PSYCH 215 Ashford University Abnormal Psychology Literature Review


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I’m stuck on a Psychology question and need an explanation.

I will attach a lit review template with 7 questions about both of the articles attached. PLEASE follow the template when answering the questions. BOTH articles need to be reviewed and typed into the template!

USE the template! USE both articles! One article will be #1 on the template and the other article will be #2 on the template

Article: Cognitive Processing Therapy for Veterans With Post traumatic Stress Disorder: A Comparison Between Outpatient and Residential Treatment

Article: Stressful Life Events in Bipolar I and II Disorder: Cause or Consequence of Mood Symptoms?

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Journal of Consulting and Clinical Psychology 2014, Vol. 82, No. 4, 551–561 In the public domain http://dx.doi.org/10.1037/a0037075 Cognitive Processing Therapy for Veterans With Posttraumatic Stress Disorder: A Comparison Between Outpatient and Residential Treatment Kristen H. Walter Ruth L. Varkovitzky Veterans Medical Research Foundation, San Diego, California, and Veterans Affairs San Diego Healthcare System, San Diego, California Veterans Affairs Puget Sound Healthcare System, American Lake Division, Tacoma, Washington Gina P. Owens Jennifer Lewis University of Tennessee–Knoxville Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio Kathleen M. Chard Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, and University of Cincinnati Objective: Across the Veterans Affairs (VA) Healthcare System, outpatient and residential posttraumatic stress disorder (PTSD) treatment programs are available to veterans of all ages and both genders; however, no research to date has compared these treatment options. This study compared veterans who received outpatient (n ⫽ 514) to those who received residential treatment (n ⫽ 478) within a VA specialty clinic on demographic and pretreatment symptom variables. Further, the study examined preto posttreatment symptom trajectories across the treatment programs. Method: All 992 veterans met diagnostic criteria for PTSD and attended at least 1 session of cognitive processing therapy (CPT) in either the outpatient or residential program. Bivariate analyses were utilized to investigate differences between samples on demographic variables and severity of pretreatment symptoms. Multilevel modeling (MLM) was used to investigate the change in symptomatology between the 2 samples from pre- to posttreatment. Results: Analyses indicated that the samples differed on all demographic and pretreatment symptom variables, with residential patients reporting higher scores on all assessment measures. MLM results demonstrated that symptom scores improved for all veterans across time, with outpatients consistently reporting fewer symptoms at both time points. The time by program interaction was significant for PTSD-related symptom trajectories, but not for the depression-related symptom trajectory. Conclusion: This is the 1st study to compare pretreatment characteristics and treatment outcome between veterans receiving outpatient and residential PTSD treatment. Findings may help clinicians select appropriate care for their patients by identifying relevant pretreatment characteristics and generally informing expectations of treatment outcome. Keywords: posttraumatic stress disorder, cognitive processing therapy, outpatient treatment, residential treatment, veterans Many veterans seeking mental health care at the Department of Veterans Affairs (VA) have experienced various traumatic events, such as combat, childhood trauma, intimate partner violence, and sexual assault (Clancy et al., 2006). Such traumatic experiences may lead to development of posttraumatic stress disorder (PTSD), depression, other anxiety disorders, and related symptomatology (Hoge et al., 2004). Estimates suggest that 19%–30% of Vietnam veterans have met lifetime criteria for PTSD (Dohrenwend et al., 2006), and as many as 22% of Operation Iraqi Freedom/Operation Enduring Freedom veterans seeking VA care met PTSD criteria (Seal et al., 2009). To meet these critical treatment needs, the VA provides a continuum of options for PTSD care, including outpatient and This article was published Online First June 9, 2014. Kristen H. Walter, Health Services Research & Development, Veterans Medical Research Foundation, San Diego, California, and Research Service, Veterans Affairs San Diego Healthcare System, San Diego, California; Ruth L. Varkovitzky, PTSD Outpatient Clinic, Veterans Affairs Puget Sound Health Care System, American Lake Division, Tacoma, Washington; Gina P. Owens, Department of Psychology, University of Tennessee–Knoxville; Jennifer Lewis, Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio; Kathleen M. Chard, Trauma Recovery Center, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, and Department of Psychiatry, University of Cincinnati. We would like to thank the staff of the Trauma Recovery Center at the Cincinnati Veterans Affairs Medical Center, particularly Jeremiah Schumm, as well as the data preparation efforts of Lindsey Davidson and Misty Wolfe. Content of this