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Running head: PORTFOLIO

Portfolio Classroom Reseach Methods Action Reseach Evaluation EDU 617

by Maria del Pilar Mora

Universidad de Turabo Ana G Mendez University 2011


Running Head: CRITIQUE OF RESEARCH ARTICLE

Critique Analysis of Reciprocal Teaching Of Reading Comprehension Strategies for Students with Learning Disabilities Who Use English as a Second Language

Maria Mora, Maria MejĂ­a, Mariana Rivas and Marco Mazzocchi

Ana G. Mendez University System

December 01, 2011

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2 Introduction

The purpose of the study of this journal, which was written by Janette Kattmann Klingner and Sharon Vaughan, and was published in The Elementary School Journal vol.96, no.3 in 1966 by the University of Chicago, is to discuss and review the critique of a project of investigation; the effect of two different instructional approaches, to provide strategies for reading comprehension instruction for seventh and eighth grade ESL students with learning difficulties in the comprehension of the English language. According to Baca & Cervantes, 1989, “there is a big significant amount of students who speak English as a second language that also shows serious learning issues that may qualify them for placement in special educational programs�. These students often exhibit more problems with reading comprehension than do fluent speakers of English of comparable ability, because of differences in background knowledge relevant to what is read in school and limited English language proficiency (Clarke, 1980; Lee, 1986; Pritchard, 1990). The aspects that are described and analyzed here are: research design, the taking of samples, measure, the procedure for analysis of data, findings and results. The summary is presented in a correct and concrete form on the effectiveness of the investigation, including the problem, subject, of the sample, methodology, findings and recommendations. The investigation follows a specific order on every step of the study, review of the literature was develop and well organized and most of the literature was up to date. The theoretical framework was presented in a very interesting way and it should be provided.


3 This study focused on two main activities; the first activity was exploratory data collection and analysis, in the school setting. The second activity was to explore the hypothesis and variables. Therefore, the study used appropriate descriptive, quantitative and qualitative analysis, using the analysis of the data to questions directly to the students of the population. The article is written in a clear and concise way using appropriate lexicon within the context of education. It is organized in clear general sections (abstract, purpose of study, method, results, discussion) as well as sub-sections allowing the readers a better understanding of the findings and outcomes of the research study (reciprocal teaching, cross-age tutoring and cooperative learning, group outcomes, patterns of change in reading comprehension, characteristics of students who showed more and less growth, etc.) Abstract Abstract aims to give a clear overview of the study including the research problems, sample, methodology and the findings. However, no recommendations are included in the abstract. Research problem The study clearly states the origins for the research problems by naming previous works, that although similar in natural different from the one proposed, as for instance Palinscar and Brown’s (1984).


4 Reciprocal Teaching The study clearly explains the meaning of the method of Reciprocal Teaching, as a teaching model to improve comprehension for students who can decode but have difficulty comprehending text through the use of four strategies prediction, summarization, question generation, and clarification. The study gives examples of previous research using this model. Cross-Age Tutoring and Cooperative Learning Although the study introduces the concept of Cross-Age Tutoring and Cooperative Learning, it doesn’t explain what they are as clearly as the study did in the case of Reciprocal Teaching. The study only exposes their advantages in terms of instructional approaches but it doesn’t say anything about how a teacher or tutor uses them with a student. Purpose of the study The purpose of the study is clearly identified as per two instructional approaches for providing reading comprehension strategy instruction to seventh and eighth grade ESL students with Learning disabilities on comprehension of English-languages text: (a) reciprocal teaching in combination with cross-age tutoring, and (b) reciprocal teaching in combination with cooperative grouping. The ultimate aim of the study – as clearly stated- is to understand the performances of individual students in each treatment group in an effort to determine which characteristics were most likely to success.


5 Method The subjects are clearly identified N= 42 seventh and eighth graders from a middle school, 73% of them Hispanic. Also, there is a good record of how is the data collection tool administered. Procedures are clearly identified and include Phase 2: crossage tutoring group (study specifies day by day what is done in this phase) and Phase 2: cooperative learning group (study specifies day by day what is done in this phase) Measures The study includes two types of measures, descriptive measures: administered individually prior to the intervention such as Woodcock-Johnson test of achievement: Letter Word Identification; and quantitative measures: that included one test, the GatesMacGinite Reading Comprehension Test (MacGinite, 1989) Results A two-way analysis of variance with one between-subjects and one withinsubjects factor was applied to answer the questions regarding treatment outcomes. The procedure was conducted using pre and posttest from MacGinite Reading Comprehension Test (MacGinite, 1989) Discussion As per the beginning, this study investigates the efficacy of two related interventions on the reading comprehension of seventh and eighth graders with learning disabilities (LD) who used English as a Second Language. Overall, the interventions administered appeared to improved the reading comprehension of ESL students with LD. The study clearly aligns the outcomes of the interventions and findings with the research questions


6 The study does not include recommendations or lessons learnt for future research made.


7 References Clarke, M.A (1980). The short circuit hypothesis of ESL reading-or when language competence interferes with reading performance. Modern Language Journal, 64, 203-209 Lee, J.F (1986). Background Knowledge and L2 reading. Modern Language Journal, 70, 350-354. MacGinite, W.H. (1989) Gates-MacGinite Reading Tests (Level 5/6 Forms K and L). Chicago: Riverside


Poster Session

Brochure


Flyer


PSYCHOTHERAPY EVALUATION SURVEY Date: _________ Gender: □ Female Age: □ under- 30 Professional Level:

□ Male □ 31-40 □ LMHC

□ Other □ 41-50 □ LCSW

□ 51-60 □ CMHP

□ 61 or older □ Other: ___________

Instructions: You are invited to participate in an educational action research project that will help us understand Cognitive Behavioral Therapy Treatment to Veterans experiencing symptoms of PTSD. Your responses are very important and should reflect you experiences and opinions as much as possible. The information provided is completely confidential and the results are entirely anonymous. Please note that participation in this study is voluntary. Please indicate your level of agreement with the following statements as: SD-Strongly Disagree (1)

D- Disagree (2)

N- Neutral (3)

Statement

A-Agree (4)

SA-Strongly Agree (5)

SD

D

N

A

SA

1

2

3

4

5

1. The CBT industry prescribed method for PTSD treatment. 2. The VA prescribed method for PTSD treatment. 3. Scholar Research supports CBT as the principal method for PTSD treatment. 4. Professional Literature supports additional methods for PTSD treatment which are equally effective. 5. CBT is an effective treatment for PTSD. 6. There are other methods equally effective in elevating PTSD symptoms. 7. CBT is aligned to online therapy. 8. Stateside Veteran's benefit from online base treatment. 9. Deployed Veteran’s would benefit from online treatment.

1. Describe your experience with online therapy. _____________________________________________________________________________________ _____________________________________________________________________________________ 2. Mention alternatives methods to CBT applicable in PTSD treatment. _____________________________________________________________________________________ _____________________________________________________________________________________


Chapter 4: Results

A survey questionnaire was administered in November 2011. The survey instrument initially queried biographic status over the age, gender and professional level of the participants. Subsequently, the survey instrument consisted of nine questions written in Linkert nondimensional format Responses to the initial nine questions was restricted to a 1 through 5 range referencing scaled responses of 1 SD-Strongly disagree, 2 D- Disagree, 3 N- Neutral, 4 A-Agree, 5 SA-Strongly agree. The response data was analyzed in Statistical Package for Social Sciences SPSS which is included as SPS Analysis Appendix IX. A description, frequency table and percentage chart is reported below for each point of the questionnaire. The survey also included two open-ended questions which were designed to provide additional insight into individual respondents experience and opinions.

