The present study examined whether certain Veterans Health Administration (VHA) therapists have more success than others in keeping patients engaged in evidence-based psychotherapies for posttraumatic stress disorder (PTSD). Our objective was to use multilevel modeling to quantify the variability between therapists in two indicators of patient engagement: early dropout (i.e., < 3 sessions) and adequate dose (i.e., ≥ 8 sessions). The phenomenon of systematic variability between therapists in patients’ treatment experience and outcomes is referred to as “therapist effects.” The sample included the 2,709 therapists who provided individual cognitive processing therapy (CPT) or prolonged exposure (PE) to 18,461 veterans with PTSD across 140 facilities in 2017. Data were extracted from administrative databases. For CPT, therapist effects accounted for 10.9% of the variance in early dropout and 8.9% of the variance in adequate dose. For PE, therapist effects accounted for 6.0% and 8.8% of the variance in early dropout and adequate dose, respectively. Facility only accounted for an additional 1.1%–3.1% of the variance in early dropout and adequate dose. For CPT, patients’ odds of receiving an adequate dose almost doubled, OR = 1.41/0.72 = 1.96, if they were seen by a therapist in the highest compared with the lowest retention decile. For PE, the odds of a patient receiving an adequate dose were 84% higher, OR = 1.38/0.75 = 1.84, when treated by a therapist in the highest compared with the lowest retention decile. Therapist skills and work environment may contribute to variability across therapists in early dropout and adequate dose.

中文翻译：

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退伍军人健康管理局创伤后应激障碍循证心理治疗中治疗师对患者参与度的影响调查

本研究检查了某些退伍军人健康管理局 (VHA) 治疗师在让患者参与创伤后应激障碍 (PTSD) 的循证心理治疗方面是否比其他治疗师更成功。我们的目标是使用多层次模型来量化治疗师在患者参与的两个指标中的可变性：早期退出（即，< 3 个疗程）和足够的剂量（即，≥ 8 个疗程）。治疗师之间在患者治疗经验和结果方面存在系统性差异的现象被称为“治疗师效应”。样本包括 2,709 名治疗师，他们在 2017 年为 140 家设施的 18,461 名患有 PTSD 的退伍军人提供个人认知加工治疗 (CPT) 或长期暴露 (PE)。数据是从管理数据库中提取的。对于彩管，治疗师效应占早期辍学方差的 10.9% 和足够剂量方差的 8.9%。对于 PE，治疗师效应分别占早期辍学和足够剂量方差的 6.0% 和 8.8%。设施仅占早期辍学和足够剂量差异的额外 1.1%–3.1%。对于 CPT，患者接受足够剂量的几率几乎翻了一番，OR = 1.41/0.72 = 1.96，如果他们被治疗师看到最高与最低保留十分位相比。对于 PE，患者接受足够剂量的几率高出 84%，OR = 1.38/0.75 = 1.84，与最低保留十分位数相比，由治疗师进行最高治疗时。治疗师的技能和工作环境可能会导致治疗师在早期辍学和充足剂量方面的差异。