Seattle VAMC Nicola ola F. De Paul, ul, PhD Seattle VAMC Candice - - PowerPoint PPT Presentation

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Seattle VAMC Nicola ola F. De Paul, ul, PhD Seattle VAMC Candice - - PowerPoint PPT Presentation

Oct 21, 2023 161 likes •348 views

Kelly lly A. Caver er, , PhD Seattle VAMC Nicola ola F. De Paul, ul, PhD Seattle VAMC Candice dice L. Barne rnett, tt, MD MD Seattle VAMC; Dept. of Psychiatry, UW Medical Center David id G. Zacharia charias, s, MD, MPH Seattle

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SLIDE 1

Kelly lly A. Caver er, , PhD Seattle VAMC Nicola

  • la F. De Paul,

ul, PhD Seattle VAMC Candice dice L. Barne rnett, tt, MD MD Seattle VAMC; Dept. of Psychiatry, UW Medical Center David id G. Zacharia charias, s, MD, MPH Seattle VAMC; Dept. of Psychiatry, UW Medical Center

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PCMHI provides:

 Population-based care  Brief treatment (2-6 sessions) for mild to moderate

symptoms and functional impairment

 Focused on functional improvement and quality of life  Integrative care supports the primary care provider’s

treatment plan Few ew ev eviden ence-bas based ed brief ef group

  • up trea

eatment ent protocols

  • cols

des esigne ned d for PCMHI

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SLIDE 3

 UP incorporates principles of CBT and

emotion science to provide transdiagnostic treatment for anxiety and depressive disorders.

 Treatment is designed to increase acceptance

  • f, willingness to experience, and ability to

tolerate strong emotions.

 12-18 weekly, 50-60 minute sessions.

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SLIDE 4

M1 – Motivational Enhancement for Treatment Engagement (1-2 sessions)

M2 – Psych choedu education cation & Tracking cking Emotion tional al Experien eriences ces (1-3 sessions)

M3 – Emoti tion

  • n Awarenes

eness Train ining ing (1-3 sessions)

M4 4 – Cognitiv gnitive Apprais isal l & Reappra rais isal l (1-2 sessions)

M5 5 – Emoti tion

  • n Avoid

idan ance ce & Emotion tion-Dr Driv iven en Beha havio iors rs (1-2 sessions)

M6 – Awareness & Tolerance of Physical Sensations (1-2 sessions)

M7 – Interoceptive & Situation-Based Emotion Exposures (2-6 sessions)

M8 – Relapse lapse Preventio ention (1-2 sessions)

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SLIDE 5

 UP treatment model is consistent with

PCMHI’s focus on functional improvement.

 The complete protocol is too long to be

practical in the PCMHI setting.

 Our alternative:

  • 5 week adaptation – Managing Stress & Emotions
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SLIDE 6

 Five 90-minute group sessions  Each session uses elements of the UP to

promote:

  • Emotional awareness and acceptance
  • Tolerance of distressing emotions
  • Cognitive flexibility
  • Values based decision making and behaviors
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SLIDE 7

Session 1: Understanding Emotions; Recognizing and Tracking Emotional Responses

  • Purpose and Nature of Emotions
  • 3 Components of Emotions (Cognitive, Behavioral, and Physiological)

Session 2: Emotion Awareness Training

  • Mindfulness: Nonjudgmental, Present Focused Emotional Awareness
  • Mood Induction Exercise

Session 3: Cognitive Appraisal and Reappraisal

  • Ambiguous Picture Exercise – Automatic Appraisals
  • Identifying Thinking Traps
  • Cognitive Reappraisal

Session 4: Emotion Driven Behaviors (EDBs)

  • Adaptive vs. non-adaptive EDBs
  • Changing non-adaptive EDBs with alternative and incompatible behaviors

Session 5: Accomplishments, Maintenance, and Relapse Prevention

  • Review of concepts
  • Review of skills
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SLIDE 8

 Offering MSE for over a year at the Seattle VA,

with ~60 patients participating

 Popular referral for Veterans with:

  • Anxiety
  • Depression
  • Trauma/adjustment
  • Anger/irritability
  • General life stress

 Veterans described meaningful improvements:

  • Coping with mood symptoms
  • Emotional regulation skills
  • Functioning and quality of life
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 “Tom” – a 55 year old Pacific Islander/White male with

a history of MDD, methamphetamine use, pain, HTN, and vertebral artery stenosis.

