Initiating Cognitive Processing Therapy (CPT) in Community Settings: A Qualitative Investigation of Therapist Decision-Making

The neuroscientific basis of post-traumatic stress disorder (PTSD): From brain to treatment

Post-traumatic stress disorder (PTSD) is a debilitating mental health condition resulting from exposure to traumatic events, marked by persistent psychological distress and impairment in daily functioning. Risk factors for PTSD include genetic predispositions, neurobiological factors, as well as psychosocial and environmental influences. Specific demographic groups, such as veterans, first responders, and individuals in high-risk environments, are more susceptible to developing the disorder. Despite growing research, there remain gaps in understanding the full pathophysiology of PTSD, and existing diagnostic methods and treatments are not universally effective, contributing to a significant public health burden. This chapter explores the pathophysiology of PTSD, focusing on its underlying mechanisms, associated risk factors, and high-risk populations. Biological biomarkers such as neuroimaging findings, hormonal imbalances, genetic predispositions, and physiological indicators are discussed in the context of their role in PTSD diagnosis and understanding. Both pharmacological treatments and non-pharmacological interventions, including Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), and mindfulness-based techniques, are reviewed for their effectiveness in symptom management. Further research is essential to advance individualized diagnostic techniques and optimize treatment strategies, ensuring more personalized care for PTSD patients.

Towards an understanding of readiness for trauma-focussed therapy in post-traumatic stress disorder: A conceptual integration of empirical data and theoretical constructs

For people with post-traumatic stress disorder (PTSD), the concept of being 'ready' for trauma-focused therapy (TFT) has emerged from research as an important factor in initiation and completion of therapy. Lack of readiness of individual service users has been proposed as a reason for poor uptake of TFT in large implementation programs. However, there has been almost no investigation of what constitutes readiness for TFT. In this review we build a conceptual case for readiness for TFT. We use qualitative research exploring PTSD treatment service users' and providers' experiences and perspectives of care together with two motivational theories (self-determination theory and motivation to engage in treatment) to propose a model of readiness for TFT. Readiness appears to encompass a) a motivational factor that includes willingness to undertake TFT and b) a set of determinants of motivation that may include the emotional burden of TFT, perceived suitability of TFT rationale; outcome expectancy; level of suffering; perceived competence; therapeutic relationship; autonomy; social supports; stigma; and problem recognition. This review is designed to encourage further research into this important clinical construct. It offers a new perspective on the need for a preparation phase before exposure in TFT, an issue of debate in the field.

Getting More Out of Clinical Documentation: Can Clinical Dashboards Yield Clinically Useful Information?

This study investigated coded data retrieved from clinical dashboards, which are decision-support tools that include a graphical display of clinical progress and clinical activities. Data were extracted from clinical dashboards representing 256 youth (M age = 11.9) from 128 practitioners who were trained in the Managing and Adapting Practice (MAP) system (Chorpita & Daleiden in BF Chorpita EL Daleiden 2014 Structuring the collaboration of science and service in pursuit of a shared vision. 43(2):323 338. 2014, Chorpita & Daleiden in BF Chorpita EL Daleiden 2018 Coordinated strategic action: Aspiring to wisdom in mental health service systems. 25(4):e12264. 2018) in 55 agencies across 5 regional mental health systems. Practitioners labeled up to 35 fields (i.e., descriptions of clinical activities), with the options of drawing from a controlled vocabulary or writing in a client-specific activity. Practitioners then noted when certain activities occurred during the episode of care. Fields from the extracted data were coded and reliability was assessed for Field Type, Practice Element Type, Target Area, and Audience (e.g., Caregiver Psychoeducation: Anxiety would be coded as Field Type = Practice Element; Practice Element Type = Psychoeducation; Target Area = Anxiety; Audience = Caregiver). Coders demonstrated moderate to almost perfect interrater reliability. On average, practitioners recorded two activities per session, and clients had 10 unique activities across all their sessions. Results from multilevel models showed that clinical activity characteristics and sessions accounted for the most variance in the occurrence, recurrence, and co-occurrence of clinical activities, with relatively less variance accounted for by practitioners, clients, and regional systems. Findings are consistent with patterns of practice reported in other studies and suggest that clinical dashboards may be a useful source of clinical information. More generally, the use of a controlled vocabulary for clinical activities appears to increase the retrievability and actionability of healthcare information and thus sets the stage for advancing the utility of clinical documentation.