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Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample()

OBJECTIVE: Trauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentatio...

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Autores principales: Ehlers, Anke, Grey, Nick, Wild, Jennifer, Stott, Richard, Liness, Sheena, Deale, Alicia, Handley, Rachel, Albert, Idit, Cullen, Deborah, Hackmann, Ann, Manley, John, McManus, Freda, Brady, Francesca, Salkovskis, Paul, Clark, David M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Science 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897916/
https://www.ncbi.nlm.nih.gov/pubmed/24076408
http://dx.doi.org/10.1016/j.brat.2013.08.006
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author Ehlers, Anke
Grey, Nick
Wild, Jennifer
Stott, Richard
Liness, Sheena
Deale, Alicia
Handley, Rachel
Albert, Idit
Cullen, Deborah
Hackmann, Ann
Manley, John
McManus, Freda
Brady, Francesca
Salkovskis, Paul
Clark, David M.
author_facet Ehlers, Anke
Grey, Nick
Wild, Jennifer
Stott, Richard
Liness, Sheena
Deale, Alicia
Handley, Rachel
Albert, Idit
Cullen, Deborah
Hackmann, Ann
Manley, John
McManus, Freda
Brady, Francesca
Salkovskis, Paul
Clark, David M.
author_sort Ehlers, Anke
collection PubMed
description OBJECTIVE: Trauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area. METHOD: A consecutive sample of 330 patients with PTSD (age 17–83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects. RESULTS: CT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience. CONCLUSIONS: The results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas.
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spelling pubmed-38979162014-01-24 Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample() Ehlers, Anke Grey, Nick Wild, Jennifer Stott, Richard Liness, Sheena Deale, Alicia Handley, Rachel Albert, Idit Cullen, Deborah Hackmann, Ann Manley, John McManus, Freda Brady, Francesca Salkovskis, Paul Clark, David M. Behav Res Ther Article OBJECTIVE: Trauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area. METHOD: A consecutive sample of 330 patients with PTSD (age 17–83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects. RESULTS: CT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience. CONCLUSIONS: The results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas. Elsevier Science 2013-11 /pmc/articles/PMC3897916/ /pubmed/24076408 http://dx.doi.org/10.1016/j.brat.2013.08.006 Text en © 2013 The Authors https://creativecommons.org/licenses/by/3.0/ Open Access under CC BY 3.0 (https://creativecommons.org/licenses/by/3.0/) license
spellingShingle Article
Ehlers, Anke
Grey, Nick
Wild, Jennifer
Stott, Richard
Liness, Sheena
Deale, Alicia
Handley, Rachel
Albert, Idit
Cullen, Deborah
Hackmann, Ann
Manley, John
McManus, Freda
Brady, Francesca
Salkovskis, Paul
Clark, David M.
Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample()
title Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample()
title_full Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample()
title_fullStr Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample()
title_full_unstemmed Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample()
title_short Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample()
title_sort implementation of cognitive therapy for ptsd in routine clinical care: effectiveness and moderators of outcome in a consecutive sample()
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897916/
https://www.ncbi.nlm.nih.gov/pubmed/24076408
http://dx.doi.org/10.1016/j.brat.2013.08.006
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