perceptions of a treatment's match with client characteristics.

Improving and sustaining delivery of CPT for PTSD in mental health systems: a cluster randomized trial.

Background: Large-scale implementation of evidence-based psychotherapies (EBPs) such as cognitive processing therapy (CPT) for posttraumatic stress disorder can have a tremendous impact on mental and physical health, healthcare utilization, and quality of life. While many mental health systems (MHS) have invested heavily in programs to implement EBPs, few eligible patients receive EBPs in routine care settings, and clinicians do not appear to deliver the full treatment protocol to many of their patients. Emerging evidence suggests that when CPT and other EBPs are delivered at low levels of fidelity, clinical outcomes are negatively impacted.