PSYCHOTHERAPY EVALUATION SURVEY Concerning the preeminence of Cognitive Behavioral Therapy treatment for Veterans and active-deployed soldiers suffering from PTSD. The sample consisted of ten clinical therapist for the Department of Veterans Affairs Miami office and was administered one time only. Regarding biographical question for gender, 6 (60%) reported themselves as female with the remaining 4 (40%) as male. (See Table 1) Regarding biographical question for age, 2 were between 31-41 years of age with 3 between 41-50 and 4 between 51-60 of Age. (See Table 2)


Regarding biographical question for professional level, 2 reported an LMHC professional level with the remaining 8 reporting “other” although disclosing MD or PsD designations. (See Table 3). Regarding Linkert-type question #1, "CBT is the industry prescribed method for PTSD treatment", the intent is to discern whether the respondent regards CBT as the preferred method of treatment for PTSD per the mental health industry. Of 10 people surveyed, 0% Strongly Disagree, 30% Disagree, 0% were Neutral, 50% Agree and 20 % Strongly Agree. (See table 4). Regarding Linkert-type question #2, "The VA has found CBT to be an effective method for PTSD treatment" the intent is to discern whether the respondent regards CBT as the preferred method of treatment for PTSD per the Veterans Administration existing programs. Of 10 people surveyed, 0% Strongly Disagree, 10% Disagree, 0% were Neutral, 70% Agree and 20% Strongly Agree. (See table 5). Regarding Linkert-type question #3, "Scholarly Research supports CBT as the principal method for PTSD treatment" the intent is to discern whether the respondent has reviewed various professional literature regarding PTSD treatment and concluded that CBT is supported as the treatment of choice. Of 10 people surveyed, 0% Strongly Disagree, 10% Disagree, 0% were Neutral, 20% Agree and 50% Strongly Agree. (See table 6). Regarding Linkert-type question 4# “Scholarly Research supports additional methods for PTSD treatment” the intent is to discern whether the respondent respondent has reviewed various professional literature regarding PTSD treatment and concluded that other methods are equally supported for treatment of PTSD. Of 10 people surveyed, 0% Strongly Disagree, 0% Disagree, 30% were Neutral, 50% Agree and 20% Strongly Agree. (See table 7).


Regarding Linkert-type question #5, "CBT is an effective treatment in reducing PTSD symptoms" the intent is to discern whether the respondents professional experience has indicated CBT to be an effective method with tangible results. Of 10 people surveyed, 0% Strongly Disagree, 0% Disagree, 0% were Neutral, 60% Agree and 40% Strongly Agree. (See table 8). Regarding Linkert-type question #6, "There are other methods equally effective in reducing PTSD symptoms" the intent is to discern whether the respondent professional experience has indicated other methods to be equally effective in reducing PTSD symptoms and achieving tangible results. Of 10 people surveyed, 0% Strongly Disagree, 0% Disagree, 30% were Neutral, 50% Agree and 20% Strongly Agree. (See table 9). Regarding Linkert-type question #7, "CBT is adaptable to online therapy" the intent is to discern whether the respondent considered CBT therapy as being successfully administrable over the internet media. Of 10 people surveyed, 0% Strongly Disagree, 30% Disagree, 70% were Neutral, 0% Agree and 0% Strongly Agree. (See table 10). Regarding Linkert-type question #8, "Stateside veterans would benefit from online based treatment" the intent is to discern whether the respondent having significant exposure to military veterans considers online therapy to be a useful vehicle given the unique logistics of military life. Of 10 people surveyed, 0% Strongly Disagree, 20% Disagree, 60% were Neutral, 20% Agree and 0% Strongly Agree. (See table 11). Regarding Linkert-type question #9, "Deployed soldiers would benefit from online based treatment " the intent is to discern whether the respondent respondent having significant exposure to active-duty soldiers consider online therapy to be a useful vehicle given the unique


logistics of active-duty deployment. Of 10 people surveyed, 0% Strongly Disagree, 20% Disagree, 40% were Neutral, 40% Agree and 0% Strongly Agree. (See table 12). Regarding open-ended qualitative questions the following responses were provided. Qualitative question #1: Regarding alternatives methods to CBT applicable in PTSD treatment: •

30% provided CPT (Cognitive Processing Therapy) as an alternative.

30% provided PE (Prolonged Exposure) as an alternative.

10% provided SSRI (Selective Serotonin Reuptake Inhibitors) as a medicinal alternative.

10% provided EMDR (Eye Movement Desensitization Reprocessing) as an alternative.

10% provided ACT (Acceptance and Commitment Therapy) as an alternative.

10% provided no response.

Qualitative question #2:

Regarding participant descriptions of their professional experience with online therapy:

1 reported no personal experience although data supports online psycho educational intervention with limited data reported specifically for online CBT based treatment.

1 facilitated brief therapy through web cam media although stated a preference for direct observation in MSE (Mental Status Examination).

1 reported no knowledge of research that would indicate efficacy of online treatment.


1 reported no personal experience and a disapproval of online therapy

6 reported “N/A” as no response


1 EDU 617 Action Research Discussion 

Chapter V Discussion Research problem As stated earlier within this study, there is uncertainty over whether CBT is empirically supportable as the preferred and most effective method for PTSD treatment over alternative available methods and whether such treatment can be effectively administrated over modern internet media to afflicted veterans and active-duty soldiers. Research Purpose Due to our countries extended involvement in warfare throughout the world, a significant portion of combat experienced soldiers and veterans have developed symptoms of PTSD. As such, it is imperative that flexible and effective intervention be provided to detect, diagnose and treat military personnel from the onset of symptoms. The purpose of this research is to validate prevailing assumptions over what constitutes the most effective treatment and whether such treatment can be adapted to online based therapy to facilitate better access-to-care. Research questions and Theoretical Framework This study is provides an effort to resolve a chain of concerns which determine the validity of applying a specific treatment program, for a specific affliction, on a specific population, over a novel media. Therefore, this study endeavored to answer the following questions: 1. Do therapy providers in-fact prefer CBT as an effective PTSD treatment? 2. Can these providers defend CBT as an effective PTSD treatment?