article does not necessarily reflect the views of the United States government or the Department of Veterans Affairs. Correspondence concerning this article should be addressed to Kristen H. Walter, Veterans Medical Research Foundation, 3350 La Jolla Village Dr. (111N1), Building 13, San Diego, CA, 92161. E-mail: Kristen.Walter@va.gov 551 552 WALTER, VARKOVITZKY, OWENS, LEWIS, AND CHARD residential treatment programs. The Veterans Health Administration (VHA) has produced guidelines for matching patient needs to the intensity of care required (U.S. Department of Veterans Affairs, 2010). According to these guidelines, outpatient treatment is intended to serve individuals with new onset or severe PTSD, while residential treatment is meant to provide a semistructured environment of rehabilitation where veterans can engage in PTSD treatment and sobriety efforts and address medical and psychological needs prior to full reintegration into the community (U.S. Department of Veterans Affairs, 2010). In part based on the intended population that residential programs aim to serve, a common assumption exists among providers that individuals in residential treatment present with greater symptom severity and functional impairment and, in turn, may not achieve as many treatment gains as outpatients. Despite this assumption, no empirical literature to date has compared patients in residential and outpatient treatment for PTSD. Evidence-Based PTSD Treatment in the VA Two evidence-based treatments for PTSD are currently being disseminated through the VA system (Karlin et al., 2010), including cognitive processing therapy (CPT; Resick, Monson, & Chard, 2010) and prolonged exposure (PE; Foa, Hembree, & Rothbaum, 2007). Both CPT and PE are considered best practice models (Foa, Keane, Friedman, & Cohen, 2008) and have been shown to effectively reduce PTSD and depression symptoms among veterans (Monson et al., 2006; Schnurr et al., 2007; Tuerk et al., 2011). Further treatment outcome research has explored the use of CPT with veterans in residential and outpatient programs and has demonstrated that CPT effectively reduces symptoms of PTSD and depression for veterans receiving treatment in both types of settings (Alvarez et al., 2011; Monson et al., 2006). CPT (rather than PE) was the treatment of focus in the present study, as it was the primary treatment modality used in the residential program at the VA clinic in which this study was conducted. In an effort to make meaningful comparisons between residential and outpatient treatment, we included only veterans receiving CPT in the current examination. CPT can be delivered in several formats, including individual (Resick et al., 2010), group, and in a format which combines individual and group sessions received concurrently (Chard, Resick, Monson, & Kattar, 2009), with the various formats effectively reducing PTSD symptoms in veteran samples (Monson et al., 2006; Walter, Bolte, Owens, & Chard, 2012). Literature supporting the use of CPT in a group format was another reason CPT was selected as the trauma-focused treatment modality. To date, no treatment outcome studies have compared outpatient and residential samples in terms of either pretreatment individual differences or symptom change trajectories. Such comparisons may shed light on the implementation of VA levels of care and allow clinicians to identify and use specific patient characteristics to improve treatment planning. Based on review of the literature previously mentioned, the goal of the current study was to empirically examine whether veterans receiving CPT for PTSD in outpatient treatment (individual CPT format) versus residential treatment (combined individual and group CPT format) differed in terms of pretreatment demographic variables, symptom severity, and treatment outcome. We hypoth- esized that as residential treatment is designed for veterans with more impairing symptoms and complex psychosocial stressors, residential patients would endorse greater PTSD and depression symptom severity at pretreatment compared with outpatients. We also hypothesized that veterans in both programs would benefit from treatment as evidenced by reductions in PTSD and depression symptoms. Due to the lack of preexisting research, analyses comparing treatment outcome trajectory across groups were exploratory. Method Participants Participants included 992 male and female veterans admitted to either the outpatient (n ⫽ 514) or residential (n ⫽ 478) PTSD programs at a midwestern Veterans Affairs medical center between 2007 and 2011. All participants met full diagnostic criteria for PTSD as set forth in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000) and as assessed by the ClinicianAdministered PTSD Scale (CAPS; Blake et al., 1995). All participants attended at least one, but no more than 15, sessions of individual CPT in either the outpatient or residential treatment program. A referral was the only eligibility criterion and was used to determine whether treatment was received in the outpatient or residential treatment program. To be eligible for the outpatient and residential PTSD programs, veterans could either be self-referred or referred by a care provider within the VA Healthcare