The proposed research is the first resubmission a competing continuation of an R01 examining the effectiveness of a cognitive behavioral treatment (CBT) program for posttraumatic stress disorder (PTSD) in persons with severe mental illness (SMI). This research builds on the success of our first randomized controlled trial, in which CBT delivered by academically trained and employed (e.g., doctoral level) clinicians improved PTSD and related outcomes more than treatment as usual in clients with SMI living in rural New Hampshire and Vermont. The proposed research will extend these findings by: 1) having treatment provided by frontline (e.g., masters level) clinicians, 2) focusing on predominantly minority clients with SMI and PTSD living in urban New Jersey, and 3) comparing the CBT program with a brief pilot-tested Psychoeducation program for PTSD. Two-hundred clients with SMI and severe PTSD will be randomized to either the 12-16 session CBT program or the 3-session Psychoeducation program, with follow-up assessments conducted after treatment, and 6 and 12 months later. Analyses will focus on testing the hypotheses that CBT is more effective than Psychoeducation at improving PTSD severity and diagnosis, other symptoms, quality of life, community functioning, as well as decreased use of acute care services and direct treatment costs. Relevance: Trauma and PTSD are common problems in the lives of persons with SMI, and are associated with considerable distress and impairment in functioning. The CBT for PTSD program is the first standardized treatment for PTSD in this population shown to be effective in rigorous, randomized controlled research. The proposed research follows up these important findings by evaluating whether frontline clinicians can implement the CBT program with clients living in urban areas, and examining its impact on the long-term outcomes of quality of life and community functioning, as well as service utilization and costs. The results of this research will bring the field one step closer to having an evidence-based practice for trauma and PTSD in clients with SMI.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH064662-06
Application #
7617529
Study Section
Interventions Committee for Disorders Related to Schizophrenia, Late Life, or Personality (ITSP)
Program Officer
Pearson, Jane L
Project Start
2002-01-01
Project End
2011-04-30
Budget Start
2009-05-01
Budget End
2010-04-30
Support Year
6
Fiscal Year
2009
Total Cost
$637,007
Indirect Cost
Name
Dartmouth College
Department
Psychiatry
Type
Schools of Medicine
DUNS #
041027822
City
Hanover
State
NH
Country
United States
Zip Code
03755
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Minsky, Shula K; Lu, Weili; Silverstein, Steven M et al. (2015) Service Use and Self-Reported Symptoms Among Persons With Positive PTSD Screens and Serious Mental Illness. Psychiatr Serv 66:845-50
Mueser, Kim T; Gottlieb, Jennifer D; Xie, Haiyi et al. (2015) Evaluation of cognitive restructuring for post-traumatic stress disorder in people with severe mental illness. Br J Psychiatry 206:501-8
Lu, Weili; Yanos, Philip T; Silverstein, Steven M et al. (2013) Public mental health clients with severe mental illness and probable posttraumatic stress disorder: trauma exposure and correlates of symptom severity. J Trauma Stress 26:266-73
Lu, Weili; Yanos, Philip T; Gottlieb, Jennifer D et al. (2012) Use of fidelity assessments to train clinicians in the CBT for PTSD program for clients with serious mental illness. Psychiatr Serv 63:785-92
Teague, Gregory B; Mueser, Kim T; Rapp, Charles A (2012) Advances in fidelity measurement for mental health services research: four measures. Psychiatr Serv 63:765-71
Gottlieb, Jennifer D; Mueser, Kim T; Rosenberg, Stanley D et al. (2011) Psychotic depression, posttraumatic stress disorder, and engagement in cognitive-behavioral therapy within an outpatient sample of adults with serious mental illness. Compr Psychiatry 52:41-9

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