Treatment decision-making for posttraumatic stress disorder: The impact of patient and therapist characteristics.

Hundt, Natalie E.; Harik, Juliette M.; Barrera, Terri L.; Cully, Jeffrey A.; Stanley, Melinda A.

doi:10.1037/tra0000102

Cited by 27 publications

(37 citation statements)

References 36 publications

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“…It was acknowledged, however, that trauma focused interventions, irrespective of whether the individual has a co-morbid psychosis diagnosis or not, can lead to distress (Devilly and Spence, 1999), and initial worsening of PTSD symptoms, emotional exhaustion and other physical symptoms of anxiety during the exposure phase of the treatment (Shearing et al, 2011; Hundt et al, 2016). No adverse events were reported in the majority of the studies.…”

Section: Discussionmentioning

confidence: 99%

Psychological Interventions for Post-traumatic Stress Symptoms in Psychosis: A Systematic Review of Outcomes

et al. 2017

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Individuals with severe mental health problems, such as psychosis, are consistently shown to have experienced high levels of past traumatic events. They are also at an increased risk of further traumatisation through victimization events such as crime and assault. The experience of psychosis itself and psychiatric hospitalization have also been recognized to be sufficiently traumatic to lead to the development of post-traumatic stress (PTS) symptoms. Rates of post-traumatic stress disorder (PTSD) are elevated in people with psychosis compared to the general population. The current guidance for the treatment of PTSD is informed by an evidence base predominately limited to populations without co-morbid psychiatric disorders. The systematic review therefore sought to present the current available literature on the use of psychological treatments targeting PTS symptoms in a population with a primary diagnosis of a psychotic disorder. The review aimed to investigate the effect of these interventions on PTS symptoms and also the effect on secondary domains such as psychotic symptoms, affect and functioning. Fifteen studies were identified reporting on cognitive behavior therapy, prolonged exposure, eye movement desensitisation and reprocessing and written emotional disclosure. The review provides preliminary support for the safe use of trauma-focused psychological interventions in groups of people with severe mental health problems. Overall, the interventions were found to be effective in reducing PTS symptoms. Results were mixed with regard to secondary effects on additional domains. Further research including studies employing sufficiently powered methodologically rigorous designs is indicated.

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Section: Discussionmentioning

confidence: 99%

Psychological Interventions for Post-traumatic Stress Symptoms in Psychosis: A Systematic Review of Outcomes

et al. 2017

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“…It is known that not only patient-related characteristics, such as comorbidity (Becker et al, 2004; van Minnen et al, 2010), but also therapist-related factors, are strongly related to the underuse of TFTs (Harned, Dimeff, Woodcock, & Contreras, 2013; Hundt, Harik, Barrera, Cully, & Stanley, 2016; Laska, Smith, Wislocki, Minami, & Wampold, 2013), such as therapists’ negative beliefs or expectations about the application of TFT (N. R. Farrell, Deacon, Kemp, Dixon, & Sy, 2013; Meyer, Farrell, Kemp, Blakey, & Deacon, 2014; van Minnen et al, 2010) or therapists’ own anxiety sensitivity (Meyer et al, 2014), indicating that some therapists may simply be afraid to conduct this type of therapy. In addition to these hesitations to start a TFT, during the TFTs some therapists drift from the protocol (Waller, 2009) or deliver their (exposure) treatment in a suboptimal way, for instance by using anxiety-diminishing techniques (Hipol & Deacon, 2013), avoiding encouraging patients to carry out exposure exercises that elevate high levels of anxiety, or avoiding the application of (therapist-assisted) exposure in vivo during the treatment sessions (N. R. Farrell et al, 2013; Hipol & Deacon, 2013).…”

Section: Introductionmentioning

confidence: 99%

Therapist rotation: a novel approach for implementation of trauma-focused treatment in post-traumatic stress disorder

Minnen

Hendriks

Kleine

et al. 2018

European Journal of Psychotraumatology

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Background: Trauma-focused treatments (TFTs) for patients with post-traumatic stress disorder (PTSD) are highly effective, yet underused by therapists.Objective: To describe a new way of implementing (adequate use of) TFTs, using a therapist rotation model in which one patient is treated by several therapists.Method: In this article, we will present two examples of working with therapist rotation teams in two treatment settings for TFT of PTSD patients. We explore the experiences with this model from both a therapist and a patient perspective.Results: Our findings were promising in that they suggested that this novel approach reduced the therapists’ fear of providing TFT to PTSD patients, increased perceived readiness for TFT, and decreased avoidance behaviour within TFT sessions, possibly leading to better implementation of TFT. In addition, the therapeutic relationship as rated by patients was good, even by patients with insecure attachment styles.Conclusions: We suggest that therapist rotation is a promising novel approach to improve implementation of TFT for PTSD.

