Using a Learning Collaborative Model to Disseminate Cognitive Processing Therapy to Community-Based Agencies

Although effective treatments for posttraumatic stress disorder exist, their use in community settings is disappointingly low. Training alone does not necessarily lead to adoption. To address this problem, we trained community clinicians in cognitive processing therapy, an evidence-based treatment for posttraumatic stress disorder, using a Learning Collaborative, an intensive training methodology focused on both clinical training and developing sustainability. Sixty clinicians within 18 agencies began the year-long, team-based Learning Collaborative. Clinicians attended three in-person Learning Sessions, received weekly consultation, and submitted audio-recorded sessions to be rated for fidelity. Clinicians were rostered as approved treatment providers if they completed all training requirements. Additionally, we engaged leadership from each agency to build a sustainable practice. Clinicians trained through the Learning Collaborative demonstrated a high degree of fidelity to the treatment (average competence ratings “satisfactory” to “good”), and most (68%) were rostered as approved treatment providers. Patients treated by clinician trainees exhibited significant symptom reductions (d = 1.68 and 1.28 for posttraumatic stress and depression symptoms, respectively, among treatment completers). At a 6-month follow-up, 95% of rostered clinicians and 100% of agencies with rostered clinicians were still providing the treatment. These results suggest that the Learning Collaborative model is a promising approach for the dissemination and implementation of evidence-based treatments for adult posttraumatic stress disorder.     

Self-Esteem, Mood, and Intentions to Use Condoms: When Does Low Self-Esteem Lead to Risky Health Behaviors?

The authors assessed the interactive effects of self-esteem and mood on intentions to engage in unprotected sexual intercourse. Prior research has shown that people with low self-esteem tend to evaluate themselves unfavorably when in a negative mood state, whereas people with high self-esteem are less susceptible to changes in self-evaluation following a negative mood induction. The authors hypothesized that people who engage in negative self-evaluations may be more likely to report intentions to engage in unprotected sexual intercourse. Undergraduate females were randomly assigned to a positive or negative mood induction condition. Consistent with their hypotheses, the authors found that among participants who were in a negative mood state, those with low self-esteem were more likely to report intentions to have sexual intercourse without a condom than were those with high self-esteem. In contrast, among participants in a positive mood, there were no differences between those who were low and high in self-esteem.     

Measuring implementation intentions in the context of the theory of planned behavior

The usefulness of measuring implementation intentions in the context of the theory of planned behavior (TPB) was explored among 112 Norwegian college students. They responded to a questionnaire measuring past behavior, perceived behavioral control, behavioral intentions, implementation intentions, and actual performance of regular exercising and recycling of drinking cartons. Implementation intentions were measured using five items relating to recycling and four items relating to exercise, which showed satisfactory internal consistencies. Consistent with the main prediction, the presence of implementation intentions was related to performing the two behaviors, although behavioral intentions were the strongest determinant for both behaviors. The results suggest that the TPB may benefit from inclusion of the concept of implementation intentions to provide a more complete understanding of the psychological process in which motivation is translated into action.     

Implementing ethics in the professions: Preparing guidelines on scientific communication for the Society for Neuroscience

In 1994, the governing council of the Society for Neuroscience was asked to make a brief statement on an issue regarding responsible conduct in publishing. The present article reviews how that initial request grew over the next four years into a lengthy document. Drawing on that experience, which was presided over by the author, comments are made about the potential impact of such guidelines, the lessons learned, and the proper role of professional societies in promoting responsible conduct in research.     

Therapist Self-Efficacy in Delivering Cognitive Processing Therapy in a Randomized Controlled Implementation Trial

