Efficacy of a practitioner’s guide
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Running Head: EFFICACY OF A PRACTITIONER’S GUIDE
Examining the Efficacy of A Practitioner’s Guide to the Understanding and Effective Diagnosis
of Posttraumatic Stress in Women
Karen D. Dunn
In Partial Fulfillment of Course Requirements: EDEP 820
December 8, 2006
Efficacy of a practitioner’s guide
Abstract
The purpose of the current study is to assess the effectiveness of A Practitioner’s Guide to the
Understanding and Effective Diagnosis of Posttraumatic Stress (PTSD) in Women. This
educational intervention has been designed to enhance the self-efficacy beliefs of 122 primary
care physicians to understand, detect, diagnose, and treat PTSD in women. To this end, a new
instrument has been developed, the UDDAT self-efficacy scale. It is hypothesized that
physicians will report greater self-efficacy beliefs to understand, detect, diagnose, obtain trauma
histories, and treat women with PTSD in post-test relative to pre-test assessments. Anticipated
results will support the hypotheses. Implications and suggestions for future research are
provided.
2
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Examining the Efficacy of A Practitioner’s Guide to the Understanding and Effective Diagnosis
of Posttraumatic Stress in Women
Interpersonal violence against women is of staggering proportions in our society. Recent
studies have examined the prevalence rates of abuse in a general population of adults (n=935)
and found that 32.3% of women reported sexual abuse prior to the age of 18. In addition, of the
sample, 19.5% of women reported childhood physical abuse (Briere & Elliot, 2003). Plichta and
Falik (2001) reported that in a nationally representative sample of U.S. women (n=2,381)
between the ages of 18-64, 17.8% reported child abuse, 19.1% reported physical assault, 20.4%
had been raped, and 34.6% had experienced intimate partner violence. Moreover, other studies
have found that women are twice as likely as men to develop post-traumatic stress disorder
(PTSD) than men subsequent to trauma (Butterfield & Becker, 2002).
PTSD has been defined as a complex anxiety disorder that can develop after an individual is
exposed to a traumatic event and is present in approximately 8% of the general population
(Kessler, 1995). The current diagnostic criterion involves the presence of one or more of the
following symptoms for duration of 3 months. The symptoms include 1) re-experiencing the
trauma via nightmares, intrusive thoughts, etc., 2) persistent avoidance of stimuli associated with
the trauma, and 3) persistent symptoms of increased arousal (DSM-IV; American Psychiatric
Association, 1994).
The symptoms of PTSD often overlap symptoms of other disorders causing the condition to
go untreated or undiagnosed by health professionals (Munro, Freeman & Law, 2004; Samson,
Bense, Beck, Price, & Nimmer, 1999). Moreover, research has indicated that women who have
experienced interpersonal trauma may not disclose previous trauma information to their primary
care physician unless asked directly (Plichta, & Falik, 2001). Yet, many studies have found that
Efficacy of a practitioner’s guide
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individual’s who suffer from PTSD are more likely to go to a medical doctor than to a mental
health provider (Gillock, Zayfert, Hegel, & Ferguson, 2005). This is partially due to the fact that
women who have suffered from victimization report physical symptoms, in addition to
psychological symptoms, which they may not realize are related to previous trauma (Butterfield
& Becker, 2002; Samson, et al., 1999). These symptoms include somatic issues of chronic pain,
respiratory illness, and cancer, irritable bowel symptoms, weight management issues, and
fibermyalgia, among others illnesses (Finestone, Stenn, Davies, Stalker, Fry, & Koumanis, 2000;
Gillock, Zayfert, Hegel, & Ferguson, 2005). Previous research has also indicated that among
women who have been victimized, the most common complaints reported are digestive,
neurological, chest pain, musculoskeletal, and gynecological (Butterfield & Becker, 2002). The
aforementioned physical illnesses and complaints are in addition to other psychological disorders
commonly associated with PTSD, such as anxiety and depression. In fact, a recent review of the
literature (Nemeroff, Bremner, Foa, Mayberg, North, & Stein, 2006) revealed findings that
health care costs were nearly double for women who indicated high scores on a PTSD measure.
However, in order to effectively treat the symptoms of PTSD, it is crucial that the disorder is
accurately diagnosed. Therefore, the purpose of this study is to examine the efficacy of an
educational intervention to enhance physician understanding/detection/diagnosis and appropriate
treatment for PTSD in women.
