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Psychological Services - Vol 13, Iss 4



Psychological Services is an American Psychological Association Division publication. The official publication of the Division of Psychologists in Public Service (Division 18), Psychological Services publishes high-quality data-based articles on the broad



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Copyright: Copyright 2016 American Psychological Association
 



Engagement in mental health treatment following primary care mental health integration contact.

2016-05-30

Although the majority of mental health conditions are treated in primary care, treatment provided in this setting is often inadequate. In response to this problem, integrated mental health programs were created to enhance direct patient care and increase support for primary care providers. Data on the efficacy of these programs have suggested improved access, treatment outcomes, and patient satisfaction. However, infrequently examined is how interaction with integrated mental health providers impacts completion of referrals to specialty mental health (SMH) programs for patients whose treatment needs are too severe to treat in primary care alone. The current study examined referral acceptance rates among a veteran population at a large Midwest Veterans Affairs (VA) medical center. Results found that completion rates to SMH following integrated mental health contact (87.1%) were higher than published comparisons (32% in 1 study). It was found that a large proportion of these veterans maintained continued attendance to SMH treatment at 1- and 6-month follow-up (88.9% and 71.9%, respectively). Finally, data also suggest that only a small amount of contact (5 or more minutes) was needed to significantly increase the likelihood of SMH referral success but was not related to improved continued attendance in treatment at follow-up intervals. Clinical implications and suggestions for future research are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Predicting engagement in psychotherapy, pharmacotherapy, or both psychotherapy and pharmacotherapy among returning veterans seeking PTSD treatment.

2016-07-18

Both pharmacotherapy and psychotherapy are effective treatments for posttraumatic stress disorder (PTSD). Better understanding factors that are associated with engaging in these different treatment options may improve treatment utilization and outcomes. This issue is especially important among veterans returning from Iraq and Afghanistan, given high rates of those seeking PTSD treatment. This study examined potential predictors of the type of treatment (psychotherapy, pharmacotherapy, or both) 232 returning veterans (92% male, mean age = 33.38) engaged in within 1 year of seeking treatment at a VA PTSD clinic. Results indicated that 32.3% of returning veterans engaged in pharmacotherapy only, 23.7% engaged in psychotherapy only, and 44.0% engaged in both. Veterans who engaged in pharmacotherapy only or in both pharmacotherapy and psychotherapy had higher pretreatment PTSD and depression symptoms than did those who engaged in psychotherapy only. History of pharmacotherapy treatment was associated with engagement in pharmacotherapy only or both pharmacotherapy and psychotherapy, as compared with psychotherapy only. Treatment engagement type was not significantly associated with differences in age, gender, race/ethnicity, service branch, alcohol use/misuse, history of psychotherapy, distance from the VA, or PTSD service connection. Implications for enhancing PTSD treatment engagement are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Initial group versus individual therapy for posttraumatic stress disorder and subsequent follow-up treatment adequacy.

2016-05-12

Accessibility of psychotherapy for individuals with posttraumatic stress disorder (PTSD) and retention in treatment are major concerns for the Veterans Health Administration (VA). Group therapy is a common method for improving access to psychotherapy; however, PTSD patients may prefer individual therapy. This study assessed whether initial treatment with individual versus group psychotherapy relates to subsequent psychotherapy adequacy among VA patients with PTSD. The sample consisted of all VA patients who received a new PTSD diagnosis during a subspecialty PTSD clinical team visit in fiscal year 2010. Logistic and negative binomial regression analyses examined the relationship between modality of the first psychotherapy encounter and subsequent number of psychotherapy encounters within 14 weeks. Among 35,144 VA patients who initiated treatment for PTSD, 38% initiated group therapy and 62% initiated individual therapy. Patients who initiated with group therapy received a greater mean number of psychotherapy visits than those who initiated with individual therapy (4.7 vs. 2.8), and were about twice as likely (29.5% vs. 14.2%) to receive a minimally effective dose of 8 or more psychotherapy encounters. Group therapy predicted a greater number of psychotherapy visits (β = 0.46, SE = .01, p < .001) and greater likelihood of 8 or more sessions of psychotherapy (OR = 2.31, 95% CI [2.19, 2.45], p < .001), after adjusting for differences in demographic characteristics, comorbid conditions, and other service use. Greater treatment adequacy among group therapy participants suggests that these patients have greater access to frequent psychotherapy sessions or are more likely to persist with psychotherapy for PTSD than those treated individually. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Correlates and reasons for mental health treatment dropout among active duty soldiers.

