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Article ; Online: Clinician Burnout and Effectiveness of Guideline-Recommended Psychotherapies.

Sayer, Nina A / Kaplan, Adam / Nelson, David B / Wiltsey Stirman, Shannon / Rosen, Craig S

JAMA network open

2024 Volume 7, Issue 4, Page(s) e246858

Abstract: Importance: Clinician burnout has been associated with clinician outcomes, but the association with patient outcomes remains unclear.: Objective: To evaluate the association between clinician burnout and the outcomes of patients receiving of ... ...

Abstract	Importance: Clinician burnout has been associated with clinician outcomes, but the association with patient outcomes remains unclear. Objective: To evaluate the association between clinician burnout and the outcomes of patients receiving of guideline-recommended trauma-focused psychotherapies for posttraumatic stress disorder (PTSD). Design, setting, and participants: This cohort study was set at the US Veterans Affairs Health Care System and included licensed therapists who provided trauma-focused psychotherapies and responded to an online survey between May 2 and October 8, 2019, and their patients who initiated a trauma-focused therapy during the following year. Patient data were collected through December 31, 2020. Data were analyzed from May to September 2023. Exposures: Therapists completing the survey reported burnout with a 5-point validated measure taken from the Physician Worklife Study. Burnout was defined as scores of 3 or more. Main outcomes and measures: The primary outcome was patients' clinically meaningful improvement in PTSD symptoms according to the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Patient dropout, therapist adherence, and session spacing was assessed through electronic health records. Multivariable random-effects logistic regression examined the association of therapist burnout and clinically meaningful improvement, adjusted for case-mix. Results: In this study, 165 of 180 (91.7%) therapists (89 [53.9%] female) completed the burnout measure and provided trauma-focused psychotherapies to 1268 patients (961 [75.8%] male) with outcome data. Fifty-eight (35.2%) therapists endorsed burnout. One third of patients (431 [34.0%]) met criterion for clinically meaningful improvement. Clinically meaningful improvement in PTSD symptoms was experienced by 120 (28.3%) of the 424 patients seen by therapists who reported burnout and 311 (36.8%) of the 844 patients seen by therapists without burnout. Burnout was associated with lower odds of clinically meaningful improvement (adjusted odds ratio [OR],0.63; 95% CI, 0.48-0.85). The odds of clinically meaningful improvement were reduced for patients who dropped out (OR, 0.15; 95% CI, 0.11-0.20) and had greater session spacing (OR, 0.80; 95% CI, 0.70-0.92). Therapist adherence was not associated with therapy effectiveness. Adjusting for dropout or session spacing did not meaningfully alter the magnitude of the association between burnout and clinically meaningful improvement. Conclusions and relevance: In this prospective cohort study, therapist burnout was associated with reduced effectiveness of trauma-focused psychotherapies. Studying when and how burnout affects patient outcomes may inform workplace interventions.
MeSH term(s)	Humans ; Female ; Male ; Cohort Studies ; Prospective Studies ; Burnout, Psychological ; Psychotherapy ; Checklist
Language	English
Publishing date	2024-04-01
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2024.6858
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Article: Rumination Syndrome in Children and Adolescents: A Mini Review.

Martinez, Marc / Rathod, Sandeep / Friesen, Hunter J / Rosen, John M / Friesen, Craig A / Schurman, Jennifer V

Frontiers in pediatrics

2021 Volume 9, Page(s) 709326

Abstract: Introduction: ...

Abstract	Introduction:
Language	English
Publishing date	2021-08-19
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2021.709326
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Article ; Online: Correction to: Participatory System Dynamics Modeling: Increasing Stakeholder Engagement and Precision to Improve Implementation Planning in Systems.

Zimmerman, Lindsey / Lounsbury, David W / Rosen, Craig S / Kimerling, Rachel / Trafton, Jodie A / Lindley, Steven E

Administration and policy in mental health

2021 Volume 48, Issue 2, Page(s) 377

Language	English
Publishing date	2021-01-12
Publishing country	United States
Document type	Published Erratum
ZDB-ID	1025319-1
ISSN	1573-3289 ; 0894-587X
ISSN (online)	1573-3289
ISSN	0894-587X
DOI	10.1007/s10488-020-01105-3
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Article ; Online: The role of therapy delivery and clinic organizational factors in explaining therapist effects for trauma-focused psychotherapies in the Veterans Health Administration.

Sayer, Nina A / Wiltsey Stirman, Shannon / Rosen, Craig S / Kehle-Forbes, Shannon / Spoont, Michele R / Eftekhari, Afsoon / Chard, Kathleen M / Kaplan, Adam / Nelson, David B

Journal of consulting and clinical psychology

2023 Volume 91, Issue 11, Page(s) 665–679

Abstract: Objective: This study estimated the size of therapist effects (TEs) for dropout and clinical effectiveness of two trauma-focused psychotherapies (TFPs) and evaluated whether therapy delivery and clinic organizational factors explained observed TEs.: ... ...