Knowledge of PTSD in Primary Care Settings
To the author’s knowledge, there is no existing comprehensive intervention to educate
primary care physicians regarding the understanding/detection/diagnosis and appropriate
treatment of traumatic stress. Previous research has indicated that with proper intervention, the
symptoms of PTSD can be reduced (Munro, Freeman, & Law, 2004). Therefore, it is critical for
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individuals who suffer from trauma related symptoms to be appropriately diagnosed and treated.
However, recent studies have reported several issues that preclude proper care for traumatized
individuals. One of these issues is a lack of education among primary care providers regarding
the diagnosis and treatment of PTSD. For example, Munro, Freeman and Law (2004) found that
in a sample of 433 general practitioners (GP’s), only (122) 28.3% recognized the symptoms of
PTSD and were able to identify the appropriate pharmacology in response to a PTSD vignette.
This was in contrast to a vignette for depression, which was included as a control; in this case
(388) 89.8% GP’s gave the correct differential diagnosis and “prescribed” the appropriate
medication. The purpose of the study was to identify knowledge gaps of general practice
physicians regarding PTSD diagnosis and treatment. The questionnaire was sent to all general
practice physicians (n=946) and all psychiatrists (n=76) who specialized in adult care via regular
mail. A total of 433 GP’s and 37 psychiatrists completed the survey. The questionnaire
consisted of 4 vignettes to reflect specific primary care clinical presentations. The vignettes
include moderate depressive episode, acute stress reaction, PTSD, and adjustment disorder. The
results of the surveys collected revealed that 42.9% of the GP’s correctly included PTSD as their
differential diagnosis in the corresponding vignette. However, 39.1% misdiagnosed the acute
stress vignette as PTSD. In contrast, 94.4% of GP’s correctly identified depression in the
appropriate vignette. There was a significant difference between the correct diagnosis for
depression and PTSD (95% CI = 23 to 32, p < .001). Moreover, less than 20% of GP’s correctly
identified the progression of PTSD from acute stress reaction, after one month, according to
clinical guidelines.
In terms of treatment, the results indicated the following: 42.9% of GP’s prescribed the
appropriate pharmacological treatment for PTSD. However, this treatment was not prescribed
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with PTSD in mind. Only 28.3% correctly diagnosed PTSD and prescribed the appropriate drug;
only 21.6% performed the previous actions within 2 months as indicated by practice guidelines.
Referrals to psychological/psychiatric services were indicated by 86.8% of GP’s for the PTSD
vignette. Unfortunately, this referral for services was made by only 46.2% who correctly
diagnosed the vignette as being PTSD. Moreover, only 26.9% gave the appropriate diagnosis and
appropriate referral within 4 months of original presentation. In addition, best practice criteria
per evidence-based guidelines were indicated by only 10.2% of GP’s for the PTSD vignette. This
was significantly different for the depression vignette of 47.7% (CI = 33.3 to 43.7, p < .001).
Recently, Stein, Sherbourne, Craske, Means-Christensen, Bystritsky, Katon, Sullivan, and
Roy-Byrne, (2004) reported that the quality of care for primary care patients with anxiety
disorders, including PTSD, was lacking. Data for this study was collected in three universityaffiliated primary care clinics in the western U.S. Board-certified physicians primarily staff these
clinics; however, residents constitute a minority of patient care responsibilities under supervision
(15-30%). Participants were recruited from waiting rooms and were given a brief, self-report
measure to assess demographic information, chronic medical conditions, and symptoms of
anxiety and depression, including posttraumatic stress disorder, among others. Participants who
screened positive for any anxiety disorder were invited to participate in a subsequent diagnostic
telephone interview. The purpose of the subsequent interview was to collect information
regarding DSM-IV diagnosis confirmation, illness and characteristics of their care over the
previous 3 months. Eight hundred and one participants (60.7%) completed the diagnostic
interview by telephone out of 1,319 eligible. Of these patients, 366 met the DSM-IV diagnostic
criteria for panic disorder, social phobia, PTSD, or generalized anxiety disorder. These patients
were asked several questions to ascertain whether they had received mental health counseling, or
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referrals for counseling. They were also asked if the primary care physician had prescribed any
medication for personal or emotional problems. These items were then used to determine quality
of care. Patient reports were also taken regarding the use of psychotropic medications, and antianxiety medications including dosage and duration of treatments over the previous 3 months.
