Psychological Services最新文献

Depression can be effectively treated with internet-based computerized cognitive behavioral therapy (cCBT). The Veterans Health Administration (VHA) provided cCBT free to all veterans nationally as of 2013; however, its uptake has been limited. This study aimed to examine VHA primary care clinicians' and patients' perspectives regarding cCBT treatment for depression. We conducted semistructured interviews with 12 primary care clinicians (September-November 2020) and four focus groups involving 15 patients with depression (March-May 2021). Interview guides were developed using the Consolidated Framework for Implementation Research; questions addressed depression treatment barriers and facilitators, cCBT awareness and acceptability, target patient population for cCBT, and integration into depression management pathways. Data were analyzed for overarching themes using matrix analysis techniques. Few primary care clinicians and patients were aware of cCBT and its availability for veterans. Clinicians stressed the importance of identifying appropriate patients for cCBT use, specifically veterans with mild-to-moderate severity depression. Clinicians believed cCBT could potentially engage patients in depression treatment who may not otherwise engage and envisioned cCBT use to be guided by integrated VHA mental health personnel. Patients spoke of multiple treatment barriers (e.g., long wait times) and, correspondingly, viewed cCBT as facilitating access to mental health treatment. While patients raised some technical questions, they expressed interest in cCBT. Though relatively unknown to participants, cCBT was widely perceived to be acceptable and with the potential to increase access to depression treatment within VHA primary care settings. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

In recent years, the emergence of alternative response models (ARMs) in the United States has shifted greater responsibility to behavioral health (BH) professionals instead of police officers when responding to BH crises. Louisville (Kentucky) Metro launched the ARM Crisis Call Diversion Program in March 2022, which provides an alternative response to certain 911 calls involving a BH crisis. Overarching goals are to deflect BH-related calls from police and reduce unnecessary institutionalizations. Utilizing the Consolidated Framework for Implementation Research, semistructured interviews were conducted between December 2022 and June 2023 with 47 ARM responders (i.e., 35 first responders; 12 alternative responders). Interviews emphasized negative experiences related to program rollout, compassion fatigue, and burnout, which may impact responders' ability to fulfill their duties. Positive coping mechanisms of responders were also ascertained. First and alternative responders expressed similar sources of stressors when responding to individuals in crisis due to insufficient social support systems. All responder groups expressed a range of symptoms of compassion fatigue and burnout, but alternative responders demonstrated more awareness of the signs and a greater range of positive coping methods to address symptoms. As BH ARMs evolve, decision making related to planning, implementation, and expansion must consider responder burnout and compassion fatigue. Understanding responder burnout and compassion fatigue increases responder buy-in and can be used to improve implementation and decrease turnover. Ignoring these needs may lead to persistent barriers to implementation and negatively impact the quality of BH care individuals in crisis receive. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Though the implementation of science frameworks has recently been expanded to understand determinants of health equity (Woodward et al., 2021), the application of these frameworks in safety net hospital settings is new. We applied the health equity implementation framework to (a) understand the determinants of implementation and equity and (b) develop an institution-wide implementation facilitation plan for three evidence-based practices (EBPs) for posttraumatic stress disorder. We utilized researcher field notes from clinical case consultation gathered during posttraumatic stress disorder treatment implementation initiatives (cognitive processing therapy, written exposure therapy, brief skills training in affective and interpersonal regulation) at the same safety net hospital (N = 94 meetings total, from 2020 to 2023) to assess determinants of implementation and equity. We developed a qualitative codebook based on the health equity implementation framework to specify determinants and then built an implementation facilitation toolkit for multi-EBP implementation. Similar determinants were found across clinics and EBPs (e.g., provider training gaps and misperceptions about manualized treatments; inefficiencies in identification, triage, and referral pathways; patient engagement barriers related to stigma, literacy, and mistrust) with additional nuance per clinic and EBP. Institution-wide facilitation strategies were then utilized to enhance implementation and equity and focused on enhancing both access and quality of services (e.g., training and consultation, refining referral pathways) and patient engagement (e.g., culturally responsive training, consultation, and treatment delivery). Implementation science has an important role to play in enhancing health equity. Our findings illustrate how pooling determinants across clinics and treatments can help implementation scientists engage with hospital leadership and advocate for system-level implementation facilitation strategies. