Development of a Quality Measure for Adults with Post-Traumatic Stress Disorder. B. Identification of Critical PTSD Psychotherapy Treatment Elements using an Established Methodology


Convening a TEP to generate a list of common treatment elements. As a first step in the development of this survey measure, we used the established "distillation and matching" approach (Chorpita 2005, 2009) to identify the elements present in evidence-based psychotherapy for adults with PTSD. Given the current research evidence, we focused on elements of cognitive behavioral approaches to the treatment of PTSD. In accordance with this method, we convened a (new) TEP, composed of national and international experts in the treatment of PTSD, particularly in prolonged exposure therapy and CPT, two psychotherapies that fall under the broader umbrella of cognitive behavioral approaches (see Appendix C). The TEP recommended an initial list of psychotherapy treatment elements that largely draw from these two therapies and include elements such as the use of Socratic questioning, cognitive restructuring, and homework assignments.

PTSD clinical treatment manual review. To determine the extent to which the psychotherapy treatment elements commonly occur, we systematically reviewed PTSD clinical manuals for the presence of the identified elements. We identified eight PTSD treatment clinical manuals (Appendix D) through web-based searches and recommendations from PTSD clinical experts. Two independent reviewers from Mathematica read each manual and documented the presence or absence of each treatment element. Mathematica's project director or deputy project director resolved discrepancies between the reviewers. In total, reviewers identified 30 elements, agreeing upon their presence or absence for 23 of them (77 percent).

Selection of common psychotherapy elements. To identify the final list of common evidence-based psychotherapy elements for the treatment of PTSD, we reviewed the frequency with which the elements were identified in the clinical manuals. We dropped any treatment elements such as stress inoculation training and relaxation training that were identified in three or fewer clinical manuals, and did not translate them into survey items. We then convened the TEP to provide input on the final list. They generally agreed with our identification and prioritization of treatment elements and recommended the inclusion of two additional elements: assessing and monitoring client symptoms and being directive in therapy sessions, which we incorporated into the list. The TEP also provided input on the extent to which the identified elements assess underlying constructs of evidence-based psychotherapy. Although they agreed that the identified elements could be grouped into treatment constructs, they were unable to reach consensus regarding how they should be grouped. The final list included 35 common elements.