Personalizing Cognitive Processing Therapy with a Case Formulation Approach to Intentionally Target Impairment in Psychosocial Functioning Associated with PTSD

采用案例制定方法进行个性化认知处理治疗，有目的地针对与 PTSD 相关的心理社会功能损伤

• 批准号: 10669662
• 负责人: TARA E GALOVSKI
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10669662
• 关键词: Address; Aftercare; Anger; Anxiety; Area; Certification; Chronic; Client; Clinic; Clinical; Cognitive; Cognitive Therapy; Complex; Data; Data Sources; Diagnosis; Diagnostic; Disease; Dose; Dropout; Drops; Effectiveness; Exposure to; Formulation; Freedom; Frequencies; Goals; Health; Healthcare; Heterogeneity; Impairment; Injury; Intervention; Interview; Leisures; Measures; Mental Depression; Mental Health; Mental Health Associations; Mental Health Services; Methods; Modeling; Monitor; Numbness; Occupational; Outcome; Panic; Patient Self-Report; Patient-Focused Outcomes; Patients; Personal Satisfaction; Post-Traumatic Stress Disorders; Process; Protocols documentation; Provider; Psychotherapy; Publishing; Quality of life; Randomized; Randomized, Controlled Trials; Recommendation; Recovery; Rehabilitation therapy; Research; Sampling; Sex Functioning; Sleep; Suicide prevention; Surveys; Symptoms; Techniques; Trauma; Traumatic Brain Injury; Treatment outcome; Veterans; Veterans Health Administration; Work; associated symptom; chronic pain; cognitive benefits; cognitive enhancement; comorbidity; depressive symptoms; diaries; effective therapy; effectiveness evaluation; evidence base; flexibility; follow-up; functional disability; improved; individual patient; individualized medicine; military veteran; novel; patient engagement; patient population; personalized intervention; premature; primary outcome; programs; psychologic; psychosocial; psychosocial rehabilitation; relative effectiveness; response; secondary outcome; social; standardize measure; substance use; success; suicidal; traumatic event; treatment responders

Anticipated Impacts on Veterans Healthcare: Findings have the potential to increase the number of Veterans who benefit from one of the most effective treatments for posttraumatic stress disorder (PTSD), Cognitive Processing Therapy (CPT). In addition to reductions in PTSD symptomology, successful completion of CPT results in improvement in functional impairment, decreases in comorbid symptoms, and enhanced quality of life. This project tackles an important question for our colleagues within the Office of Mental Health and Suicide Prevention, who have expressed a need for strategies that enable flexibility while maintaining fidelity to the demonstrably efficacious CPT protocol. This proposal addresses RR&D’s priority area of conducting research on cognitive behavioral therapy for Veterans with psychological health conditions. Project Background: CPT has been widely disseminated throughout VHA with over 4000 VHA providers certified to provide CPT through the Mental Health Dissemination Initiative to date. However, as CPT has been implemented several factors have limited its impact on Veterans’ health. Veteran engagement in CPT is suboptimal, outcomes achieved in Veteran populations are more modest than those obtained with civilians, and improvements in functioning and quality of life are more modest than those observed in the core symptoms of PTSD. Strategies for improving patient engagement, enhancing treatment outcomes, and expanding the success of the intervention to functional impairments are needed for Veterans to fully benefit from the CPT dissemination initiative. Expanding and enhancing the CPT protocol is a promising strategy for achieving these goals. Integrating a case formulation (CF) approach into the existing CPT protocol may enable providers to increase treatment flexibility while maintaining fidelity to effective CPT principles. CF is a collaborative process between providers and patients that enables providers to tailor cognitive-behavioral treatments to specific clients’ needs within clear parameters of what justifies deviation from the standard protocol. Our study team has preliminarily demonstrated that CF-integrated CPT (CF-CPT) yields lower levels of dropout and a higher proportion of patients losing their PTSD diagnoses than published accounts of CPT. Project Objectives: Our long-term objective is to build on the success of the CPT Dissemination Initiative on Veterans’ health by directly targeting functional impairments and enhancing patient outcomes. We propose the following aims: 1) Compare the relative effectiveness of CF-CPT to CPT in improving Veterans’ psychosocial functioning quality of life and well-being as well as core PTSD and depression symptoms; 2.) Determine the effectiveness of CF-CPT as compared to CPT in improving Veterans’ treatment engagement; 3.) Evaluate CF- CPT’s indirect impact on Veterans’ psychosocial functioning, quality of life, well-being and PTSD/depression as influenced by improvement in the idiosyncratic clinical challenges targeted by the CF. Project Methods: We are proposing a randomized control trial in which a national sample of up to 56 CPT- certified providers will be randomized to administer either CPT or CF-CPT. Each provider will deliver their assigned version of CPT to four Veterans presenting for treatment in their clinic. Data sources will include pre- and posttreatment diagnostic interviews, Veteran self-report surveys; administrative data extracted from mental health progress notes; and therapy process data including daily symptom monitoring diaries (Aim 3. Our primary Aim 1 outcomes will be standardized measures of functioning, quality of life, and well-being; secondary Aim 1 outcomes include clinician-assessed PTSD symptomology and comorbid mental health symptoms (e.g. depression). Data sources for Aim 3 will include standardized measures of the host of clinical challenges that disrupt therapy and that are specifically targeted by the CF approach as well as novel, idiosyncratic measures (daily diaries) of challenges.

