Presentation Title: Training to Promote National Dissemination of CBCT for PTSD in the U.S. Department of Veterans Affairs

Abstract: The US. Department of Veterans Affairs has embarked on a major national effort to disseminate several evidence-based couple and family therapies in response to the mandate from Public Law 110-387. While the first couples intervention selected for dissemination was a broad-based treatment to reduce marital distress (Integrative Behavioral Couples Therapy; Jacobson and Christensen, 1996), subsequent initiatives have employed disorder-specific couple therapies to reduce substance abuse (Behavioral Couples Therapy for Substance Abuse; O’Farrell, 2000) and post-traumatic stress disorder (PTSD) (Cognitive-Behavioral Conjoint Therapy for PTSD; (CBCT) Monson & Fredman, 2012). This presentation will provide an overview of the VA initiative to train VA mental health clinicians to conduct CBCT with Veterans diagnosed with PTSD and their partners. CBCT is a manualized conjoint outpatient treatment which includes psychoeducation, behavioral skills to enhance communication and decrease PTSD-related avoidance, and dyadic cognitive techniques to address maladaptive thoughts that maintain PTSD. Licensed mental health clinicians undergo a competitive selection process for openings in twice yearly 3 ½ day face-to-face workshops which include didactic and experiential learning, followed by a 6-month phone consultation in which they receive weekly feedback using standard adherence ratings on audiotaped therapy sessions they conduct with 2-3 training cases. Trainees must meet specified competency standards in CBCT to be deemed successful completers. To date, the VA has held two rounds of training. Knowledge gains and participant satisfaction with the trainings are high. While the majority of those who attended the initial trainings have become successful completers, they have also encountered challenges in implementing the model, primarily around 1) identifying and engaging appropriate training cases and 2) incorporating a treatment whose intensive structure (e.g. weekly 75 minutes sessions) is challenging to mount in a system recommitted to assuring timely service access to Veterans with emerging problems. Strategies to address these challenges will be presented.

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