Does postworkshop consultation affect which patients receive prolonged exposure and who improves the most?

Area of Science:

• Psychology
• Clinical Psychology
• Psychotherapy Research

Background:

• Effective training for behavioral health providers is crucial for widespread treatment adoption.
• The impact of different training models on provider adherence and patient outcomes remains understudied.
• Prolonged Exposure (PE) therapy is indicated for Posttraumatic Stress Disorder (PTSD), but its application across diverse patient profiles needs investigation.

Purpose of the Study:

• To evaluate the effect of Prolonged Exposure (PE) therapy training on provider implementation and patient outcomes in PTSD.
• To examine how patient comorbidities (e.g., substance use disorder, anxiety disorders, suicidality) moderate the impact of PE training.
• To compare the effectiveness of a standard PE workshop versus a workshop with postworkshop consultation.

Main Methods:

• 103 behavioral health providers in military clinics were randomized to a 4-day PE workshop with or without weekly consultation.
• Providers treated 242 patients with PTSD, and their use of PE components was assessed.
• Statistical analyses, including Poisson regression and multilevel models, examined moderating effects of patient characteristics on PE implementation and PTSD symptom change.

Main Results:

• Provider training with postworkshop consultation improved PE implementation, particularly for patients with comorbid substance use disorder (SUD).
• Providers without consultation used fewer PE components across comorbid conditions.
• Patients with comorbid SUD and suicidality showed greater PTSD improvement when treated by providers who received consultation.

Conclusions:

• Postworkshop consultation enhances the implementation of PE therapy for PTSD, especially in complex cases.
• Consultation is vital for improving clinical outcomes in military mental health settings.
• Training models incorporating ongoing support are more effective in promoting evidence-based practice.