Given the frequency with which individuals seek treatment for alcohol-related consequences in eme... more Given the frequency with which individuals seek treatment for alcohol-related consequences in emergency departments (EDs), they may be the optimal setting to deliver brief interventions (BIs) for alcohol misuse. Studies examining the effectiveness of BIs for alcohol misuse conducted in EDs have yielded mixed results, and new articles have been published since the last review in 2008. The aim of this study was to provide an updated systematic review on the effectiveness of BIs for alcohol misuse delivered to adults in EDs. Articles published in June 2014 and earlier were identified from online databases (PsycInfo, Healthstar, CINAHL, Medline, Nursing and Allied Health). Search terms included (1) alcohol, (2) "alcohol screening", "brief intervention", "brief alcohol intervention" or feedback and (3) "emergency department" or "emergency room". Once duplicates were removed, 171 abstracts were identified for review. Thirty-four studies were included in the systematic review. All studies reported a significant reduction in alcohol consumption at 3months post-BI, with some studies finding significant differences between the BI and control groups, and other studies finding significant decreases in both conditions but no between-groups differences. The majority of studies did not find significant between-group differences at 6 and 12months post-BI with regard to decreases in alcohol consumption. Individuals who received a BI were significantly less likely to have an alcohol-related injury at 6 or 12months post-BI than individuals who did not receive a BI. BIs are unlikely to reduce subsequent hospitalizations however, they may be effective in reducing risky driving and motor vehicle crashes associated with alcohol use, which can result in hospitalization. Beyond the effects generated by visiting EDs, BIs delivered in EDs may not be effective in reducing alcohol consumption, or in reducing subsequent hospitalizations. BIs may be effective in reducing some alcohol-related consequences. Future studies ought to investigate for whom BIs are most effective, and the processes that lead to decreases in alcohol consumption and alcohol-related consequences.
Journal of Aggression, Maltreatment & Trauma, 2015
ABSTRACT Parental posttraumatic stress disorder (PTSD) is associated with parenting difficulties.... more ABSTRACT Parental posttraumatic stress disorder (PTSD) is associated with parenting difficulties. Cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD) improves PTSD symptoms, relationship adjustment, and partners’ mental health functioning. However, the impact of CBCT for PTSD on parenting competency is unknown. In this pilot study, the effects of CBCT for PTSD on parenting competency were investigated in 14 individuals (6 patients with PTSD and 8 partners) who had children under age 18. Results suggested that most participants perceived themselves as competent in their parenting prior to treatment, and some enhancements in competency occurred following CBCT for PTSD. Moreover, changes in parenting competency were associated with improvements in patient-rated PTSD. Adjunctive interventions targeting parenting and goals for future research are discussed.
The efficacy of a present-focused version of cognitive-behavioral conjoint therapy for posttrauma... more The efficacy of a present-focused version of cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD) was examined in a community sample. Seven couples completed pretreatment assessments, including measures of clinician-, self- and partner-rated PTSD symptoms and relationship satisfaction. Six couples completed present-focused CBCT for PTSD and all posttreatment assessments. A seventh couple terminated their relationship prior to completing treatment; therefore, they completed posttreatment symptom measures, but not ratings of relationship satisfaction. Results revealed significant decreases in PTSD symptoms that were associated with medium-to-large effect sizes. Medium effect sizes for changes in relationship satisfaction were found, though were only significant for partners. Results from this pilot study suggest that present-focused CBCT for PTSD may be a promising alternative for individuals who are unwilling to engage in a trauma-focused treatment.
Posttraumatic Stress Disorder (PTSD) is a serious mental health condition with substantial costs ... more Posttraumatic Stress Disorder (PTSD) is a serious mental health condition with substantial costs to individuals and society. Among military veterans, the lifetime prevalence of PTSD has been estimated to be as high as 20%. Numerous research studies have demonstrated that short-term cognitive-behavioral psychotherapies, such as Cognitive Processing Therapy (CPT), lead to substantial and sustained improvements in PTSD symptoms. Despite known benefits, only a minority of clinicians provide these therapies. Transferring this research knowledge into clinical settings remains one of the largest hurdles to improving the health of veterans with PTSD. Attending a workshop alone is insufficient to promote adequate knowledge transfer and sustained skill; however, relatively little research has been conducted to identify effective post-training support strategies. The current study investigates whether clinicians receiving post-workshop support (six-month duration) will deliver CPT with greater fidelity (i.e., psychotherapy adherence and competence) and have improved patient outcomes compared with clinicians receiving no formal post-workshop support. The study conditions are: technology-enhanced group tele-consultation; standard group tele-consultation; and fidelity assessment with no consultation. The primary outcome is independent assessment (via audio-recordings) of the clinicians' adherence and competence in delivering CPT. The secondary outcome is observed changes in patient symptoms during and following treatment as a function of clinician fidelity. Post-consultation interviews with clinicians will help identify facilitators and barriers to psychotherapy skill acquisition. The study results will inform how best to implement and transfer evidence-based psychotherapy (e.g., CPT) to clinical settings to attain comparable outcomes to those observed in research settings. Findings will deepen our understanding of how much and what type of support is needed following a workshop to help clinicians become proficient in delivering a new protocol. Several influences on clinician learning and patient outcomes will be discussed. An evidence-based model of clinical consultation will be developed, with the ultimate goal of informing policy and influencing best practice in clinical consultation. ClinicalTrials.gov: NCT01861769.