Abstract	Objective: This study estimated the size of therapist effects (TEs) for dropout and clinical effectiveness of two trauma-focused psychotherapies (TFPs) and evaluated whether therapy delivery and clinic organizational factors explained observed TEs. Method: Participants were 180 therapists (54.4% psychologists, 42.2% social workers) from 137 Veterans Health Administration facilities and 1,735 patients (24.7% women; 27.2% people of color) who completed at least two TFP sessions. Outcomes were dropout (< 8 TFP sessions) and for a subsample ( Results: Over half (51.2%) of patients dropped out and those who dropped out were less likely to meet criteria for clinically meaningful improvement or recovery ( Conclusions: Interventions targeting therapy delivery and clinic organization have the potential to reduce variation between therapists in TFP dropout, so that more patients stay engaged long enough to experience clinical benefit. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Language	English
Publishing date	2023-09-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	121321-0
ISSN	1939-2117 ; 0022-006X
ISSN (online)	1939-2117
ISSN	0022-006X
DOI	10.1037/ccp0000832
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Article ; Online: Organizing principles of astrocytic nanoarchitecture in the mouse cerebral cortex.

Salmon, Christopher K / Syed, Tabish A / Kacerovsky, J Benjamin / Alivodej, Nensi / Schober, Alexandra L / Sloan, Tyler F W / Pratte, Michael T / Rosen, Michael P / Green, Miranda / Chirgwin-Dasgupta, Adario / Mehta, Shaurya / Jilani, Affan / Wang, Yanan / Vali, Hojatollah / Mandato, Craig A / Siddiqi, Kaleem / Murai, Keith K

Current biology : CB

2023 Volume 33, Issue 5, Page(s) 957–972.e5

Abstract: Astrocytes are increasingly understood to be important regulators of central nervous system (CNS) function in health and disease; yet, we have little quantitative understanding of their complex architecture. While broad categories of astrocytic ... ...

Abstract	Astrocytes are increasingly understood to be important regulators of central nervous system (CNS) function in health and disease; yet, we have little quantitative understanding of their complex architecture. While broad categories of astrocytic structures are known, the discrete building blocks that compose them, along with their geometry and organizing principles, are poorly understood. Quantitative investigation of astrocytic complexity is impeded by the absence of high-resolution datasets and robust computational approaches to analyze these intricate cells. To address this, we produced four ultra-high-resolution datasets of mouse cerebral cortex using serial electron microscopy and developed astrocyte-tailored computer vision methods for accurate structural analysis. We unearthed specific anatomical building blocks, structural motifs, connectivity hubs, and hierarchical organizations of astrocytes. Furthermore, we found that astrocytes interact with discrete clusters of synapses and that astrocytic mitochondria are distributed to lie closer to larger clusters of synapses. Our findings provide a geometrically principled, quantitative understanding of astrocytic nanoarchitecture and point to an unexpected level of complexity in how astrocytes interact with CNS microanatomy.
MeSH term(s)	Animals ; Mice ; Astrocytes/physiology ; Synapses/physiology ; Cerebral Cortex
Language	English
Publishing date	2023-02-16
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1071731-6
ISSN	1879-0445 ; 0960-9822
ISSN (online)	1879-0445
ISSN	0960-9822
DOI	10.1016/j.cub.2023.01.043
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Article ; Online: Mucosal eosinophils, mast cells, and intraepithelial lymphocytes in youth with rumination syndrome.

Friesen, Hunter J / Rosen, John / Low Kapalu, Christina / Singh, Meenal / Spaeth, Tracy / Cocjin, Jose T / Friesen, Craig A / Schurman, Jennifer V

Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society

2021 Volume 33, Issue 10, Page(s) e14155

Abstract: Background: Rumination syndrome has been associated with increased duodenal eosinophils and intraepithelial lymphocytes in adults. The aims of the current study were to assess densities of antroduodenal eosinophils and mast cells and duodenal ... ...

