PTSD and ASD 2023 VA/DoD Clinical Practice Guidelines Released

[AbnormalPsych]

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[cara susanna]

As I mentioned elsewhere, the WET people don't seem happy that they are now considered below EMDR. Lol.

 

[AbnormalPsych]

As I mentioned elsewhere, the WET people don't seem happy that they are now considered below EMDR. Lol.

In starting this, similar feelings probably for the Seeking Safety folks.

 

[Pragma]

In starting this, similar feelings probably for the Seeking Safety folks.

I was thinking the same thing

 

[cara susanna]

Seeking Safety didn't do very well in the 2017 guidelines either, but, yeah. I bet it also sucks for the CBCT people. It's interesting because CBCT and now WET are currently being promoted as EBPs for PTSD under the rollout... but now they're TECHNICALLY not EBPs.

 

[AbnormalPsych]

Welp, I'm doing a WET training next month, so thats exciting for me.

 

[AcronymAllergy]

Seeking Safety didn't do very well in the 2017 guidelines either, but, yeah. I bet it also sucks for the CBCT people. It's interesting because CBCT and now WET are currently being promoted as EBPs for PTSD under the rollout... but now they're TECHNICALLY not EBPs.

So they wouldn't consider WET as an EBP even though it's still "weak for" as far as evidence?

Seeking safety, yeah, I could see it no longer technically being an EBP based on these guidelines. And that seems to mirror providers' takes on it (here and elsewhere) that I've seen/heard.

 

[cara susanna]

So they wouldn't consider WET as an EBP even though it's still "weak for" as far as evidence?

Seeking safety, yeah, I could see it no longer technically being an EBP based on these guidelines. And that seems to mirror providers' takes on it (here and elsewhere) that I've seen/heard.

Seeking Safety has never been an EBP, so that won't change. But right now WET and CBCT are offered under VA EBP rollouts. Fwiw, they think someday WET will get to recommend treatment section. I doubt anything will change, I'm probably just overthinking.

Welp, I'm doing a WET training next month, so thats exciting for me.

I just got trained in WET and it's a really cool therapy. It's also VERY easy to implement, lol.

 

[AbnormalPsych]

It's also VERY easy to implement, lol.

One of my primary motivations to add it to the tool belt haha

 

[ccpsych16]

I like WET but have been thinking about other things to add to it before or after. Feels incomplete when not coupled with behavioral components. Feels like a pre-treatment in its current state, like I’m getting someone ready for PE.

 

[Fan_of_Meehl]

VA.gov | Veterans Affairs

Apply for and manage the VA benefits and services you’ve earned as a Veteran, Servicemember, or family member—like health care, disability, education, and more.

www.healthquality.va.gov

Group therapies for PTSD (including manualized approaches) are still minimally better than 'no treatment.' You go, groups.

 

[AbnormalPsych]

Group therapies for PTSD (including manualized approaches) are still minimally better than 'no treatment.' You go, groups.

Shhh don't let management know

 

[AcronymAllergy]

Group therapies for PTSD (including manualized approaches) are still minimally better than 'no treatment.' You go, groups.

The most significantly impacted outcome variable with VA groups, and the one upper-level leadership seems to care the most about, is the exceedingly important "wait list duration."

 

[PsyDr]

I like the authors.


"The Lewin Group is the Consulting business unit within Optum Serve, the federal health services business of Optum and UnitedHealth Group."

 

[cara susanna]

I like WET but have been thinking about other things to add to it before or after. Feels incomplete when not coupled with behavioral components. Feels like a pre-treatment in its current state, like I’m getting someone ready for PE.

I've had the experience that people start doing the behavioral exposure stuff on their own. Don't know why, and I was skeptical when I heard this, but it turned out to be true.

Group therapies for PTSD (including manualized approaches) are still minimally better than 'no treatment.' You go, groups.

I know PCTs that are pretty much nothing but process or psychoeducational groups so... awkward. There's also that one study that found trauma preparatory work was only helpful for later EBP engagement and success if it was individual, the group modality had actually worse outcomes.

