Practically Speaking: Behind the Episode: Massed Treatments for PTSD - The Quickest Way Through the Fog?
Even die-hard proponents of evidence-based psychotherapy (EBP) such as myself acknowledge that it comes with challenges. Of course, there are some patients who are uninterested in EBPs for a variety of reasons. But even motivated and engaged patients don’t always complete treatment or gain significant benefit. Research has long focused on how we can improve outcomes and completion rates for “non responders” and “dropouts.”
Click here to listen to the episode! “Massed Treatments for PTSD: The Quickest Way Through the Fog?”
One adaptation that has been gaining empirical support is the massed delivery of EBPs. More specifically, research has been measuring engagement and outcomes for patients who receive treatments such as Cognitive Processing Therapy (CPT) or Prolonged Exposure (PE) more intensively, with daily sessions over a shorter duration of time. This promising research leads me to ask “what if I could successfully treat PTSD in two weeks instead of 12?”
On this episode of CDP’s Practical for Your Practice podcast, we talk to Dr. Cynthia Yamokoski, who has been applying this research to real clinical practice. In addition to being a consultant with the National Center for PTSD, Dr. Yamokoski also led a treatment team at a large VA medical center. She describes the challenges her team faced when working with Veterans with PTSD:
“One thing we did notice pretty early on is we did have some trouble keeping people engaged. We tried lots of different strategies, like what kind of support [do we need], do we need more training? We asked ourselves those same questions, maybe it's something we're doing. But I think we were left with that same concern that there seem to be some barriers and seem to be some challenges for some of our Veterans being able to finish these treatments that we know to be quite effective. So we didn't come up with … any immediate solutions, but we were left just pondering, ‘there has to be some other approach here.’ “
Her team became motivated to apply emerging research on the massed delivery of EBPs such as PE and CPT and they piloted a massed treatment program within their clinic. Their pilot generated promising data:
50% of veterans completed treatment when it was delivered weekly, but 87% completed it when delivery was massed.
For veterans with comorbid substance use concerns, completion rates for massed treatment were almost 80%, compared to 35% for those receiving weekly treatment.
There was no statistically significant difference in outcomes between completers who received weekly vs massed treatment, suggesting that massed treatment is noninferior to weekly treatment.
There is clearly cause for optimism in these findings. And while we all can’t deliver daily treatment to our patients, there may be ways to incorporate some of the strategies and lessons learned into many practices. In this episode, Dr. Yamokoski delves deeper into her team’s findings, shares some thoughts on why massed treatment may be more convenient for some patients than others, and she shares practical suggestions on how practicing clinicians can start applying this data to real world practice. Of course, she also shares her “EBP Confessional,” as all of our guests have done this season. Dr. Yamokoski’s “misstep” reminds us that we’re always recalibrating our treatment approach, no matter how experienced we are.
Click here to listen to the episode! “Massed Treatments for PTSD: The Quickest Way Through the Fog?”
If you have a question or topic you want to suggest for a future episode, feel free to drop us a voice-mail message at https://www.speakpipe.com/cdpp4p.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Carin Lefkowitz, Psy.D., is a clinical psychologist and Senior Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Dr. Lefkowitz earned her M.A. and Psy.D. in clinical psychology at Widener University, with a concentration in cognitive-behavioral therapy.
Even die-hard proponents of evidence-based psychotherapy (EBP) such as myself acknowledge that it comes with challenges. Of course, there are some patients who are uninterested in EBPs for a variety of reasons. But even motivated and engaged patients don’t always complete treatment or gain significant benefit. Research has long focused on how we can improve outcomes and completion rates for “non responders” and “dropouts.”
Click here to listen to the episode! “Massed Treatments for PTSD: The Quickest Way Through the Fog?”
One adaptation that has been gaining empirical support is the massed delivery of EBPs. More specifically, research has been measuring engagement and outcomes for patients who receive treatments such as Cognitive Processing Therapy (CPT) or Prolonged Exposure (PE) more intensively, with daily sessions over a shorter duration of time. This promising research leads me to ask “what if I could successfully treat PTSD in two weeks instead of 12?”
On this episode of CDP’s Practical for Your Practice podcast, we talk to Dr. Cynthia Yamokoski, who has been applying this research to real clinical practice. In addition to being a consultant with the National Center for PTSD, Dr. Yamokoski also led a treatment team at a large VA medical center. She describes the challenges her team faced when working with Veterans with PTSD:
“One thing we did notice pretty early on is we did have some trouble keeping people engaged. We tried lots of different strategies, like what kind of support [do we need], do we need more training? We asked ourselves those same questions, maybe it's something we're doing. But I think we were left with that same concern that there seem to be some barriers and seem to be some challenges for some of our Veterans being able to finish these treatments that we know to be quite effective. So we didn't come up with … any immediate solutions, but we were left just pondering, ‘there has to be some other approach here.’ “
Her team became motivated to apply emerging research on the massed delivery of EBPs such as PE and CPT and they piloted a massed treatment program within their clinic. Their pilot generated promising data:
50% of veterans completed treatment when it was delivered weekly, but 87% completed it when delivery was massed.
For veterans with comorbid substance use concerns, completion rates for massed treatment were almost 80%, compared to 35% for those receiving weekly treatment.
There was no statistically significant difference in outcomes between completers who received weekly vs massed treatment, suggesting that massed treatment is noninferior to weekly treatment.
There is clearly cause for optimism in these findings. And while we all can’t deliver daily treatment to our patients, there may be ways to incorporate some of the strategies and lessons learned into many practices. In this episode, Dr. Yamokoski delves deeper into her team’s findings, shares some thoughts on why massed treatment may be more convenient for some patients than others, and she shares practical suggestions on how practicing clinicians can start applying this data to real world practice. Of course, she also shares her “EBP Confessional,” as all of our guests have done this season. Dr. Yamokoski’s “misstep” reminds us that we’re always recalibrating our treatment approach, no matter how experienced we are.
Click here to listen to the episode! “Massed Treatments for PTSD: The Quickest Way Through the Fog?”
If you have a question or topic you want to suggest for a future episode, feel free to drop us a voice-mail message at https://www.speakpipe.com/cdpp4p.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Carin Lefkowitz, Psy.D., is a clinical psychologist and Senior Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Dr. Lefkowitz earned her M.A. and Psy.D. in clinical psychology at Widener University, with a concentration in cognitive-behavioral therapy.