Understanding therapists’ perceived determinants of trauma narrative use

Abstract Background Trauma narratives are a critical, exposure-based component of trauma-focused cognitive-behavioral therapy, yet community therapists rarely use them. Given evidence that intentions to deliver elements of cognitive behavioral therapy vary by component, and that intentions to deliver exposure are the weakest, this study focused specifically on trauma narratives. We drew on a social psychology causal theory (Theory of Planned Behavior (TPB)) and an implementation science framework (the Consolidated Framework for Implementation Research (CFIR)) to glean insight into multilevel influences on trauma narrative use. While the CFIR offers a broad list of factors potentially affecting implementation, the TPB offers causal pathways between individual-level constructs that predict behavior, including the uptake of an evidence-based intervention. The integration of these approaches may provide a more complete understanding of factors affecting therapists’ use of TNs. Methods Therapists (n=65) trained in trauma-focused cognitive behavioral therapy completed a survey about their use of and beliefs about trauma narratives. Content analysis was used to identify common beliefs about trauma narratives. A subset of participants (n=17) completed follow-up qualitative interviews, which were analyzed using an integrated approach informed by the CFIR. Results While most participants reported high intentions to use TNs, nearly half reported that they did not use TNs in the last 6 months. Survey data indicate a number of TPB-related determinants related to using trauma narratives. Qualitative interviews identified CFIR-relevant contextual factors that may influence constructs central to TPB. Conclusions These results highlight the importance of integrating approaches that address multiple theoretical determinants of therapist behavior, including therapist, organizational, and client factors with causal explanations to explain implementation behavior.

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Understanding Therapists’ Perceived Determinants of Trauma Narrative Use

10.21203/rs.3.rs-419425/v1 ◽

2021 ◽

Author(s):

Hannah E Frank ◽

Briana S Last ◽

Reem AlRabiah ◽

Jessica Fishman ◽

Brittany N Rudd ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Qualitative Interviews ◽

Integrated Approach ◽

Cognitive Behavioral ◽

Trauma Narratives ◽

Trauma Narrative ◽

Causal Explanations ◽

Factors Affecting ◽

Causal Pathways

Abstract Background: Trauma narratives are a critical, exposure-based component of trauma-focused cognitive-behavioral therapy, yet community therapists do not always use them. Given evidence that intentions to deliver elements of cognitive behavioral therapy vary by component, and that intentions to deliver exposure are the weakest, this study focused specifically on trauma narratives. We drew on a social psychology causal theory (Theory of Planned Behavior; TPB) and an implementation science framework (the Consolidated Framework for Implementation Research; CFIR) to glean insight into multilevel influences on trauma narrative use. While the CFIR offers a broad list of factors potentially affecting implementation, the TPB offers causal pathways between constructs that predict behavior, including the uptake of an evidence-based intervention. The integration of these approaches may provide a comprehensive understanding of factors affecting therapists’ use of TNs.Methods: Therapists (n=65) trained in trauma-focused cognitive behavioral therapy completed a survey about their use of and beliefs about trauma narratives. Content analysis was used to identify common beliefs about trauma narratives. A subset of participants (n=17) completed follow-up qualitative interviews, which were analyzed using an integrated approach informed by the CFIR.Results: While most participants reported high intentions to use TNs, nearly half reported that they did not use TNs in the last six months. Survey data indicate a number of TPB-related determinants to using on trauma narratives. Qualitative interviews identified CFIR-relevant contextual factors that may influence constructs central to TPB. Conclusions: These results highlight the importance of integrating approaches that address multiple theoretical determinants of therapist behavior, including therapist, organizational, and client factors with causal explanations.

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Trauma-focused cognitive behavioral therapy for children: impact of the trauma narrative and treatment length

Depression and Anxiety ◽

10.1002/da.20744 ◽

2010 ◽

Vol 28 (1) ◽

pp. 67-75 ◽

Cited By ~ 194

Author(s):

Esther Deblinger ◽

Anthony P. Mannarino ◽

Judith A. Cohen ◽

Melissa K. Runyon ◽

Robert A. Steer

Keyword(s):

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Trauma Narrative ◽

Treatment Length

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The Synergistic Process of Improvement in Cognitive Behavioral Therapy for Major Depression

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052292 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2292

Author(s):

Anders Malkomsen ◽

Jan Ivar Røssberg ◽

Toril Dammen ◽

Theresa Wilberg ◽

André Løvgren ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Therapeutic Relationship ◽