2 EDU 617 Action Research Discussion 

3. Does evidence show that CBT is effective with combat experienced veterans? 4. Does military personnel need and will they benefit from online based treatment? 5. Are CBT programs adaptable to the constraints of online media? 6. What alternatives to CBT have been applied and reviewed? The response to these inquiries in aggregate provide insight over whether CBT programs provide the most effective treatment and whether it can and would be beneficial to adapt it to online administration. Assumptions As stated earlier, the research data is an aggregate of the individual opinions of counselors within the Department t of Veterans Affairs currently providing CBT treatment to veterans and active-duty soldiers. As such assumptions were initially made that: 1. Participants were experienced with PTSD treatment. 2. Participants were experienced with CBT treatment. 3. Participants were experienced with alternative treatment methods for PTSD. 4. The participants provides accurate and complete answers. 5. The survey provides sufficient information to resolve the research question. 6. The existing preference for CBT does not in itself validate its superior effectiveness. Overall findings of the study Based upon results of the administered survey, the following relevant findings were revealed. With respect to the experience of individual participating counselors, over 75% held advanced experience and doctoral level credentials. With respect to CBT, 70% of the


3 EDU 617 Action Research Discussion 

participating counselors supported CBT as the most effective method for PTSD treatment, Over 70% state that CBT is prescribed by the mental health industry with 90% confirming CBT as prescribed by the VA. Moreover, all of the participating counselors personally supported CBT as the most effective treatment. However, 70% confirm that CPT, PE, EMDR and ACT alternative methods were also currently utilized and effective. Interestingly, with respect to online based PTSD treatment 70% of the participating counselors were neutral (undecided) over effectiveness of the treatment through this media. Furthermore, 30% were unsupportive to the effectiveness of online based treatment. However, when differentiating between stateside veterans and active-deployed soldiers, a marked shift in opinion was noted. For stateside veterans 60% reported a neutral (undecided) opinion with 20% unsupportive of online based treatment. Conversely, with active-duty soldiers, 20% remained unsupportive, 40% remained neutral, yet 40% shifted to a supportive position. However, this outcome should be viewed in context as only 20% of the participating counselors had practical experience in providing treatment online. Implications of findings It can be interpreted from the findings of this study that both the mental health industry and the VA prescribe CBT as the preferred method for PTSD treatment. Furthermore, that experienced and credentialed counselors personally prefer CBT treatment although other methods are also utilized. Moreover, it is revealed by the the findings that the opinion over the effectiveness of online based treatment is predominantly neutral (undecided) with the remainder being


4 EDU 617 Action Research Discussion 

unsupportive. This is especially true with respect to stateside veterans who have access to faceto-face care. In essence, it is apparent that VA counselors prefer face-to-face treatment. However, with respect to deployed active-duty soldiers, the marked shift in opinion to a more favorable position of online based treatment implies that face-to-face treatment may not be possible or access-to-care more problematic. In such situations, online treatment may provide a viable option. What is more striking, is that the findings reveal a lack of practical exposure to online treatment with only two of the ten participating counselors reporting such experience. It can be assumed that this lack of experience could be the basis for the resulting negative opinions over online treatment.

Limitation of the study As disclosed earlier, this study was restricted to the Department of Veterans Affairs local Miami clinic and therefore limited in scope to a small number of participants all of which are treating patients residing within the local area. Through the study an additional limitation became apparent as only a small percentage of participating counselors had practical experience with online based treatment. Moreover, all data is the result of a qualitative survey based on the individual opinions of the participating counselors and as such no professional industry studies are included which statistically and empirically support the the effectiveness of online CBT treatment as applied to online application.


5 EDU 617 Action Research Discussion 

Recommendations for further research Although the participants of this study held limited experience with online based therapy, additional research not contained within this report support that numerous private enterprises sponsored through VA are developing online based treatment programs for military personnel diagnosed with PTSD. It is apparent from this study that VA providers may lack sufficient exposure, training and access to such technology and these programs being developed. Therefore, the researcher recommends that further investigation be approved which will resolve the following concerns. 1. Are VA providers adequately informed of and trained for online based treatment? 2. Can online based treatment be effectively administered to deployed active-duty soldiers?


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Running Head: CBT CYBER-THERAPY FOR SOLDIERS WITH PTSD

Cognitive-Behavioral-CyberTherapy for soldiers with PTSD

By Maria del Pilar Mora

An Action Research Submitted to the Classroom Research Methods/ Action Research Evaluation in Partial Fulfillment of the Requirements for the Degree of Master of Education (Specialization Guidance and Counseling) (EDUC 617)

Ana G. Mendez University System 2011

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Running Head: CBT CYBER-THERAPY FOR SOLDIERS WITH PTSD

Approval Page This research paper was submitted by Maria del Pilar Mora under the direction of the person listed below. It was submitted to Ana G. Mendez University System in fulfillment of the requirements for Research Course EDU 600- 617.

____________________________

________________

Maria C. Sevillano, EdD

Date

Professor

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Running Head: CBT CYBER-THERAPY FOR SOLDIERS WITH PTSD

Acknowledgments I wish to thank Daniella David MD Chief of Psychiatry PTSD Program Medical Director of the United States Department of Veterans Affairs for the assistance of her and her staff in providing the valuable survey data for this research. I wish to thank Julie Carrion, Director of Faculty and Curriculum of Ana Mendez University for her assistance in arranging the cooperation of the U.S. Department of Veterans Affairs. I wish to thank Wilfredo Estrada for his patients and instruction with the SPSS data analysis program as well as his advice with numerous other course assignments.

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Running Head: CBT CYBER-THERAPY FOR SOLDIERS WITH PTSD

Abstract Due to the growing epidemic of Post Traumatic Stress Disorder discovered amongst combat experienced soldiers both at home and abroad, the military community urgently needs access to effective global treatment. For the Department of Veterans Affairs, access-to-care over this debilitating mental health disorder is a growing concern. If effective, Cognitive-BehavioralCyberTherapy would be a solution that reaches out worldwide to remote and underserved military personnel. Therefore, the objective of this research is to investigate whether Cognitive-BehavioralCyberTherapy (CBCT) is supported as an effective treatment-solution for combat-experienced soldiers suffering from Post Traumatic Stress Disorder (PTSD). This focus is based on recent trends reporting the growth and predominance of Cognitive-Behavioral-Therapy(CBT) in both clinical and internet based cyber-therapy programs administered by the mental health industry and the VA. This trend, though demonstrating an institutional preference for CBT, does not initself validate the effectiveness of the CBT psychotherapy method, nor support its functionality in a cyber-therapy program. As such, a research problem exist on whether practicing counselors as the providers support Cognitive-Behavioral-CyberTherapy as an effective treatment-solution. The theoretical framework necessary to resolve this question, begins with gathering initial qualitative evidence that supports a chain of logic. In this research-problem questions the viability of a specific treatment, applied to a specific affliction, on a specific population, through a specific media. Each of these variables needed to be addressed individually and in a logical order. iv


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Running Head: CBT CYBER-THERAPY FOR SOLDIERS WITH PTSD

Qualitative evidence should reveal whether the community of experienced VA counselors do infact consider CBT as an effective method for PTSD; that they prescribe CBT as treatment for combat experienced soldiers, that this treatment will be effective within a cyber-therapy setting, and that soldiers will benefit from a cyber-therapy program.