 Referred by PCP to PCMHI due to difficulties

managing irritability and anxiety related to his health.

 After completing MSE;  Tom described significant overall improvements in

his mood, anger, anxiety, and pain levels.

 Tom demonstrated improved social functioning as he

began volunteer work.

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Self-report measures were used to assess symptom severity and functional impairment:

  • Work & Social Adjustment Scale (WSAS)
  • Overall Anxiety Severity and Impairment Scale (OASIS)
  • Overall Depression Severity and Impairment Scale (ODSIS)

Self-report measures were administered at pre- and post-treatment time points:

  • Pre-treatment (beginning of session 1)
  • Post-treatment (end of session 5)

 Paired samples t tests were used to evaluate pre-post change for

each outcome measure

 Correlations and linear regression models were examined to confirm

that there were no unexpected impacts from independent variables (e.g., demographics, diagnostic category).

 Results were considered significant when p<0.05.

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 54 Veteran participants

  • 92.6% male
  • Racially/ethnically diverse:

 White: 51.9%  African American 25.9%  Asian American 11.1%  Hispanic or Latino 5.6%  Native American 3.7%

  • Diagnoses:

 PTSD, 27.8%  Adjustment Disorder, 9.3%  Other specified Anxiety Disorder 22.2%  Depressive Disorder 33.3%

 Average number of sessions attended was 4.2

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 Paired samples t tests:

  • Statistically significant pre-post change across all functional outcome

measurements

 Pre-Post change:

Pre: Post: % Decrease

  • WSAS M = 20.1

WSAS M = 14.9 (27)

  • OASIS M = 12.1

OASIS M = 8.2 (32)

  • ODSIS M = 10.3

ODSIS M = 6.8 (33)

 All results significant at p <0.001

 Correlations & Linear Regression:

  • No evidence of unexpected correlations or statistically

significant effects related to influence of independent variables (e.g., demographics, diagnostic category).

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SLIDE 14

 Tom’s objective scores support his anecdotal

improvement.

 Pre-Post change:

Pre score: Post score: % Decrease

  • WSAS M = 29

WSAS M = 20 (36)

  • OASIS M = 14

OASIS M = 9 (33)

  • ODSIS M = 15

ODSIS M = 10 (31)

 All results significant at p <0.001

 Tom states his coping has changed, he is using:

  • Breathing & mindfulness to cope with pain and worry about

his health

  • Perspective taking, present focus, and practicing

forgiveness in interpersonal situations

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SLIDE 15

 Evidence-Based treatment option

appropriate to PCMHI

 Increased access for Veterans due to brief

treatment model

 Transdiagnostic treatment facilitates

recruitment and clinical efficiency

 Promotes training opportunities for

interns/post-doctoral Fellows

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 Primary Care

  • Effective treatment within PCMHI clinic
  • Preparation for specialty level MH treatment

 Specialty Mental Health

  • Introduction to treatment
  • Refresher group

 Specialty Medicine Clinics

  • Transplant
  • Pain
  • Infectious Disease
  • Cardiology
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SLIDE 17

Barlow, D. H., Ellard, K. K., Fairholme, C. P., Farchione, T. J., Boisseau, C. L., May, J. T. E., & Allen, L. B., (2010). Unified protocol for transdiagnostic treatment of emotional disorders: Workbook. Oxford University Press, USA.

Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & May, J. T. E., (2010). Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. Oxford University Press, USA.

Boswell, J. F. (2013). Intervention strategies and clinical process in transdiagnostic cognitive-behavioral therapy. Psychotherapy, 50, 381- 386.

Ellard, K. K., Fairholme, C. P., Boisseau, C. L., Farchione, T. J., & Barlow,

  • D. H. (2010). Unified protocol for the transdiagnostic treatment of

emotional disorders: Protocol development and initial outcome data. Cognitive Behavioral Practice, 17, 88-101.

Wilamowska, Z. A., Thompson-Holland, J., Fairholme, C. P., Ellard, K. K., Farchione, T. J., & Barlow, D. H. (2010). Conceptual background, development, and preliminary data from the unified protocol for transdiagnostic treatment of emotional disorders. Depression and Anxiety, 27, 882-890.

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Kelly Caver: kelly.caver@va.gov Nicola De Paul: nicola.depaul2@va.gov