Pub Date : 2019-01-01Epub Date: 2019-01-10DOI: 10.1017/S1754470X18000144
Laura K Murray, Emily E Haroz, Michael D Pullmann, Shannon Dorsey, Jeremy Kane, Jura Augustinavicius, Catherine Lee, Paul Bolton
The use of transdiagnostic mental health treatments in low resource settings has been proposed as a possible aid in scaling up mental health services. Modular, multi-problem transdiagnostic treatments can be used to treat a range of mental health problems and are designed to handle comorbidity. Two randomized controlled trials have been completed on one treatment - the Common Elements Treatment Approach, or CETA - delivered by lay counsellors in Iraq and Thailand. This paper utilizes data from two clinical trials to explore the delivery of CETA by lay providers, examining fidelity and flexibility of element use. Data were collected at every therapy session. Clients completed a short symptom assessment and providers described the clinical elements delivered during sessions. Analyses included descriptive statistics of delivery including selection and sequencing of treatment elements, and the variance in element dose, clustering at the counsellor level, using multi-level models. Results indicate that lay providers in low resource settings (with supervision) demonstrated fidelity to the recommended CETA elements, order and dose, and occasionally added in elements and flexed dosage based on client presentation (i.e. flexibility). This modular approach did not result in significantly longer treatment duration. Our analysis suggests that lay providers were able to learn decision-making processes of CETA based on client presentation and adjust treatment as needed with supervision. As modular multi-problem transdiagnostic treatments continue to be explored in low resource settings, research should continue to focus on 'unpacking' lay counsellor delivery of these interventions, decision-making processes, and the level of supervision required.
有人建议在资源匮乏的环境中使用跨诊断精神卫生治疗，作为扩大精神卫生服务的一种可能的援助。模块化、多问题的跨诊断治疗可用于治疗一系列精神健康问题，并设计用于处理合并症。两项随机对照试验已经完成了一种治疗方法——共同要素治疗方法(Common Elements treatment Approach，简称CETA)——由伊拉克和泰国的非专业咨询师提供。本文利用两项临床试验的数据来探索由非专业提供者提供的CETA，检查元素使用的保真度和灵活性。在每次治疗过程中收集数据。客户完成了一个简短的症状评估，提供者描述了在会议期间提供的临床要素。分析包括描述性统计，包括治疗要素的选择和顺序，以及要素剂量的方差，辅导员水平的聚类，使用多层次模型。结果表明，在低资源环境下(在监督下)，非专业医务人员对推荐的CETA元素、顺序和剂量表现出忠诚，偶尔会根据客户的介绍添加元素和灵活剂量(即灵活性)。这种模块化方法并没有显著延长治疗时间。我们的分析表明，非专业医生能够根据病人的陈述学习CETA的决策过程，并根据需要在监督下调整治疗。随着模块化多问题跨诊断治疗在低资源环境下的不断探索，研究应继续侧重于“拆解”非专业咨询师提供这些干预措施、决策过程和所需的监督水平。
{"title":"Under the hood: lay counsellor element use in a modular multi-problem transdiagnostic intervention in lower resource countries.","authors":"Laura K Murray, Emily E Haroz, Michael D Pullmann, Shannon Dorsey, Jeremy Kane, Jura Augustinavicius, Catherine Lee, Paul Bolton","doi":"10.1017/S1754470X18000144","DOIUrl":"https://doi.org/10.1017/S1754470X18000144","url":null,"abstract":"<p><p>The use of transdiagnostic mental health treatments in low resource settings has been proposed as a possible aid in scaling up mental health services. Modular, multi-problem transdiagnostic treatments can be used to treat a range of mental health problems and are designed to handle comorbidity. Two randomized controlled trials have been completed on one treatment - the Common Elements Treatment Approach, or CETA - delivered by lay counsellors in Iraq and Thailand. This paper utilizes data from two clinical trials to explore the delivery of CETA by lay providers, examining fidelity and flexibility of element use. Data were collected at every therapy session. Clients completed a short symptom assessment and providers described the clinical elements delivered during sessions. Analyses included descriptive statistics of delivery including selection and sequencing of treatment elements, and the variance in element dose, clustering at the counsellor level, using multi-level models. Results indicate that lay providers in low resource settings (with supervision) demonstrated fidelity to the recommended CETA elements, order and dose, and occasionally added in elements and flexed dosage based on client presentation (i.e. flexibility). This modular approach did not result in significantly longer treatment duration. Our analysis suggests that lay providers were able to learn decision-making processes of CETA based on client presentation and adjust treatment as needed with supervision. As modular multi-problem transdiagnostic treatments continue to be explored in low resource settings, research should continue to focus on 'unpacking' lay counsellor delivery of these interventions, decision-making processes, and the level of supervision required.