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      A multi-site single-blind clinical study to compare the effects of STAIR Narrative Therapy to treatment as usual among women with PTSD in public sector mental health settings: study protocol for a randomized controlled trial

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          Abstract

          Background

          This article provides a description of the rationale, design, and methods of a multisite clinical trial which evaluates the potential benefits of an evidence-based psychosocial treatment, STAIR Narrative Therapy, among women with posttraumatic stress disorder (PTSD) related to interpersonal violence who are seeking services in public sector community mental health clinics. This is the first large multisite trial of an evidence-based treatment for PTSD provided in the context of community settings that are dedicated to the treatment of poverty-level patient populations.

          Methods

          The study is enrolling 352 participants in a minimum of 4 community clinics. Participants are randomized into either STAIR Narrative Therapy or Treatment As Usual (TAU). Primary outcomes are PTSD, emotion management and interpersonal problems. The study will allow a flexible application of the protocol determined by patient need and preferences. Secondary analyses will assess the relationship of outcomes to different patterns of treatment implementation for different levels of baseline symptom severity.

          Discussion

          The article discusses the rationale and study issues related to the use of a flexible delivery of a protocol treatment and of the selection of treatment as it is actually practiced in the community as the comparator.

          Trial registration

          Clinicaltrials.gov identifier: NCT01488539.

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          Most cited references21

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          Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC).

          Resilience may be viewed as a measure of stress coping ability and, as such, could be an important target of treatment in anxiety, depression, and stress reactions. We describe a new rating scale to assess resilience. The Connor-Davidson Resilience scale (CD-RISC) comprises of 25 items, each rated on a 5-point scale (0-4), with higher scores reflecting greater resilience. The scale was administered to subjects in the following groups: community sample, primary care outpatients, general psychiatric outpatients, clinical trial of generalized anxiety disorder, and two clinical trials of PTSD. The reliability, validity, and factor analytic structure of the scale were evaluated, and reference scores for study samples were calculated. Sensitivity to treatment effects was examined in subjects from the PTSD clinical trials. The scale demonstrated good psychometric properties and factor analysis yielded five factors. A repeated measures ANOVA showed that an increase in CD-RISC score was associated with greater improvement during treatment. Improvement in CD-RISC score was noted in proportion to overall clinical global improvement, with greatest increase noted in subjects with the highest global improvement and deterioration in CD-RISC score in those with minimal or no global improvement. The CD-RISC has sound psychometric properties and distinguishes between those with greater and lesser resilience. The scale demonstrates that resilience is modifiable and can improve with treatment, with greater improvement corresponding to higher levels of global improvement. Copyright 2003 Wiley-Liss, Inc.
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            Construction and factorial validation of a short form of the Self-Compassion Scale.

            The objective of the present study was to construct and validate a short-form version of the Self-Compassion Scale (SCS). Two Dutch samples were used to construct and cross-validate the factorial structure of a 12-item Self-Compassion Scale-Short Form (SCS-SF). The SCS-SF was then validated in a third, English sample. The SCS-SF demonstrated adequate internal consistency (Cronbach's alpha ≥ 0.86 in all samples) and a near-perfect correlation with the long form SCS (r ≥ 0.97 all samples). Confirmatory factor analysis on the SCS-SF supported the same six-factor structure as found in the long form, as well as a single higher-order factor of self-compassion. The SCS-SF thus represents a reliable and valid alternative to the long-form SCS, especially when looking at overall self-compassion scores. Copyright © 2010 John Wiley & Sons, Ltd.
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              The development of a Clinician-Administered PTSD Scale.

              Several interviews are available for assessing PTSD. These interviews vary in merit when compared on stringent psychometric and utility standards. Of all the interviews, the Clinician-Administered PTSD Scale (CAPS-1) appears to satisfy these standards most uniformly. The CAPS-1 is a structured interview for assessing core and associated symptoms of PTSD. It assesses the frequency and intensity of each symptom using standard prompt questions and explicit, behaviorally-anchored rating scales. The CAPS-1 yields both continuous and dichotomous scores for current and lifetime PTSD symptoms. Intended for use by experienced clinicians, it also can be administered by appropriately trained paraprofessionals. Data from a large scale psychometric study of the CAPS-1 have provided impressive evidence of its reliability and validity as a PTSD interview.
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                Author and article information

                Contributors
                Journal
                Trials
                Trials
                Trials
                BioMed Central
                1745-6215
                2014
                29 May 2014
                : 15
                : 197
                Affiliations
                [1 ]VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA
                [2 ]New York University Langone Medical Center, 550 First Ave, New York, NY 10016, USA
                [3 ]Harvard University Medical School, Cambridge Health Alliance, 1493 Cambridge, St. Cambridge, MA 02139, USA
                [4 ]VA New York Harbor Healthcare System – Manhattan Campus, 423 E 23rd Street, New York, NY 10010, USA
                [5 ]Grady Department of Psychiatry, Health System, Emory University School of Medicine, 1648 Pierce Drive, NE, Atlanta, GA, 30322, USA
                [6 ]The Nathan S. Kline Institute for Psychiatric Research, of New York State Office of Mental Health (OMH), 140 Old Orangeburg Rd, Orangeburg, NY 10962, USA
                Article
                1745-6215-15-197
                10.1186/1745-6215-15-197
                4071147
                24886235
                ed5bb0cb-a3d4-4e2c-b5ec-e570e4c32dba
                Copyright © 2014 Cloitre et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 1 February 2014
                : 17 April 2014
                Categories
                Study Protocol

                Medicine
                ptsd,community mental health clinics,women’s health,flexible service delivery
                Medicine
                ptsd, community mental health clinics, women’s health, flexible service delivery

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