System. Eligibility for the residential program did not require veterans to have comorbid diagnoses or to have received (or not responded to) prior treatment; however, veterans did commonly present with comorbid conditions and prior treatment experience. Participants were excluded from the study for the following reasons: active substance dependence, current unmanaged psychosis, a significant interfering medical condition (e.g., unmedicated seizure disorder), or the presence of suicidal or homicidal intentions (individuals with ideation but not intention were included). Eleven participants were excluded as they did not attend at least one CPT session after intake, and 14 were excluded because they attended 16 or more sessions. Seventy-five individuals presented to the clinic for at least two unique treatment periods (e.g., two outpatient treatment periods, two residential treatment periods, or one treatment period of each outpatient and residential). These cases were handled by including data from the first treatment period (whichever type of treatment was received first) and eliminating data from any subsequent treatment periods. This method was selected as a conservative approach to reduce the effects of previous treatment exposure. The mean age for the outpatient sample was 43.48 years (SD ⫽ 14.59), and the mean years of education was 13.21 (SD ⫽ 1.84). For the residential sample, the mean age was 47.87 years (SD ⫽ 10.96), and the mean years of education was 13.51 (SD ⫽ 2.43). Additional demographic information for the outpatient and residential treatment samples can be found in Table 1. Measures The pre- and posttreatment assessment battery administered for both outpatient and residential programs included structured clin- OUTPATIENT AND RESIDENTIAL PTSD TREATMENT Table 1 Demographics Across Outpatient and Residential Groups Variable Sex Men Women Race/ethnicity White African American Latino Native American Multicultural Asian American Marital status Married Divorced Never married Separated Widowed Employment status Employed Unemployed Disabled Retired Student Service era OEF/OIF/OND Vietnam Persian Gulf Post-Vietnam Othera Index Traumab Combat Adult sexual assault Childhood sexual abuse Transportation accident Sudden unexpected death Outpatient % (n ⫽ 514) Residential % (n ⫽ 478) 88.5 11.5 63.4 36.6 81.8 15.2 1.8 0.6 0.4 0.2 61.9 34.3 1.9 1.0 0.7 0.2 53.1 23.3 17.9 4.3 1.4 28.1 46.0 18.4 5.2 2.3 43.0 25.0 16.0 9.0 7.0 12.6 37.6 39.3 9.2 1.3 43.4 32.9 12.3 9.7 1.7 17.8 32.2 15.7 32.4 1.9 71.9 6.9 3.3 3.3 2.8 38.2 32.5 8.8 2.5 2.9 Note. OEF/OIF/OND ⫽ Operation Enduring Freedom, Operation Iraqi Freedom/Operation New Dawn. a Other service eras include Korean War, between Korea and Vietnam, Somalia, Kosovo, World War II, Bosnia, and Lebanon. b The five most frequently reported types of index trauma. ical interviews and self-report measures completed in approximately 2–3 hr. The measures used in the current study were derived from these larger pre- and posttreatment batteries. The summary scores used for the present analyses were obtained from chart review, and as a result, item-level data were unavailable. Clinician-Administered PTSD Scale (CAPS; Blake et al., 1995). The CAPS is a structured clinical interview for the assessment of PTSD based on the DSM–IV–TR. A PTSD symptom, as measured on the CAPS, counted toward meeting diagnostic criteria if the frequency (on a 0 – 4 scale) was rated as at least 1 (symptoms occur at least monthly) and intensity (on a 0 – 4 scale) was rated as at least 2 (moderate distress). This scoring procedure was used to determine PTSD diagnostic status based on response to CAPS items (Weathers, Ruscio, & Keane, 1999). A CAPS total severity score was also computed by summing ratings of the frequency and intensity of each PTSD symptom (higher scores indicate greater distress or impairment). Prior research with the CAPS has suggested that the interview is reliable and valid (Blake et al., 1995; Weathers et al., 1999), with excellent psychometric 553 properties among veteran samples (Weathers, Keane, & Davidson, 2001). PTSD diagnostic status, as determined by the CAPS, was used for inclusion criteria, while the CAPS total severity scores at pre- and posttreatment were used for the current study analyses. At posttreatment, the period of assessment used for the CAPS was the previous week, which was intended for repeated assessment over a reasonably brief time interval (Weathers et al., 2001). The 1-week time frame at posttreatment was selected to ensure that the assessment period did not significantly overlap with the treatment period in either program. Structured Clinical Interview for DSM–IV Axis I Disorders (SCID–I; First, Spitzer, Gibbon, & Williams, 1996). The SCID–I is a semistructured interview designed to assess the presence of Axis I symptoms and disorders. The SCID–I was used in the present study to detect current and lifetime mood disorders, substance use disorders, and anxiety disorders other than PTSD, and to screen for psychotic symptoms. In the current study, pretreatment SCID–I diagnoses were used for descriptive purposes. Among veterans in the residential program, the most frequent current psychiatric conditions comorbid with