The results of the study indicated that of the 366 patients, 122 (33.3%) met the DSM-IV criteria
for PTSD; the remaining 244 participants had other types of anxiety disorders. In addition, of the
122 participants who had PTSD, (106) 86.9% also met criteria for a co-morbid anxiety disorder.
The quality of care index found that only (38.5%) of PTSD patients had been referred to a mental
health provider, only 35.2% had been prescribed an appropriate anti-anxiety medication for a
duration of more than 6 weeks. In addition, only 39.2% of patients with PTSD had received
either counseling with 3 components of Cognitive Behavioral Therapy, or appropriate
medication for more than 6 weeks (per treatment guidelines). This particular study did not have
access to physician-based diagnoses of these patients, so it remains unclear if these patients had
been diagnosed with the appropriate disorder. However, it is clear that the quality of care for
patients with PTSD is lacking in the primary care setting.
The studies described above indicate that PTSD is prevalent in primary care settings.
Moreover, physicians in primary care settings do not often recognize the symptoms of PTSD in
their patients. In many cases, even when PTSD is recognized in primary care settings, the quality
of treatment is lacking according to established professional guidelines.
PTSD & Physical Health
Other studies have found that patients who suffer from PTSD report many physical medical
conditions. It has been suggested that these patients are unaware that a previous trauma is related
to their current medical problems. Patients with PTSD report higher rates of medical utilization,
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more painful physical symptoms and reduced physical health functioning than non-PTSD
patients. As an example, Gilcock, et al., (2005) examined the prevalence of PTSD and related
health conditions in a sample of 232 (68% female), individuals who were recruited from waiting
rooms at a primary care facility. The participants were either patients or persons accompanying a
patient. Two surveys were given to assess PTSD. In addition, participants were assessed on
measures of health functioning, number of medical visits in the past 3 months, and physical
symptoms. Of the sample, 9% (n=21) met the diagnostic criteria for current full PTSD, and 25%
(n=57) were identified as having partial PTSD. The full PTSD group reported higher rates of
medical visits, more intense physical symptoms, and poorer health functioning than the nonPTSD group. The partial and full PTSD groups were similar in the number of medical visits and
in perceptions of their general health and role limitations due to physical problems. The partial
PTSD group compared more closely to the PTSD group than the non-PTSD group. The
differences between the 2 PTSD groups were primarily in symptom severity. Both PTSD groups
reported poorer health and greater medical visits than the non-PTSD group.
The above findings are congruent with previous research linking patients with PTSD to higher
levels of adverse medical conditions, and greater medical service utilization than non-PTSD
patients (Ciechanowski, Walker, Russo, Newman, & Katon, 2004). This study included 1225
women between the ages of 18-65, (M age = 41.8, SD = 11.5). Participants were randomly
selected from a large HMO database in the Northwest, which also provided researchers with
access to patient medical histories. The purpose of the study was to compare differences in selfreport health outcomes, health risk behaviors, and automated physician diagnostic codes in
women with low, moderate, and high levels of PTSD symptom severity. The researchers
hypothesized that PTSD symptom severity would be positively related to poorer health
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functioning in terms of functional disability, more self-reported health risk behaviors, physical
symptoms, and physician coded diagnoses. A 22-page questionnaire was mailed to each of the
1963 female HMO enrollees as a result of random sampling procedures. The self-report
measures included the use of validated instruments to assess PTSD symptoms, childhood trauma,
maltreatment severity, functional disability, physical symptoms, and health risk behaviors (e.g.,
smoking, alcohol use, driving while intoxicated, high risk sexual encounters, etc). In addition,
physician-coded diagnostic information was collected for all participants, including nonresponders for the previous year. These codes were subsequently grouped into four categories as
follows; infectious diseases (e.g., vaginitus, sinusitis, etc.), pain disorders (i.e., neck headache,
back pain, etc.), mental health diagnoses (i.e., stress, depression, marital discord, etc.) and other
physical health diseases (i.e., hypertension, diabetes, asthma, etc.).
