Alan McGuire1, Marianne S Matthias2, Marina Kukla3, Nancy Henry4, Jessica Carter5, Mindy Flanagan6, Matthew J Bair7, Jennifer L Murphy8. 1. Clinical Research Psychologist at the Richard L. Roudebush VA Medical Center in the HSR&D Center for Health Information and Communication and an Associate Research Professor in the Department of Psychology at Indiana University-Purdue University at Indianapolis. 2. Research Scientist at the Roudebush VA Medical Center and Regenstrief Institute in Indianapolis, IN, and Associate Research Professor in the Department of General Internal Medicine and Geriatrics at the Indiana University School of Medicine. 3. Research Scientist and Clinical Psychologist at the Richard L. Roudebush VA Medical Center in the HSR&D Center for Health Information and Communication and an Associate Research Professor in the Department of Psychology at Indiana University-Purdue University at Indianapolis. 4. project manager for the Richard L. Roudebush VA Medical Center in the HSR&D Center for Health Information and Communication and the Department of Psychology at Indiana University-Purdue University at Indianapolis. 5. research assistant for the Richard L. Roudebush VA Medical Center in the HSR&D Center for Health Information and Communication. 6. Senior Research Scientist at Parkview Health and Research Consultant at Richard L. Roudebush VA HSR&D Center for Health Information and Communication. 7. Research Scientist for the Richard L. Roudebush VA Health Services Research and Development Center for Health Information and Communication, Staff Physician at Richard L. Roudebush VA Medical Center, and Regenstrief Research Scientist. 8. Director of Behavioral Pain Medicine for the Veterans Health Administration and is Master Trainer for VA's Cognitive Behavioral Therapy for Chronic Pain (CBT-CP). Dr. Murphy is Associate Professor in the University of South Florida's Morsani College of Medicine and serves on the editorial board of Pain Medicine.
Abstract
The implementation of evidence-based psychotherapies, including patient-level measures such as penetration and rates of successfully completing a course of therapy, has received increasing attention. While much attention has been paid to the effect of patient-level factors on implementation, relatively little attention has been paid to therapist factors (e.g., professional training, experience). OBJECTIVE: The current study explores therapists' decisions to offer a particular evidence-based psychotherapy (cognitive behavioral therapy for chronic pain; CBT-CP), whether and how they modify CBT-CP, and the relationship between these decisions and patient completion rates. METHODS: The study utilized survey responses from 141 Veterans Affairs therapists certified in CBT-CP. RESULTS: Therapists reported attempting CBT-CP with a little less than one half of their patients with chronic pain (mean = 48.8%, s.d.=35.7). Therapist were generally split between reporting modifying CBT-CP for either very few or most of their patients. After controlling for therapist characteristics and modification, therapist-reported percentage of patients with attempted CBT-CP was positively associated with completion rates, t (111) = 4.57, p<.001. CONCLUSIONS: Therapists who attempt CBT-CP more frequently may experience better completion rates, perhaps due to practice effects or contextual factors that support both attempts and completion. Future research should examine this relationship using objective measures of attempt rates and completion.
The implementation of evidence-based psychotherapies, including patient-level measures such as penetration and rates of successfully completing a course of therapy, has received increasing attention. While much attention has been paid to the effect of patient-level factors on implementation, relatively little attention has been paid to therapist factors (e.g., professional training, experience). OBJECTIVE: The current study explores therapists' decisions to offer a particular evidence-based psychotherapy (cognitive behavioral therapy for chronic pain; CBT-CP), whether and how they modify CBT-CP, and the relationship between these decisions and patient completion rates. METHODS: The study utilized survey responses from 141 Veterans Affairs therapists certified in CBT-CP. RESULTS: Therapists reported attempting CBT-CP with a little less than one half of their patients with chronic pain (mean = 48.8%, s.d.=35.7). Therapist were generally split between reporting modifying CBT-CP for either very few or most of their patients. After controlling for therapist characteristics and modification, therapist-reported percentage of patients with attempted CBT-CP was positively associated with completion rates, t (111) = 4.57, p<.001. CONCLUSIONS: Therapists who attempt CBT-CP more frequently may experience better completion rates, perhaps due to practice effects or contextual factors that support both attempts and completion. Future research should examine this relationship using objective measures of attempt rates and completion.
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