Using the Multiphase Optimization Strategy to Adapt Cognitive Processing Therapy
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 271
- 试验地点
- 3
- 主要终点
- The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) Change
研究概览
简要总结
Cognitive Processing Therapy (CPT) consists of discrete therapeutic components that are delivered across 12 sessions, but most Veterans never reach session 12, and those who drop out receive only 4 sessions on average. Veterans drop out because of time constraints, logistics, and lack of perceived benefit. Unfortunately, Veterans who drop out prematurely may never receive the most effective components of CPT and continue to experience symptom-related distress and numerous other negative outcomes, including lost productivity, substance use, later-life physical disability, reduced quality of life, and increased risk of suicide.
The overall objective of this study is to adapt CPT into a brief, effective format. The rationale is that identifying the most effective intervention components and delivering only those components will make CPT deliverable in a shorter timeframe, thus improving efficiency, reducing drop-out related to poor treatment response, and ensuring that Veterans receive the most beneficial components of treatment, which will significantly improve their quality of life.
详细描述
Background: One third of post-9/11 Veterans in VHA suffer from posttraumatic stress disorder (PTSD), and among those who initiate Cognitive Processing Therapy (CPT), up to 70% drop out before receiving an adequate dose of treatment. Unfortunately, Veterans who drop out prematurely may never receive the most effective components of CPT. Thus, there is an urgent need to use empirical approaches to identify the most effective components of CPT, so that CPT can be adapted into a briefer format. The long-term goal of this line of research is to adapt, test, and implement brief, evidence-based treatment for Veterans with PTSD. The overall objective of the current application is to adapt CPT into a brief, effective format. The rationale is that identifying the most effective intervention components and delivering only those components will make CPT deliverable in a shorter timeframe, thus improving efficiency, reducing drop-out related to poor treatment response, and ensuring that Veterans receive the most beneficial components of treatment, which will significantly improve their quality of life.
Significance/Impact: Upon completion of this project, the investigators expect to have produced an empirically-based, brief version of CPT. This contribution is likely to improve clinical practice for Veterans with PTSD by providing the most effective components at an earlier session, thus increasing the overall effectiveness of treatment and mitigating the negative consequences of untreated PTSD, such as lost productivity, substance use, later-life physical disability, reduced quality of life, and increased risk of suicide. Using a highly efficient experimental design, we will identify which of five CPT components contribute meaningfully to reduction in PTSD symptoms. The investigators will test the effectiveness of each component and each two-way interaction between components.
Methodology: The MOST is an innovative engineering-inspired framework that uses an optimization trial to assess the performance of individual intervention components within a multicomponent intervention such as CPT. Guided by the MOST framework, the goal of the proposed project is to empirically inform an abbreviated version of CPT via a highly efficient fractional factorial design. Veterans (N = 270) at three VAMCs with clinically significant PTSD symptoms who meet minimal inclusion/exclusion criteria will be randomized to receive two or more CPT components. This design will test the effectiveness of each component and each two-way interaction between components, as measured by PTSD symptom reduction on the Clinician-administered PTSD scale for DSM-5 (CAPS-5) across six months of follow-up.
Implementation/Next Steps: Upon completion of these aims, the expected outcome is an adapted, abbreviated version of CPT that consists of the most effective elements of the intervention. The adapted intervention will be primed for a future large scale, fully powered effectiveness trial. The adapted intervention can be easily disseminated through the VA CPT training program and will have a positive impact on the health and wellbeing of Veterans with PTSD.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Factorial