 

[Fan_of_Meehl]

I've had the experience that people start doing the behavioral exposure stuff on their own. Don't know why, and I was skeptical when I heard this, but it turned out to be true.



I know PCTs that are pretty much nothing but process or psychoeducational groups so... awkward. There's also that one study that found trauma preparatory work was only helpful for later EBP engagement and success if it was individual, the group modality had actually worse outcomes.

The simple task of familiarizing oneself with the FULL VA/DoD Clinical Practice Guidelines for various disorders/issues (especially PTSD, mTBI, and Suicidality) with ACTUAL practices and (ideologically-driven) directives at the local VA hospital operational level...will disabuse most thinking people of the notion that the organization actually is all about 'evidence-based practice.' I mean, there are some basic bright spots such as requiring all sites offer CPT/PE as first-line treatments for PTSD, but...

Again, I encourage everyone...read the full guidelines for things and then cross-reference local policies/initiatives.

 

[Fan_of_Meehl]

Seeking Safety didn't do very well in the 2017 guidelines either, but, yeah. I bet it also sucks for the CBCT people. It's interesting because CBCT and now WET are currently being promoted as EBPs for PTSD under the rollout... but now they're TECHNICALLY not EBPs.

This entire organization needs to take a deep breath, a large step backwards, and re-conceptualize the construct of 'evidence-based psychotherapy,' beginning with a definition of the term.

The only actual definitions of 'evidence-based therapy' or 'evidence-based psychotherapy' that I've run across (maybe there are others) are borrowed from the 'evidence-based medicine' construct and it is the conjunction of three things:
(a) what the scientific literature says
(b) what the therapist is competent to do (and familiar with) and
(c) the patient's values/preferences

Where (a) + (b) + (c) intersect, that is (by this operational definition) 'evidence-based psychotherapy.' Visualize three interlocking circles in the classic Venn diagram.

Now, manualized protocols (CPT, CBT-i, PE, EMDR, XYZ-BBQ-ROFL-LOL, etc. etc. ad infinitum) are particular instances of 'evidence based psychotherapy (but only where a, b, and c intersect (see above)).' Trying to ram a CPT protocol down the throat of a client who refuses to discuss their trauma, or refuses to fill out worksheets, or refuses to attend weekly therapy is stupid/iatrogenic/wasteful and is not 'evidence-based psychotherapy.' These 'protocols for syndromes' (as Hayes likes to refer to them) represent very highly structured and very high effort and very detailed protocols that qualify as evidence-based psychotherapies but they do not in any way, shape or form exclusively constitute the entire universe of 'evidence-based therapy.' Structure and client effort are variables that can (I would argue must, in many cases) be dialed up or dialed down based on the response of the client and the phase of engagement with the therapy. Just throwing protocols at people has, unfortunately, been afforded some sort of 'brilliant' or 'heroic' status at VA and it is idiotic and disgusting to witness. We need a reset. Of course, when I see a client with PTSD for example and am just beginning assessment/therapy with them, my goal is to get them into a protocol like CPT or PE. I am not 'anti-protocol.' I am 'pro-realism' and 'pro-sanity.'

The kinds of psychotherapy courses that people like Donald Meichenbaum, Aaron T. Beck, David Barlow, Judith Beck, David Clark, etc., etc. etc. have conducted (and in some cases still do) with clients utilizing individualized cognitive-behavioral case formulations and interventions based on clinical science with outcome monitoring (but without a session-by-session pre-written and pre-scripted agenda) are very much 'evidence-based' psychotherapies.

I'd highly recommend the Hayes and Hofmann book Process-Based CBT. I think we are at the beginning of a 'reality check' and mini-paradigm shift in the coming years in the field. This over-emphasis on fixed-length protocol-for-syndrome/diagnosis approach as the only way to responsibly practice 'evidence-based psychotherapy' just isn't cutting it.