Given the frequency with which individuals seek treatment for alcohol-related consequences in eme... more Given the frequency with which individuals seek treatment for alcohol-related consequences in emergency departments (EDs), they may be the optimal setting to deliver brief interventions (BIs) for alcohol misuse. Studies examining the effectiveness of BIs for alcohol misuse conducted in EDs have yielded mixed results, and new articles have been published since the last review in 2008. The aim of this study was to provide an updated systematic review on the effectiveness of BIs for alcohol misuse delivered to adults in EDs. Articles published in June 2014 and earlier were identified from online databases (PsycInfo, Healthstar, CINAHL, Medline, Nursing and Allied Health). Search terms included (1) alcohol, (2) "alcohol screening", "brief intervention", "brief alcohol intervention" or feedback and (3) "emergency department" or "emergency room". Once duplicates were removed, 171 abstracts were identified for review. Thirty-four studies were included in the systematic review. All studies reported a significant reduction in alcohol consumption at 3months post-BI, with some studies finding significant differences between the BI and control groups, and other studies finding significant decreases in both conditions but no between-groups differences. The majority of studies did not find significant between-group differences at 6 and 12months post-BI with regard to decreases in alcohol consumption. Individuals who received a BI were significantly less likely to have an alcohol-related injury at 6 or 12months post-BI than individuals who did not receive a BI. BIs are unlikely to reduce subsequent hospitalizations however, they may be effective in reducing risky driving and motor vehicle crashes associated with alcohol use, which can result in hospitalization. Beyond the effects generated by visiting EDs, BIs delivered in EDs may not be effective in reducing alcohol consumption, or in reducing subsequent hospitalizations. BIs may be effective in reducing some alcohol-related consequences. Future studies ought to investigate for whom BIs are most effective, and the processes that lead to decreases in alcohol consumption and alcohol-related consequences.
Journal of Aggression, Maltreatment & Trauma, 2015
ABSTRACT Parental posttraumatic stress disorder (PTSD) is associated with parenting difficulties.... more ABSTRACT Parental posttraumatic stress disorder (PTSD) is associated with parenting difficulties. Cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD) improves PTSD symptoms, relationship adjustment, and partners’ mental health functioning. However, the impact of CBCT for PTSD on parenting competency is unknown. In this pilot study, the effects of CBCT for PTSD on parenting competency were investigated in 14 individuals (6 patients with PTSD and 8 partners) who had children under age 18. Results suggested that most participants perceived themselves as competent in their parenting prior to treatment, and some enhancements in competency occurred following CBCT for PTSD. Moreover, changes in parenting competency were associated with improvements in patient-rated PTSD. Adjunctive interventions targeting parenting and goals for future research are discussed.
The efficacy of a present-focused version of cognitive-behavioral conjoint therapy for posttrauma... more The efficacy of a present-focused version of cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD) was examined in a community sample. Seven couples completed pretreatment assessments, including measures of clinician-, self- and partner-rated PTSD symptoms and relationship satisfaction. Six couples completed present-focused CBCT for PTSD and all posttreatment assessments. A seventh couple terminated their relationship prior to completing treatment; therefore, they completed posttreatment symptom measures, but not ratings of relationship satisfaction. Results revealed significant decreases in PTSD symptoms that were associated with medium-to-large effect sizes. Medium effect sizes for changes in relationship satisfaction were found, though were only significant for partners. Results from this pilot study suggest that present-focused CBCT for PTSD may be a promising alternative for individuals who are unwilling to engage in a trauma-focused treatment.
Posttraumatic Stress Disorder (PTSD) is a serious mental health condition with substantial costs ... more Posttraumatic Stress Disorder (PTSD) is a serious mental health condition with substantial costs to individuals and society. Among military veterans, the lifetime prevalence of PTSD has been estimated to be as high as 20%. Numerous research studies have demonstrated that short-term cognitive-behavioral psychotherapies, such as Cognitive Processing Therapy (CPT), lead to substantial and sustained improvements in PTSD symptoms. Despite known benefits, only a minority of clinicians provide these therapies. Transferring this research knowledge into clinical settings remains one of the largest hurdles to improving the health of veterans with PTSD. Attending a workshop alone is insufficient to promote adequate knowledge transfer and sustained skill; however, relatively little research has been conducted to identify effective post-training support strategies. The current study investigates whether clinicians receiving post-workshop support (six-month duration) will deliver CPT with greater fidelity (i.e., psychotherapy adherence and competence) and have improved patient outcomes compared with clinicians receiving no formal post-workshop support. The study conditions are: technology-enhanced group tele-consultation; standard group tele-consultation; and fidelity assessment with no consultation. The primary outcome is independent assessment (via audio-recordings) of the clinicians' adherence and competence in delivering CPT. The secondary outcome is observed changes in patient symptoms during and following treatment as a function of clinician fidelity. Post-consultation interviews with clinicians will help identify facilitators and barriers to psychotherapy skill acquisition. The study results will inform how best to implement and transfer evidence-based psychotherapy (e.g., CPT) to clinical settings to attain comparable outcomes to those observed in research settings. Findings will deepen our understanding of how much and what type of support is needed following a workshop to help clinicians become proficient in delivering a new protocol. Several influences on clinician learning and patient outcomes will be discussed. An evidence-based model of clinical consultation will be developed, with the ultimate goal of informing policy and influencing best practice in clinical consultation. ClinicalTrials.gov: NCT01861769.
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Papers by Meredith Landy