The data from the PTSD instruments were divided into 3 groups (low, medium, and high
scorers), which were then used to categorize the patients into 3 groups (no, or low PTSD,
moderate PTSD, and severe PTSD) for analysis. The results indicated that of the 1196 women
with PTSD data, 843 (70%) were in the no-PTSD group, 270 (23%) were in the moderate PTSD
group, and 83 (7%) were in the severe-PTSD group. Moreover, demographic information was
significantly different between each of the 3 groups. For example, the severe-PTSD group was
significantly younger, less likely to have attended college, and less likely to be Caucasian. These
women also reported lower income than the other 2 groups, which did not differ, on this variable.
In terms of functional disability, the no-PTSD group had significantly better functioning than the
moderate and severe groups on all scales. The severe group reported significantly worse
functioning than the moderate group in emotional role function, social function, and mental
health. On all other scales, there were no significant differences between the moderate and severe
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groups. As far as child maltreatment, the three groups were significantly different on all scales.
The no-PTSD had significantly lower scores on all scales and the total than the 2 PTSD groups.
The moderate group indicated significantly lower rates of abuse and neglect than the severe
group on emotional abuse, physical abuse and neglect, and the total score. The severe group also
reported significantly higher rates of health risk behaviors than the no-PTSD group. Moreover
both PTSD groups reported significantly more physical symptoms than the no-PTSD group.
These findings were consistent with the physician-coded diagnoses. For example, the moderate
and severe groups had significantly greater numbers of physician-coded diagnoses on mental
disorders and ICD-9 codes, and severe groups reported significantly greater pain conditions than
the no-PTSD group.
Taubman-Ben-Ari, Rabinowitz, Feldman and Vatur (2001) took the previous studies further
and examined both the prevalence and physician detection of PTSD in a sample of 2975 (1788
female) adults (M age = 51.4, SD = 17.8) who were recruited from various primary care settings.
The respondents completed a general health questionnaire to assess current psychological
distress, a PTSD inventory, which included trauma history and a demographic questionnaire. In
addition, each patient’s physician completed a form regarding his/her detection of distress or
PTSD in the patient. The physician was not provided access to the patient questionnaires. The
results indicated that 25% (n= 455) of women reported some type of trauma. Of these women,
40% (n=180) met criteria for current PTSD (10.5% of overall women; 7.5% of overall men). In
addition, 92% of the women who met PTSD criteria reported psychological distress, as indicated
on the general health questionnaire. According to physician reports, only 49% of patients were
distressed compared to self-report measures, which indicated that 88% (total, male and female)
were actually distressed. Moreover, the physicians only detected 2% of patients meeting criteria
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for PTSD. The aforementioned studies clearly indicate the need for educational efforts to
enhance the understanding/detection/diagnosis and appropriate treatment of trauma related
symptoms and PTSD in women. Many assessment tools and diagnostic algorithms exist for
primary care providers. Therefore it remains unclear why these resources are not being widely
used in practice. We offer several possibilities for this disconnect. Firstly, many primary care
physicians report having little time with patients in managed care settings (Freeborn, Hooker, &
Pope, 2002). Secondly, most medical schools do not provide training in PTSD and trauma.
Thirdly, there are currently no educational interventions that address all of the issues described in
this paper. Therefore, the proposed intervention will include 1) an overview of PTSD to promote
understanding, 2) a screening tool to enhance assessment per guidelines established by the
American Academy of Family Physicians (AAFP), 3) Complete diagnostic criteria per DSM-IV
guidelines, and 4) Guidelines for obtaining a trauma history in patients who exhibit symptoms of
anxiety and depression using compassion and empathy. It is hoped that this intervention will
provide busy physicians a thorough, yet concise education regarding PTSD. Moreover, we are
hopeful that this intervention will improve the quality of care for women in primary care settings.
It is expected that primary care physicians will report 1) greater overall self-efficacy to
understand/detect/diagnose/appropriately treat (UDDAT) symptoms of PTSD in women in posttest assessments on the UDDAT self-efficacy scale as represented by total scores. 2) It is also
hypothesized that post-test scores will be significantly greater than pre-test scores for selfefficacy on all subscales of the UDDAT as follows; a) knowledge and understanding of PTSD
symptomatology in women, b) ability to inquire about previous trauma with compassion and
understanding, c) ability to effectively diagnose PTSD in women, and d) appropriately treat
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symptoms of PTSD according to best practice guidelines established by the American Academy
of Family Physicians (AAFP).