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Running Head: CBT CYBER-THERAPY FOR SOLDIERS WITH PTSD

Table of Contents

Chapter 1: Introduction Setting of the project Profile of the Organization Nature of the problem Impact of the Problem Purpose of the Project Utility of the Project Definition of Terms Chapter 2: Review of Related Literature A Brief History of the Topic Existing Solution and Industry Practice The Research Problem, Purpose and Question Theoretical Framework Chapter 3: Methodology Paradigm Study Design Study Population Vs Target Population Investigative Techniques Ethical Consideration Researcher Bias Assumptions Limitation of the study Delimitations of the study Chapter 4: Results Psychotherapy Evaluation Survey Results relative to Research Questions Summary Chapter 5: Discussion The Research Problem, Purpose and Question Theoretical Framework Assumptions Overall findings of the study Implications of the findings Limitation of the study Delimitations of the study Recommendations for further research References Appendices A Study Conceptual Framework B Psychotherapy Evaluation Survey C Matrix vi

1 1 1 2 2 2 3 3 4 5 6 6 8 8 8 9 9 9 9 10 10 11 11

15 15 16 16 17 18 18 19 20 23 24 25


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Running Head: CBT CYBER-THERAPY FOR SOLDIERS WITH PTSD

Tables

26 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Graphs 1 2 3 4 5 6 7 8 9 10 11 12

Gender Age Professional Level CBT is the industry prescribed method for PTSD treatment The VA has found CBT to be an effective method for PTSD treatment Scholarly Research supports CBT as the principal method for PTSD treatment Scholarly Research supports additional methods for PTSD treatment CBT is an effective method in reducing PTSD symptoms There are other methods equally effective in reducing PTSD symptoms CBT is adaptable to online therapy Stateside veterans would benefit from online based treatment Deployed soldiers would benefit from online based treatment Mention alternatives methods to CBT applicable in PTSD treatment Describe your experience with online therapy

26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 Gender 40 Age 41 Professional Level 42 CBT is the industry prescribed method for PTSD treatment 43 The VA has found CBT to be an effective method for PTSD treatment 44 Scholarly Research supports CBT as the principal method for PTSD treatment 45 Scholarly Research supports additional methods for PTSD treatment 46 CBT is an effective method in reducing PTSD symptoms 47 There are other methods equally effective in reducing PTSD symptoms 48 CBT is adaptable to online therapy 49 Stateside veterans would benefit from online based treatment 50 Deployed soldiers would benefit from online based treatment 51

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Running Head: CBT CYBER-THERAPY FOR SOLDIERS WITH PTSD

Chapter 1: Introduction According to Morland, PsyD,et al.(2010):

Many individuals in need of specialized PTSD services live in geographically remote regions. Because people with PTSD often use self-isolation to reduce stimulation, people with PTSD are more likely to settle in remote areas. Mental health care in these remote areas is generally only available on a limited basis - especially mental health care for PTSD. Traditionally, the individuals that need treatment do not get the services they need. (p.1) According to Repeat Iraq Tours Raise Risk of PTSD, Scoot (2007): U.S. soldiers serving repeated deployments are 50 percent more likely than those with one tour to suffer from acute combat stress, raising their risk of post-traumatic stress disorder. (p. 1) The U.S. Department of Veterans Affairs is beginning to explore, develop and implement mental health policy that address an urgent need for soldiers requiring diagnosis and treatment of PTSD. Setting of the Project: This research takes place within the Miami Veterans Affairs clinic as it is focused on the nature of current treatment provided to combat experienced veterans at home and abroad. Profile of Organizations: The Veterans Administration is the sole administrative body responsible to care for the physical and mental health of military personnel. As such, it is the VA that develops and enacts all mental health related programs administered through their network.


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Running Head: CBT CYBER-THERAPY FOR SOLDIERS WITH PTSD

Nature of the problem: Due to the countries extended involvement in warfare throughout the world, many soldiers with combat experience have developed symptoms of post-traumatic stress disorder (PTSD). The population of professional soldiers is at risk both during and after their tour of duty to the severe adverse effects of this disorder. As such, it is imperative that effective treatment be accessible to detect, diagnose and treat soldiers from the onset of symptoms. Although the VA recognizes this need and offers treatment, accessibility to clinic sponsored programs is problematic as they do not accommodate the thousands of mobilized active-duty soldiers deployed throughout the globe, or veterans living in remote rural areas. This access-to-care issue, creates a barrier-to-service that cannot be fully resolved by the VA’s limited network of stateside clinics. Fortunately, today's global internet technology provides an unrestricted media that can reach out and meet the needs of soldiers and veterans worldwide. Its use however, rest on the assumption that cyber-therapy programs will be effective and beneficial. Impact of the problem: Individual suffers of PTSD are inherently a high risk population to themselves, their military function, and the public at large. Effective and accessible cyber-therapy can significantly reduce the destructive behavior our soldiers endure and inflict upon others. Purpose of the project: The objective of this research was to focus on the solution. With modern internet technology cyber-therapy treatment can be provide worldwide and in real-time, to soldiers and


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Running Head: CBT CYBER-THERAPY FOR SOLDIERS WITH PTSD

veterans that need it. This however, rest upon the assumption, that Cognitive Behavioral CyberTherapy is an effective treatment-solution for the military. Therefore, this project is designed to affirm from the perspective of VA counselors, whether this assumption as promoted by the mental health industry and the VA, is also supported by the counselors that provide therapy service to our soldiers. Utility of the project: With supportive evidence, the VA will be better informed by its counselors regarding CBCT is a sound treatment-solution. Additionally, the VA will be better informed over potential alternatives to CBT as the base treatment method. Moreover, the VA will be better informed whether cyber-therapy is an effective vehicle for any psychotherapy treatment. Definition of Terms Post Traumatic Stress Disorder Posttraumatic Stress Disorder is a complex health condition that can develop in response to a traumatic experience - a life-threatening or extremely distressing situation that causes a person to feel intense fear, horror or a sense of helplessness. (DSM IV, p. 186 ) Cognitive Behavioral Therapy is a type of psychotherapeutic treatment that helps patients to understand the thoughts and feelings that influence behaviors. CBT is commonly used to treat a wide range of disorders. CBT is generally focused on helping clients deal with a very specific problem. During the course of treatment, people learn how to identify and change destructive or disturbing thought patterns that have a negative influence on their behavior. (DSM IV, p. 382).


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Running Head: CBT CYBER-THERAPY FOR SOLDIERS WITH PTSD

Chapter 2: Review of Related Literature This chapter discusses some background of PTSD and the VA’s current response to the disorder. From here, a research-problem is developed regarding cognitive behavioral cybertherapy as an effective treatment-solution as well as the theoretical framework for resolve. Brief History of the Topic:

As stated earlier, over the recent decade numerous soldiers suffer from varying degrees of PTSD as a byproduct of their service. More than two million coalition troops have served in Iraq and Afghanistan with thousands of troops deployed on multiple tours of duty. It is estimated that 20% or more of these soldiers suffer from symptoms of PTSD.

According to American Psychiatric Associations Diagnostic and Statistic Manual of Mental Disorder, (1997), a significant portion of veterans endure persistent and sever symptoms of PTSD Syndrome.

Kudler, M.D director of the VA’s Mental Illness (2011) states that PTSD is highly prevalent among soldiers during and returning from combat duty with an overall, twenty percent of the active troops and over 42 percent of Reserve troops identified as needing mental health care. (p.1).

PTSD is a pervasive and degenerative disorder that results in persistent mood swings, outbursts of anger, chronic pain, sleep disturbances, somatization, profound identity problems, and difficulties in interpersonal relations. As such, it is of serious ongoing concern to both our military establishment and the general public.