对退伍军人医疗保健的预期影响：发现有可能增加数量 受益于创伤后应激障碍（PTSD）最有效治疗方法之一的退伍军人， 认知加工疗法（CPT）。除了减少PTSD症状外，成功完成 CPT导致功能障碍的改善，合并症的症状减少并增强 生活质量。该项目解决了心理健康办公室内我们同事的重要问题 和预防自杀，他们表示需要在保持灵活性的同时保持灵活性的策略 忠于证明有效的CPT协议。该建议涉及RR＆D的优先区域 对具有心理健康状况的退伍军人进行认知行为疗法的研究。 项目背景：CPT在整个VHA中广泛传播，超过4000个VHA提供商 迄今为止，通过心理健康传播计划提供了CPT的认证。但是，就像CPT一样 实施的几个因素限制了其对退伍军人健康的影响。退伍军人参与CPT是 在退伍军人人口中取得的次优的成果比在平民获得的成果更适中 与核心中观察到的生活质量相比 PTSD的症状。改善患者参与度，增强治疗结果的策略和 需要将干预措施的成功扩展到功能障碍，以使退伍军人充分利益 来自CPT传播计划。扩展和增强CPT协议是一个有前途的策略 实现这些目标。将案例公式（CF）方法集成到现有的CPT协议中可能启用 提供者可以提高治疗灵活性，同时保持有效的CPT原则。 CF是 提供者和患者之间的协作过程，使提供者能够量身定制认知行为 在明确的参数中，对特定客户的需求进行处理，以证明与标准的背离合理 协议。我们的研究团队初步证明了CF集成的CPT（CF-CPT）产生较低的水平 与CPT的公开记录相比，辍学和丢失PTSD诊断的患者比例更高。 项目目标：我们的长期目标是基于CPT传播计划的成功 退伍军人的健康直接针对功能障碍并增强患者结果。我们建议 以下目的：1）比较CF-CPT对CPT改善退伍军人心理社会的相对有效性 生活质量和福祉以及核心PTSD和抑郁症状的功能； 2.）确定 与CPT相比，CF-CPT在改善退伍军人的治疗参与方面的有效性； 3.）评估CF- CPT对退伍军人的社会心理功能，生活质量，福祉和PTSD/抑郁症的间接影响 受CF针对的特质临床挑战的改善影响。 项目方法：我们提出了一项随机对照试验，该试验最多可容纳56个CPT- 经过认证的提供商将被随机管理CPT或CF-CPT。每个提供商将交付他们的 将CPT的版本分配给了四名退伍军人，他们在其诊所进行治疗。数据源将包括 和治疗后的诊断访谈，资深自我报告调查；从精神中提取的行政数据 健康进度笔记；和治疗过程数据，包括每日症状监测日记（AIM 3。 主要目标1的结果将是标准化的功能，生活质量和福祉的度量；次要 AIM 1的结果包括临床评估的PTSD症状和合并症的心理健康症状（例如 沮丧）。 AIM 3的数据源将包括对临床挑战的标准化措施 干扰治疗，并由CF方法和新颖的特质措施专门针对的治疗 （每日日记）挑战。