SMART Therapist Training: A Hybrid Factorial-SMART Design
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorVA Office of Research and Development
About this trial
Cognitive Processing Therapy (CPT) is highly effective in randomized controlled trials, but its effectiveness drops substantially in standard clinical practice, largely due to therapist "drift" from fidelity to the protocol. What remains unknown is which components of CPT training yield high therapist fidelity. Thus, there is a critical need to use empirical approaches to identify the most effective components of CPT training and to develop an adaptive training model for CPT by testing sequences of empirically-supported training strategies. The long-term goal of this research is to develop a sustainable model of therapy training that is personalized to the needs of the therapist trainee.
The overall objective of this application is to empirically optimize an adaptive model for CPT training. The rationale is that developing an adaptive training model will improve efficiency and personalization, yield higher fidelity, and ultimately improve Veteran outcomes. The investigators expect that completion of this project will produce an adaptive CPT training program that yields high therapist fidelity. Improving CPT fidelity in VHA will have a positive impact on the health and wellbeing of Veterans with PTSD.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Participants must be licensed mental health clinicians or a mental health trainee in VA service (e.g., practicum students, psychology interns, postdoctoral fellows) whose formal job responsibilities include the provision of psychotherapy services to Veterans on a regular basis
Participants must be able to participate for 9 months.
Participants must work in a setting where CPT may be implemented (12 weekly 60-minute individual sessions or 90-minute group sessions).
Participants must have local/supervisor support to implement CPT and fully participate in all training and consultation activities.
Disqualifiers
Participant is not a licensed mental health clinician
Participant is already certified in CPT
Trial design
Design model
Factorial
Treatments tested in this trial
Web-Based Training (WBT)
Other interventionA self-paced online training course that includes video demonstrations, self-guided modules, and clinical materials/resources.
Work Sample Review (WR)
Other interventionFour months of weekly hour-long consultation that will include trainer-led reviews of work samples, focusing on the Impact Statement and Stuck Point Log.
Step down to fidelity self-monitoring
Other interventionAfter four months, and for participants who are classified as meeting "early fidelity", for the next two months, therapists in self-monitored fidelity will no longer attend group consultation. Instead, they will assess their own fidelity through self-report surveys.
Step up to session audio review
Other interventionAfter four months, and for participants who are classified as meeting "fidelity in progress", for the next two months, therapists will have their session audio recordings reviewed and rated for fidelity.
Standard Consultation (SC)
Other interventionFour months of weekly hour-long group consultation
Standard Training (ST)
Other intervention2-day instructor-led CPT workshop.
Continue in Standard Consultation
Other interventionAfter four months, therapists will continue to attend weekly hour-long group consultation for another two months.
Treatment groups
240 Participants
are divided into 16 treatment groups16
Treatment groupsSee each treatment group below.
Group A: Condition 1-AExperimental treatment 3 interventions
Group B: Condition 1-BExperimental treatment 2 interventions
Group C: Condition 1-CExperimental treatment 3 interventions
Group D: Condition 1-DExperimental treatment 3 interventions
Group E: Condition 2-AExperimental treatment 3 interventions
Group F: Condition 2-BExperimental treatment 2 interventions
Group G: Condition 2-CExperimental treatment 3 interventions
Group H: Condition 2-DExperimental treatment 3 interventions
Group I: Condition 3-AExperimental treatment 3 interventions
Group J: Condition 3-BExperimental treatment 2 interventions
Group K: Condition 3-CExperimental treatment 3 interventions
Group L: Condition 3-DExperimental treatment 3 interventions
Group M: Condition 4-AExperimental treatment 3 interventions
Group N: Condition 4-BExperimental treatment 3 interventions
Group O: Condition 4-CExperimental treatment 3 interventions
Group P: Condition 4-DExperimental treatment 3 interventions
Trial outcomes
Primary outcomes
1
CPT Therapist Adherence and Competence Scale (TAC)
The TAC measures both adherence to specific unique and essential CPT elements, and competence in delivering these interventions. Adherence is rated on a 3-point Likert-type scale, with 0=incomplete, 1=mostly complete, and 2=fully complete as prescribed in each session. Competence is rated on a 7-point Likert-type scale, from 0=not competent to 6=outstanding competence. Items rated as a "0" on adherence are automatically rated a "0" for competence. Competence scores between 0 and 2 are cases in which the therapist requires "substantial corrective feedback." Scores between 3 and 4 indicate "acceptable to good; opportunities for feedback," such that the therapist performs the intervention well, but has room for improvement. Scores of 5 and 6 require very little to no feedback.
Time frame
Baseline (0-months), 6-months, 9-months, and 12-monthsSecondary outcomes
1
The Cognitive Therapy Scale-Revised (CTS-R)
The CTS-R assesses transdiagnostic CBT specific skills (Guided discovery, Conceptualization, Identifying key cognitions, Application of change methods, Application of behavioral techniques, Homework, and Facilitation of emotional expression) and general therapeutic skills (Agenda, Feedback, Collaboration, Pacing/use of time, and Interpersonal effectiveness). Items are rated on a 0 = incompetent (non-compliance) to 6 = expert (compliance + high skill) scale with item-specific descriptions for each anchor. The range of scores is 0-72.
Time frame
Baseline (0-months), 6-months, 9-months, and 12-monthsSponsors and contacts
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Source ClinicalTrials.gov