Behavioral Therapy ◽

Qualitative Interviews ◽

Cognitive Behavioral ◽

Therapeutic Interventions ◽

Major Depressive ◽

Therapy Termination ◽

The Individual ◽

Patients Experience

Background: There is a substantial lack of qualitative research concerning individual cognitive behavioral therapy (CBT) for patients with major depressive disorder (MDD). In the present study, we wanted to explore how patients suffering from MDD experience improvement in CBT. Method: Patients with MDD (N = 10) were interviewed at therapy termination with semi-structured qualitative interviews. The transcripts were analyzed using a thematic analysis approach. Results: We identified three elements that were relevant to the process of improvement for all patients: the therapeutic relationship, the therapeutic interventions and increased insight. There is a dynamic interrelationship and synergy between these elements that may explain why patients considered the same elements as helpful, but often in different ways and at different stages of therapy. Conclusions: Highlighting the synergies and interrelationship between the elements that patients experience as helpful, may help therapists to learn from and utilize these experiences. This is a reminder of the importance of always being attentive to the individual processes of patients.

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Supported Internet-Delivered Cognitive Behavioral Therapy Programs for Depression, Anxiety, and Stress in University Students: Open, Non-Randomised Trial of Acceptability, Effectiveness, and Satisfaction

JMIR Mental Health ◽

10.2196/11467 ◽

2018 ◽

Vol 5 (4) ◽

pp. e11467 ◽

Cited By ~ 9

Author(s):

Jorge E Palacios ◽

Derek Richards ◽

Riley Palmer ◽

Carissa Coudray ◽

Stefan G Hofmann ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

University Students ◽

Behavioral Therapy ◽

Qualitative Interviews ◽

Randomised Trial ◽

The United States ◽

Cognitive Behavioral ◽

Feasibility Trial ◽

Web Based ◽

Symptom Profile

Background Many university campuses have limited mental health services that cannot cope with the high demand. One alternative is to use internet-delivered cognitive behavioral therapy (iCBT) as a way of tackling barriers such as lack of availability and scheduling issues. Objective This study aimed to assess feasibility, acceptability, effectiveness, and satisfaction of a supported iCBT intervention offering 3 programs on depression, anxiety, and stress to university students. The design was an open or nonrandomized feasibility trial. Methods Participants were recruited from 3 counseling centers at a large midwestern University in the United States. Those agreeing to take part chose 1 of 3 iCBT programs—Space from Depression, Space from Anxiety, or Space from Stress —all comprised 8 modules of media-rich interactive content. Participants were supported throughout the trial by a trained professional. The Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7) questionnaire, and stress subscale of the Depression Anxiety and Stress Scale (DASS-21) were completed at baseline, 8 weeks, and 3-month follow-up. A Satisfaction With Treatment (SAT) questionnaire was completed at 8 weeks, and qualitative interviews were completed by a subsample of participants at 3 months. Results A total of 102 participants were recruited, with 52 choosing Space from Anxiety, 31 choosing Space from Depression, and 19 choosing Space from Stress. Mixed-effects models showed a significant decrease in symptoms of depression (F4=6.36, P<.001), anxiety (F4=7.97, P<.001), and stress (F4=8.50, P<.001) over time across all 3 programs. The largest decreases in PHQ-9 scores at 8 weeks were among participants who chose the Space from Depression program (d=0.84); at 3 months, the largest decreases in PHQ-9 scores were among those who chose the Space from Stress program (d=0.74). The largest decreases in GAD-7 scores were among those who chose the Space from Anxiety program (d=0.74 at 8 weeks and d=0.94 at 3 months). The largest decrease in DASS-21 stress subscale scores was among those who chose the Space from Stress program (d=0.49 at 8 weeks and d=1.16 at 3 months). The mean time spent using the platform per session was 27.4 min (SD 33.8), and participants completed 53% (SD 37.6) of the total program content on average. Most (37/53, 69%) participants found the programs helpful or very helpful and liked the convenience and flexibility of the intervention. Qualitative interviews (n=14) indicated the intervention met students’ expectations, and they saw it as a valuable complement to face-to-face treatment. Conclusions The iCBT programs tested in our study appear to be feasible, acceptable, and effective in a university environment. Participants described the benefits of having a flexible, supported Web-based intervention available on campus. Larger trials should be conducted to further test the effectiveness of supported Web-based interventions that give students a choice of program depending on their symptom profile.

