Does postworkshop consultation affect which patients receive prolonged exposure and who improves the most?

McLean, C. P., Foa, E. B., Peterson, A. L., Young-McCaughan, S., Tse, D., Hanson, B. S., Lillard, I. J., Patterson, T. J., Rosado, J., & Rosenfield, D.

One of the goals of training behavioral health providers in a treatment approach is for them to use the treatment with the full range of patients for whom the treatment is indicated. Whether certain training models are more effective than others in achieving this goal is unknown. The goal of this study was to examine the impact of behavioral health provider training in prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD) on the use of PE and clinical outcomes among patients with different clinical presentations. Providers (N = 103) working at military behavioral health clinics were randomized to receive a 4-day PE workshop with or without weekly postworkshop consultation for their first two patients and then provided the treatment of their choice to 242 patients with PTSD. Poisson regression analyses and multilevel models tested the moderating effect of PTSD severity, comorbid disorders, anger, and suicidality on provider use of PE components and on patient change in PTSD severity. Results showed that both the presence of a comorbid substance use disorder (SUD) and the total number of comorbid anxiety disorders moderated the impact of provider training on the use of PE. Specifically, providers who did not receive PE consultation used few PE components across comorbid conditions, whereas providers who received consultation used more PE components with patients with comorbid SUD and fewer components with patients with comorbid anxiety disorders. In addition, comorbid SUD and suicidality moderated the impact of training on clinical improvement such that patients with comorbid SUD and patients with suicidality experienced greater PTSD improvement when treated by providers who did versus did not receive postworkshop consultation. Findings demonstrate the impact of postworkshop consultation on therapy implementation and clinical outcomes across common clinical presentations in a military treatment setting.