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •The investigators designed the sample to be representative of Veterans with PTSD who are treated in PTSD Clinical Teams (PCTs), with minimal
排除标准
- •. PCT clinicians will provide care for those with exclusionary comorbidities or preference for a medication-based approach, as per standard policies and procedures. Inclusion criteria are:
- •score of 33 or above on the PCL-5
- •at least 4 weeks on a stable dose for individuals who are taking psychotropic medication
- •over the age of 18
- •Exclusion Criteria:
- •active suicidality (assessed by the Columbia Suicide Severity Rating Scale with scores indicating elevated acute risk for suicide warranting hospitalization or intensive treatment)
- •need for detoxification
- •severe cognitive impairment that, in the judgment of the investigator, makes it unlikely that the patient can provide informed consent or adhere to the study regimen (as evidenced by confusion, inability to track discussion or answer questions, or other clear and significant indicators of cognitive impairment)
- •psychosis or unmanaged bipolar disorder
- •previous receipt of CPT in the past year
- •current engagement in trauma-focused psychotherapy (Prolonged Exposure or Cognitive Processing Therapy)
研究组 & 干预措施
1
Core Session 1, Core Session 2, Module Choice, Final Session
干预措施: Veteran's choice of Module (Safety/Trust/Power and Control/Esteem/Intimacy) (Behavioral)
4
Core Session 1, Core Session 2, Modified A-B-C, Challenging Questions, Module Choice, Final Session
干预措施: Veteran's choice of Module (Safety/Trust/Power and Control/Esteem/Intimacy) (Behavioral)
5
Core Session 1, Core Session 2, Problematic Patterns, Final Session
干预措施: Patterns of Problematic Thinking (Behavioral)
2
Core Session 1, Core Session 2, Modified A-B-C, Final Session
干预措施: Modified A-B-C: Working with Events, Thoughts, and Feelings (Behavioral)
3
Core Session 1, Core Session 2, Challenging Questions, Final Session
干预措施: Challenging Questions (Behavioral)
4
Core Session 1, Core Session 2, Modified A-B-C, Challenging Questions, Module Choice, Final Session
干预措施: Modified A-B-C: Working with Events, Thoughts, and Feelings (Behavioral)
4
Core Session 1, Core Session 2, Modified A-B-C, Challenging Questions, Module Choice, Final Session
干预措施: Challenging Questions (Behavioral)
6
Core Session 1, Core Session 2, Modified A-B-C, Problematic Patterns, Module Choice, Final Session
干预措施: Modified A-B-C: Working with Events, Thoughts, and Feelings (Behavioral)
6
Core Session 1, Core Session 2, Modified A-B-C, Problematic Patterns, Module Choice, Final Session
干预措施: Patterns of Problematic Thinking (Behavioral)
6
Core Session 1, Core Session 2, Modified A-B-C, Problematic Patterns, Module Choice, Final Session
干预措施: Veteran's choice of Module (Safety/Trust/Power and Control/Esteem/Intimacy) (Behavioral)
7
Core Session 1, Core Session 2, Challenging Questions, Problematic Patterns, Module Choice, Final Session
干预措施: Challenging Questions (Behavioral)
7
Core Session 1, Core Session 2, Challenging Questions, Problematic Patterns, Module Choice, Final Session
干预措施: Patterns of Problematic Thinking (Behavioral)
7
Core Session 1, Core Session 2, Challenging Questions, Problematic Patterns, Module Choice, Final Session
干预措施: Veteran's choice of Module (Safety/Trust/Power and Control/Esteem/Intimacy) (Behavioral)
12
Core Session 1, Core Session 2, Modified A-B-C, Challenging Questions, Challenging Beliefs, Final Session
干预措施: Challenging Questions (Behavioral)
8
Core Session 1, Core Session 2, Modified A-B-C, Challenging Questions, Problematic Patterns, Final Session
干预措施: Modified A-B-C: Working with Events, Thoughts, and Feelings (Behavioral)
8
Core Session 1, Core Session 2, Modified A-B-C, Challenging Questions, Problematic Patterns, Final Session
干预措施: Challenging Questions (Behavioral)
8
Core Session 1, Core Session 2, Modified A-B-C, Challenging Questions, Problematic Patterns, Final Session
干预措施: Patterns of Problematic Thinking (Behavioral)
9
Core Session 1, Core Session 2, Challenging Beliefs, Final Session
干预措施: Challenging Beliefs (Behavioral)
10
Core Session 1, Core Session 2, Modified A-B-C , Challenging Beliefs, Module Choice, Final Session
干预措施: Modified A-B-C: Working with Events, Thoughts, and Feelings (Behavioral)
10
Core Session 1, Core Session 2, Modified A-B-C , Challenging Beliefs, Module Choice, Final Session
干预措施: Challenging Beliefs (Behavioral)
10
Core Session 1, Core Session 2, Modified A-B-C , Challenging Beliefs, Module Choice, Final Session
干预措施: Veteran's choice of Module (Safety/Trust/Power and Control/Esteem/Intimacy) (Behavioral)
