Implementation of Evidence-Based Psychotherapies for Posttraumatic Stress Disorder in VA Specialty Clinics

Watts, Bradley V.; Shiner, Brian; Zubkoff, Lisa; Carpenter‐Song, Elizabeth; Ronconi, Julia McDougal; Coldwell, Craig M.

doi:10.1176/appi.ps.201300176

Cited by 121 publications

(99 citation statements)

References 30 publications

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“…Our findings are consistent with a recent study of implementation of traditional, in-clinic delivery of EBP for PTSD in the VA. 6 Specialty clinics retrospectively applied the PARIHS framework to identify factors associated with successful implementation and found that ''. those sites with a more sustained connection with the facilitation team were more likely to use evidence-based therapy for PTSD.''…”

Section: Discussionmentioning

confidence: 99%

“…4 Although significant progress has been made to increase availability of EBPs, veterans with PTSD have low rates of initiation and retention in such programs. 5,6 Perceived stigma associated with mental illness and practical, logistic barriers (e.g., living in rural areas, conflicting job schedule) reduce the likelihood a veteran will engage in, or receive, an adequate dose of psychotherapy. [7][8][9] Additionally, too few trained therapists and difficulty in accessing training hinder clinics' ability to provide EBPs for PTSD.…”

Section: Introductionmentioning

confidence: 99%

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Implementation of Video Telehealth to Improve Access to Evidence-Based Psychotherapy for Posttraumatic Stress Disorder

Lindsay

Kauth

Hudson

et al. 2015

Telemedicine and e-Health

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Background: Increasing access to psychotherapy for posttraumatic stress disorder (PTSD) is a primary focus of the Department of Veterans Affairs (VA) healthcare system. Delivery of treatment via video telehealth can expand availability of treatment and be equally effective as in-person treatment. Despite VA efforts, barriers to establishing telehealth services remain, including both provider acceptance and organizational obstacles. Thus, development of specific strategies is needed to implement video telehealth services in complex healthcare systems, like the VA. Materials and Methods: This project was guided by the Promoting Action on Research Implementation in Health Services framework and used external facilitation to increase access to psychotherapy via video telehealth. The project was conducted at five VA Medical Centers and their associated community clinics across six states in the South Central United States. Results: Over a 21-month period, 27 video telehealth clinics were established to provide greater access to evidence-based psychotherapies for PTSD. Examination of change scores showed that participating sites averaged a 3.2-fold increase in unique patients and a 6.5-fold increase in psychotherapy sessions via video telehealth for PTSD. Differences between participating and nonparticipating sites in both unique patients and encounters were significant (p = 0.041 and p = 0.009, respectively). Two groups emerged, separated by degree of engagement in the facilitation intervention. Facilitation was perceived as useful by providers.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Implementation of Video Telehealth to Improve Access to Evidence-Based Psychotherapy for Posttraumatic Stress Disorder

Lindsay

Kauth

Hudson

et al. 2015

Telemedicine and e-Health

View full text Add to dashboard Cite

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“…However, there has been some controversy regarding the specificity of the exposure stimuli, with some (e.g., Watson & Marks, 1971) suggesting that any stimulus can be used during exposure sessions, as long as those stimuli elicit intense negative affect from the individual. If this is the case, then expressive writing should produce positive results regardless of whether or not the individual changes topics as long as whatever the individual writes about elicits strong negative affect.…”

Section: Development Of Wetmentioning

confidence: 99%

“…In addition to the efficacy data, there is emerging evidence that VA and DoD providers are infrequently using these treatments even after receiving training in PE and CPT (Borah et al, 2013;Finley et al, 2015;Watts et al, 2014). Finley and colleagues (2015) found that VA providers used supportive-care treatment approaches for veterans presenting for PTSD treatment substantially more often than PE or CPT, citing high-care demands in combination with limited staff resources as a barrier for not using PE and CPT more often.…”

Section: Special Ptsd Treatment Considerations For Veteran and Activementioning

confidence: 99%

“…However, regardless of the therapy a client selects it is critical that therapists follow the therapy protocol. Implementation data from VA and DoD (Borah et al, 2013;Finley et al, 2015;Watts et al, 2014)) is making it clear that when PE and CPT are used by providers, critical components are often left out (e.g., the in-vivo hierarchy in PE). The effectiveness of a given treatment is likely dampened when critical components of the treatment are discarded.…”

Section: The Implementation Of Wet By Austernmentioning

confidence: 99%

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On the Implementation of Written Exposure Therapy (WET) with Veterans Diagnosed with PTSD

Sloan¹,

Marx²

2017

PCSP

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We provide commentary on the article by Austern (2017) in which several composite PTSD treatment cases with veteran clients are presented. Written Exposure Therapy (WET) was implemented in each case, with varying levels of success. We provide additional background on the development of WET to provide readers with a better understanding of how this treatment was created. We also describe the available efficacy data supporting the use of WET as well as describe efficacy studies that are currently underway. Lastly, we comment on Austern's use of WET in the three composite veteran cases that are described.Key words: PTSD; military combat; veterans; trauma; exposure therapy; composite case studies; clinical case studies ____________________________________________________________________________We read Austern's case study paper with great interest and are pleased to have an opportunity to comment. In this commentary, we first provide a background on how written exposure therapy (WET) was developed and describe the efficacy data to support its use. Following this, we will discuss the manner and methods in which WET was used by Austern. Throughout our commentary we will refer to the empirical data on PTSD treatment and the gaps in the literature, especially related to treating military service members and veterans. DEVELOPMENT OF WETBecause only a partial description of the development of WET is provided by Austern, we want to describe how WET was developed, as well as offer the reader an understanding of the mechanism by which exposure-based treatments for PTSD work. A thorough description of the development of WET will enable a better understanding of the theoretical model underlying the treatment, which in turn provides a better understanding in the ways the treatment should and should not be altered.

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Loving-Kindness Meditation vs Cognitive Processing Therapy for Posttraumatic Stress Disorder Among Veterans

et al. 2021

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Key Points Question Is group loving-kindness meditation noninferior to group cognitive processing therapy for treatment of posttraumatic stress disorder (PTSD) among veterans? Findings In this randomized clinical trial, 184 veterans with PTSD were assigned to group loving-kindness meditation or group cognitive processing therapy; the differences in the decrease from baseline to 6-month follow-up for measures of PTSD and depression were very similar and within predefined margins considered not meaningfully different. Attendance was better for loving-kindness meditation. Meaning This study adds to the evidence indicating that interventions without a specific focus on trauma, including meditation-based interventions, can yield results similar to trauma-focused therapies.

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Implementation of Evidence-Based Psychotherapies for Posttraumatic Stress Disorder in VA Specialty Clinics

Cited by 121 publications

References 30 publications

Implementation of Video Telehealth to Improve Access to Evidence-Based Psychotherapy for Posttraumatic Stress Disorder

Implementation of Video Telehealth to Improve Access to Evidence-Based Psychotherapy for Posttraumatic Stress Disorder

On the Implementation of Written Exposure Therapy (WET) with Veterans Diagnosed with PTSD

Loving-Kindness Meditation vs Cognitive Processing Therapy for Posttraumatic Stress Disorder Among Veterans

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