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Running Head: CBT CYBER-THERAPY FOR SOLDIERS WITH PTSD

VA/DOD Clinical Practice Guideline (2010) defines:

Post-Traumatic Stress Disorder (PTSD) is a clinically significant condition with symptoms continuing more than 1 month after exposure to a trauma that has caused significant distress or impairment in social, occupational, or other important areas of functioning. Patients with PTSD may exhibit persistent re-experiencing of the traumatic event(s), persistent avoidance of stimuli associated with the trauma, numbing of general responsiveness (not present before the trauma), and persistent symptoms of increased arousal (not present before the trauma). PTSD can also have a delayed onset, which is described as a clinically significant presentation of symptoms (causing significant distress or impairment in social, occupational, or other important areas of functioning) at least 6 months after exposure to trauma. (p.5) Existing Solutions and Industry Practice

The Department of Veterans Affairs and the Department of Defense have developed a Psychological First Aid program for veterans with PTSD. This program currently is designed to provide psychotherapeutic intervention and includes cyber-therapy treatment, the focus of this research.

Per the VA, existing PTSD programs rely predominantly on Cognitive Behavioral Therapy(CBT) as the preferred psychotherapy method. Unfortunately, research over numerous Critical Incident Stress Debriefings (CISD), has revealed disappointing results with respect to its efficacy to mitigate post traumatic distress, or to forestall later development of the syndrome. However, according to the VA there is insufficient evidence to make a recommendation either for or against CBT as an effective online intervention.

The Department of Veteran Affairs (2010) states:


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Running Head: CBT CYBER-THERAPY FOR SOLDIERS WITH PTSD

There are significant difficulties in categorizing the different evidence-based psychotherapies that have been found to be most effective for PTSD and lack of consensus between proponents for specific treatments. (p.43)

The Research Question, Problem and Purpose

The research addresses the VA's uncertainty over lack of evidence verifying CBT as an effective base method, or the validity of administering CBT through cyber-therapy. This absence of convincing data introduces research designed to determine whether practicing counselors support through their experience that Cognitive-Behavioral-CyberTherapy is an effective treatmentsolution. Research into the aggregate opinions of counselors providing direct therapy service to soldiers with PTSD should provide convincing evidence regarding whether CBCT is an effective treatment-solution. The purpose of this research is therefore to determine a consensus of opinion by VA counselors and furthermore reveal any shift in consensus with regard to specific variables. A statistically supportable consensus of opinion from a research-sample of experienced VA counselors will provide a valid response to the research-question "is Cognitive Behavioral CyberTherapy an effective treatment-solution for combat-experienced soldiers with PTSD". Theoretical Framework The theoretical framework necessary to resolve this single question, began with gathering initial qualitative research results from VA counselors which followed a sequential chain of logic. Does the specific treatment function for the specific affliction, with the specific population, and over the specific media. The single research question therefore breaks down into components to address whether:


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Running Head: CBT CYBER-THERAPY FOR SOLDIERS WITH PTSD

1. VA counselors support CBT as an effective method for PTSD. 2. VA counselors support CBT as effective with combat-experienced soldiers. 3. VA counselors support cyber-therapy an effective treatment vehicle. 4. VA counselors support that soldiers will benefit from a cyber-therapy program. The response to the investigation in aggregate determined whether professional VA counselors supported the effectiveness of Cognitive Behavioral CyberTherapy for soldiers with PTSD.


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Running Head: CBT CYBER-THERAPY FOR SOLDIERS WITH PTSD

Chapter 3: Methodology The theoretical framework establishes a methodology competently to collect, analyze and draw conclusions from the data. Paradigm The set of practices to be used in this project are based on empirical analysis of qualitative data to reveal statistically evident opinions and opinion patterns. Study Design The methodology of the project revolves around the collection and aggregation of qualitative survey data to reveal overall consensus by practicing counselors over the research questions. The survey questioner was administered to participating VA counselors. Quantitative analysis of the survey data was intended to reveal any dominant positions or evident shifts in a position. The aggregate results of the research was intended to deliver an affirmative yes/no response to our primary research question. It is inherent in the study design that the findings reveal alternative treatment methods to CBT which merit consideration by the VA, or that although CBT is effective in clinical settings, it is not be adaptable to cyber-therapy. Study-Population Vs Target-Population Although the topic population revolves around veterans and soldiers suffering from PTSD, the project is focused on the efficacy of existing cyber-therapy programs from the perspective of professional VA counselors. As such the study-population is restricted to counselors within the Veterans Affairs clinics. Furthermore, due to assignment restrictions of the


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Running Head: CBT CYBER-THERAPY FOR SOLDIERS WITH PTSD

research, the study-population was further restricted to local counselors within the VA clinic of Miami, FL. Investigative Techniques Raw qualitative data was acquired through questioners submitted to participating VA counselors at the Miami VA clinic. Ethical Considerations As individual patients have a legally enforced right to privacy, all information acquired was from a method/program macro-based perspective and therefore non-patient specific. Bias: As stated, an existing bias within the mental health industry supports CBT and this research aimed to test that bias. Although with reservation, the VA also currently supports CBT as a prescribed PTSD treatment, both clinically and through active cyber-therapy programs. This research aimed to test this bias also. With respect to the researcher, I hoped to offer a more nonbiased analysis being that I am not a member of the military nor part of its current provider network. An additional point of inherent bias was the desire by the industry, the VA, the military and this researcher, that Cognitive Behavioral CyberTherapy was validated as an effective solution. Any solution that reduces the strain of PTSD for our soldiers is a benefit to society as a whole. Assumptions Although the quantitative analysis of survey data utilized in this project was assumed to be reasonably accurate, with respect to the survey, qualitative questioners rely on honest


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Running Head: CBT CYBER-THERAPY FOR SOLDIERS WITH PTSD

responses and the assumption that the participants are sufficiently experienced with soldiers, PTSD treatment, and cyber-therapy. Limitations of the study:

Because the survey was undertaken by a single researcher, the number of participants had to be limited. Due to the limited sample size and geographically limited study population, results of the survey cannot be confidently extrapolated to the nationwide community of VA counselors. Furthermore, all data is the result of a qualitative survey based on the individual opinions of the participating counselors only. As such no clinical patient studies were included which empirically support the effectiveness of CBT or CBCT treatment.

Delimitations of the study:

As previously stated, the research took place within the setting of a VA clinic. Due to travel limitation of the researcher the study was restricted to the Miami Vet Center because of its availability to the researcher. Moreover, because the survey was undertaken by a single researcher, the number of participants had to be limited. The study was also restricted to military personnel afflicted with PTSD as the sole affliction of concern, and combat experienced soldiers or veterans as the sole target-population of concern. Only VA counselors perceptions and opinions were investigated. Due to the complexity of psychotherapeutic theory and application, the scope of the report was predominantly restricted to addressing CBT from a resident and telemental health perspective at the exclusion of alternative psychotherapy methods.