Efforts to improve the implementation of evidence-based treatments (EBT) have recently made important strides. One such example is understanding the vital role that weekly consultation plays as therapists learn to deliver an EBT. Because mechanism-based research can further support EBT implementation, the present study sought to examine the potential relationship between therapist self-efficacy in relation to treatment fidelity and outcomes.We examined therapist self-efficacy ratings from 80 therapists working with 188 patients. These data were collected as part of a randomized controlled implementation trial testing cognitive processing therapy (CPT). Across post-workshop training conditions, we ran multilevel models to assess (1) changes in therapist self-efficacy, (2) therapist self-efficacy in relation to treatment fidelity, and (3) therapist-self-efficacy in relation to patient PTSD symptom outcomes.We found that therapist self-efficacy significantly improved over the course of 6 months of CPT training. Baseline therapist self-efficacy was differentially associated with client outcomes based on post-workshop training condition. Specifically, therapists with low self-efficacy that did not receive post-workshop consultation tended to have poorer outcomes than therapists with low self-efficacy that received consultation. In the present sample, therapist self-efficacy was not related to treatment fidelity.As this was the first study to examine therapist self-efficacy in the implementation of an evidence-based treatment, our findings suggest that self-efficacy may be an important implementation factor in treatment outcomes and worthy of ongoing research.     

Exposure Therapy Beliefs and Utilization for Treatment of PTSD: A Survey of Licensed Mental Health Providers

Exposure-based therapies for posttraumatic stress disorder (PTSD) and anxiety disorders remain underutilized, despite their effectiveness and widescale dissemination efforts. This study surveyed a broad range of licensed providers (N = 155) to examine rates at which prolonged exposure (PE) and other interventions are used to treat PTSD and to investigate provider characteristics linked to exposure beliefs and utilization. While 92.3% of clinicians reported understanding of or training in exposure, only 55.5% of providers reported use of PE to treat PTSD. Clinicians with current cognitive behavioral therapy (CBT) orientation, CBT training orientation, a doctoral degree, and training in PE endorsed greater likelihood of exposure utilization for PTSD (ps < .001, ds = 0.82–1.98) and less negative beliefs about exposure (ps < .01, ds = 0.55–2.00). Exposure beliefs also differed based on healthcare setting (p < .001). Among providers trained in exposure (n = 106), master’s degree and non-CBT current theoretical orientation were associated with high utilization yet also negative beliefs. Results suggest exposure training, accurate beliefs, and utilization still lag among some groups of providers. Additionally, negative beliefs and misunderstanding of the exposure rationale may persist even among providers who are trained and report high utilization.     

Intention inertia and the plasticity of planning

In this article, I examine Michael Bratman’s account of stability in his planning theory of intention (PTI). Future-directed intentions should be stable, or appropriately resistant to change, over time. Bratman claims that the norm of stability governs both intentions and plans. The aim of this article is to critically enrich Bratman’s account of stability by introducing plasticity as an additional norm of planning. I construct plasticity as a kind of stability of intentions which supplements Bratman’s notion of “reasonable stability.” Unlike the latter, plasticity applies mainly to cases in which plan states are abandoned without reconsideration. I focus on the intra-theoretical problems of PTI and elucidate: (1) the distinction between future-directed intentions and plans, (2) the conceptual difference between stability and inertia, which is only implicit in PTI, and (3) the role of the environment of the planner, which has a vestigial role in Bratman’s work. I also defend my incorporation of plasticity against one possible objection and support it in the context of Bratman’s later works. Although critical, my proposal is in moderate harmony with PTI.     

Person-environment fit,job satisfaction and intentions to leave: The moderating effect of leader empowering behaviour

This study sought to determine the possible indirect effect of person-environment (PE) fit on intentions to leave via job satisfaction and the moderating effect of leader empowering behaviour on job satisfaction and intentions to leave the work organisation. Participants were 398 employees working for a retail company in Gauteng Province, South Africa (females = 68.6 %, blacks = 58 %; managerial = 5.8 %; age range = under 20 to 60 years +). They completed the Perceived Fit Scale, Job Satisfaction Scale, Turnover Intentions Scale, and the Leader Empowering Behaviour Questionnaire. Statistical mediation analysis (of PE on JS and IL), and moderation analysis (of LEB on JS and IL) were conducted. Results indicated that PE fit has an indirect effect on intentions to leave via job satisfaction. Leader empowering behaviour moderated the relationship between job satisfaction and intentions to leave. Low PE fit leads to job dissatisfaction and intentions to leave, therefore leaders should instil a sense of empowerment in employees to alleviate the impact of poor fit.