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Supported Internet-Delivered Cognitive Behavioral Therapy Programs for Depression, Anxiety, and Stress in University Students: Open, Non-Randomised Trial of Acceptability, Effectiveness, and Satisfaction (Preprint)

10.2196/preprints.11467 ◽

2018 ◽

Author(s):

Jorge E Palacios ◽

Derek Richards ◽

Riley Palmer ◽

Carissa Coudray ◽

Stefan G Hofmann ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

University Students ◽

Behavioral Therapy ◽

Qualitative Interviews ◽

Randomised Trial ◽

The United States ◽

Cognitive Behavioral ◽

Feasibility Trial ◽

Web Based ◽

Symptom Profile

BACKGROUND Many university campuses have limited mental health services that cannot cope with the high demand. One alternative is to use internet-delivered cognitive behavioral therapy (iCBT) as a way of tackling barriers such as lack of availability and scheduling issues. OBJECTIVE This study aimed to assess feasibility, acceptability, effectiveness, and satisfaction of a supported iCBT intervention offering 3 programs on depression, anxiety, and stress to university students. The design was an open or nonrandomized feasibility trial. METHODS Participants were recruited from 3 counseling centers at a large midwestern University in the United States. Those agreeing to take part chose 1 of 3 iCBT programs—Space from Depression, Space from Anxiety, or Space from Stress —all comprised 8 modules of media-rich interactive content. Participants were supported throughout the trial by a trained professional. The Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7) questionnaire, and stress subscale of the Depression Anxiety and Stress Scale (DASS-21) were completed at baseline, 8 weeks, and 3-month follow-up. A Satisfaction With Treatment (SAT) questionnaire was completed at 8 weeks, and qualitative interviews were completed by a subsample of participants at 3 months. RESULTS A total of 102 participants were recruited, with 52 choosing Space from Anxiety, 31 choosing Space from Depression, and 19 choosing Space from Stress. Mixed-effects models showed a significant decrease in symptoms of depression (F4=6.36, P<.001), anxiety (F4=7.97, P<.001), and stress (F4=8.50, P<.001) over time across all 3 programs. The largest decreases in PHQ-9 scores at 8 weeks were among participants who chose the Space from Depression program (d=0.84); at 3 months, the largest decreases in PHQ-9 scores were among those who chose the Space from Stress program (d=0.74). The largest decreases in GAD-7 scores were among those who chose the Space from Anxiety program (d=0.74 at 8 weeks and d=0.94 at 3 months). The largest decrease in DASS-21 stress subscale scores was among those who chose the Space from Stress program (d=0.49 at 8 weeks and d=1.16 at 3 months). The mean time spent using the platform per session was 27.4 min (SD 33.8), and participants completed 53% (SD 37.6) of the total program content on average. Most (37/53, 69%) participants found the programs helpful or very helpful and liked the convenience and flexibility of the intervention. Qualitative interviews (n=14) indicated the intervention met students’ expectations, and they saw it as a valuable complement to face-to-face treatment. CONCLUSIONS The iCBT programs tested in our study appear to be feasible, acceptable, and effective in a university environment. Participants described the benefits of having a flexible, supported Web-based intervention available on campus. Larger trials should be conducted to further test the effectiveness of supported Web-based interventions that give students a choice of program depending on their symptom profile.

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Changes in the trauma narratives of youth receiving trauma-focused cognitive behavioral therapy in relation to posttraumatic stress symptoms

Psychotherapy Research ◽

10.1080/10503307.2017.1303208 ◽

2017 ◽

Vol 29 (1) ◽

pp. 99-111 ◽

Cited By ~ 2

Author(s):

Marie Knutsen ◽

Tine K. Jensen

Keyword(s):

Cognitive Behavioral Therapy ◽

Posttraumatic Stress ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Posttraumatic Stress Symptoms ◽

Trauma Narratives ◽

Stress Symptoms

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Utilization and Implementation of Trauma-Focused Cognitive–Behavioral Therapy for the Treatment of Maltreated Children

Child Maltreatment ◽

10.1177/1077559511418220 ◽

2011 ◽

Vol 17 (1) ◽

pp. 80-85 ◽

Cited By ~ 40

Author(s):

Brian Allen ◽

Jennifer C. Johnson

Keyword(s):

Cognitive Behavioral Therapy ◽

Behavior Management ◽

Behavioral Therapy ◽

The United States ◽

Cognitive Behavioral ◽

Mental Health Clinicians ◽

Management Skills ◽

Trauma Narrative ◽

Full Sample ◽

Maltreated Children

Trauma-Focused Cognitive–Behavioral Therapy (TF-CBT) is one of the most researched and widely disseminated interventions for maltreated children. This study describes the findings of a survey of 132 mental health clinicians in children’s advocacy centers (CACs) across the United States to determine the percentage of clinicians who are trained in and utilize TF-CBT and the frequency with which TF-CBT components are implemented. A total of 103 (78%) of the clinicians reported being trained in and utilizing TF-CBT on a regular basis; however, only 66% of these clinicians (58% of the full sample) reported being likely to use each component. The most preferred components were teaching relaxation skills and providing psychoeducation, whereas teaching caregiver child behavior management skills, developing a trauma narrative, and cognitive restructuring were less preferred. Results are discussed in the context of continued dissemination efforts and implications for improving clinical practice.

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