2016-04-14

Many soldiers who seek treatment for mental health problems drop out of treatment before it is complete. The present study examined factors that are associated with dropout among active duty soldiers. Soldiers who had sought treatment (N = 260) responded to measures of beliefs about mental health treatment, mental health symptoms, treatment-seeking behaviors, and treatment dropout. Fifty-seven soldiers reported dropping out before treatment was completed. Commonly endorsed reasons for dropout were that soldiers were too busy with work and a preference to handle the symptoms oneself. A series of logistic regressions revealed that depression symptoms (odds ratio [OR] = 1.07), functional impairment (OR = 1.49), career stigma (OR = 1.70), differential treatment stigma (OR = 1.62), practical barriers (OR = 1.76), negative beliefs about treatment (OR = 1.98), and self-reliance (OR = 1.78) were associated with an increased likelihood of dropout. Positive beliefs about treatment were associated with a decreased likelihood of dropout (OR = 0.60). Functional impairment, career stigma, and self-reliance remained unique predictors in a final forward conditional regression. These findings highlight the need for interventions to support service members in treatment by educating them on the benefits of treatment and reducing practical barriers. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Efficacy of Warrior Renew group therapy for female veterans who have experienced military sexual trauma.

2016-08-18

This is a program evaluation of the Warrior Renew treatment protocol delivered in an outpatient therapy group for survivors of military sexual trauma (MST) at a Department of Veterans Affairs medical center. The group was delivered via a manualized protocol with 12 weekly topics. It includes coping skills for affect management (e.g., triggers and anxiety) and addresses unique aspects of MST including anger/resentments because of injustice and lack of closure, betrayal, and self-blame. It also addresses interpersonal factors such as relationship patterns and healthy interpersonal skills. This evaluation was conducted as part of routine clinical care in a naturalistic setting. Forty-three female veterans started and 34 completed treatment (21% dropout rate). Of the 34 graduates, 32 opted to complete pre- and posttreatment assessments. Findings revealed significant decreases in symptoms of anxiety, depression, posttraumatic negative thinking, and posttraumatic stress disorder (PTSD) all with large effect sizes. In addition, 75% of the sample had a reliable clinical change at the 95% confidence interval. These results are promising and further investigation is warranted to examine Warrior Renew to address the unique issues related to MST. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Effectiveness of PTSD telehealth treatment in a VA clinical sample.

2016-09-22

Over the past decade, the Veterans Health Administration has supported multiple national rollouts of evidence-based treatments for mental health disorders. Recent studies have shown, however, that the majority of veterans with mental health diagnoses are not utilizing psychotherapy services. In this article, we attempt to address one of the more commonly known barriers to treatment, distance to care. We do this by comparing the effectiveness of outpatient and telehealth cognitive processing therapy (CPT) and prolonged exposure (PE) Therapy for posttraumatic stress disorder (PTSD) in a Veteran clinical sample. Multilevel modeling analyses revealed statistically significant differences between the outpatient and telehealth treatments once baseline demographic and symptom severity differences were taken into account. Given that a number of randomized control studies have not found similar outcome differences, future research would benefit from examining whether the outcomes differences in the present study are because of treatment delivery method or sample differences. Veterans completing treatment via outpatient and telehealth delivery methods achieved clinically significant change in PTSD from pre- to posttreatment. These results suggest that delivering evidence-based treatment for PTSD via telehealth may be a viable treatment option for veterans who cannot easily access care because of geographic distance. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



The DBT Coach mobile application as an adjunct to treatment for suicidal and self-injuring individuals with borderline personality disorder: A preliminary evaluation and challenges to client utilization.

2016-08-15

Acquisition and generalization of specific behavioral skills is a key component of dialectical behavior therapy (DBT) for individuals with borderline personality disorder (BPD). We examined the feasibility, acceptability, usability, and immediate effects of the DBT Coach, a mobile phone application (app) designed specifically to augment skills generalization through interactive coaching in DBT skills. In this pilot study, we provided the DBT Coach installed on a mobile device as an adjunct to 6 months of standard DBT, among a sample of 16 individuals with BPD and a recent history of attempted suicide and/or nonsuicidal self-injury (NSSI). Results indicate good acceptability and usability of the DBT Coach with considerable between-person variability in the frequency of app use and a median use of only 11.5 times over the course of treatment and a 3-month follow-up period. Using a hierarchical linear modeling approach, analyses indicated the DBT Coach reduced subjective distress and urges to self-harm following app use. However, use of the DBT Coach was not related to any treatment outcomes, except for reductions in NSSI. This study is the first to examine the use of mobile technology as an adjunct in DBT and highlights some potential challenges in incorporating apps into treatment. Implications for future research and clinical utility are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Meta-analysis of average symptom change in inpatient treatment for posttraumatic stress disorder in veteran and active duty U.S. military samples.

