A Mixed-Methods Evaluation of Intensive Trauma-Focused Programming

Every year, millions of individuals in the United States experience the symptoms of posttraumatic stress disorder (PTSD) because of a traumatic or stressor-related event (Kessler, Chiu, Demler, & Walters, 2005; Kilpatrick et al., 2013). For some, the intrusive thoughts/images, avoidance, negative mood, and increased arousal that characterize PTSD may be transitory because of preexisting coping skills or protective factors (Grella, Lovinger, & Warda, 2013; Schultz et al., 2013). For others, time-referenced counseling interventions, such as cognitive behavior therapies (Meichenbaum, 1977), prolonged exposure (Foa, Hembree, & Rothbaum, 2007), or eye-movement desensitization and reprocessing (EMDR; Shapiro, 2001), can provide relatively lasting relief from symptoms that promote a return to increased functioning. In contrast, systematic reviews of published studies have revealed that a significant number of individuals do not seek or receive mental health interventions following traumatic events, which can lead to chronic expressions of symptoms over time (Gavrilovic, Schutzwohl, & Priebe, 2005). Individuals within this group have reported marked disparities in functioning, including strained family relationships and divorce (Dekel & Monson, 2010), unemployment (Diene et al., 2012), and vulnerability to co-occurring mental health and substance use disorders (Najt, Fusar-Poli, & Brambilla, 2011). Consequently, when clients present with more complex PTSD symptoms because of delayed treatment, more rigorous treatment protocols may be warranted. Intensive outpatient programs (IOPs) offer one option for treating severe cases of PTSD that exceed the capabilities of routine outpatient care, but do not require hospitalization (Forman & Nagy, 2006; Lande, Williams, Francis, Gragnani, & Morin, 2011). Commonalities across IOP settings include 4 to 5 hours of service delivery on multiple days per week, medical management of symptoms, psychoeducation, individual counseling, group interventions, and various adjunctive treatments aligned with program ideology (Lande et al,, 2011). The IOP approach to treatment has been shown to be an effective strategy for monitoring progress toward goals, providing the appropriate level of care, preventing relapse, and allowing clients to remain in the community (Forman & Nagy, 2006). Researchers have reported promising findings for the treatment of PTSD among IOPs grounded in cognitive behavior therapies (Lande et al,, 2011), body-oriented interventions (Bloch-Atefi & Smith, 2014), and expressive arts interventions (Gantt & Tinnin, 2007). Within these findings, clients reported decreased psychological symptoms and increased functioning across relational, social, and occupational domains. However, given the recent emergence of additional therapies for treating individuals with PTSD, it is unclear the degree of treatment effect that is associated with IOPs grounded in specific trauma-focused treatments that promote cognitive and physiological processing. Meta-analyses have indicated that PTSD symptoms may be best treated through trauma-focused treatments, including cognitive processing therapy (see Lenz, Bruijn, Serman, & Bailey, 2014), prolonged exposure (see Powers, Halpern, Ferenschak, Gillihan, & Foa, 2010), and EMDR (see Ho & Lee, 2012). However, within these studies, evaluations are predominantly based on treatment outcomes within either inpatient or community-based settings that afford little understanding regarding IOPs as a midpoint within the continuum of care. Furthermore, studies of trauma-focused treatments among individuals with PTSD have tended to present findings associated with stand-alone treatments rather than intensive, integrative approaches that implement multiple modalities meaningfully. Purpose of the Study This study was completed as part of a larger program evaluation intended to investigate the treatment effect associated with a trauma-focused IOP for individuals who have PTSD. …