A Non-randomized Comparison of Strategies for Consultation in a Community-Academic Training Program to Implement an Evidence-Based Psychotherapy.

Despite the central role of training and consultation in the implementation of evidence-based psychological interventions (EBPIs), comprehensive reviews of research on training have highlighted serious gaps in knowledge regarding best practices. Consultation after initial didactic training appears to be of critical importance, but there has been very little research to determine optimal consultation format or interventions. This observational study compared two consultation formats that included review of session audio and feedback in the context of a program to train clinicians (n = 85) in community mental health clinics to deliver cognitive therapy (CT). A "gold standard" condition in which clinicians received individual feedback after expert consultants reviewed full sessions was compared to a group consultation format in which short segments of session audio were reviewed by a group of clinicians and an expert consultant. After adjusting for potential baseline differences between individuals in the two consultation conditions, few differences were found in terms of successful completion of the consultation phase or in terms of competence in CT at the end of consultation or after a 2 year follow-up. However, analyses did not support hypotheses regarding non-inferiority of the group consultation condition. While both groups largely maintained competence, clinicians in the group consultation condition demonstrated increases in competence over the follow-up period, while a sub-group of those in the individual condition experienced decreases. These findings, if replicated, have important implications for EBP implementation programs, as they suggest that observation and feedback is feasible in community mental health setting, and that employing this method in a group format is an effective and efficient consultation strategy that may enhance the implementation and sustainability of evidence-based psychotherapies.

The influence of depressive symptoms on suicidal ideation among U.S. Vietnam-era and Afghanistan/Iraq-era veterans with posttraumatic stress disorder.

Major depressive disorder (MDD) co-occurs frequently with posttraumatic stress disorder (PTSD), and both disorders are linked to suicidal ideation. An emergent literature examines suicidal ideation in U.S. Afghanistan/Iraq-era veterans. Little research, however, has studied the role of PTSD and comorbid MDD on suicidal ideation across service eras. Therefore, this study aimed to examine the impact of depression on suicidal ideation in Afghanistan/Iraq-era and Vietnam-era veterans with PTSD. The sample included 164 Vietnam and 98 Afghanistan/Iraq veterans diagnosed with PTSD at a VA outpatient PTSD Clinic. Using structured interviews, 63% of the Vietnam sample and 45% of the Afghanistan/Iraq sample were diagnosed with comorbid current MDD. Measures included self-report assessments of PTSD and depressive symptoms and the Personality Assessment Inventory. Results of analyses suggested that in veterans of both eras, PTSD, MDD, and their interaction were significantly related to suicidal ideation (PTSD: η(2) = .01; MDD: η(2) = .10; PTSD × MDD: η(2) = .02). For veterans reporting greater depressive symptoms, there was a stronger relationship between PTSD symptoms and suicidal ideation. These results suggest that veterans from both eras display a similar clinical presentation and highlight the need to consider depressive symptoms when assessing veterans with PTSD. Future research should examine suicidal ideation and behaviors as they change over time in these two cohorts.

Staff Views of an Emergency Department Intervention Using Safety Planning and Structured Follow-Up with Suicidal Veterans.

The objective of this study is to summarize staff perceptions of the acceptability and utility of the safety planning and structured post-discharge follow-up contact intervention (SPI-SFU), a suicide prevention intervention that was implemented and tested in five Veterans Affairs Medical Center emergency departments (EDs). A purposive sampling approach was used to identify 50 staff member key informants. Interviews were transcribed and coded using thematic analysis. Almost all staff perceived the intervention as helpful in connecting SPI-SFU participants to follow-up services. A slight majority of staff believed SPI-SFU increased Veteran safety. Staff members also benefited from the implementation of SPI-SFU. Their comfort discharging Veterans at some suicide risk increased. SPI-SFU provides an appealing option for improving suicide prevention services in acute care settings.

An Emergency Department Intervention and Follow-Up to Reduce Suicide Risk in the VA: Acceptability and Effectiveness.

OBJECTIVE: Emergency departments (EDs) are often the primary contact point for suicidal individuals. The post-ED visit period is a high suicide risk time. To address the need for support during this time, a novel intervention was implemented in five Department of Veterans Affairs medical center EDs. The intervention combined the Safety Planning Intervention (SPI) with structured follow-up and monitoring (SFU) by telephone for suicidal individuals who did not require hospitalization. This study assessed the intervention's acceptability and perceived usefulness. METHODS: A selected sample of 100 intervention participants completed a semistructured interview consisting of open-ended questions about the intervention's acceptability, usefulness, and helpfulness. Satisfaction with the SPI and SFU was separately evaluated. RESULTS: Nearly all participants found the SAFE VET intervention to be acceptable, reporting that it was helpful in preventing further suicidal behavior and fostering treatment engagement. CONCLUSIONS: The SAFE VET intervention showed promise as an ED intervention for suicidal patients.

Public eyewitness confidence can be influenced by the presence of other witnesses.

Four experiments were conducted to examine whether witnesses' public confidence ratings differ from their private ratings when there are social pressures to use confidence as an impression-management tool. In all four experiments, participants answered questions about a source event (a series of faces in the first three experiments and a simulated crime scene in the fourth). Half of the responses and confidence ratings were given privately and anonymously, and half were given publicly in front of one or more mock jurors. Two central findings emerged from the results. First, public confidence differed from private confidence only when there was more than one witness; when there were no other witnesses, public and private confidence were the same. Second, the direction of the change in public confidence in the multiple-witness settings was influenced by whether or not there was a possibility of being contradicted by the other witnesses. When there was no chance that the participants' responses could be contradicted, they raised their confidence ratings in public; when there was a chance that the other witnesses might contradict them, the participants lowered their public confidence ratings. The results are discussed in terms of self-presentation theory and implications for the legal system.

Post-traumatic stress disorder and acute stress disorder I: their nature and assessment considerations.

POST-TRAUMATIC STRESS DISORDER (PTSD) is a common and often chronic and disabling anxiety disorder that can develop after exposure to highly stressful events characterized by actual or threatened harm to the self or others. This is the first of two articles summarizing the nature and treatment of PTSD and the associated condition of acute stress disorder (ASD). The present article presents the diagnostic criteria for PTSD and ASD, summarizes the epidemiology of exposure to trauma and resulting PTSD/ASD, discusses implications of these data for assessment and treatment, and provides a summary of several useful assessment instruments. A companion paper to be published in a future issue of Psychiatry 2005 will provide a summary of empirically supported treatments, both psychological and pharmacological, for PTSD and ASD.

Posttraumatic Stress Disorder and Acute Stress Disorder II: Considerations for Treatment and Prevention.

Posttraumatic stress disorder is a common and often chronic and disabling anxiety disorder that can develop after exposure to highly stressful events characterized by actual or threatened harm to the self or others. This is the second of two invited articles summarizing the nature and treatment of PTSD and the associated condition of acute stress disorder (ASD). The present article reviews evidence for the efficacy of psychological and pharmacological treatments for PTSD and ASD. In summary, cognitive behavior therapy (CBT) has been found efficacious in the treatment of chronic PTSD as well as the treatment of ASD/prevention of PTSD. The selective serotonin reuptake inhibitors, sertraline, paroxetine, and fluoxetine, have been found efficacious in the treatment of chronic PTSD, with sertraline and paroxetine receiving the FDA indication for this condition. There is less evidence for efficacious medications in the treatment of ASD/prevention of PTSD. At present, hydrocortisone and propranolol show the greatest promise. Limitations of these treatments, including dropout and a significant number of patients showing no or only partial response, are discussed as well as issues related to selecting among efficacious treatments.