Therapist Training for PTSD

(SMART Trial)

Recruiting at 3 trial locations

Overseen By Rebecca K Sripada, PhD MS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Not licensed, Already CPT certified

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 6

240 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests new methods to train therapists in delivering Cognitive Processing Therapy (CPT) more effectively for PTSD. It explores various training strategies to determine which best helps therapists adhere to the therapy protocol, ultimately aiming to improve treatment for Veterans with PTSD. The trial includes multiple training approaches, such as SMART Therapist Training, Web-Based Training, and Standard Training, combined with different feedback and consultation methods. Licensed mental health clinicians or trainees working at VA facilities who regularly provide therapy to Veterans are ideal candidates. As an unphased trial, this study offers a unique opportunity to contribute to innovative training methods that could enhance PTSD treatment for Veterans.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What prior data suggests that this therapist training is safe?

Research has shown that SMART Therapist Training helps therapists adhere more closely to Cognitive Processing Therapy (CPT) for PTSD. This program is not a medication or medical treatment, so it does not involve traditional safety concerns like side effects. Instead, it uses online tools and consultations to train therapists, aiming to enhance their support for patients. This can lead to improved outcomes for veterans with PTSD. As a training program, it poses no side effects or risks, making therapy more effective without any danger to patients or therapists. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the SMART Therapist Training for PTSD because it introduces innovative methods to enhance therapist skills through technology. Unlike traditional approaches that rely heavily on in-person training, this program leverages Web-Based Training (WBT) and Work-Sample Reviews (WR) to provide flexible and scalable learning opportunities. Additionally, the incorporation of fidelity monitoring and the option to step up to session audio reviews allows for personalized feedback and continuous improvement, which could lead to more effective therapy outcomes. These features are expected to help therapists deliver higher-quality care, ultimately benefiting patients with PTSD.

What evidence suggests that this trial's training methods could be effective for improving therapist fidelity in treating PTSD?

Research has shown that Cognitive Processing Therapy (CPT) works well for treating PTSD in controlled studies. However, its effectiveness decreases in everyday clinical settings because therapists often don't follow the program closely. The SMART Therapist Training, provided to participants in this trial, aims to address this by helping therapists learn and use CPT more effectively, ensuring adherence to the program. Studies have found that SMART improves cognitive skills, which could help therapists maintain high treatment standards and improve patient outcomes. This training model could lead to better management of PTSD symptoms by focusing on therapists' adherence to proven treatment techniques. ^{1 4 5 6 7}

Who Is on the Research Team?

Rebecca Kaufman Sripada, PhD MS

Principal Investigator

VA Ann Arbor Healthcare System, Ann Arbor, MI

Are You a Good Fit for This Trial?

This trial is for licensed mental health clinicians or trainees in VA services who regularly provide psychotherapy to Veterans and can implement CPT. They must have support to participate for 9 months, including those on a 6-month rotation with supervisor approval.

Inclusion Criteria

Participants must have local/supervisor support to implement CPT and fully participate in all training and consultation activities

Participants must be able to participate for 9 months

Participating trainees (e.g. psychology interns) on a 6-month training rotation must have permission from their supervisors to continue the study into their next rotation

Exclusion Criteria

Participant is not a licensed mental health clinician

Participant is already certified in CPT

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Initial Training Phase

Participants undergo Web-Based Training and Work-Sample Review to assess initial therapist fidelity

4 months

Monthly evaluations

Adaptive Training Phase

Participants are re-randomized based on fidelity progress to either continue standard consultation or adjust training intensity

8 months

Evaluations at 6, 9, and 12 months

Follow-up

Participants are monitored for therapist fidelity and competence after training completion

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• SMART Therapist Training

Trial Overview

The study tests different training methods for Cognitive Processing Therapy (CPT) fidelity. It includes Standard Consultation, Web-Based Training, Work Sample Review, and other steps to find the most effective training sequence.

How Is the Trial Designed?

Group I: Condition 4-D Experimental Treatment 3 Interventions

Standard Training (ST) + Standard Consultation (SC) + fidelity in progress + continue in Standard Consultation.

Group II: Condition 4-C Experimental Treatment 3 Interventions

Standard Training (ST) + Standard Consultation (SC) + fidelity in progress + step up to session audio review.

Group III: Condition 4-B Experimental Treatment 3 Interventions

Standard Training (ST) + Standard Consultation (SC) + early fidelity + continue in Standard Consultation.