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Chapter 4: Results

A survey questionnaire was administered in November 2011. The survey instrument initially queried biographic status over the age, gender and professional level of the participants. Subsequently, the survey instrument consisted of nine questions written in Linkert nondimensional format Responses to the initial nine questions was restricted to a 1 through 5 range referencing scaled responses of 1 SD-Strongly disagree, 2 D- Disagree, 3 N- Neutral, 4 A-Agree, 5 SA-Strongly agree. The response data was analyzed in Statistical Package for Social Sciences SPSS format. A description, frequency table and percentage chart is reported below for each point of the questionnaire. The survey also included two open-ended questions which were designed to provide additional insight into individual respondents experience and opinions. Psychotherapy Evaluation Survey

Concerning Online Cognitive Behavioral Therapy treatment for Veterans and activedeployed soldiers suffering from PTSD. The study-population consisted of ten clinical therapist from the Department of Veterans Affairs Miami office and was administered one time only. Result relative to Research Questions Regarding biographical question for gender, 6 (60%) reported themselves as female with the remaining 4 (40%) as male. (See Table 1) Regarding biographical question for age, 2 were between 31-41 years of age with 3 between 41-50 and 4 between 51-60 of Age. (See Table 2)


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Regarding biographical question for professional level, 2 reported an LMHC professional level with the remaining 8 reporting “other” although disclosing MD or PsD designations. (See Table 3). Regarding Linkert-type statement 1, "CBT is the industry prescribed method for PTSD treatment", the intent is to discern whether the respondent regards CBT as the preferred method of treatment for PTSD per the mental health industry. Of 10 people surveyed, 0% Strongly Disagree, 30% Disagree, 0% were Neutral, 50% Agree and 20 % Strongly Agree. (See table 4). Regarding Linkert-type statement 2, "The VA has found CBT to be an effective method for PTSD treatment" the intent is to discern whether the respondent regards CBT as the preferred method of treatment for PTSD per the Veterans Administration existing programs. Of 10 people surveyed, 0% Strongly Disagree, 10% Disagree, 0% were Neutral, 70% Agree and 20% Strongly Agree. (See table 5). Regarding Linkert-type statement 3, "Scholarly Research supports CBT as the principal method for PTSD treatment" the intent is to discern whether the respondent has reviewed various professional literature regarding PTSD treatment and concluded that CBT is supported as the treatment of choice. Of 10 people surveyed, 0% Strongly Disagree, 10% Disagree, 0% were Neutral, 20% Agree and 50% Strongly Agree. (See table 6). Regarding Linkert-type statement 4 “Scholarly Research supports additional methods for PTSD treatment” the intent is to discern whether the respondent has reviewed various professional literature regarding PTSD treatment and concluded that other methods are equally supported for treatment of PTSD. Of 10 people surveyed, 0% Strongly Disagree, 0% Disagree, 30% were Neutral, 50% Agree and 20% Strongly Agree. (See table 7).


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Running Head: CBT CYBER-THERAPY FOR SOLDIERS WITH PTSD

Regarding Linkert-type statement 5, "CBT is an effective treatment in reducing PTSD symptoms" the intent is to discern whether the respondents professional experience has indicated CBT to be an effective method with tangible results. Of 10 people surveyed, 0% Strongly Disagree, 0% Disagree, 0% were Neutral, 60% Agree and 40% Strongly Agree. (See table 8). Regarding Linkert-type statement 6, "There are other methods equally effective in reducing PTSD symptoms" the intent is to discern whether the respondent professional experience has indicated other methods to be equally effective in reducing PTSD symptoms and achieving tangible results. Of 10 people surveyed, 0% Strongly Disagree, 0% Disagree, 30% were Neutral, 50% Agree and 20% Strongly Agree. (See table 9). Regarding Linkert-type statement 7, "CBT is adaptable to online therapy" the intent is to discern whether the respondent considered CBT therapy as being successfully administrable over the internet media. Of 10 people surveyed, 0% Strongly Disagree, 30% Disagree, 70% were Neutral, 0% Agree and 0% Strongly Agree. (See table 10). Regarding Linkert-type statement 8, "Stateside veterans would benefit from online based treatment" the intent is to discern whether the respondent having significant exposure to military veterans considers online therapy to be a useful vehicle given the unique logistics of military life. Of 10 people surveyed, 0% Strongly Disagree, 20% Disagree, 60% were Neutral, 20% Agree and 0% Strongly Agree. (See table 11). Regarding Linkert-type statement 9, "Deployed soldiers would benefit from online based treatment " the intent is to discern whether the respondent having significant exposure to activeduty soldiers consider online therapy to be a useful vehicle given the unique logistics of active-


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duty deployment. Of 10 people surveyed, 0% Strongly Disagree, 20% Disagree, 40% were Neutral, 40% Agree and 0% Strongly Agree. (See table 12). Regarding open-ended statement 1, this question was designed for participating counselors to provide useful insight to alternatives to CBT therapy whether online or clinical based. Per the survey responses 30% provided CPT (Cognitive Processing Therapy), 30% provided PE (Prolonged Exposure), 10% provided EMDR (Eye Movement Desensitization Reprocessing), 10% provided ACT (Acceptance and Commitment Therapy), and 10% provided no response. Regarding open-ended statement 2, this question was designed for participating counselors to provide useful insight regarding their individual experience with online based therapy. Per the survey responses 10% reported personal experience with web-cam online based therapy while 90% reported no experience or a not-applicable response due to disfavor or lack of exposure with cyber-therapy.


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Chapter 5: Discussion The Research Problem, Purpose and Question

The research addressed the VA's uncertainty over the lack of evidence verifying CBT as an effective base method, and the validity of administering CBT through cyber-therapy. The absence of convincing data introduced research designed to determine whether practicing counselors supported through their experience that Cognitive-Behavioral-CyberTherapy is an effective treatment-solution. Research into the aggregate opinions of counselors providing direct therapy service to soldiers with PTSD was intended to provide convincing evidence regarding whether CBCT is an effective treatment-solution. The purpose of the research was therefore to determine the consensus of opinion by VA counselors and furthermore to reveal any shift in consensus with regard to specific variables. A statistically supportable consensus of opinion from the research-sample of experienced VA counselors provided a valid response to the researchquestion "is Cognitive Behavioral CyberTherapy an effective treatment-solution for combatexperienced soldiers with PTSD". Theoretical Framework The study attempted to resolve the question "Is online CBT an effective treatmentsolution for soldiers with PTSD" by first breaking the question down into its individual components that in a logical order determined if practicing VA counselors actually supported the CBCT program in concurrence with mental health industry promotion and VA policy. As such, the research investigated whether: 1. VA counselors support CBT as an effective method for PTSD.


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2. VA counselors support CBT as effective with combat-experienced soldiers. 3. VA counselors support cyber-therapy an effective treatment vehicle. 4. VA counselors support that soldiers will benefit from a cyber-therapy program. The response to the investigation in aggregate determined whether professional VA counselors supported that online CBT is an effective treatment-solution for soldiers with PTSD. Assumptions As stated earlier, the research data is an aggregate of the individual opinions of counselors within the Department t of Veterans Affairs currently providing CBT treatment to veterans and active-duty soldiers. As such assumptions were initially made that: 1. Participants were experienced and credentialed clinical therapist. 2. Participants were experienced with the CBT method. 3. Participants were experienced with PTSD treatment. 4. Participants were experienced with alternative treatment methods for PTSD. 5. The participants provides accurate and complete answers. 6. The survey provides sufficient information to resolve the research question. Overall findings of the study Based upon results of the administered survey, the following relevant findings were determined. With respect to the experience of individual participating counselors, over 75% held advanced experience and doctoral level credentials. With respect to CBT, 70% of the


