Building strong therapeutic relationships quickly: The effect of the perceived working alliance on veterans’ intensive PTSD treatment outcomes.

Held, Philip; Meade, Enya A; Kovacevic, Merdijana; Smith, Dale L.; Pridgen, Sarah; Coleman, Jennifer A.; Klassen, Brian J.

doi:10.1037/pst0000447

Cited by 6 publications

(2 citation statements)

References 60 publications

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“…In the 2-week program psychoeducation, mindfulness and yoga were omitted, but the number of therapy sessions remained the same. The study concluded that the 2-week program could be considered non-inferior to the 3-week program in both clinical outcomes and satisfaction (Held et al, 2023). The study does not report the prevalence of comorbidity disorders in this veteran sample.…”

Section: Discussionmentioning

confidence: 78%

Exhausting, but necessary: the lived experience of participants in an intensive inpatient trauma treatment program

Vaage-Kowalzik,

Engeset,

Jakobsen

et al. 2024

Front. Psychol.

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BackgroundIntensive inpatient treatment programs have shown robust results in the treatment of post-traumatic stress disorder (PTSD). How patients experience this treatment program and what changes they experience as a result of the treatment have, however, only scarcely been explored through qualitative studies.ObjectiveThis study aimed to explore the lived experience of participants in an intensive inpatient trauma treatment program. Our research questions were as follows: how do patients experience intensive trauma-focused treatment? How do they experience possible changes related to participating in the treatment program?MethodsSix patients diagnosed with PTSD with significant comorbidities, who recently participated in an intensive 2-week (4 + 4 days) inpatient trauma treatment program with prolonged exposure (PE), eye movement desensitization and reprocessing (EMDR), and therapist rotation (TR), were interviewed with a semi-structured qualitative interview. Transcripts were analyzed using a thematic analysis approach.ResultsOur analysis resulted in five main themes: (1) the need to feel safe; (2) the benefits of many and different therapeutic encounters; (3) variable experience with elements of treatment; (4) intensity; and (5) experienced change. Our results suggest that feeling safe within the framework of the treatment program facilitated the treatment process. Many and different therapeutic encounters, both through TR and with ward staff, contributed to experienced change. All participants described the intensity as facilitative to trauma processing. However, most participants also describe often feeling too overwhelmed to benefit from all elements of the treatment program.ConclusionsOur findings suggest that participants experience the overall treatment program as beneficial and contributing to experienced change. Participants described the intensity of the program as exhausting, but necessary. Most did, however, report at times of being too overwhelmed to benefit from elements of the program. Consequently, our results prompt us to question the optimal level of intensity.Trial registrationClinicalTrials.gov identifier: NCT05342480. Date of registration: 2022-04-22.

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Section: Discussionmentioning

confidence: 78%

Exhausting, but necessary: the lived experience of participants in an intensive inpatient trauma treatment program

Vaage-Kowalzik,

Engeset,

Jakobsen

et al. 2024

Front. Psychol.

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“…Veterans in this sample spoke about the desire for ongoing emotional support and accountability from mental health providers. The therapeutic alliance serves an important role in the success of TFT, including retention (Keller et al, 2010; Sijercic et al, 2021) and outcomes (Held et al, 2022; Keefe et al, 2022; Saraiya et al, 2023) and may be an important construct to measure throughout TFT, such as via the Working Alliance Inventory (Horvath & Greenberg, 1989). Irrespective of posttreatment symptom severity, many spoke about wanting to have contact with their therapist as little or as often as needed to ensure gains solidified and to bolster confidence in the use of skills.…”

Section: Discussionmentioning

confidence: 99%

Rates and reasons for veteran mental health service utilization following completion of evidence-based trauma-focused treatment for PTSD.

Baier,

Nugent,

Horton

et al. 2024

Psychological Services

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Despite the effectiveness of prolonged exposure (PE) and cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) in reducing symptoms of PTSD and co-occurring symptoms, emerging research suggests continued mental health service utilization (MHSU) following the completion of these interventions. Reasons for continued MHSU remain unknown despite its relevance to PE/CPT outcomes and implementation. The present study employed a mixed methods approach to explore rates and reasons for VA MHSU post PE/CPT. A national sample of 5,634 U.S. veterans who completed either PE or CPT were identified to quantitatively determine the frequency, type, and location of MHSU in the 12 months following PE/CPT completion. A random subsample of 60 veterans completed semistructured qualitative interviews to explore reasons for MHSU post PE/CPT. Findings suggest high MHSU; 98.4% of veterans attended at least one mental health appointment in the year following completion of PE/CPT, with an average attending 27.64 appointments in the year following treatment completion. Qualitatively, veterans, particularly those with lowto-moderate residual symptoms, described a preference for additional treatment to continue practicing and applying skills learned in treatment. Veterans expressed low self-efficacy to maintain treatment gains without support and accountability from their therapists and viewed ongoing treatment as a safety net until they felt more confident in their skills and stability of gains. Veterans with high residual symptoms indicated needing additional PTSD-specific treatment or treatment for a co-occurring condition. Notably, some veterans reported no additional treatment needs, despite continued engagement in care. Evidence-based strategies for facilitating self-efficacy and ongoing application of PE/CPT principles posttreatment are needed. Impact StatementMental health service utilization among U.S. veterans following completion of prolonged exposure (PE) and cognitive processing therapy (CPT) is higher than previously reported. Veterans with low-tomoderate posttraumatic stress disorder symptoms indicated a perceived need for the continued practice of PE/CPT principles and therapist support in the face of low self-efficacy, and fear treatment gains would not be sustained without ongoing treatment. Results demonstrate a need to facilitate self-efficacy for the ongoing application of PE/CPT principles following successful completion.

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Predictors of treatment attendance in patients with posttraumatic stress disorder and comorbid personality disorders

van den End,

Snoek,

Aarts

et al. 2024

Comprehensive Psychiatry

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Building strong therapeutic relationships quickly: The effect of the perceived working alliance on veterans’ intensive PTSD treatment outcomes.

Abstract: This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Cited by 6 publications

References 60 publications

Exhausting, but necessary: the lived experience of participants in an intensive inpatient trauma treatment program

Exhausting, but necessary: the lived experience of participants in an intensive inpatient trauma treatment program

Rates and reasons for veteran mental health service utilization following completion of evidence-based trauma-focused treatment for PTSD.

Predictors of treatment attendance in patients with posttraumatic stress disorder and comorbid personality disorders

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