</p>","PeriodicalId":45163,"journal":{"name":"Cognitive Behaviour Therapist","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S1754470X18000144","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37061057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01Epub Date: 2016-06-01DOI: 10.1017/S1754470X16000052
Manveer Kaur, Dominic Murphy, Kirsten V Smith
Trauma-focused cognitive behavioural therapy (TF-CBT) is beneficial for individuals with post-traumatic stress disorder (PTSD); however, a subset of clients struggle to engage with traditional methods, due to high levels of avoidance and dissociation. This paper aims to describe an adapted approach to imaginal reliving and prolonged exposure, to facilitate subsequent cognitive updating. The paper demonstrates the technique with veterans, who are a client group that may struggle with some aspects of traditionally implemented TF-CBT. Two case studies are described, both with PTSD symptoms stemming from traumatic military experiences. An adapted exposure technique is utilized to address the barriers of high dissociation, poor access to trauma-related cognitions and fixed intrusive imagery. The approach involved three stages: (1) reliving the trauma outdoors, (2) manipulating the perspectives of the imagery, and (3) restructuring the narrative with new perspectives. Both clients showed decreased dissociation and improved toleration of their traumatic imagery. Improvement of PTSD symptoms and quality-of-life functioning was observed for both clients on objective measures. Adapting TF-CBT to have a stronger emphasis on grounding and allocentric processing may be helpful for a subset of patients with PTSD that present with high levels of dissociation and avoidance. Further research and investigation into alternative populations is needed.
{"title":"An adapted imaginal exposure approach to traditional methods used within trauma-focused cognitive behavioural therapy, trialled with a veteran population.","authors":"Manveer Kaur, Dominic Murphy, Kirsten V Smith","doi":"10.1017/S1754470X16000052","DOIUrl":"https://doi.org/10.1017/S1754470X16000052","url":null,"abstract":"<p><p>Trauma-focused cognitive behavioural therapy (TF-CBT) is beneficial for individuals with post-traumatic stress disorder (PTSD); however, a subset of clients struggle to engage with traditional methods, due to high levels of avoidance and dissociation. This paper aims to describe an adapted approach to imaginal reliving and prolonged exposure, to facilitate subsequent cognitive updating. The paper demonstrates the technique with veterans, who are a client group that may struggle with some aspects of traditionally implemented TF-CBT. Two case studies are described, both with PTSD symptoms stemming from traumatic military experiences. An adapted exposure technique is utilized to address the barriers of high dissociation, poor access to trauma-related cognitions and fixed intrusive imagery. The approach involved three stages: (1) reliving the trauma outdoors, (2) manipulating the perspectives of the imagery, and (3) restructuring the narrative with new perspectives. Both clients showed decreased dissociation and improved toleration of their traumatic imagery. Improvement of PTSD symptoms and quality-of-life functioning was observed for both clients on objective measures. Adapting TF-CBT to have a stronger emphasis on grounding and allocentric processing may be helpful for a subset of patients with PTSD that present with high levels of dissociation and avoidance. Further research and investigation into alternative populations is needed.</p>","PeriodicalId":45163,"journal":{"name":"Cognitive Behaviour Therapist","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S1754470X16000052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36485220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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