SMART Therapist Training: A Hybrid Factorial-SMART Design

Conditions

• Psychotherapy
• Stress Disorders, Post-Traumatic

Eligibility Criteria

Sex

ALL

Age

18 Years - N/A

Healthy Volunteers

Not accepted

Interventions

• Web-Based Training (WBT) — OTHER
  A self-paced online training course that includes video demonstrations, self-guided modules, and clinical materials/resources.
• Work Sample Review (WR) — OTHER
  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.
• Step down to fidelity self-monitoring — OTHER
  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.
• Step up to session audio review — OTHER
  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.
• Standard Consultation (SC) — OTHER
  Four months of weekly hour-long group consultation
• Standard Training (ST) — OTHER
  2-day instructor-led CPT workshop.
• Continue in Standard Consultation — OTHER
  After four months, therapists will continue to attend weekly hour-long group consultation for another two months.

Study Details

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.

Key Dates

Start date

Aug 15, 2025

Status verified

Aug 2025

Primary completion

May 31, 2030

Completion

Aug 30, 2030

Study Design

Enrollment

240 participants (estimated)

Allocation

RANDOMIZED

Intervention model

FACTORIAL

Primary purpose

OTHER

Arms

• Experimental: Condition 1-A
  Web-Based Training (WBT) + Work-Sample Review (WR) + early fidelity + step down to fidelity self-monitoring.
• Experimental: Condition 1-B
  Web-Based Training (WBT) + Work-Sample Review (WR) + early fidelity + continue in Standard Consultation.
• Experimental: Condition 1-C
  Web-Based Training (WBT) + Work-Sample Review (WR) + fidelity in progress + step up to session audio review.
• Experimental: Condition 1-D
  Web-Based Training (WBT) + Work-Sample Review (WR)+ fidelity in progress + continue in Standard Consultation.
• Experimental: Condition 2-A
  Web-Based Training (WBT) + Standard Consultation (SC) + early fidelity + step down to fidelity self-monitoring.
• Experimental: Condition 2-B
  Web-Based Training (WBT) + Standard Consultation (SC) + early fidelity + continue in Standard Consultation.
• Experimental: Condition 2-C
  Web-Based Training (WBT) + Standard Consultation (SC) + fidelity in progress + step up to session audio review.
• Experimental: Condition 2-D
  Web-Based Training (WBT) + Standard Consultation (SC) + fidelity in progress + continue in Standard Consultation.
• Experimental: Condition 3-A
  Standard Training (ST) + Work-Sample Review (WR) + early fidelity + step down to fidelity self-monitoring.
• Experimental: Condition 3-B
  Standard Training (ST) + Work-Sample Review (WR) + early fidelity + continue in Standard Consultation.
• Experimental: Condition 3-C
  Standard Training (ST) + Work-Sample Review (WR) + fidelity in progress + step up to session audio review.
• Experimental: Condition 3-D
  Standard Training (ST) + Work-Sample Review (WR)+ fidelity in progress + continue in Standard Consultation.
• Experimental: Condition 4-A
  Standard Training (ST) + Standard Consultation (SC) + early fidelity + step down to fidelity self-monitoring.
• Experimental: Condition 4-B
  Standard Training (ST) + Standard Consultation (SC) + early fidelity + continue in Standard Consultation.
• Experimental: Condition 4-C
  Standard Training (ST) + Standard Consultation (SC) + fidelity in progress + step up to session audio review.
• Experimental: Condition 4-D
  Standard Training (ST) + Standard Consultation (SC) + fidelity in progress + continue in Standard Consultation.

Primary Outcome Measure

CPT Therapist Adherence and Competence Scale (TAC) [ Time Frame: Baseline (0-months), 6-months, 9-months, and 12-months. ]

Central Contacts

• Rebecca K Sripada, PhD MS
  (734) 222-7432
  [email protected]
• Isabel Gracy, BS

Locations (4)

Find similar trials in Palo Alto, CA

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