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Reintegration into civilian society following military separation is a challenging process. There is a dearth of research into the impact of these factors on Australian veteran reintegration. The purpose of this phenomenological study was to explore the lived experience of Australian veterans during reintegration, through the lens of acculturative stress and identity. Ten interviews were conducted with ex-serving members of the Australian Defence Force. Post-1990 veterans of all genders, who were at least 18 years of age, from all service branches were eligible for the study. Thematic analysis revealed two overarching themes each with three main themes; acculturative stress (assimilation, societal issues, social isolation), and integrated identity (acceptance, integrated communities, and adapting to the civilian world). Each main theme contained two subthemes illustrating their significance. Difficulty integrating civilian and veteran identities was a key barrier to successful reintegration and negative separation experiences undermined integration of civilian and veteran identities. Acculturative stressors identified were poor understanding by family, community, and clinicians of the incompatibility between military and civilian cultures. Education is needed for clinicians, the community, and families about military culture and difficulties for veterans when reintegrating into civilian society. Support for reintegration should be tailored to the needs of veterans encompassing personally meaningful activities, use of military skills in civilian contexts, ongoing membership of the military community and engagement with other veterans. This will ultimately foster integration of veteran and civilian identities, enabling veterans to retain their veteran identity in a manner that is adaptive for the civilian context. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Chronic insomnia is one of the most common health problems among veterans and can significantly impact health, function, and quality of life. Brief behavioral treatment for insomnia (BBTI), an adaptation of cognitive behavioral therapy for insomnia (CBT-I), was developed to help increase access to care outside of specialty settings. However, training providers alone is rarely sufficient, and implementation strategies are needed for successful uptake, adoption, and sustainable delivery of care. The current analysis compares the impact of providing BBTI training alone (BBTI) versus training plus implementation strategies (BBTI + IS) on veteran engagement in BBTI (i.e., reach) in Primary Care Mental Health Integration clinics. Providers from four Veterans Affairs (VA) medical centers completed BBTI training and then were given access to and support for implementation strategies. Core strategies implemented across all sites included developing an implementation blueprint, organizing implementation and educational meetings, developing and distributing educational materials, developing tools for quality monitoring, and facilitation. Veteran engagement in BBTI, CBT-I, insomnia diagnoses, and prescription sleep medication was measured using retrospective data from the VA Corporate Data Warehouse. Analyses were conducted using generalized linear models. Overall, sites significantly increased veteran engagement in BBTI (reach) from training alone and achieved further engagement with implementation strategies. At the site level, there was variability by phase, with three sites increasing BBTI only with training and one site increasing BBTI with training plus implementation support. These results are promising-increasing access to evidence-based behavioral insomnia care can be accomplished via BBTI training and easily implementable strategies. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Many who die by suicide seek care in general health care settings within a year before death, but only recently has suicide prevention become a core responsibility in these settings. Implementing suicide prevention practices is challenging, and common barriers to adoption include clinician attitudes and self-efficacy. Identifying clinician profiles can further illuminate patterns of suicide prevention practice attitudes and self-efficacy within clinician subgroups to inform implementation strategy selection and development. This study identified distinct clinician profiles of suicide prevention attitudes and confidence and examines their associations with suicide prevention practice delivery to patients. This study also investigated variables that help explain an individual's likelihood of belonging to latent profiles. Clinicians (N = 1,570) from one health care system completed a survey assessing attitudes, confidence in using suicide prevention practices, and current practice use. Latent profile analysis was conducted, followed by outcome and predictor analyses. Four unique profiles characterized by varying levels of attitudes and self-efficacy were identified. The profile characterized by poor attitudes toward the universal screening practice but high self-efficacy to utilize suicide prevention practices reported higher practice use with patients. Clinician characteristics (e.g., role) and contextual factors (e.g., leadership support) predicted profile membership. Results highlight meaningful variations in clinicians' suicide prevention attitudes and self-efficacy, identifying four distinct profiles. These findings highlight the need for further tailoring suicide prevention training and implementation strategy selection. Profiles characterized by neutral or low self-efficacy may benefit from implementation strategies that provide interactive assistance, while high confidence profiles may benefit from strategies targeting sustainment. Specific approaches to leverage these profiles for improved practice adoption are discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

