title: Enhancing the Reach of Cognitive-Behavioral Therapy Targeting Posttraumatic Stress in Acute Care Medical Settings.
abstract: Injured patients presenting to acute care medical settings have high rates of posttraumatic stress disorder (PTSD) and comorbidities, such as depression and substance use disorders. Integrating behavioral interventions that target symptoms of PTSD and comorbidities into the acute care setting can overcome common barriers to obtaining mental health care. This study examined the feasibility and acceptability of embedding elements of cognitive-behavioral therapy (CBT) in the delivery of routine postinjury care management. The investigation also explored the potential effectiveness of completion of CBT element homework that targeted PTSD symptom reduction.
  
  
  
  This study was a secondary analysis of data from a U.S. clinical trial of the effectiveness of a stepped collaborative care intervention versus usual care for injured inpatients. The investigation examined patients' willingness at baseline (prerandomization) to engage in CBT and pre- and postrandomization mental health service utilization among 115 patients enrolled in the clinical trial. Among intervention patients (N=56), the investigation examined acceptability of the intervention and used multiple linear regression to examine the association between homework completion as reported by the care manager and six-month PTSD symptom reduction as assessed by the PTSD Checklist-Civilian DSM-IV Version.
  
  
  
  Patients in the intervention condition reported obtaining significantly more psychotherapy or counseling than patients in the control group during the six-month follow-up, as well as a high degree of intervention acceptability. Completion of CBT element homework assignments was associated with improvement in PTSD symptoms.
  
  
  
  Integrating behavioral interventions into routine acute care service delivery may improve the reach of evidence-based mental health care targeting PTSD.
authors.affiliation: Dr. Darnell, Dr. Russo, Dr. Wang, Ms. Ingraham, Ms. Sandgren, and Dr. Zatzick are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (e-mail: darnelld@uw.edu ). Dr. O'Connor is with the Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky. Dr. Wagner is with the Department of Mental Health, Portland Department of Veterans Affairs Medical Center, Portland, Oregon.
authors.forename: Doyanne
authors.initials: D
authors.lastname: Darnell
authors.affiliation: Dr. Darnell, Dr. Russo, Dr. Wang, Ms. Ingraham, Ms. Sandgren, and Dr. Zatzick are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (e-mail: darnelld@uw.edu ). Dr. O'Connor is with the Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky. Dr. Wagner is with the Department of Mental Health, Portland Department of Veterans Affairs Medical Center, Portland, Oregon.
authors.forename: Stephen
authors.initials: S
authors.lastname: O'Connor
authors.affiliation: Dr. Darnell, Dr. Russo, Dr. Wang, Ms. Ingraham, Ms. Sandgren, and Dr. Zatzick are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (e-mail: darnelld@uw.edu ). Dr. O'Connor is with the Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky. Dr. Wagner is with the Department of Mental Health, Portland Department of Veterans Affairs Medical Center, Portland, Oregon.
authors.forename: Amy
authors.initials: A
authors.lastname: Wagner
authors.affiliation: Dr. Darnell, Dr. Russo, Dr. Wang, Ms. Ingraham, Ms. Sandgren, and Dr. Zatzick are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (e-mail: darnelld@uw.edu ). Dr. O'Connor is with the Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky. Dr. Wagner is with the Department of Mental Health, Portland Department of Veterans Affairs Medical Center, Portland, Oregon.
authors.forename: Joan
authors.initials: J
authors.lastname: Russo
authors.affiliation: Dr. Darnell, Dr. Russo, Dr. Wang, Ms. Ingraham, Ms. Sandgren, and Dr. Zatzick are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (e-mail: darnelld@uw.edu ). Dr. O'Connor is with the Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky. Dr. Wagner is with the Department of Mental Health, Portland Department of Veterans Affairs Medical Center, Portland, Oregon.
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.affiliation: Dr. Darnell, Dr. Russo, Dr. Wang, Ms. Ingraham, Ms. Sandgren, and Dr. Zatzick are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (e-mail: darnelld@uw.edu ). Dr. O'Connor is with the Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky. Dr. Wagner is with the Department of Mental Health, Portland Department of Veterans Affairs Medical Center, Portland, Oregon.
authors.forename: Leah
authors.initials: L
authors.lastname: Ingraham
authors.affiliation: Dr. Darnell, Dr. Russo, Dr. Wang, Ms. Ingraham, Ms. Sandgren, and Dr. Zatzick are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (e-mail: darnelld@uw.edu ). Dr. O'Connor is with the Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky. Dr. Wagner is with the Department of Mental Health, Portland Department of Veterans Affairs Medical Center, Portland, Oregon.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Sandgren
authors.affiliation: Dr. Darnell, Dr. Russo, Dr. Wang, Ms. Ingraham, Ms. Sandgren, and Dr. Zatzick are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle (e-mail: darnelld@uw.edu ). Dr. O'Connor is with the Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, Kentucky. Dr. Wagner is with the Department of Mental Health, Portland Department of Veterans Affairs Medical Center, Portland, Oregon.
authors.forename: Douglas
authors.initials: D
authors.lastname: Zatzick
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010342:Patient Acceptance of Health Care; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000628:therapy*; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*
keywords: Acute care; Behavior therapy; Cognitive-behavioral therapy elements; Posttraumatic stress disorder (PTSD); Public health