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participating counselors supported CBT as the most effective method for PTSD treatment, Over 70% state that CBT is prescribed by the mental health industry with 90% confirming CBT as prescribed by the VA. Moreover, all of the participating counselors personally supported CBT as the most effective treatment. However, 70% confirm that CPT, PE, EMDR and ACT alternative methods were also currently utilized and effective. Interestingly, with respect to online based treatment 70% of the participating counselors were neutral (undecided) over the effectiveness of PTSD treatment through this media. Furthermore, 30% were unsupportive as to the effectiveness of cyber-therapy. However, when differentiating between stateside veterans and active-deployed soldiers, a marked shift in consensus of opinion was noted. For stateside veterans 60% reported a neutral (undecided) opinion with 20% unsupportive of cyber-therapy. Conversely, with active-duty soldiers, 20% remained unsupportive and 40% remained neutral, however 40% shifted to a supportive position. This shift in consensus can be attributed to the logistical reality that stateside soldiers and veterans are accessible to the VA clinics. Conversely, active deployed soldiers are not. The fact that the percentage of shift was not greater should also be viewed in context, as of the ten participants, only 10% had practical experience in providing cyber-therapy treatment. Implications of findings It can be interpreted from the findings of this study that both the mental health industry and the VA prescribe CBT as the preferred method for PTSD treatment. Furthermore, that experienced and credentialed counselors in aggregate prefer CBT treatment although other methods are also utilized.


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Moreover, it is revealed by the findings that opinion over the effectiveness of cybertherapy is predominantly neutral (undecided) with the remainder being unsupportive. This is especially true with respect to stateside veterans who have access to face-to-face care. In essence, it is apparent that VA counselors prefer face-to-face treatment. However, with respect to deployed active-duty soldiers, the marked shift in opinion to a more favorable position of cyber-therapy implies that face-to-face treatment may not be possible or access-to-care more problematic. In such situations, online treatment is viewed as viable. What is more striking, is that the findings reveal a significant lack of practical experience with cyber-therapy amongst the participants with only one of the ten counselors reporting such experience. It can be assumed that this lack of experience could be the very basis for the negative opinions over cyber-therapy treatment. Limitations of the study:

Because the survey was undertaken by a single researcher, the number of participants had to be limited. Due to the limited sample size and geographically limited study population, results of the survey cannot be confidently extrapolated to the nationwide community of VA counselors. Furthermore, all data was the result of a qualitative survey based on the individual opinions of the participating counselors only. As such no clinical patient studies are included which empirically support the effectiveness of CBT or CBCT treatment.

Delimitations of the study:

As previously stated, the research took place within the setting of a VA clinic. Due to travel limitation of the researcher the study was restricted to the Miami Vet Center because of its


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availability to the researcher. Moreover, because the survey was undertaken by a single researcher, the number of participants had to be limited. The study was also restricted to military personnel afflicted with PTSD as the sole affliction of concern, and combat experienced soldiers or veterans as the sole target-population of concern. Only the VA counselors perceptions and opinions were investigated. Due to the complexity of psychotherapeutic theory and application, the scope of the report was predominantly restricted to addressing CBT from a resident and telemental health perspective at the exclusion of alternative psychotherapy methods.

Recommendations for further research Although the participants of the study held limited experience with cyber-therapy, additional research not contained within the report supported that numerous private enterprises and the VA are developing and currently offer Cognitive Behavioral CyberTherapy programs for soldiers diagnosed with PTSD. It is apparent from the study, that on a local level VA counselors in various geographical regions may lack sufficient exposure, training and access to such technology or the programs being developed. Therefore, the researcher recommends that further investigation be approved which will resolve the following concerns. 1. Are VA providers adequately informed of and trained for online based PTSD treatment? 2. Do military patient therapy results support that CBCT is an effective treatment-solution for combat-experienced soldiers with PTSD?


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Referencies

Corporación para Investigaciones Biológicas (Ed.) (1997). Fundamentos de Medicina, Psiquiatria.Colombia: Medellín.. Friedman, M. MD, PhD. (2007). Posttraumatic Stress Disorder: An Overview. United States Department of Veterans Affairs. from http://www.ptsd.va.gov/professional/pages/ptsd-overview.asp

Hamblen, Schnurr, Rosenberg, & Eftekhari ( 2010). Enhancing PTSD Treatment and Delivery. United States Department of Veterans Affairs. from http://www.ptsd.va.gov/professional/pages/enhancing-ptsd-treatment.asp

Levin, A. (2011). IOM Investigates Effectiveness of Current PTSD Treatments. American Psychiatric Association, Psychiatric News. (4). from http://pn.psychiatryonline.org/content/46/11/4.1.full Leslie Morland, PsD, Carolyn Greene, PhD, Josef Ruzek, PhD, & Linda Godleski, MD (2007) PTSD and Telemental Health. United States Department of Veterans Affairs. from http://www.ptsd.va.gov/professional/pages/ptsd-telemental.asp The Management of Post-Traumatic Stress Working Group. (2010). VA/DOD Clinical Practice Guideline for The Management of Post-Traumatic Stress. Department of Veterans Affairs Department of Defense from http://www.healthquality.va.gov/ptsd/Mgmt_of_PTSD_final_92111.pdf


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Scott. T. (2007, April 13). Repeat Iraq Tours Raise Risk of PTSD, Army Finds. The Washington Post. Retrieved from http://www.highbeam.com/Search?FilterByPublicationID=5554&FilterByPublicationName=The +Washington+Post&searchTerm=U.S.+soldiers+serving+repeated+deployments+are+50+percen t


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Appendixes


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Appendix A Study Conceptual Framework    

TOPIC Online CBT programs for soldiers with PTSD

     

PROBLEM

Soldiers with combat experience are developing symptoms of PTSD at an alarming rate. Although the VA recognizes the need for treatment, accessibility to clinic-based programs is problematic as they do not accommodate the thousands of continually mobilized active-duty soldiers deployed throughout the globe, or retired veterans living in areas distant from VA clinics. Online Cognitive Behavioral Therapy(CBT) offers an effective treatment-solution for combat experienced soldiers suffering from PTSD.

           

TRENDS   Research supports an epidemic growth in soldiers suffering from PTSD. Current VA programming trends appear to favor CBT for clinical therapy methods. Improvements in internet technology are fostering a growth in online treatment.

RESEARCH QUESTION 

 

1. is Cognitive Behavioral CyberTherapy an effective treatment-solution for combatexperienced soldiers with PTSD".

Although a single concept, it contains several variables demanding a progressive chain of logic to resolve. The research problem and question therefore breaks down into specific components designed to validate whether:

1. VA counselors support CBT as an effective method for PTSD.

2. VA counselors support CBT as effective with combat-experienced soldiers. 3. VA counselors support cyber-therapy an effective treatment vehicle.

4. VA counselors support that soldiers will benefit from a cyber-therapy program.


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Appendices B PSYCHOTHERAPY EVALUATION SURVEY Date: ________ Gender: □ Female Age: □ under- 30 Professional Level:

□ Male □ 31-40 □ LMHC

□ 41-50 □ LCSW

□ 51-60 □ CMHP

□ 61 or older □ Other: ___________

Instructions: You are invited to participate in an educational action research project that will help us understand Cognitive Behavioral Therapy Treatment to Veterans experiencing symptoms of PTSD. Your responses are very important and should reflect you experiences and opinions as much as possible. The information provided is completely confidential and the results are entirely anonymous. Please note that participation in this study is voluntary.