Method
Participants
The proposed participants will be a representative sample of general health care providers.
Ideally, the sample will include practicing physicians, residents, and medical students. All
participants will be over the age of 18 and will volunteer to participate via flyers distributed at
local hospitals, academic settings, women’s health care facilities, and/or medical offices. The
flyers will describe the opportunity to participate in a research program in the area of women’s
health care. Participants will receive either continuing medical education credits (CME), or
course credit for completing the educational program.
Instruments
Demographic information will be taken including gender information, current position,
profession, years of practice, previous training in trauma and PTSD, and country of medical
education.
The Understanding, detection, diagnosis and treatment of PTSD self-efficacy Scale (UDDAT)
This is a new self-efficacy scale that has been developed to assess the effectiveness of the
educational program (Appendix A). The scale is a 20-item likert style scale, which solicits a
response from 0, “Probably cannot do it” to 10, “definitely can do it”. The scale is subdivided
into 4 core areas including: 1) self-efficacy of knowledge base in the area of PTSD, including
recognition and detection of symptoms, within a biological, social, gender, & cultural context
(8-items). A sample item includes, “In my current practice I am able to distinguish between
symptoms of PTSD and other anxiety disorders”, 2) self-efficacy to inquire about previous
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trauma history using sensitivity toward patient (3-items). This is assessed by items such as, “In
my current practice I can “assess prior trauma in patients without fear of offending the patient”,
3) self-efficacy to diagnose PTSD in women in general practice (3-items). A sample item is, “In
my current practice I am able to make a definitive diagnosis of PTSD primary to comorbid
disorders of anxiety and/or depression”, and 4) self-efficacy to effectively/appropriately (by
professional standards established in his/her profession) provide a first line of treatment (4items). For example, “In my current practice I am able to follow the guidelines established by the
American Academy of Family Physicians (AAFP) to initiate the first line of treatment for
patients I diagnose with PTSD”.
A Practitioner’s Guide to the Understanding and Effective Diagnosis of PTSD in Women
This educational program consists of 4 main topic areas. Each of the 4 main topics will be
covered in a distinct session with opportunity for participant questions and review at the
completion of each session. The final session (5) will comprise an overview of all topic areas and
will incorporate a dramatization using participant volunteers to illustrate a mock interaction
between the physician and a woman seeking treatment for PTSD. The following section offers an
overview of each of the five sessions:
Session I: Understanding the nature of the physiological response to traumatic stress and the
development of PTSD in women.

This session will begin with a definition of trauma and the historical and socio-cultural
aspects of the human response to traumatic stress. A brief overview of neurophysiological aspects of the human stress response will be provided. In addition, we will
discuss gender differences as reviewed in current literature. Moreover, the discussion will
incorporate an underlying philosophical position of traumatic stress as a normal response
to abnormal events, rather than a pathological condition.
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Session II: Obtain trauma history in women who seek treatment for symptoms of anxiety and/or
depression.

Session 2 will offer evidence-based guidelines for obtaining trauma history using
sensitivity, and compassion for the patient. The basis for this session is derived from
current literature, which indicates that physicians may be reluctant to inquire about
previous trauma. Moreover, the research has found that women who have been
victimized may not reveal this information unless asked directly. Other research has
indicated that most women appreciate being asked about abuse and trauma by their
primary care physician and feel that it is important.
Session III: Guidelines for the effective and accurate diagnosis of PTSD

This session will provide an overview of current instruments available for assessing and
diagnosing PTSD. In addition, diagnostic criteria will be reviewed and discussed
(Appendix B). The basis for differentiating PTSD from other anxiety disorders will also
be covered in the session.
Session IV: Current treatment approaches for patients with PTSD

Physicians will be given a symptom severity assessment tool to assess the degree to
which an individual is suffering. A variety of treatment options will be discussed
including cognitive behavioral, pharmacological, and mixed approaches. In addition, the
provider will be trained to recognize when to refer an individual to a mental health
specialist in traumatic stress. Patient education tools will also be incorporated in helping
the physician to provide accurate information to patients using lay terms.
Session V: Overview, review and mock patient interview
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
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The physicians will have the opportunity to observe a trained physician incorporate the
above elements in a mock patient interview. All participants will practice the interview
procedures with other physicians both as a “patient” and as a “physician”. The session
will end with physician questions and discussions related to the intervention.