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“…It is possible that positive experiences with using exposure reduced initial therapist fears and insecurities, which is in accordance with the findings of Eftekhari et al (45), who found that experiences of success encourage further use of this technique. A significant effect of positive experience of application was also found by Hundt et al (39), who ascertained that behavioural-cognitive therapists who are younger and have less experience but frequently treat patients with PTSD are more likely to choose empirically proven treatments such as exposure therapy. The authors conclude that greater knowledge of protocol and more confidence in the therapist's own competences increase their readiness to recommend and use exposure therapy.…”

Section: Discussionmentioning

confidence: 57%

“…Although almost all therapists required an insurance cover from an insurance agency for the use of exposure in their work with patients with obsessive-compulsive disorder, over 80% of patients reported that not a single form of exposure was used during treatment. Also, despite evidence that effective treatment for post-traumatic stress disorder include prolonged exposure, studies have shown that only 6-13% of veterans seeking help for PTSD receive empirically proven treatments (39), most often due to the fears of therapists and patients regarding the possibility of tolerating exposure therapy. Qualitative analysis of interviews with veterans who participated in eight exposure sessions showed that, despite initial worsening of symptoms, most veterans claimed that it was a positive and useful experience.…”

Section: Introductionmentioning

confidence: 99%

Therapeuts’ Beliefs about Exposure Therapy

2019

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Brojna istraživanja potvrđuju učinkovitost tehnike izlaganja zbog čega se ta tehnika smatra prvim izborom u tretmanu većine anksioznih poremećaja. Unatoč tome u praksi se tehnika nedovoljno primjenjuje. Osim nesklonosti klijenata da se izlažu neugodi, tome pridonose i negativni stavovi terapeuta prema primjeni ove tehnike. Cilj je istraživanja ispitati stavove terapeuta prema terapiji izlaganjem, te razlike u vjerovanjima s obzirom na tip i razinu psihoterapijske edukacije, kao i na iskustvo u primjeni ove terapije. U istraživanju je sudjelovalo 226 terapeuta različitih psihoterapijskih usmjerenja i razina edukacije. Ispitanici su ispunili kratki online upitnik koji je sadržavao Ljestvicu vjerovanja terapeuta o izlaganju. Rezultati pokazuju da terapeuti bihevioralno-kognitivnog usmjerenja i oni koji u svom radu primjenjuju tehniku izlaganja imaju pozitivniji stav prema njezinoj primjeni u odnosu na terapeute drugih psihoterapijskih usmjerenja i one koji je u svom radu ne koriste. Među bihevioralno-kognitivnim terapeutima, akreditirani terapeuti, supervizori i supervizanti imaju pozitivniji stav od terapeuta na nižim stupnjevima edukacije. Može se zaključiti da znanje i pozitivna vjerovanja o terapiji izlaganjem potiču primjenu ove tehnike, a pozitivna iskustva u primjeni povratno podržavaju i jačaju pozitivna vjerovanja o njoj. Preporuča se da se u okviru edukacije iz bihevioralno-kognitivne terapije radi na prepoznavanju i mijenjanju potencijalnih disfunkcionalnih vjerovanja o terapiji izlaganjem./ Numerous studies have confirmed the efficacy of exposure therapy, which is why this approach is considered the primary option in the treatment of most anxiety disorders. Despite this fact, in practice this approach is not used enough. Apart from the reluctance of clients to expose themselves to discomfort, therapists' negative attitudes to exposure therapy also contribute to this. The aim of this study is to examine therapists' attitudes toward exposure therapy and differences in beliefs according to type and level of psychotherapeutic education as well as experience with using this type of therapy. 226 therapists of various psychotherapeutic orientations and education levels participated in the study. The participants filled in a short online questionnaire which contained the Therapist Beliefs about Exposure Scale. The results show that behavioural-cognitive therapists and those who apply exposure therapy in their work have a more positive attitude toward its use in comparison with therapists of other psychotherapeutic orientations and those who do not use exposure therapy in their work. Among behavioural-cognitive therapists, accredited therapists, supervisors, and supervisees have a more positive attitude than therapists with lower levels of education. It may be concluded that knowledge and positive beliefs about exposure therapy encourage the application of this technique, while positive experiences of its application support and strengthen positive beliefs about it. It is suggested that within the training in beh...

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Treatment decision-making for posttraumatic stress disorder: The impact of patient and therapist characteristics.

Cited by 27 publications

References 36 publications

Psychological Interventions for Post-traumatic Stress Symptoms in Psychosis: A Systematic Review of Outcomes

Psychological Interventions for Post-traumatic Stress Symptoms in Psychosis: A Systematic Review of Outcomes

Therapist rotation: a novel approach for implementation of trauma-focused treatment in post-traumatic stress disorder

Therapeuts’ Beliefs about Exposure Therapy

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