There is a pressing need to scale up access to evidence-based mental health treatment. Offering transdiagnostic treatments that accommodate a variety of presenting concerns and comorbidities in integrated primary care settings via group format and telehealth modalities can help to efficiently increase access to care. To meet this need, we refined a brief group adaptation of the Unified Protocol for the transdiagnostic treatment of emotional disorders, called managing stress and emotions (MSE), which was modified for feasibility in integrated primary care settings and telehealth delivery. MSE comprises five 60-min classes emphasizing experiential skills-based learning. This pilot study evaluated the feasibility and acceptability of MSE while preliminarily evaluating effectiveness. We conducted an open trial with 18 patients (33% female, 89% White, M_age = 47 years) experiencing anxiety, depression, or adjustment difficulties who were recruited from Veterans Health Administration primary care. Using mixed methods, we assessed mental health symptoms and functioning from pre- to posttreatment and 3-month follow-up as well as treatment feasibility, acceptability, and satisfaction. MSE was feasible (89% engaged), and patients reported high treatment satisfaction. Pre- to posttreatment changes were promising, with medium-to-large effect sizes, and treatment gains generally remained stable at 3-months. Mixed methods data showed increased awareness of emotions and more use of adaptive coping strategies after MSE. Findings suggest further research evaluating effectiveness and implementation is warranted, as this is the briefest version of group Unified Protocol that has been tested thus far and can help to efficiently increase access to mental health treatment. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Exposure to trauma is a pervasive stressor that globally impacts millions of children and adults and can lead to severe adjustment problems. Although receiving evidence-based trauma-focused mental health treatment can effectively reduce distress associated with exposure to trauma, over half of those who schedule an intake session fail to attend, known as preintake attrition. Understanding factors that predict preintake attrition is essential for improving clinical care and triaging the allocation of clinic resources. This study examined clinic archival data sourced from an outpatient training clinic that focuses on delivering evidence-based trauma treatment. Data included records from 249 clients (n = 96 children; n = 153 adults) who completed a phone screen at the clinic between January 2022 and December 2023. Of the 249 total clients placed on the clinic waitlist, 52% (n = 129) attended their intake appointment. Results indicated that certain factors assessed during the initial phone screen (demographic characteristics, index trauma, and referral source) predicted preintake attrition. Notably, waitlist duration also emerged as a predictor of attrition; children who did not attend their intake spent nearly twice as many days on the waitlist compared with children who attended their intake. These findings provide insight into predictors of preintake attrition and suggest potential targets for developing strategies to increase engagement in trauma-focused treatment. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Previous research has found that Black veterans (vs. White veterans) evidence less symptom improvement following trauma-focused evidence-based psychotherapy (EBP) for posttraumatic stress disorder (PTSD). Black veterans' experiences of racism and discrimination, as well as how providers respond to these experiences during PTSD EBPs, may help to explain these racial disparities in outcomes. However, there is a lack of qualitative research exploring providers' experiences delivering PTSD EBPs to Black veterans. This study aimed to fill this gap in the literature by interviewing 15 mental health providers with experience delivering PTSD EBPs working at a West Coast Veterans Affairs Medical Center about (a) their comfort in discussing racism and discrimination with veterans, (b) the role of their identity in these discussions, (c) the extent to which racism and discrimination are presenting problems in PTSD EBPs, (d) Black veterans' response to PTSD EBPs, and (e) ways PTSD EBPs may be improved for Black veterans. Rapid analysis procedures were used to identify prominent and relevant themes, which are summarized and discussed with a focus on informing clinical recommendations and the development of provider training that may improve experiences and outcomes for Black veterans engaging in PTSD EBPs. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

In recent decades, depression and anxiety have worsened among American adults. Meditation apps may provide an accessible route for reducing these symptoms. However, many users experience barriers to persisting in their use of these apps. Prior research has identified psychosocial and practical barriers and facilitators to the use of meditation apps, as well as barriers and facilitators related to the apps themselves. Yet few prior studies have drawn on frameworks from the highly relevant field of implementation science, such as the Consolidated Framework for Implementation Research. A lack of unifying implementation science frameworks has limited shared language to describe barriers and facilitators and has made it challenging to identify and account for multilevel factors impacting the implementation of meditation apps. As such, this study used the Consolidated Framework for Implementation Research to explore the implementation of the Healthy Minds Program meditation app among users experiencing elevated depressive and/or anxiety symptoms. Participants (n = 20) were drawn from a meditation dosage clinical trial and interviewed about their experiences establishing a meditation practice using the Healthy Minds Program app. Using the Consolidated Framework for Implementation Research and deductive qualitative content analysis, four categories were generated: practical facilitators to developing a meditation practice, motivations for developing and maintaining a meditation practice, barriers to developing a meditation practice, and recommendations for improving the app. Overall, participants reported positive outcomes from their practice, which, for some, motivated their continued use of the Healthy Minds Program app. Future research should consider how barriers and facilitators may change over time with increased engagement and experience with meditation apps and practice. (PsycInfo Database Record (c) 2025 APA, all rights reserved).