LoSavio Stefanie T, Worley Courtney B, Walser Robyn D, Kaysen Debra, Rosen Craig S, Wiltsey Stirman Shannon
Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio.
National Center for PTSD, Dissemination and Training Division.
Psychol Serv. 2024 Oct 3. doi: 10.1037/ser0000890.
The Veterans Health Administration (VHA) has rolled out evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD); however, reach has remained low, and there is a need for briefer interventions. The National Center for PTSD conducted a facilitated learning collaborative to train clinicians and support VHA PTSD teams in their adoption of an emerging best practice, written exposure therapy (WET). Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) evaluation framework, the present study utilized longitudinal data from 178 clinicians and 556 patients across seven training cohorts to evaluate key clinical and implementation outcomes and whether clinic (i.e., implementation climate) or clinician factors (i.e., treatment attitudes) were associated with effectiveness and implementation. Intent-to-treat analyses indicated WET was effective in reducing PTSD ( = 0.54) and depression symptoms ( = 0.39). Data indicated that 87.60% of clinicians reported using WET 6 months postconsultation. Clinic-wide reach was modest after training (14.53% of individuals with PTSD); however, WET-trained clinicians continued to offer WET to an average of 87.38% of their patients. Fidelity remained high after training, with essential session elements most often being offered "always" ( = 6.65 on a scale from 1 to 7). More positive postconsultation clinician treatment attitudes predicted higher posttraining rates of having patients engaged in WET. Clinician treatment attitudes and implementation climate did not predict any other implementation or effectiveness outcomes examined. Results suggest that WET implementation is advancing in VHA, with good clinical outcomes. Data provide evidence that a facilitated learning collaborative can be used to support and scale EBPs. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
退伍军人健康管理局（VHA）已推出针对创伤后应激障碍（PTSD）的循证心理疗法（EBPs）；然而，其普及程度仍然较低，因此需要更简短的干预措施。美国国家PTSD中心开展了一项促进学习协作项目，以培训临床医生，并支持VHA的PTSD治疗团队采用一种新兴的最佳实践方法——书面暴露疗法（WET）。本研究以普及、效果、采用、实施和维持（RE-AIM）评估框架为指导，利用来自七个培训队列的178名临床医生和556名患者的纵向数据，评估关键的临床和实施结果，以及诊所因素（即实施氛围）或临床医生因素（即治疗态度）是否与疗效和实施情况相关。意向性分析表明，WET在减轻PTSD症状（ = 0.54）和抑郁症状（ = 0.39）方面有效。数据显示，87.60%的临床医生报告在咨询后6个月使用WET。培训后，全诊所范围内的普及程度一般（PTSD患者中的14.53%）；然而，接受WET培训的临床医生继续为平均87.38%的患者提供WET。培训后保真度仍然很高，基本的疗程要素最常被“始终”提供（在1至7分的量表上得分为6.65）。咨询后更积极的临床医生治疗态度预示着患者接受WET培训后的比例更高。临床医生的治疗态度和实施氛围并未预测所检查的任何其他实施或疗效结果。结果表明，VHA中WET的实施正在推进，临床效果良好。数据提供了证据，表明促进学习协作可用于支持和推广EBPs。（PsycInfo数据库记录（c）2025美国心理学会，保留所有权利）