PTSD, as diagnosed by the SCID–I, were major depressive disorder (66.7%), panic disorder (13.7%), bipolar I disorder (8.5%), social phobia (7.3%), and specific phobia (6.3%). Among veterans in the outpatient program, the most frequent current comorbid conditions were major depressive disorder (56.5%), panic disorder (8.2%), social phobia (4.5%), alcohol abuse (3.7%), and specific phobia (3.4%). PTSD Checklist–Stressor-Specific Version (PCL–S; Weathers, Huska, & Keane, 1991). The PCL–S is a widely used 17item self-report measure of PTSD symptomatology that corresponds with diagnostic criteria in the DSM–IV–TR. The PCL–S was used to assess PTSD symptom severity in relation to participants’ reported index trauma (i.e., worst identified trauma or the trauma that they reported as affecting them the most). PCL–S scale items are rated on a 5-point Likert-type scale ranging from 1 (not at all) to 5 (extremely), with total scores ranging from 17 to 85 (higher scores indicate greater distress). The PCL–S has demonstrated reliability and validity across various populations (Blanchard, Jones-Alexander, Buckley, & Forneris, 1996), as well as sensitivity to change over the course of psychological treatment (McDonald & Calhoun, 2010). PCL–S total scores from pre- and posttreatment were used for the current study analyses. Consistent with the CAPS assessment, the time period used for the PCL–S at posttreatment was the previous week. Beck Depression Inventory-II (BDI–II; Beck, Steer, & Brown, 1996). The BDI–II is a well-established 21-item selfreport measure used to assess the presence and severity of depressive symptoms. Items are rated on a 4-point Likert-type scale ranging from 0 to 3. Ratings are summed to yield a total severity index, with higher scores indicating more severe depressive symptoms. Research has demonstrated that the BDI–II has strong psychometric properties, including internal reliability, test–retest reliability, and convergent validity (Beck et al., 1996). For the current study, BDI–II total scores at pre- and posttreatment were used for the analyses and assessed symptoms over the past 2 weeks. Procedure All data were collected as part of routine clinical care at a VA PTSD specialty clinic in the Midwest. A waiver of written consent based on archival data was obtained from a university institutional 554 WALTER, VARKOVITZKY, OWENS, LEWIS, AND CHARD review board and the VA Research and Development Office. During admission into both outpatient and residential treatment programs, veterans were administered a series of assessment instruments to determine their pretreatment diagnostic status and functioning. All assessments were conducted by clinicians with extensive training and supervision in the provision of psychological tests. Diagnostic interviews and treatment sessions were not recorded in the clinic, precluding assessment of interrater reliability. CPT Protocol Following the pretreatment assessment, veterans received either the 12-session individual standard CPT protocol (Resick et al., 2010) on an outpatient basis or the 12-session combined group and individual CPT protocol (Chard et al., 2009) within the residential PTSD treatment program. Prior work has demonstrated similar effect sizes for treatment outcome using various CPT protocols, including individual only and combined group and individual formats (see Chard, 2005; Resick, Nishith, Weaver, Astin, & Feuer, 2002). Veterans who received residential treatment were grouped in cohorts of approximately 10 people. Within both outpatient and residential programs, CPT treatment consisted of three stages: (a) an initial stage consisting of examination of the meaning of the trauma and the relationship between thoughts and emotions and identification of “stuck points” (i.e., disruptive cognitions about trauma that exacerbate PTSD symptoms); (b) a second stage that included the writing of a trauma account(s) to facilitate activation and normalizing natural emotions related to trauma, and further identification of stuck points; and (c) a final stage that focused on challenging stuck points and replacing them with more adaptive cognitions. Throughout treatment, cognitive techniques (including Socratic dialogue) were employed to facilitate further evaluation of potentially maladaptive beliefs. During the final CPT session, veterans were again asked to discuss the meaning of their trauma in order to highlight changes in their beliefs that may have emerged through the course of treatment. CPT was provided by licensed clinicians (i.e., nurse practitioners, social workers, psychiatrists, psychologists) or by trainees (i.e., psychiatry residents or psychology interns) supervised by a licensed clinician. Although providers varied in their ...
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PSY 215 Literature Review Template
Please note: Keep in mind that the following questions are practice and preparation for the more
detailed literature review elements to come. When you complete your literature review, you will
be addressing more specific elements. These questions are the first thing to think about when
beginning a literature review.
Track and Topic _____________________________________
Article #1 (Preassigned #1)