Group IV: Condition 4-A Experimental Treatment 3 Interventions

Standard Training (ST) + Standard Consultation (SC) + early fidelity + step down to fidelity self-monitoring.

Group V: Condition 3-D Experimental Treatment 3 Interventions

Standard Training (ST) + Work-Sample Review (WR)+ fidelity in progress + continue in Standard Consultation.

Group VI: Condition 3-C Experimental Treatment 3 Interventions

Standard Training (ST) + Work-Sample Review (WR) + fidelity in progress + step up to session audio review.

Group VII: Condition 3-B Experimental Treatment 2 Interventions

Standard Training (ST) + Work-Sample Review (WR) + early fidelity + continue in Standard Consultation.

Group VIII: Condition 3-A Experimental Treatment 3 Interventions

Standard Training (ST) + Work-Sample Review (WR) + early fidelity + step down to fidelity self-monitoring.

Group IX: Condition 2-D Experimental Treatment 3 Interventions

Web-Based Training (WBT) + Standard Consultation (SC) + fidelity in progress + continue in Standard Consultation.

Group X: Condition 2-C Experimental Treatment 3 Interventions

Web-Based Training (WBT) + Standard Consultation (SC) + fidelity in progress + step up to session audio review.

Group XI: Condition 2-B Experimental Treatment 2 Interventions

Web-Based Training (WBT) + Standard Consultation (SC) + early fidelity + continue in Standard Consultation.

Group XII: Condition 2-A Experimental Treatment 3 Interventions

Web-Based Training (WBT) + Standard Consultation (SC) + early fidelity + step down to fidelity self-monitoring.

Group XIII: Condition 1-D Experimental Treatment 3 Interventions

Web-Based Training (WBT) + Work-Sample Review (WR)+ fidelity in progress + continue in Standard Consultation.

Group XIV: Condition 1-C Experimental Treatment 3 Interventions

Web-Based Training (WBT) + Work-Sample Review (WR) + fidelity in progress + step up to session audio review.

Group XV: Condition 1-B Experimental Treatment 2 Interventions

Web-Based Training (WBT) + Work-Sample Review (WR) + early fidelity + continue in Standard Consultation.

Group XVI: Condition 1-A Experimental Treatment 3 Interventions

Web-Based Training (WBT) + Work-Sample Review (WR) + early fidelity + step down to fidelity self-monitoring.

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Citations

1.

clinicaltrials.gov

clinicaltrials.gov/study/NCT07010770

Study Details | NCT07010770 | SMART Therapist Training ...

CPT is highly effective in randomized controlled trials, but its effectiveness drops substantially in standard clinical practice, largely due to therapist " ...

2.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC12098106/

SMART accelerates rate of cognitive gains in service ...

SMART is an efficient and effective CR protocol for improving higher-order cognitive abilities in ADSMs with mTBI, achieving comparable outcomes to SCORE in 60 ...

3.

sciencedirect.com

sciencedirect.com/science/article/abs/pii/S0165032720331578

The power of appraisals in predicting PTSD symptom ...

Our findings suggest that interventions that do not directly target PTSD symptoms can lead to PTSD symptom change via change in appraisals of functioning.

4.

bmcpsychiatry.biomedcentral.com

bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-024-06097-0

Efficacy of an internet-based guided trauma-focused ...

The primary outcome will be the severity of PTSD symptoms as measured with the International Trauma Interview (ITI) [35] at baseline and 10 ...

5.

clinicaltrials.gov

clinicaltrials.gov/study/NCT06957067

Reducing Dropout and Improving Outcomes From PTSD ...

Outcomes include post-traumatic stress disorder (PTSD) severity [primary], depression, functioning, and treatment retention; to compare two approaches to ...

6.

trialx.com

trialx.com/clinical-trials/listings/309408/smart-therapist-training-a-hybrid-factorial-smart-design/

SMART Therapist Training: A Hybrid Factorial- ...

This contribution will improve therapist fidelity to CPT and ultimately yield superior clinical outcomes for Veterans with PTSD. The ...

7.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC10349653/

Testing adaptive interventions to improve PTSD treatment ...

We are conducting a Sequential, Multiple Assignment, Randomized Trial (SMART) with 430 adults with PTSD in FQHCs. Participants are initially randomized to CS ...