Clinicians' perspectives on cognitive-behavioral treatment for PTSD among persons with severe mental illness.

Frueh BC, Cusack KJ, Grubaugh AL, Sauvageot JA, Wells C. Clinicians' perspectives on cognitive-behavioral treatment for PTSD among persons with severe mental illness. Psychiatric services (Washington, D.C.). 2006 Jul 1; 57(7):1027-31.

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Abstract:

OBJECTIVE: As an intermediate step in the development of a cognitive-behavioral posttraumatic stress disorder (PTSD) treatment program for persons with severe mental illness, a focus group gathered feedback from clinicians and clinical supervisors within a public-sector mental health system. METHODS: Five qualitative focus group discussions were held with 33 clinicians and clinical supervisors within a state-funded community mental health center system. RESULTS: Clinicians perceived trauma to be a significant adverse factor in the lives of their mental health services consumers, were reluctant to address trauma with them, and yet believed that cognitive-behavioral treatments for PTSD may be effective and appropriate for them. Clinicians also offered practical suggestions to improve the feasibility and acceptability of the proposed cognitive-behavioral treatment program. Examples include creating gender-specific treatment groups; ensuring that trust and rapport with clients are established before the discussion of traumatic experiences; developing careful safety precautions for clients, especially for the exposure therapy component; preparing for the possibility that some consumers will lack the cognitive ability to understand treatment; and collaborating with other care providers to ensure optimal integration with other aspects of care and minimize clinic disruptions. CONCLUSIONS: These findings provide information relevant to the development and implementation of PTSD interventions for patients with severe mental illness treated in public-sector settings.