1. What is the title of the article? Provide a reference for the article in APA format.
The title of the article is “Cognitive Processing Therapy for Veterans With Posttraumatic Stress
Disorder: A Comparison Between Outpatient and Residential Treatment”. The reference in APA
format is:
Walter, K. H., Varkovitzky, R. L., Owens, G. P., Lewis, J., & Chard, K. M. (2014). Cognitive
processing therapy for veterans with posttraumatic stress disorder: A comparison between
outpatient and residential treatment. Journal of Consulting and Clinical
Psychology, 82(4), 551–561. doi: 10.1037/a0037075
2. What is the purpose of the article?
The purpose of the article is to compare veterans of two types: those who received outpatient,
and those who received residential treatment in a Veterans Affairs (VA) specialty clinic, on
variables like demographic and pretreatment symptom. Additionally, the article also evaluates
pretreatment and posttreatment symptom trajectories occurring throughout the treatment

3. What is the hypothesis of the study? In other words, what claims do the authors make in
the article? What are the outcomes of the study, that is, the conclusions that the authors
made as a result of the study?
The hypothesis is that the residential patients would have greater PTSD and depression symptom
severity during pretreatment, compared to outpatients. The authors also hypothesized that in both
programs, veterans would benefit from this treatment. The outcome is that residential patients
scored higher on all assessment measures, compared to the veterans who received outpatient.

Furthermore, over time, symptom scores improved for all veterans, and outpatients are consistent
to have fewer symptom scores at the two time points.
4. What variables (factors) are being looked at as an influence on ab...

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