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：调查结果有可能增加 退伍军人谁受益于一个最有效的治疗创伤后应激障碍（PTSD）， 认知加工疗法（CPT）。除了减少创伤后应激障碍，成功完成 CPT的结果改善功能障碍，减少共病症状，并增强 生活质量这个项目为我们的精神卫生办公室的同事解决了一个重要的问题 和自杀预防，他们表示需要制定能够实现灵活性同时保持 对已证明有效的CPT方案的忠实性。本建议涉及经常性资源和发展的优先领域， 对有心理健康问题的退伍军人进行认知行为疗法的研究。 项目背景：CPT已在VHA中广泛传播，超过4000家VHA供应商 迄今为止，通过心理健康传播倡议认证提供CPT。然而，由于CPT已 实施的几个因素限制了它对退伍军人健康的影响。退伍军人参与CPT是 次优，在退伍军人群体中获得的结果比在平民中获得的结果更温和， 功能和生活质量的改善比在核心区观察到的要温和得多。 PTSD的症状提高患者参与度、改善治疗效果和 为了使退伍军人充分受益，需要将干预的成功扩大到功能障碍 从CPT传播倡议。扩大和加强CPT协议是一个有前途的战略， 实现这些目标。将案例表述方法纳入现有的CPT协议， 提供者增加治疗灵活性，同时保持对有效CPT原则的忠诚。CF是一 提供者和患者之间的协作过程，使提供者能够定制认知行为 在证明偏离标准合理的明确参数范围内， 议定书我们的研究小组已经初步证明，CF-整合CPT（CF-CPT）产生较低的水平， 的辍学率和更高比例的患者失去他们的创伤后应激障碍诊断比出版帐户的CPT。 项目目标：我们的长期目标是在《防止酷刑和其他残忍、不人道或有辱人格的待遇或处罚公约》的成功基础上， 通过直接针对功能障碍和改善患者预后来改善退伍军人的健康。我们建议 目的：1）比较CF-CPT和CPT在改善退伍军人心理社会方面的相对有效性 功能性生活质量和幸福感以及核心PTSD和抑郁症状; 2.）确定 与CPT相比，CF-CPT在改善退伍军人治疗参与方面的有效性; 3.）评估CF- CPT对退伍军人的心理社会功能，生活质量，幸福感和创伤后应激障碍/抑郁症的间接影响 受CF针对的特异质临床挑战改善的影响。 项目方法：我们提出了一项随机对照试验，其中国家样本多达56 CPT- 经认证的提供者将被随机分配给CPT或CF-CPT。每个供应商都将提供他们的 分配CPT版本给四名在其诊所接受治疗的退伍军人。数据来源包括： 和治疗后诊断访谈，退伍军人自我报告调查;从精神疾病中提取的管理数据 健康进展记录;和治疗过程数据，包括每日症状监测日记（目标3.我们 主要目标1的结果将是功能、生活质量和福祉的标准化测量;次要目标 目标1结果包括临床医生评估的PTSD病理学和共病精神健康症状（例如， 抑郁症）。Aim 3的数据源将包括一系列临床挑战的标准化指标， 破坏治疗，并通过CF方法以及新的特异质措施专门针对 （每日日记）的挑战。