SMART Therapist Training: A Hybrid Factorial-SMART Design

Summary

Cognitive Processing Therapy (CPT) is highly effective in randomized controlled trials, but its effectiveness drops substantially in standard clinical practice, largely due to therapist "drift" from fidelity to the protocol. What remains unknown is which components of CPT training yield high therapist fidelity. Thus, there is a critical need to use empirical approaches to identify the most effective components of CPT training and to develop an adaptive training model for CPT by testing sequences of empirically-supported training strategies. The long-term goal of this research is to develop a sustainable model of therapy training that is personalized to the needs of the therapist trainee.

The overall objective of this application is to empirically optimize an adaptive model for CPT training. The rationale is that developing an adaptive training model will improve efficiency and personalization, yield higher fidelity, and ultimately improve Veteran outcomes. We expect that completion of this project will produce an adaptive CPT training program that yields high therapist fidelity. Improving CPT fidelity in VHA will have a positive impact on the health and wellbeing of Veterans with PTSD.

Conditions

• Stress Disorders, Post-Traumatic
• Psychotherapy

Interventions

OTHER

Web-Based Training (WBT)

A self-paced online training course that includes video demonstrations, self-guided modules, and clinical materials/resources.

OTHER

Work Sample Review (WR)

Four months of weekly hour-long consultation that will include trainer-led reviews of work samples, focusing on the Impact Statement and Stuck Point Log.

OTHER

Step down to fidelity self-monitoring

After four months, and for participants who are classified as meeting "early fidelity", for the next two months, therapists in self-monitored fidelity will no longer attend group consultation. Instead, they will assess their own fidelity through self-report surveys.

OTHER

Step up to session audio review

After four months, and for participants who are classified as meeting "fidelity in progress", for the next two months, therapists will have their session audio recordings reviewed and rated for fidelity.

OTHER

Standard Consultation (SC)

Four months of weekly hour-long group consultation

OTHER

Standard Training (ST)

2-day instructor-led CPT workshop.

OTHER

Continue in Standard Consultation

After four months, therapists will continue to attend weekly hour-long group consultation for another two months.

Sponsors & Collaborators

• VA Office of Research and Development

  lead FED

Principal Investigators

• Rebecca Kaufman Sripada, PhD MS · VA Ann Arbor Healthcare System, Ann Arbor, MI

Study Design

Allocation

RANDOMIZED

Purpose

OTHER

Masking

SINGLE

Model

FACTORIAL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-08-15

Primary Completion

2030-05-31

Completion

2030-08-30

Countries

• United States

Study Locations