Delivery of an evidence-based therapy for posttraumatic stress disorder (PTSD): A combined analysis of clinical effectiveness and associated economic benefits.

The project represents an open trial, aiming to examine the benefits to society of providing effective PTSD therapy to clients (i.e., does reducing PTSD have economic and social benefits) while also examining the cost-benefit ratio of training costs and client outcomes. Additionally this project will explore clinician’s beliefs surrounding evidence-based practices, in order to better understand the barriers preventing the implementation of EBPs in trauma treatment. There are two components to this project, first, approximately 30 clinicians will receive training in an evidence-based trauma-focused therapy known as Cognitive Processing Therapy (CPT). Second, each clinician will then engage with 5-10 clients over the course of the study and provide CPT. 30 clinicians across multiple sites and services in Adelaide (e.g., SA health sites) will receive CPT training. In this study ‘clinicians’ encompass psychologists, social workers, counsellors or other suitable health professionals. Clinicians first undertake an online training course in CPT (taking approximately 13hrs), followed by a 2-day workshop in Cognitive Processing Therapy (CPT), conducted by Prof Reg Nixon. Clinicians will complete the online training 1-2 weeks before attending the workshop. Following the training, clinicians receive 6-months of weekly (1 hour) expert CPT consultation, from two Clinical Psychologists who are certified CPT trainers. This is conducted via Zoom in groups of up to 10 clinicians. Delivery of CPT sessions will start following the 2-day workshop, with weekly expert CPT consultations occurring concurrently for 6-months. Clinicians will continue to provide CPT to clients presenting at their service for a further 6-months. Potential clients will already be seeking mental health treatment at the sites involved in this study. Each site has its own routine clinical intake process and clients identified as potentially being eligible through these processes will be given the opportunity to participate in the study (and will complete measures to establish eligibility). Eligible clients will then complete pre-treatment assessment via a Qualtrics survey. As this is an effectiveness trial (done in routine mental health setting), we are not doing formal fidelity adherence. However, clinicians will indicate what is done during therapy in their routine case notes and additionally, monitoring occurs during consultation (supervision) in the first 6-months. CPT is an evidence-based cognitive behavioural therapy for PTSD developed by Resick, Monsoon and Chard (2017). In the current study, participants will receive individually administered CPT which involves weekly, 60-minute sessions (face to face, or via tele-health if required). CPT duration is usually between 8 to 18 weeks depending on a client's individual needs. In determining how many sessions are required, Clinicians will use their clinical judgment which will be informed by weekly monitoring of PTSD symptoms. Regardless of how many sessions are administered all key CPT components will be covered, some clients may just need more sessions on particular components. Initial sessions provide a rationale for the approach, and psychoeducation about PTSD. Participants are asked to write an impact statement about how the trauma has impacted their life and beliefs about their self, others and the world. Client’s will complete the impact statements in their own time and clients can be quite variable in the length of time they take to complete these impact statements. Subsequent sessions then focus upon learning to identify and label thoughts and feelings, and challenging unhelpful automatic thoughts through Socratic questioning. Therapist works with the participant to develop strategies for generating more useful and helpful thinking patterns. The final sessions focus on maladaptive beliefs surrounding safety, trust, power, esteem, intimacy (domains that are often impacted by PTSD). Before the final session of CPT, participants write a new impact statement which typically reflects treatments gains, and relapse prevention is discussed.