11
Core Session 1, Core Session 2, Challenging Questions, Challenging Beliefs, Module Choice, Final Session
干预措施: Challenging Questions (Behavioral)
11
Core Session 1, Core Session 2, Challenging Questions, Challenging Beliefs, Module Choice, Final Session
干预措施: Challenging Beliefs (Behavioral)
11
Core Session 1, Core Session 2, Challenging Questions, Challenging Beliefs, Module Choice, Final Session
干预措施: Veteran's choice of Module (Safety/Trust/Power and Control/Esteem/Intimacy) (Behavioral)
12
Core Session 1, Core Session 2, Modified A-B-C, Challenging Questions, Challenging Beliefs, Final Session
干预措施: Modified A-B-C: Working with Events, Thoughts, and Feelings (Behavioral)
12
Core Session 1, Core Session 2, Modified A-B-C, Challenging Questions, Challenging Beliefs, Final Session
干预措施: Challenging Beliefs (Behavioral)
13
Core Session 1, Core Session 2, Problematic Patterns, Challenging Beliefs, Module Choice, Final Session
干预措施: Patterns of Problematic Thinking (Behavioral)
13
Core Session 1, Core Session 2, Problematic Patterns, Challenging Beliefs, Module Choice, Final Session
干预措施: Challenging Beliefs (Behavioral)
13
Core Session 1, Core Session 2, Problematic Patterns, Challenging Beliefs, Module Choice, Final Session
干预措施: Veteran's choice of Module (Safety/Trust/Power and Control/Esteem/Intimacy) (Behavioral)
14
Core Session 1, Core Session 2, Modified A-B-C, Problematic Patterns, Challenging Beliefs, Final Session
干预措施: Modified A-B-C: Working with Events, Thoughts, and Feelings (Behavioral)
14
Core Session 1, Core Session 2, Modified A-B-C, Problematic Patterns, Challenging Beliefs, Final Session
干预措施: Patterns of Problematic Thinking (Behavioral)
14
Core Session 1, Core Session 2, Modified A-B-C, Problematic Patterns, Challenging Beliefs, Final Session
干预措施: Challenging Beliefs (Behavioral)
15
Core Session 1, Core Session 2, Challenging Questions, Problematic Patterns, Challenging Beliefs, Final Session
干预措施: Challenging Questions (Behavioral)
15
Core Session 1, Core Session 2, Challenging Questions, Problematic Patterns, Challenging Beliefs, Final Session
干预措施: Patterns of Problematic Thinking (Behavioral)
15
Core Session 1, Core Session 2, Challenging Questions, Problematic Patterns, Challenging Beliefs, Final Session
干预措施: Challenging Beliefs (Behavioral)
16
Core Session 1, Core Session 2, Modified A-B-C, Challenging Questions, Problematic Patterns, Challenging Beliefs, Module Choice, Final Session
干预措施: Modified A-B-C: Working with Events, Thoughts, and Feelings (Behavioral)
16
Core Session 1, Core Session 2, Modified A-B-C, Challenging Questions, Problematic Patterns, Challenging Beliefs, Module Choice, Final Session
干预措施: Challenging Questions (Behavioral)
16
Core Session 1, Core Session 2, Modified A-B-C, Challenging Questions, Problematic Patterns, Challenging Beliefs, Module Choice, Final Session
干预措施: Patterns of Problematic Thinking (Behavioral)
16
Core Session 1, Core Session 2, Modified A-B-C, Challenging Questions, Problematic Patterns, Challenging Beliefs, Module Choice, Final Session
干预措施: Challenging Beliefs (Behavioral)
16
Core Session 1, Core Session 2, Modified A-B-C, Challenging Questions, Problematic Patterns, Challenging Beliefs, Module Choice, Final Session
干预措施: Veteran's choice of Module (Safety/Trust/Power and Control/Esteem/Intimacy) (Behavioral)
结局指标
主要结局
The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) Change
时间窗: Baseline, 6-week, 3-month, 6-month
The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) is a 30-item structured interview used to measure of PTSD severity. In addition to assessing the 20 DSM-5 PTSD symptoms, questions target the onset and duration of symptoms, subjective distress, impact of symptoms on social and occupational functioning and improvement in symptoms since a previous CAPS administration. Scoring An index trauma/Criterion A event At least one Criterion B symptom (questions 1-5) At least one Criterion C symptom (questions 6-7) At least two Criterion D symptoms (questions 8-14) At least two Criterion E symptoms (questions 15-20) Both criterion F and G must be met as well for a PTSD diagnosis. To meet criteria for a symptom, a patient must meet criteria in both frequency and intensity score for each item. Frequency and intensity then combined to form a single severity score. Severity scores range from 0-4, with 0 being absent to 4 being extreme/incapacitating.
次要结局
- PTSD Checklist for DSM-5 (PCL-5) Change(Baseline, 6-week, 3-month, 6-month)
- Patient Health Questionnaire (PHQ-9) Change(Baseline, 6-week, 3-month, 6-month)