Please indicate your level of agreement with the following statements as: SD-Strongly Disagree (1) D- Disagree (2) N- Neutral (3) A-Agree (4)

SA-Strongly Agree (5)

SD

D

N

A

SA

1

2

3

4

5

Statement

1. CBT is the industry prescribed method for PTSD treatment. 2. The VA has found CBT to be an effective method for PTSD treatment. 3. Scholarly Research supports CBT as the principal method for PTSD treatment. 4. Scholarly Research supports additional methods for PTSD treatment which are equally effective. 5. CBT is an effective treatment in reducing PTSD symptoms. 6. There are other methods equally effective in reducing PTSD symptoms. 7. CBT is adaptable to online therapy. 8. Stateside Veteran's would benefit from online based treatment. 9. Deployed soldiers would benefit from online based treatment.

1. Mention alternatives methods to CBT applicable in PTSD treatment. ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ 2. Describe your experience with online therapy. ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________


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Appendices C Matrix


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Tables Table 1 Gender ____________________________________________________________________________ Frequency

Percent

____________________________________________________________________________ Female 6 60.0 Male 4 40.0 Total 10 100.0 ______________________________________________________________________________


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Table 2 Age ______________________________________________________________________________ Age Frequency Valid Percent ______________________________________________________________________________ Valid

2 22.22 3 33.33 4 44.44 Missing 1 Total 10 100.0 ______________________________________________________________________________

31-40 41-50 51-60


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Table 3 Professional Level ______________________________________________________________________________ Professional Level Frequency Valid Percent ______________________________________________________________________________ Valid

2 22.22 7 77.77 Missing 1 Total 10 100.00 ______________________________________________________________________________

LCSW Other


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Table 4 CBT is the industry prescribed method for PTSD treatment ______________________________________________________________________________ Frequency Valid Percent ______________________________________________________________________________

Valid

0 00.0 3 30.0 0 00.0 5 50.0 2 20.0 Missing 0 00.0 Total 10 100.0 ______________________________________________________________________________

Strongly Disagree Disagree Neutral Agree Strongly Agree


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Table 5 The VA has found CBT to be an effective method for PTSD treatment ______________________________________________________________________________ Frequency Valid Percent ______________________________________________________________________________ Valid

0 00.0 1 10.0 0 00.0 7 70.0 2 20.0 Missing 0 00.0 Total 10 100.0 ______________________________________________________________________________

Strongly Disagree Disagree Neutral Agree Strongly Agree


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Table 6 Scholarly Research supports CBT as the principal method for PTSD treatment ______________________________________________________________________________ Frequency Valid Percent ______________________________________________________________________________ Valid

0 00.0 1 10.0 2 20.0 2 20.0 5 50.0 Missing 0 00.0 Total 10 100.0 ______________________________________________________________________________

Strongly Disagree Disagree Neutral Agree Strongly Agree


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Table 7 Scholarly Research supports additional methods for PTSD treatment ______________________________________________________________________________ Frequency Valid Percent ______________________________________________________________________________ Valid

0 00.0 0 00.0 3 30.0 5 50.0 2 20.0 Missing 0 00.0 Total 10 100.0 ______________________________________________________________________________

Strongly Disagree Disagree Neutral Agree Strongly Agree


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Table 8

CBT is an effective method in reducing PTSD symptoms ______________________________________________________________________________ Frequency Valid Percent ______________________________________________________________________________ Valid

0 00.0 0 00.0 0 00.0 6 60.0 4 40.0 Missing 0 00.0 Total 10 100.0 ______________________________________________________________________________

Strongly Disagree Disagree Neutral Agree Strongly Agree


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Table 9 There are other methods equally effective in reducing PTSD symptoms ______________________________________________________________________________ Frequency Valid Percent ______________________________________________________________________________ Valid

0 00.0 0 00.0 3 30.0 5 50.0 2 20.0 Missing 0 00.0 Total 10 100.0 ______________________________________________________________________________

Strongly Disagree Disagree Neutral Agree Strongly Agree


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Table 10 CBT is adaptable to online therapy ______________________________________________________________________________ Frequency Valid Percent ______________________________________________________________________________ Valid

0 00.0 3 30.0 7 70.0 0 00.0 0 00.0 Missing 0 00.0 Total 10 100.0 ______________________________________________________________________________

Strongly Disagree Disagree Neutral Agree Strongly Agree


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Table 11 Stateside veterans would benefit from online based treatment ______________________________________________________________________________ Frequency Valid Percent ______________________________________________________________________________ Valid

0 00.0 2 20.0 6 60.0 0 50.0 0 20.0 Missing 0 00.0 Total 10 100.0 ______________________________________________________________________________

Strongly Disagree Disagree Neutral Agree Strongly Agree


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Table 12

Deployed soldiers would benefit from online based treatment ______________________________________________________________________________ Frequency Valid Percent ______________________________________________________________________________ Valid

0 00.0 2 20.0 4 40.0 4 40.0 0 00.0 Missing 0 00.0 Total 10 100.0 ______________________________________________________________________________

Strongly Disagree Disagree Neutral Agree Strongly Agree


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Table 13 Mention alternatives methods to CBT applicable in PTSD treatment ______________________________________________________________________________ Frequency Valid Percent ______________________________________________________________________________ Valid

Cognitive Processing Therapy

3

30.0

Prolonged Exposure

3

30.0

Eye Movement Desensitization Reprocessing

1

10.0

Acceptance and Commitment Therapy

1

10.0

1

10.0

Invalid

Missing 1 10.0 Total 10 100.0 _____________________________________________________________________________


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Table 14 Describe your experience with online therapy ______________________________________________________________________________ Frequency Valid Percent ______________________________________________________________________________ Valid

Experience reported

1

10.0

No experience

9

90.0

Total 10 100.0 _____________________________________________________________________________

                                                       


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Graphs Graph 1


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Graph 2


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Graph 3


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Graph 4


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Graph 5


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Graph 6


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Graph 7


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Graph 8


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Graph 9


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Graph 10


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Graph 11


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Graph 12


Conclusion and Final thoughts: Based upon results of this action research project it is evident that over 70% of counselors support CBT as the most effective method for PTSD treatment with 90% confirming support by the VA. However, 70% confirm that alternative methods were utilized, such as CPT, PE, EMDR and ACT. Interestingly, with respect to the effectiveness of cyber-therapy, 70% were undecided with the remaining unsupportive. However, when differentiating between stateside and deployed soldiers, a shift in consensus resulted. For deployed soldiers, 40% of the counselors shifted to a supportive position over cyber-therapy treatment. This shift can be attributed to the practical reality that stateside soldiers are accessible to the VA clinics while deployed soldiers are not. What is more striking, is the findings reveal a significant lack of experience with cyber-therapy, as only one of the ten counselors reported such experience. It is apparent from the study, that various VA clinics may lack sufficient training and access to cyber-therapy technology or the programs being developed. Therefore, the researcher recommends that further investigation be approved which will resolve the following concerns. 1. Are VA providers adequately informed of and trained for PTSD cyber-therapy treatment? 2. Do military-patient therapy results support that CBCT is an effective treatment-solution PTSD?

CLASSROOM RESEARCH METHODS  

EDUCATION, RESEARCH, COUNSELING

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