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: 10066146
• 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 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10066146
• 关键词: Address; Anger; Anxiety; Area; 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; 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; Recommendation; Recovery; Rehabilitation therapy; Research; Sampling; Sex Functioning; Sleep; Suicide; 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; control trial; 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; 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 从最有效的创伤后应激障碍（PTSD）中受益的退伍军人， 认知处理疗法（CPT）。 经常会改善功能障碍，凸孔症状的减少和增强 生活质量。 和预防自杀，哈贝表示需要在维护同时灵活性的策略 忠实于有效的CPT协议。 对具有心理健康内容的退伍军人的治疗进行认知行为的研究。 项目背景：CPT在VHA Withoders VHA提供商中广泛传播 迄今为止，通过心理健康传播计划提供了CPT的认证。 实施的几个因素限制了对退伍军人健康的影响。 在退伍军人人口中取得的次优，比与平民的人更适度 与核心相比，改善功能和生活质量比 PTSD的症状。 需要将干预措施的成功扩大到功能障碍，以使退伍军人完全受益 从CPT传播计划中，扩大和增强CPT协议是一个有前途的策略 实现目标。 提供者提高治疗灵活性，同时保持有效的CPT原则 提供者和患者之间的协作过程 在明确的参数中，对特定客户的需求进行处理，以证明与标准偏离的合理性 协议。 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传播的成功。 退伍军人的健康直接针对功能障碍和增强患者的结果 以下目的：1）比较CF-CPT对CPT改善退伍军人的社会心理的相对有效性 生活质量和福祉，作为核心PTSD和Depthtoms； 2） 评估CF-评估CF- CF-CPT的效率与CPT相比在改善退伍军人的治疗方面； CPT对退伍军人的社会心理功能的间接影响，对生活的主要，幸福感和PTSD/PTSD/抑郁症的影响 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- 认证的提供商将被随机管理CPT或CF-CPT。 将CPT的版本分配给了四名退伍军人，他们的诊所接受治疗。 和治疗后的诊断访谈，资深自我报告调查； 健康进度注释和治疗过程数据，包括每日症状监测日记（AIM 3。 主要目标1将是标准化的功能，生活质量和福祉的措施 AIM 1的结果包括临床医生评论的PTSD症状和Comiolbid健康症状（例如 深度）。 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。