Understanding therapists' perceived determinants of trauma narrative use

Hannah E Frank^{1

2}, Briana S Last³, Reem AlRabiah⁴, Jessica Fishman^{4

5

6}, Brittany N Rudd^{4

7}, Hilary E Kratz⁸, Colleen Harker⁴, Sara Fernandez-Marcote⁹, Kamilah Jackson^{10

11}, Carrie Comeau⁹, Sosunmolu Shoyinka¹⁰, Rinad S Beidas^{4

6

12

13

14}

Affiliations

¹ Department of Psychology, Temple University, Philadelphia, PA, USA. Hannah_Frank@brown.edu.
² Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA. Hannah_Frank@brown.edu.
³ Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
⁵ Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA.
⁶ Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA.
⁷ Department of Psychiatry, University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
⁸ Department of Psychology, La Salle University, Philadelphia, PA, USA.
⁹ Community Behavioral Health, Philadelphia, PA, USA.
¹⁰ Department of Behavioral Health and Intellectual Disability Services, Philadelphia, PA, USA.
¹¹ PerformCare New Jersey, Robbinsville, NJ, USA.
¹² Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
¹³ Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
¹⁴ Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA, USA.

PMID: 34852850
PMCID: PMC8638192
DOI: 10.1186/s43058-021-00231-9

Understanding therapists' perceived determinants of trauma narrative use

Hannah E Frank et al. Implement Sci Commun. 2021.

. 2021 Dec 2;2(1):131.

doi: 10.1186/s43058-021-00231-9.

Authors

Affiliations

¹ Department of Psychology, Temple University, Philadelphia, PA, USA. Hannah_Frank@brown.edu.
² Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA. Hannah_Frank@brown.edu.
³ Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
⁵ Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA.
⁶ Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA.
⁷ Department of Psychiatry, University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
⁸ Department of Psychology, La Salle University, Philadelphia, PA, USA.
⁹ Community Behavioral Health, Philadelphia, PA, USA.
¹⁰ Department of Behavioral Health and Intellectual Disability Services, Philadelphia, PA, USA.
¹¹ PerformCare New Jersey, Robbinsville, NJ, USA.
¹² Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
¹³ Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
¹⁴ Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA, USA.

PMID: 34852850
PMCID: PMC8638192
DOI: 10.1186/s43058-021-00231-9

Abstract

Background: Trauma narratives are a critical, exposure-based component of trauma-focused cognitive-behavioral therapy, yet community therapists rarely use them. Given evidence that intentions to deliver elements of cognitive behavioral therapy vary by component, and that intentions to deliver exposure are the weakest, this study focused specifically on trauma narratives. We drew on a social psychology causal theory (Theory of Planned Behavior (TPB)) and an implementation science framework (the Consolidated Framework for Implementation Research (CFIR)) to glean insight into multilevel influences on trauma narrative use. While the CFIR offers a broad list of factors potentially affecting implementation, the TPB offers causal pathways between individual-level constructs that predict behavior, including the uptake of an evidence-based intervention. The integration of these approaches may provide a more complete understanding of factors affecting therapists' use of TNs.

Methods: Therapists (n=65) trained in trauma-focused cognitive behavioral therapy completed a survey about their use of and beliefs about trauma narratives. Content analysis was used to identify common beliefs about trauma narratives. A subset of participants (n=17) completed follow-up qualitative interviews, which were analyzed using an integrated approach informed by the CFIR.

Results: While most participants reported high intentions to use TNs, nearly half reported that they did not use TNs in the last 6 months. Survey data indicate a number of TPB-related determinants related to using trauma narratives. Qualitative interviews identified CFIR-relevant contextual factors that may influence constructs central to TPB.

Conclusions: These results highlight the importance of integrating approaches that address multiple theoretical determinants of therapist behavior, including therapist, organizational, and client factors with causal explanations to explain implementation behavior.

Keywords: Consolidated Framework for Implementation Research; Determinants; Implementation science; Theory of Planned Behavior; Trauma-focused cognitive behavioral therapy.

PubMed Disclaimer

Conflict of interest statement

Dr. Beidas receives royalties from Oxford University Press. She has provided consultation to the Camden Coalition for Healthcare Providers. She is a consultant to United Behavioral Health and serves on the Clinical and Scientific Advisory Committee for Behavioral Health.

Figures

**Fig. 1**
Proposed combined TPB and CFIR model. *Note*: This is a proposed conceptual model that we developed based on our data. Colored ovals represent the CFIR domains and gray boxes represent the TPB. This integrated model may look different for other interventions and contexts

See this image and copyright information in PMC

References

1. Garland AF, Bickman L, Chorpita BF. Change what? Identifying quality improvement targets by investigating usual mental health care. Admin Pol Ment Health. 2010;37(1-2):15–26. - PMC - PubMed
1. Aarons GA, Ehrhart MG, Farahnak LR, Hurlburt MS. Leadership and organizational change for implementation (LOCI): a randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation. Implement Sci. 2015;10(1):11. - PMC - PubMed
1. Beidas RS, Marcus S, Aarons GA, Hoagwood KE, Schoenwald S, Evans AC, et al. Predictors of Community Therapists’ Use of Therapy Techniques in a Large Public Mental Health System. JAMA Pediatr. 2015;169(4):374. - PMC - PubMed
1. Trask EV, Fawley-King K, Garland AF, Aarons GA. Client Report of Delivery of Common Elements in Usual Care and the Association to Satisfaction. J Child Fam Stud. 2016;25(3):845–855.
1. Lewis CC, Klasnja P, Powell BJ, Lyon AR, Tuzzio L, Jones S, Walsh-Bailey C, Weiner B. From Classification to Causality: Advancing Understanding of Mechanisms of Change in Implementation Science. Front Public Health. 2018;6:136. 10.3389/fpubh.2018.00136. - PMC - PubMed

Grants and funding

LinkOut - more resources

Full Text Sources

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Understanding therapists' perceived determinants of trauma narrative use

Affiliations

Understanding therapists' perceived determinants of trauma narrative use

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources