Category: PTSD

Symposium

Contributions and Interactions Between Therapist Skill and Patient Engagement in Optimizing Therapy Outcomes

Sunday, November 19
8:30 AM - 10:00 AM
Location: Sapphire Ballroom M & N, Level 4, Sapphire Level

Keywords: CPT (Cognitive Processing Therapy) | Psychotherapy Process | Psychotherapy Outcome
Presentation Type: Symposium

A host of variables can contribute to the success of a course of therapy for PTSD.   Perhaps some of the observed non-response to treatment and attrition rates observed in PTSD clinical trials is due to both patient and therapist variables.  Independent raters (with demonstrated excellent inter-rater  reliability) evaluated 533 therapy tapes from 70 participants diagnosed with PTSD (86% female, age 18-65, survivors of interpersonal violence) who participated in one of two controlled clinical trials testing cognitive processing therapy. We examined the contributions of patient avoidance (as measured by patient report of amount and helpfulness of homework completed, number of worksheets returned to session, attendance, and in-session emotional engagement) and therapist’s focus on patient engagement (as rated by therapist competence in Socratic questions, prioritizing trauma-related cognitions, attention to homework in session and facilitation of emotional engagement) to change in PTSD (measured by the Clinician Administered PTSD Scale) and depression (Beck Depression Inventory – II). Preliminary results assessing patient avoidance showed that greater avoidance of the trauma memory in session was associated with less change in PTSD and only perceived helpfulness of homework was associated with improvement.  The amount of homework completed, regularity of attendance, and attendance compliance were surprisingly not related to outcomes. This is the first study to assess the influence of homework on outcomes to this extent. With respect to therapist variables, competence in Socratic questions and prioritizing trauma-related cognitions contributed to greater improvement in PTSD while attention to practice assignments and emphasis on patient affective engagement was not associated with outcome.  This study will further explore the interaction between patient and therapist engagement variables to assess their relative contributions as well as interactive effects to outcomes. The clinical relevance of increasing attention to the process variables that are critical in recovery (and implications for additional training in those domains) will be discussed.

Tara Galovski

Director
National Center for PTSD, VA Boston Healthcare System; Boston University School of Medicine

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