Understanding therapists' perceived determinants of trauma narrative use

Area of Science:

• Implementation Science
• Clinical Psychology
• Behavioral Health

Background:

• Trauma narratives are a core component of trauma-focused cognitive-behavioral therapy (TF-CBT) but are underutilized by community therapists.
• Exposure-based components, like trauma narratives, show the weakest therapist intentions for delivery within TF-CBT.
• Understanding multilevel influences on trauma narrative (TN) use requires integrating social psychology and implementation science frameworks.

Purpose of the Study:

• To investigate the multilevel factors influencing community therapists' use of trauma narratives.
• To integrate the Theory of Planned Behavior (TPB) and the Consolidated Framework for Implementation Research (CFIR) to understand therapist behavior regarding TNs.
• To identify determinants of therapist behavior related to the implementation of evidence-based practices.

Main Methods:

• Survey data from 65 therapists trained in TF-CBT assessed beliefs and use of trauma narratives.
• Content analysis identified common therapist beliefs regarding trauma narratives.
• Qualitative interviews with 17 therapists, analyzed using an integrated CFIR approach, explored contextual factors.

Main Results:

• Despite high intentions, nearly half of therapists reported not using trauma narratives in the past six months.
• Survey data revealed several TPB-related determinants influencing trauma narrative use.
• Qualitative findings identified CFIR-relevant contextual factors impacting TPB constructs.

Conclusions:

• Therapist intentions to use trauma narratives do not consistently translate into practice.
• Implementation of evidence-based practices like trauma narratives is influenced by a complex interplay of individual, organizational, and client factors.
• Integrating theoretical approaches addressing multiple determinants is crucial for explaining and improving therapist behavior in implementing interventions.