Clinical and Administrative Insights From Delivering Massed Trauma-Focused Therapy to Service Members and Veterans

Wright, Edward C.; Wachen, Jennifer Schuster; Yamokoski, Cynthia; Galovski, Tara E.; Morris, Kris; Goetter, Elizabeth M.; Klassen, Brian J.; Jacoby, Vanessa M.; Zwiebach, Liza; Sornborger, Jo; Dondanville, Katherine A.; Fina, Brooke A; Rauch, Sheila A. M.

doi:10.1016/j.cbpra.2022.06.005

Cited by 8 publications

(4 citation statements)

References 85 publications

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“…rapidly, making moderate reductions in symptom severity in veterans and service members with varying degrees of diagnostic complexity and various psychiatric disorders. While advancements in PTSD-specific massed delivered interventions have been encouraging (Ragsdale et al, 2020;Wright et al, 2023), the present study suggests veterans and service members could also benefit from an intensive transdiagnostic approach, especially patients who are not strong candidates for a PTSD-specific intervention due to subthreshold PTSD symptoms. This preliminary evidence of feasibility and effectiveness of UP-IOP warrants further investigation of massed delivered transdiagnostic treatments as a strategy to address treatment barriers and increase access to qualified mental health providers.…”

Section: Discussionmentioning

confidence: 67%

“…Previous research indicates the utility of disorder-specific massed delivery of CBT treatments for veterans and service members (Sherrill et al, 2022; Wright et al, 2023). However, these disorder-specific approaches may be inadequate for the mental health treatment demands of this population, as comorbid symptom presentations are common in military samples (Crum-Cianflone et al, 2016; Richardson et al, 2017; Trivedi et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, one notable outcome of massed delivery protocols is high retention (90%–98%; Ragsdale et al, 2020). To date, evidence supporting massed delivery of CBTs has only investigated disorder-specific protocols such as those for posttraumatic stress disorder (PTSD; Wright et al, 2023). Less is known about the feasibility and outcomes of massed delivery of transdiagnostic CBTs.…”

Section: Transdiagnostic Treatmentsmentioning

confidence: 99%

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Effectiveness of the massed delivery of unified protocol for emotional disorders within an intensive outpatient program for military service members and veterans.

Sherrill,

Mehta,

Patton

et al. 2024

Psychological Services

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Recent evidence supports the implementation of massed delivery of disorder-specific treatments in the military service member and veteran population. However, many treatment settings serve patients with a wide range of diagnoses, and often patients present with comorbid conditions. Growing evidence suggests transdiagnostic cognitive behavioral treatments are effective for a wide range of emotional disorders and may reduce barriers to access. Little is known about the feasibility and outcomes of the massed delivery of transdiagnostic treatments. The present study examined real-world outcomes of a 2-week intensive outpatient program using the Unified Protocol for emotional disorders (UP-IOP). The sample included military service members and veterans diagnosed with a range of emotional disorders, namely trauma-and stressor-related disorders, unipolar depressive disorders, and anxiety disorders. The present study examined outcomes of UP-IOP (depression, trauma-related symptom severity, and emotion dysregulation). Participants included all patients who sought UP-IOP in its first 15 months of operation (N = 117). A diagnosis of posttraumatic stress disorder (PTSD) was an exclusion criterion because the site had an established PTSD-specific IOP treatment option. Findings indicate UP-IOP was feasible, had 94% patient retention, and was effective in reducing symptom severity (Cohen's d = 0.76 for depression symptom severity, Cohen's d = 0.80 for trauma-related symptom severity). There was no observed reduction in emotion dysregulation over the 2-week course of treatment. The intensive transdiagnostic approach resulted in effective symptom reduction in an accelerated timeframe while minimizing patient attrition. These findings indicate massed delivery of transdiagnostic cognitive behavioral therapy (CBT) treatments should continue to be explored, especially for this population. Impact StatementThis study investigated the Unified Protocol, a transdiagnostic cognitive behavioral therapy delivered every day over 2 weeks with a sample of military service members and veterans diagnosed with anxious, depressive, or trauma-related disorders. Results indicated moderate reductions in symptom severity, and almost all patients completed treatment. Intensive transdiagnostic treatments should be explored further as an approach to retain patients and achieve rapid gains for clinical populations with diverse symptom presentations.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Transdiagnostic Treatmentsmentioning

confidence: 99%

See 1 more Smart Citation

Effectiveness of the massed delivery of unified protocol for emotional disorders within an intensive outpatient program for military service members and veterans.

Sherrill,

Mehta,

Patton

et al. 2024

Psychological Services

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“…PE has not demonstrated consistent superiority to PCT, and studies of PE and other evidence‐based psychotherapies (EBPs) for PTSD in military samples generally report smaller effect sizes than civilian studies. However, massed PE seems to be an acceptable and effective treatment that has now been used in several studies, primarily with veterans (see Ragsdale et al., 2020, and Wright et al., 2023). A recent trial found that a modified version of the previously studied massed PE protocol and a more intensive outpatient PE program were both efficacious in reducing PTSD severity, with 61% of participants achieving clinically significant reductions in interviewer‐assessed PTSD ( N = 319; U.S. service members; Peterson et al., 2023).…”

Section: Early Studies Of Pementioning

confidence: 99%

State of the Science: Prolonged exposure therapy for the treatment of posttraumatic stress disorder

McLean,

Foa

2024

Journal of Traumatic Stress

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Prolonged exposure therapy (PE) is a well‐established first‐line treatment for posttraumatic stress disorder (PTSD) that is based on emotional processing theory. PE has been rigorously evaluated and tested in a large number of clinical trials in many countries covering a wide range of trauma populations. In this review, we summarize the evidence base supporting the efficacy of PE across populations, including adults with sexual assault–related PTSD and mixed trauma–related PTSD, military populations, and adolescents. We highlight important strengths and gaps in the research on PE with individuals from marginalized communities. We discuss the efficacy of PE on associated psychopathology and in the presence of the most commonly comorbid conditions, either alone or integrated with other treatments. In addition, we provide an overview of research examining strategies to augment PE. Much of this work remains preliminary, but numerous trials have tested PE in combination with other psychological or pharmacological approaches, interventions to facilitate extinction learning, and behavioral approaches, in the hopes of further increasing the efficiency and efficacy of PE. There are now several trials testing PE in novel formats that may have advantages over standard in‐person PE, such as lower dropout and increased scalability. We examine this recent work on new models of delivering PE, including massed treatment, telehealth, and brief adaptations for primary care, all of which have the potential to increase access to PE. Finally, we highlight several promising areas for future research.

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Changes in Dispositional Mindfulness Predict Veterans’ Symptom Severity After an Intensive Cognitive Processing Therapy Program with Mindfulness Components

Szoke,

Murphy,

Smith

et al. 2024

Mindfulness

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Clinical and Administrative Insights From Delivering Massed Trauma-Focused Therapy to Service Members and Veterans

Cited by 8 publications

References 85 publications

Effectiveness of the massed delivery of unified protocol for emotional disorders within an intensive outpatient program for military service members and veterans.

Effectiveness of the massed delivery of unified protocol for emotional disorders within an intensive outpatient program for military service members and veterans.

State of the Science: Prolonged exposure therapy for the treatment of posttraumatic stress disorder

Changes in Dispositional Mindfulness Predict Veterans’ Symptom Severity After an Intensive Cognitive Processing Therapy Program with Mindfulness Components

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