Abstract	Background: Rumination syndrome has been associated with increased duodenal eosinophils and intraepithelial lymphocytes in adults. The aims of the current study were to assess densities of antroduodenal eosinophils and mast cells and duodenal intraepithelial lymphocytes in youth with rumination syndrome and to compare cell densities in those with and without abdominal pain or early satiety. Methods: Twenty-eight youth fulfilling Rome IV criteria for rumination syndrome who had undergone endoscopy were identified and compared to 10 controls. Antral and duodenal biopsies were assessed to determine densities of eosinophils, mast cells, and intraepithelial lymphocytes. Cell densities were also compared between rumination patients with and without abdominal pain and those with and without early satiety. Key results: Antral mast cell (peak 18.5±6.5 vs. 12.5±2.7) and eosinophil (peak 9.6±5.2 vs. 4.9±2.1) densities were significantly greater in patients with rumination syndrome as compared to controls. Duodenal intraepithelial lymphocyte densities were also increased in rumination syndrome (18.9 ± 5.1 vs. 11.7 ± 1.5; p<.001). Associations were independent of the presence of abdominal pain or early satiety. Conclusions and inferences: In conclusion, we found an increase in eosinophil and mast cell densities in the gastric antrum and an increase in intraepithelial lymphocytes in the duodenum in youth with rumination syndrome which was independent of the presence of abdominal pain or early satiety. These findings suggest a potential role for inflammation in the pathophysiology of rumination syndrome. Future studies should address whether treatment directed at these cells are beneficial in treating rumination syndrome.
MeSH term(s)	Adolescent ; Adult ; Cell Count ; Duodenum/pathology ; Eosinophils/pathology ; Humans ; Intestinal Mucosa/pathology ; Intraepithelial Lymphocytes ; Mast Cells/pathology ; Rumination Syndrome
Language	English
Publishing date	2021-04-10
Publishing country	England
Document type	Journal Article
ZDB-ID	1186328-6
ISSN	1365-2982 ; 1350-1925
ISSN (online)	1365-2982
ISSN	1350-1925
DOI	10.1111/nmo.14155
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Article ; Online: Implementation context and burnout among Department of Veterans Affairs psychotherapists prior to and during the COVID-19 pandemic.

Rosen, Craig S / Kaplan, Adam N / Nelson, David B / La Bash, Heidi / Chard, Kathleen M / Eftekhari, Afsoon / Kehle-Forbes, Shannon / Wiltsey Stirman, Shannon / Sayer, Nina A

Journal of affective disorders

2022 Volume 320, Page(s) 517–524

Abstract: Background: The first goal of this study was to assess longitudinal changes in burnout among psychotherapists prior to (T1) and during the COVID-19 pandemic (T2). The second objective was to assess the effects of job demands, job resources (including ... ...

Abstract	Background: The first goal of this study was to assess longitudinal changes in burnout among psychotherapists prior to (T1) and during the COVID-19 pandemic (T2). The second objective was to assess the effects of job demands, job resources (including organizational support for evidence-based psychotherapies, or EBPs) and pandemic-related stress (T2 only) on burnout. Method: Psychotherapists providing EBPs for posttraumatic stress disorder in U.S. Department of Veterans Affairs (VA) facilities completed surveys assessing burnout, job resources, and job demands prior to (T1; n = 346) and during (T2; n = 193) the COVID-19 pandemic. Results: Burnout prevalence increased from 40 % at T1 to 56 % at T2 (p < .001). At T1, stronger implementation climate and implementation leadership (p < .001) and provision of only cognitive processing therapy (rather than use of prolonged exposure therapy or both treatments; p < .05) reduced burnout risk. Risk factors for burnout at T2 included T1 burnout, pandemic-related stress, less control over when and how to deliver EBPs, being female, and being a psychologist rather than social worker (p < .02). Implementation leadership did not reduce risk of burnout at T2. Limitations: This study involved staff not directly involved in treating COVID-19, in a healthcare system poised to transition to telehealth delivery. Conclusion: Organizational support for using EBPs reduced burnout risk prior to but not during the pandemic. Pandemic related stress rather than increased work demands contributed to elevated burnout during the pandemic. A comprehensive approach to reducing burnout must address the effects of both work demands and personal stressors.
MeSH term(s)	Humans ; Female ; Male ; COVID-19/epidemiology ; COVID-19/prevention & control ; Pandemics/prevention & control ; Psychotherapists ; Veterans ; Burnout, Professional/epidemiology ; Burnout, Professional/psychology ; Surveys and Questionnaires ; Job Satisfaction
Language	English
Publishing date	2022-09-30
Publishing country	Netherlands
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	135449-8
ISSN	1573-2517 ; 0165-0327
ISSN (online)	1573-2517
ISSN	0165-0327
DOI	10.1016/j.jad.2022.09.141
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Article ; Online: Prevalence of overlap syndromes and symptoms in pediatric functional dyspepsia.

Friesen, Craig A / Rosen, John M / Schurman, Jennifer V

BMC gastroenterology

2016 Volume 16, Issue 1, Page(s) 75

Abstract: Background: The purpose was to evaluate the overlap frequency of irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and overactive bladder syndrome (OBS), as well as other gastrointestinal and systemic symptoms, in functional ... ...

