Which patients initiate cognitive processing therapy and prolonged exposure in department of veterans affairs PTSD clinics?

2019 ◽  
Vol 62 ◽  
pp. 53-60 ◽  
Author(s):  
Craig S. Rosen ◽  
Nancy C. Bernardy ◽  
Kathleen M. Chard ◽  
Barbara Clothier ◽  
Joan M. Cook ◽  
...  
Keyword(s):  
Cognitive Processing ◽  
Prolonged Exposure ◽  
Veterans Affairs ◽  
Cognitive Processing Therapy ◽  
Department Of Veterans Affairs

Introduction and Overview

2021 ◽  
pp. 1-16
Author(s):  
Frederic N. Busch ◽  
Barbara L. Milrod ◽  
Cory K. Chen ◽  
Meriamne B. Singer
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Cognitive Processing ◽  
Prolonged Exposure ◽  
Psychodynamic Therapy ◽  
Veterans Administration ◽  
Cognitive Processing Therapy ◽  
Persistent Symptoms ◽  
Prolonged Exposure Therapy ◽  
Trauma Processing ◽  
Multiple Traumas

This chapter provides an introduction to efficacious treatments for posttraumatic stress disorder (PTSD). Despite efficacy of these treatments, many patients do not respond to them or experience persistent symptoms. Efficacious psychotherapies for PTSD used at the Veterans Administration (VA), including prolonged exposure therapy and cognitive processing therapy, are described. While these treatments can be helpful, many patients are avoidant of trauma processing and homework. Furthermore, both treatments tend to focus on one central trauma, to which exposure exercises are targeted, whereas most Veterans experience multiple traumas. An overview of the development and framework of trauma-focused psychodynamic psychotherapy (TFPP), a PTSD-symptom focused brief psychodynamic therapy, is presented. A brief background of psychoanalytic and psychodynamic literature and thinking about trauma is provided to further frame the place of TFPP

Comparing PTSD treatment retention among survivors of military sexual trauma utilizing clinical video technology and in-person approaches

2019 ◽  
Vol 26 (7-8) ◽  
pp. 443-451 ◽  
Author(s):  
Lisa M Valentine ◽  
Shannon D Donofry ◽  
Rachel B Broman ◽  
Erin R Smith ◽  
Sheila AM Rauch ◽  
...  
Keyword(s):  
Cognitive Processing ◽  
Sexual Trauma ◽  
Prolonged Exposure ◽  
Cognitive Processing Therapy ◽  
Military Sexual Trauma ◽  
Health Administration ◽  
Video Technology ◽  
Post Traumatic Stress ◽  
Ptsd Treatment ◽  
Delivery Format

Introduction Interventions such as Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) have demonstrated efficacy for the treatment of post-traumatic stress disorder (PTSD) following military sexual trauma (MST). However, MST survivors report a number of logistical and social barriers that impede treatment engagement. In an effort to address these barriers, the Veterans Health Administration offers remote delivery of services using clinical video technology (CVT). Evidence suggests PE and CPT can be delivered effectively via CVT. However, it is unclear whether rates of veteran retention in PTSD treatment for MST delivered remotely is comparable to in-person delivery in standard care. Methods Data were drawn from veterans ( N = 171, 18.1% CVT-enrolled) with PTSD following MST who were engaged in either PE or CPT delivered either via CVT or in person. Veterans chose their preferred treatment modality and delivery format in collaboration with providers. Data were analysed to evaluate full completion (FP) of the protocol and completion of a minimally adequate care (MAC) number of sessions. Results FP treatment completion rates did not differ significantly by treatment delivery format. When evaluating receipt of MAC care, CVT utilizers were significantly less likely to complete. Kaplan–Meier analyses of both survival periods detected significant differences in attrition speed, with the CVT group having higher per-session attrition earlier in treatment. Discussion Disengagement from CVT-delivered treatment generally coincided with early imaginal exposures and writing of trauma narratives. CVT providers may have to take special care to develop rapport and problem-solve anticipated barriers to completion to retain survivors in effective trauma-focused interventions.

The Ethics of Neglecting Clinical Relationship and Alliance Building in Trauma-Focused Treatments

2019 ◽  
Vol 21 (2) ◽  
pp. 104-116
Author(s):  
Enrico Gnaulati
Keyword(s):  
Cognitive Processing ◽  
Prolonged Exposure ◽  
Ethical Issues ◽  
American Psychological Association ◽  
Treatment Protocol ◽  
Relationship Building ◽  
Drop Out ◽  
Cognitive Processing Therapy ◽  
Clinical Relationship ◽  
Alliance Building

The American Psychological Association Clinical Practice Guideline for the Treatment of posttraumatic stress disorder (PTSD; APA, 2017) privileges two trauma-focused treatments (TFTs)—Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE)—on scientific grounds, without considering the ethical issues posed by these treatments being relatively nonrelational and nonalliance building in nature. Fidelity to treatment protocol over clinical relationship building and alliance formation and maintenance can slot practitioners into an “I-it” therapeutic stance, depriving clients of real engagement and leaving them feeling objectified as standard cases of PTSD whose symptoms need to be tracked and managed. The high drop-out and failure to initiate treatment rates associated with TFTs ought to raise concerns about how their technique-heavy, protocol-driven methods, alienate practitioners, and the traumatized clients they serve.

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