2016-08-29

This study tested the hypothesis that inpatient/residential treatment for PTSD associated with military duty should result in significantly lower PTSD symptoms at patient discharge compared to patient intake. Meta-analysis of effects comparing intake and discharge PTSD symptoms from 26 samples, reported in 16 studies, supported this hypothesis (d = −.73; p < .00001). Moderator analysis indicated between-study variation in PTSD symptom changes was predominantly due to the type of measure used, with the Clinician Administered PTSD Scale producing the largest effect (d = −1.60). Larger effects were also observed for more recently published studies and studies with larger percentages of females. These findings support the efficacy of inpatient treatment for military PTSD, although a causal factor for effectiveness could not be identified. Further, the results indicate between-program comparisons of symptom reduction require the same measure of PTSD. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Veterans’ perceptions of the impact of PTSD on their parenting and children.

2016-07-21

Although considerable research has examined the impact of posttraumatic stress disorder (PTSD) on couples and partners, relatively little is known about how it can affect parenting, children, and the parent–child relationship. Although adverse effects of parental PTSD on child functioning have been documented, the processes by which these outcomes occur are unknown. Further, parents’ perspectives of how their PTSD affects parenting and children have yet to be studied. This 3-site, mixed methods exploratory study included 19 veteran parents who had a diagnosis of PTSD. Participants were recruited from Veterans Affairs (VA) medical centers. Veterans participated in focus groups or individual interviews and completed questionnaires, responding to questions about the impact of PTSD on their functioning as parents. Two sets of themes emerged from the qualitative inquiry. First, veterans reported parenting difficulties that were associated with three PTSD symptom clusters, including avoidance, alterations in arousal and reactivity, and negative alterations of cognitions and mood. Second, veterans described both emotional (e.g., hurt, confusion, frustration, fear) and behavioral (e.g., withdrawal, mimicking parents’ behavior) reactions in their children. Veterans also shared numerous ways in which their children provided practical and emotional support. Implications of these findings for future research, program development, and clinical care are offered, including a free online parenting resource for veterans with PTSD based on this research. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Use of evidence-based assessments for childhood anxiety disorders within a regional medical system.

2016-06-13

Anxiety disorders represent a common and serious threat to mental health in children and adolescents. To effectively treat anxiety in children, clinicians must conduct accurate assessment of patients’ symptoms. However, despite the importance of assessment in the treatment of childhood anxiety disorders, the literature lacks a thorough analysis of the practices used by clinicians’ when evaluating such disorders in community settings. Thus, the current study examines the quality of assessment for childhood anxiety disorders in a large regional health system. The results suggest that clinicians often provide non-specific diagnoses, infrequently document symptoms according to diagnostic criteria, and rarely administer rating scales and structured diagnostic interviews. Relatedly, diagnostic agreement across practice settings was low. Finally, the quality of assessment differed according to the setting in which the assessment was conducted and the complexity of the patient’s symptomatology. These results highlight the need to develop and disseminate clinically feasible evidence-based assessment practices that can be implemented within resource-constrained service settings. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Medical and psychosocial barriers to weight management in older veterans with and without serious mental illness.

2016-07-21

Older adults with serious mental illness (SMI) are an understudied population with complex care needs and high rates of obesity/overweight. Little is known about the experiences of older adults with SMI with weight management. The present study is an observational study of veterans ages 55 and over with a body mass index in the overweight or obese range, comparing Veterans with schizophrenia or bipolar disorder (n = 9044) to their same-age peers with no mental health disorders (n = 71156), on their responses to a questionnaire assessment of medical and psychosocial factors related to weight management. Responses to the questionnaire between August, 2005 and May, 2013 were used to examine the following: demographics, clinical characteristics, medical barriers to weight management, current weight loss plan, reliability of social support, reasons for being overweight, and weight loss barriers. Physical health concerns were highly prevalent in both groups. Veterans in the SMI group endorsed more medical issues and were significantly more likely to endorse experiences that indicated that their medical conditions were poorly controlled (e.g., shortness of breath). Veterans in the SMI group were more likely to endorse many barriers to healthy eating and physical activity, across medical, psychological, social, and environmental domains. Even within a sample at medically high-risk for complications related to obesity and metabolic syndrome, older veterans with SMI and overweight/obesity experience more challenges with weight management than their same-age peers with overweight/obesity and no mental health disorders. Weight management interventions for this population should take a multifaceted approach. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)



Do organizational expectations influence workers’ implementation perceptions?

2016-08-08

The purpose of this article is to report on the use of empirically supported treatments (ESTs) among clinical addiction workers, in order to relate the use of ESTs to both perceived agency expectations and worker-level attitudes. We recruited a convenience sample of 120 frontline workers within 4 agencies providing addiction services in St. Louis. The results found that agency expectations were related to clinician’s reported use of ESTs, but were unrelated to clinician attitudes. The regression results revealed that reported use of ESTs was associated with openness to ESTs, but was not associated with favoring clinical experience. Organizational leaders interested in using ESTs should send clear, strong messages that they expect workers to use ESTs during clinical practice. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(image)