Factors Associated With Receipt of Cognitive-Behavioral Therapy or Prolonged Exposure Therapy Among Individuals With PTSD

Carissa van den Berk Clark, Rachel Moore, Scott Secrest, Peter Tuerk, Sonya Norman, Ursula Myers, Patrick J. Lustman, F. David Schneider, Jacqueline Barnes, Randy Gallamore, Muhammad Ovais, James Alex Plurad, Jeffrey F. Scherrer

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: The aim of this study was to systematically review variables associated with initiation of trauma-centered cognitive-behavioral therapy (TC-CBT) among individuals with posttraumatic stress disorder (PTSD). METHODS: PubMed, PsycINFO, Web of Science, Published International Literature on Traumatic Stress (PILOTS), and Scopus were searched in a systematic manner up to 2018, and 26 relevant studies were recovered and analyzed. RESULTS: The average weighted initiation rate was 6% in larger hospital systems with a high rate of trauma and 28% in outpatient mental health settings (range 4%-83%). Older age (odds ratio [OR]=1.56, 95% confidence interval [CI]=0.51-1.61), female gender (OR=1.18, 95% CI=1.08-1.27), black or other racial-ethnic minority group (OR=1.16, 95% CI=1.03-1.28), Veterans Affairs PTSD service connection status (OR=2.30, 95% CI=2.18-2.42), mental health referral (OR=2.28, 95% CI=1.05-3.50), greater staff exposure to TC-CBT (OR=2.30, 95% CI=2.09-2.52), adaptability of TC-CBT to staff workflow (OR=4.66, 95% CI=1.60-7.72), greater PTSD severity (OR=1.46, 95% CI=1.13-1.78), and comorbid depression (OR=1.21, 95% CI=1.14-1.29) increased the likelihood of TC-CBT initiation, whereas delayed treatment reduced the likelihood of TC-CBT initiation (OR=0.93, 95% CI=0.92-0.95). Qualitative studies showed that mental health beliefs (stigma and lack of readiness), provider organizational factors (low availability, privacy issues), and patient lack of time (logistics) were perceived as barriers to initiation by patients and providers. CONCLUSIONS: TC-CBT initiation increased among patients who were older and female. Initiation was also higher among providers who had more exposure to TC-CBT in their work environment and when TC-CBT fit into their existing workflow.

Original languageEnglish (US)
Pages (from-to)703-713
Number of pages11
JournalPsychiatric services (Washington, D.C.)
Volume70
Issue number8
DOIs
StatePublished - Aug 1 2019

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Implosive Therapy
Cognitive Therapy
Post-Traumatic Stress Disorders
Odds Ratio
Confidence Intervals
Wounds and Injuries
Mental Health
Workflow
Minority Groups
Privacy
Veterans
Ethnic Groups
PubMed
Outpatients
Referral and Consultation

Keywords

  • behavioral health services utilization
  • Cognitive behavioral therapy
  • Posttraumatic stress disorder (PTSD
  • Prolonged Exposure Therapy
  • Treatment Initiation

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Factors Associated With Receipt of Cognitive-Behavioral Therapy or Prolonged Exposure Therapy Among Individuals With PTSD. / van den Berk Clark, Carissa; Moore, Rachel; Secrest, Scott; Tuerk, Peter; Norman, Sonya; Myers, Ursula; Lustman, Patrick J.; Schneider, F. David; Barnes, Jacqueline; Gallamore, Randy; Ovais, Muhammad; Plurad, James Alex; Scherrer, Jeffrey F.

In: Psychiatric services (Washington, D.C.), Vol. 70, No. 8, 01.08.2019, p. 703-713.

Research output: Contribution to journalArticle

van den Berk Clark, C, Moore, R, Secrest, S, Tuerk, P, Norman, S, Myers, U, Lustman, PJ, Schneider, FD, Barnes, J, Gallamore, R, Ovais, M, Plurad, JA & Scherrer, JF 2019, 'Factors Associated With Receipt of Cognitive-Behavioral Therapy or Prolonged Exposure Therapy Among Individuals With PTSD', Psychiatric services (Washington, D.C.), vol. 70, no. 8, pp. 703-713. https://doi.org/10.1176/appi.ps.201800408
van den Berk Clark, Carissa ; Moore, Rachel ; Secrest, Scott ; Tuerk, Peter ; Norman, Sonya ; Myers, Ursula ; Lustman, Patrick J. ; Schneider, F. David ; Barnes, Jacqueline ; Gallamore, Randy ; Ovais, Muhammad ; Plurad, James Alex ; Scherrer, Jeffrey F. / Factors Associated With Receipt of Cognitive-Behavioral Therapy or Prolonged Exposure Therapy Among Individuals With PTSD. In: Psychiatric services (Washington, D.C.). 2019 ; Vol. 70, No. 8. pp. 703-713.
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AU - Secrest, Scott

AU - Tuerk, Peter

AU - Norman, Sonya

AU - Myers, Ursula

AU - Lustman, Patrick J.

AU - Schneider, F. David

AU - Barnes, Jacqueline

AU - Gallamore, Randy

AU - Ovais, Muhammad

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N2 - OBJECTIVE: The aim of this study was to systematically review variables associated with initiation of trauma-centered cognitive-behavioral therapy (TC-CBT) among individuals with posttraumatic stress disorder (PTSD). METHODS: PubMed, PsycINFO, Web of Science, Published International Literature on Traumatic Stress (PILOTS), and Scopus were searched in a systematic manner up to 2018, and 26 relevant studies were recovered and analyzed. RESULTS: The average weighted initiation rate was 6% in larger hospital systems with a high rate of trauma and 28% in outpatient mental health settings (range 4%-83%). Older age (odds ratio [OR]=1.56, 95% confidence interval [CI]=0.51-1.61), female gender (OR=1.18, 95% CI=1.08-1.27), black or other racial-ethnic minority group (OR=1.16, 95% CI=1.03-1.28), Veterans Affairs PTSD service connection status (OR=2.30, 95% CI=2.18-2.42), mental health referral (OR=2.28, 95% CI=1.05-3.50), greater staff exposure to TC-CBT (OR=2.30, 95% CI=2.09-2.52), adaptability of TC-CBT to staff workflow (OR=4.66, 95% CI=1.60-7.72), greater PTSD severity (OR=1.46, 95% CI=1.13-1.78), and comorbid depression (OR=1.21, 95% CI=1.14-1.29) increased the likelihood of TC-CBT initiation, whereas delayed treatment reduced the likelihood of TC-CBT initiation (OR=0.93, 95% CI=0.92-0.95). Qualitative studies showed that mental health beliefs (stigma and lack of readiness), provider organizational factors (low availability, privacy issues), and patient lack of time (logistics) were perceived as barriers to initiation by patients and providers. CONCLUSIONS: TC-CBT initiation increased among patients who were older and female. Initiation was also higher among providers who had more exposure to TC-CBT in their work environment and when TC-CBT fit into their existing workflow.

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