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Implementation of cognitive therapy for PTSD in routine clinical care: effectiveness and moderators of outcome in a consecutive sample

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Implementation of cognitive therapy for PTSD in routine clinical care : effectiveness and moderators of outcome in a consecutive sample. / Ehlers, Anke; Grey, Nick; Wild, Jennifer; Stott, Richard; Liness, Sheena; Deale, Alicia; Handley, Rachel; Albert, Idit; Cullen, Deborah; Hackmann, Ann; Manley, John; McManus, Freda; Brady, Francesca; Salkovskis, Paul; Clark, David M.

In: Behaviour Research and Therapy, Vol. 51, No. 11, 11.2013, p. 742-752.

Research output: Contribution to journalArticle

Harvard

Ehlers, A, Grey, N, Wild, J, Stott, R, Liness, S, Deale, A, Handley, R, Albert, I, Cullen, D, Hackmann, A, Manley, J, McManus, F, Brady, F, Salkovskis, P & Clark, DM 2013, 'Implementation of cognitive therapy for PTSD in routine clinical care: effectiveness and moderators of outcome in a consecutive sample' Behaviour Research and Therapy, vol. 51, no. 11, pp. 742-752. DOI: 10.1016/j.brat.2013.08.006

APA

Ehlers, A., Grey, N., Wild, J., Stott, R., Liness, S., Deale, A., ... Clark, D. M. (2013). Implementation of cognitive therapy for PTSD in routine clinical care: effectiveness and moderators of outcome in a consecutive sample. DOI: 10.1016/j.brat.2013.08.006

Vancouver

Ehlers A, Grey N, Wild J, Stott R, Liness S, Deale A et al. Implementation of cognitive therapy for PTSD in routine clinical care: effectiveness and moderators of outcome in a consecutive sample. Behaviour Research and Therapy. 2013 Nov;51(11):742-752. Available from, DOI: 10.1016/j.brat.2013.08.006

Author

Ehlers, Anke ; Grey, Nick ; Wild, Jennifer ; Stott, Richard ; Liness, Sheena ; Deale, Alicia ; Handley, Rachel ; Albert, Idit ; Cullen, Deborah ; Hackmann, Ann ; Manley, John ; McManus, Freda ; Brady, Francesca ; Salkovskis, Paul ; Clark, David M. / Implementation of cognitive therapy for PTSD in routine clinical care : effectiveness and moderators of outcome in a consecutive sample. In: Behaviour Research and Therapy. 2013 ; Vol. 51, No. 11. pp. 742-752

Bibtex Download

@article{a19e796d6a7346d5953da66f066570d6,
title = "Implementation of cognitive therapy for PTSD in routine clinical care: effectiveness and moderators of outcome in a consecutive sample",
abstract = "ObjectiveTrauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area.MethodA consecutive sample of 330 patients with PTSD (age 17–83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects.ResultsCT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8{\%}/57.3{\%}; completer: 84.5{\%}/65.1{\%}. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2{\%} of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience.ConclusionsThe results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas.",
keywords = "Acknowledged-BRC, Acknowledged-BRC-13/14",
author = "Anke Ehlers and Nick Grey and Jennifer Wild and Richard Stott and Sheena Liness and Alicia Deale and Rachel Handley and Idit Albert and Deborah Cullen and Ann Hackmann and John Manley and Freda McManus and Francesca Brady and Paul Salkovskis and Clark, {David M}",
year = "2013",
month = "11",
doi = "10.1016/j.brat.2013.08.006",
language = "English",
volume = "51",
pages = "742--752",
journal = "Behaviour Research and Therapy",
issn = "0005-7967",
publisher = "Elsevier Limited",
number = "11",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Implementation of cognitive therapy for PTSD in routine clinical care

T2 - Behaviour Research and Therapy

AU - Ehlers,Anke

AU - Grey,Nick

AU - Wild,Jennifer

AU - Stott,Richard

AU - Liness,Sheena

AU - Deale,Alicia

AU - Handley,Rachel

AU - Albert,Idit

AU - Cullen,Deborah

AU - Hackmann,Ann

AU - Manley,John

AU - McManus,Freda

AU - Brady,Francesca

AU - Salkovskis,Paul

AU - Clark,David M

PY - 2013/11

Y1 - 2013/11

N2 - ObjectiveTrauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area.MethodA consecutive sample of 330 patients with PTSD (age 17–83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects.ResultsCT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience.ConclusionsThe results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas.

AB - ObjectiveTrauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area.MethodA consecutive sample of 330 patients with PTSD (age 17–83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects.ResultsCT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience.ConclusionsThe results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas.

KW - Acknowledged-BRC

KW - Acknowledged-BRC-13/14

U2 - 10.1016/j.brat.2013.08.006

DO - 10.1016/j.brat.2013.08.006

M3 - Article

VL - 51

SP - 742

EP - 752

JO - Behaviour Research and Therapy

JF - Behaviour Research and Therapy

SN - 0005-7967

IS - 11

ER -

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