Veterans are at risk for many psychological problems, including depression. One of the approaches most commonly used to address the increase in cases of depression through the Veterans Health Administration (VHA) is the use of antidepressant medication. Treatment options also include therapy, specifically cognitive behavioral therapy for depression (CBT-D). Although both methods have been shown to be effective when used alone or together, CBT-D often is preferred because it can also alleviate symptoms of comorbid problems and does not carry the risk of side effects. However, many therapists in the VA are not adequately trained in evidence based psychotherapies (EBP) such as CBT. The majority of training required for EBP is cost- and time-prohibitive, a challenge for organizations like the VHA. Therefore, if VA therapists could receive abbreviated training that provides a fundamental framework for effective delivery of CBT, it could decrease depression rates for thousands of veterans.
Bradley E. Karlin, of the Office of Mental Health Services at the Veterans Affairs Central Office in Washington, D.C., recently conducted a study that assessed the depression scores of 356 veterans seeking help for depression after they received CBT-D from therapists who underwent brief training through the VHA. Karlin evaluated the competency of the therapists before and after training, and measured depression and quality-of-life scores of all participants after they completed therapy. He found that nearly all the therapists completed the training and scored in the competent level. Additionally, 70% of participants completed most of the therapy sessions and saw decreases in symptom severity upward of 40%.
The findings of this study show that the training provided by the VHA results in significant reductions in depression and increases overall quality of life for veterans. The retention rates achieved in this study also support the efficacy of brief training and suggest that veterans who receive CBT-D from adequately trained therapists are likely to adhere to treatment and thus have better outcomes than those who drop out early. Karlin believes the findings might need further exploration because the therapists recruited for this study expressed an interest in learning more about CBT, which could have influenced the outcome. Future work should address this and also look at how comorbid conditions, such as posttraumatic stress, affect the reductions in depression. Despite these shortcomings, this study emphasizes the dynamic impact that brief training can have on the veteran population. “These findings, yielded far outside of the laboratory environment, suggest that CBT may indeed be transportable to and flourish in complex, real-world settings,” Karlin said.
Karlin, Bradley E., Gregory K. Brown, Mickey Trockel, Darby Cunning, and Antonette M. Zeiss. National dissemination of cognitive behavioral therapy for depression in the Department of Veterans Affairs health care system: Therapist and patient-level outcomes. Journal of Consulting and Clinical Psychology 80.5 (2012): 707-18. Print.
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