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

对退伍军人医疗保健的预期影响：研究结果有可能增加 受益于创伤后应激障碍(PTSD)最有效治疗之一的退伍军人， 认知加工疗法(CPT)。除了创伤后应激障碍症状的减少外，成功完成 CPT的结果是改善了功能损害，减少了并存症状，并增强了 生活质量。这个项目为心理健康办公室的同事们解决了一个重要的问题 和自杀预防，他们表示需要在保持灵活性的同时实现战略 忠于明显有效的CPT协议。本提案涉及RR&D的优先领域 开展对有心理健康问题的退伍军人的认知行为治疗研究。 项目背景：CPT已在VHA内广泛传播，有4000多家VHA提供商 到目前为止，通过精神健康传播倡议获得了提供CPT的认证。然而，由于CPT一直以来 实施的几个因素限制了它对退伍军人健康的影响。CPT的资深员工是 在退伍军人群体中取得的结果比在平民中取得的结果要温和得多， 在功能和生活质量方面的改善比在核心区域观察到的要温和得多 创伤后应激障碍的症状。改善患者参与度、提高治疗结果的策略，以及 将干预的成功扩大到功能障碍是退伍军人充分受益的需要 来自CPT传播倡议。扩展和增强CPT协议是一种很有前途的策略 实现这些目标。将案例描述(CF)方法集成到现有的CPT协议中可以实现 提供者增加治疗灵活性，同时保持对有效CPT原则的忠诚度。Cf是 提供者和患者之间的协作流程，使提供者能够定制认知行为 在明确的参数内处理特定客户的需求，以证明偏离标准是合理的 协议。我们的研究小组初步证明，CF整合CPT(CF-CPT)产生的水平较低 辍学的比例和失去创伤后应激障碍诊断的患者比例高于发表的CPT报告。 项目目标：我们的长期目标是在CPT传播倡议取得成功的基础上 通过直接针对功能障碍和改善患者预后，改善退伍军人的健康。我们建议 目的：1)比较CF-CPT和CPT改善退伍军人心理社会的相对有效性 功能生活质量和幸福感以及核心创伤后应激障碍和抑郁症状；确定 与CPT相比，CF-CPT在提高退伍军人治疗敬业度方面的有效性；评估CF- CPT对退伍军人心理社会功能、生活质量、幸福感和创伤后应激障碍/抑郁的间接影响 受CF针对的特殊临床挑战的改善的影响。 项目方法：我们正在提出一项随机对照试验，在该试验中，全国样本多达56个CPT- 认证的提供者将随机接受CPT或CF-CPT的管理。每个提供商都将交付他们的 向四名在诊所接受治疗的退伍军人分配了CPT版本。数据源将包括Pre- 和治疗后诊断性访谈、退伍军人自我报告调查；从精神疾病中提取的管理数据 健康进展说明；以及治疗过程数据，包括每日症状监测日记(目标3。我们 主要目标1成果将是功能、生活质量和幸福感的标准化衡量标准；次要目标 目的1结果包括临床医生评估的创伤后应激障碍症状和共病的精神健康症状(例如： 抑郁)。AIM 3的数据来源将包括对一系列临床挑战的标准化测量，这些测量 扰乱治疗，并且是CF方法以及新的特殊措施所专门针对的 (每日日记)的挑战。

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.