Abstract	Background: The purpose was to evaluate the overlap frequency of irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and overactive bladder syndrome (OBS), as well as other gastrointestinal and systemic symptoms, in functional dyspepsia (FD). Additionally, we sought to determine whether adult Rome III FD subtypes were uniquely related to overlap syndromes or symptoms. Methods: The study was a retrospective review of 100 consecutive pediatric patients, age 8-17 years, diagnosed with FD. All had completed a standardized medical history including gastrointestinal and systemic symptoms as well as specific symptoms related to GERD and OBS. The frequency of overlap with IBS, GERD, and OBS were determined for the whole group and for those fulfilling adult FD subtype criteria. Individual symptoms were also compared by FD subtype. Results: Overlap IBS was present in 33 % of the FD patients. At least one GERD symptom was present in 74 % of patients with 41 % reporting heartburn. At least one OBS symptom was present in 44 % of patients with 29 % reporting urinary urgency. Other than pain, the most common reported gastrointestinal symptom was nausea (86 %). Systemic symptoms were common. Overlap syndromes/symptoms did not vary by FD subtype. Postprandial distress syndrome was associated with pain with eating, weight loss, and waking at night to have a stool. Conclusions: FD is a heterogeneous condition in children and adolescents with significant variability in the presence of gastrointestinal and non-gastrointestinal symptoms and overlap syndromes. Varying symptom profiles need to be accounted for and analyzed in studies involving subjects with FD.
MeSH term(s)	Adolescent ; Child ; Comorbidity ; Dyspepsia/classification ; Dyspepsia/epidemiology ; Female ; Gastroesophageal Reflux/epidemiology ; Gastrointestinal Diseases/epidemiology ; Humans ; Irritable Bowel Syndrome/epidemiology ; Male ; Midwestern United States/epidemiology ; Prevalence ; Retrospective Studies ; Urinary Bladder, Overactive/epidemiology
Language	English
Publishing date	2016-07-25
Publishing country	England
Document type	Journal Article
ISSN	1471-230X
ISSN (online)	1471-230X
DOI	10.1186/s12876-016-0495-3
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Article ; Online: Investigation of Therapist Effects on Patient Engagement in Evidence-Based Psychotherapies for Posttraumatic Stress Disorder in the Veterans Health Administration.

Sayer, Nina A / Wiltsey-Stirman, Shannon / Rosen, Craig S / Bernardy, Nancy C / Spoont, Michele R / Kehle-Forbes, Shannon M / Eftekhari, Afsoon / Chard, Kathleen M / Nelson, David B

Journal of traumatic stress

2021 Volume 35, Issue 1, Page(s) 66–77

Abstract: 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 ... ...

Abstract	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.
MeSH term(s)	Humans ; Implosive Therapy ; Patient Participation ; Psychotherapy ; Stress Disorders, Post-Traumatic/psychology ; Stress Disorders, Post-Traumatic/therapy ; Veterans/psychology ; Veterans Health
Language	English
Publishing date	2021-05-28
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	639478-4
ISSN	1573-6598 ; 0894-9867
ISSN (online)	1573-6598
ISSN	0894-9867
DOI	10.1002/jts.22679
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Article ; Online: The role of symptom accommodation in trauma-focused treatment engagement and response.

Howard, Kristen P / Spoont, Michele R / Polusny, Melissa A / Eftekhari, Afsoon / Rosen, Craig S / Meis, Laura A

Journal of traumatic stress

2023 Volume 36, Issue 3, Page(s) 524–536

Abstract: Although trauma-focused treatments (TFTs) are generally effective, not all patients improve. Symptom accommodation (i.e., altering one's behavior in response to another's symptoms) by loved ones may be particularly relevant to TFT treatment response and ... ...

Abstract	Although trauma-focused treatments (TFTs) are generally effective, not all patients improve. Symptom accommodation (i.e., altering one's behavior in response to another's symptoms) by loved ones may be particularly relevant to TFT treatment response and engagement. We examined the role of symptom accommodation by support persons (SPs) in veterans' PTSD treatment response, including the mediating role of treatment engagement and the moderating role of relationship strain. Veterans engaging in prolonged exposure or cognitive processing therapy and a loved one (N = 172 dyads) were sampled at two time points approximately four months apart. Measures of treatment engagement (i.e., highest session completed from the treatment protocol and homework completion) were obtained from hospital records. We found that relationship strain moderated the effect of symptom accommodation on treatment response, ∆R
MeSH term(s)	Humans ; Stress Disorders, Post-Traumatic/psychology ; Veterans/psychology ; Mental Processes ; Cognitive Behavioral Therapy/methods
Language	English
Publishing date	2023-02-13
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	639478-4
ISSN	1573-6598 ; 0894-9867
ISSN (online)	1573-6598
ISSN	0894-9867
DOI	10.1002/jts.22912
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