Ruzek Josef I, Eftekhari Afsoon, Rosen Craig S, Crowley Jill J, Kuhn Eric, Foa Edna B, Hembree Elizabeth A, Karlin Bradley E
National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System.
Department of Psychiatry, University of Pennsylvania.
Psychol Trauma. 2016 May;8(3):348-355. doi: 10.1037/tra0000004. Epub 2015 Nov 2.
Evidence for treatment efficacy does not guarantee adoption in clinical practice. Attitudinal "buy-in" from clinicians is also important. This study examines evaluation data from a national training program in an evidence-based treatment for PTSD, Prolonged Exposure (PE) therapy, to assess changes in clinician beliefs related to the importance of specific treatment goals, PE outcome expectations, self-efficacy to deliver PE, perceived time and emotional burdens associated with delivering PE, and intentions to use PE.
Training included both an interactive workshop and posttraining telephone consultation. Participants were 943 licensed mental health clinicians who treated veterans with PTSD. They completed questionnaires before and after the workshop, and after consultation.
Results indicated that workshop participation was associated with significant increases in perceptions of the importance of helping patients improve by employing PE, expectations that patients would benefit from PE, and self-efficacy to deliver PE, and with reduced expectations of negative patient outcomes and concerns about distressing patients. The workshop alone had little impact on expected clinician emotional burden and no impact on anticipated time burden. Participation in ongoing case consultation was associated with additional increases in expected positive patient outcomes and clinician self-efficacy and further reductions in concerns about distressing patients and negative patient outcomes. Unlike the workshop, consultation was associated with decreased expectancies that PE would take too much time and would be emotionally burdensome to provide.
Overall, the results suggest that the combination of workshop and ongoing consultation can significantly improve beliefs likely to affect treatment adoption. (PsycINFO Database Record
治疗效果的证据并不能保证其在临床实践中的应用。临床医生的态度“认同”也很重要。本研究调查了一项针对创伤后应激障碍（PTSD）的循证治疗——延长暴露（PE）疗法的全国培训项目的评估数据，以评估临床医生在以下方面信念的变化：特定治疗目标的重要性、对PE疗效的期望、实施PE的自我效能感、实施PE所感知到的时间和情感负担，以及使用PE的意向。
培训包括一个互动研讨会和培训后的电话咨询。参与者为943名治疗PTSD退伍军人的有执照心理健康临床医生。他们在研讨会前、研讨会后以及咨询后完成问卷。
结果表明，参加研讨会与以下方面的显著增加相关：认为通过采用PE帮助患者改善的重要性、对患者将从PE中受益的期望以及实施PE的自我效能感，同时与对患者负面结果的期望降低以及对困扰患者的担忧减少相关。仅研讨会对预期的临床医生情感负担影响不大，对预期的时间负担没有影响。参与持续的病例咨询与预期的患者积极结果和临床医生自我效能感的进一步增加以及对困扰患者和患者负面结果的担忧进一步减少相关。与研讨会不同，咨询与认为PE会花费太多时间且提供时情感负担过重的期望降低相关。
总体而言，结果表明研讨会和持续咨询相结合可以显著改善可能影响治疗应用的信念。（PsycINFO数据库记录）