Procedures
All participants will complete the demographic questionnaire and the above measure of selfefficacy, the UDDAT, prior to beginning the educational program. The participants will
complete the educational program according to guidelines recommended by the AAFP. Upon
completion of the intervention, the UDDAT will be completed for the second time.
Data Analysis
Factor analysis will be conducted to validate the new self-efficacy scale items. In addition,
descriptive statistics will be run for all of the data collected. Paired t-tests will be run to
determine any differences between pre and post data on individual items on the self-efficacy
scale. Moreover, composites for each of the 4 core areas (i.e., self-efficacy to 1) understand
complex trauma and PTSD within a biological, social, gender, & cultural context 2) successfully
obtain trauma history using compassion and sensitivity toward patient, 3) effectively diagnose
PTSD in women and 4) to effectively/appropriately (by professional standards established in
his/her profession) provide a first line of treatment, will be analyzed by paired t analyses. In
addition, the total score representing all 20-items will be analyzed with paired t-tests using pre
and post data sets.
Results
It is expected that all hypotheses will be supported. For example, post-test scores on the self-
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efficacy scale will be significantly higher than pre-test scores in each of the four core areas (i.e.,
self-efficacy to understand and recognize symptomatology of PTSD, self-efficacy to obtain
trauma history, self-efficacy to detect and effectively diagnose PTSD in women, and selfefficacy to provide effective first line of treatment as indicated in the current “best practice”
protocol. It is also expected that there will be significant differences on pre-test and post-test
total UDDAT scores.
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References
American Academy of Family Physicians (AAFP), CME Center, CME Accreditation. Retrieved
December 9, 2006, from http://www.aafp.org/online/en/home/cme/cmea.html
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders
(4th ed.). Washington, DC: Author.
Briere, J. & Elliott, D. (2003). Prevalence and psychological sequelae of self-reported
childhood physical and sexual abuse in a general population sample of men and women.
Child Abuse & Neglect, 27, 1205-1222.
Butterfield, M. I. & Becker, M. E., (2002). Posttraumatic stress disorder in women: Assessment
and treatment in primary care. Women’s Mental Health, 29(1), 151-170.
Ciechanowski, P. S., Walker, E. A., Russo, J. E., Newman, E., & Katon, W. J. (2004). Adult
health status of women HMO members with posttraumatic stress disorder symptoms. General
Hospital Psychiatry, 26, 261-268.
Finestone, H. M., Stenn, P., Davies, F., Stalker, C., Fry, R., & Koumanis, J. (2000). Chronic pain
and health care utilization in women with a history of childhood sexual abuse. Child Abuse &
Neglect, 24(4), 547-556.
Freeborn, D. K., Hooker, R. S., & Pope, C. R. (2002). Satisfaction and well-being of primary
care providers in managed care. Evaluation & the Health Professions, 25(2), 239-254.
Gillock, K. L., Zayfert, C., Hegel, M. T., & Ferguson, R. J. (2005). Posttraumatic stress disorder
in primary care: Prevalence and relationships with physical symptoms and medical utilization.
General Hospital Psychiatry, 27, 392-399.
Kessler, R. C., Sonnega, A., Bromet, E. J., Hughes, M., & Nelson, C. B. (1995). Posttraumatic
stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52,
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1048-1060.
Munro, C. G., Freeman, C. P., & Law, R. (2004). General practitioners’ knowledge of
posttraumatic stress disorder: A controlled study. British Journal of General Practice, 54,
843-847.
Nemeroff, C. B., Bremner, J. D., Foa, E. B., Mayberg, H. S., North, C. S., & Stein, M. B. (2006).
Posttraumatic stress disorder: A state-of-the-science review. Journal of Psychiatric Research,
40, 1-21.
Plichta, S. B., Falik, M. (2001). Prevalence of violence and its implications for women’s health.
Women’s Health Issues, 11(3), 244-258.
Samson, A. Y., Bensen, S., Beck A., Price, D., & Nimmer, C. (1999). Posttraumatic stress
disorder in primary care. The Journal of Family Practice, 48(3/, 222-227.
Stein, M. B., Sherbourne, C. D., Craske, M. G., Means-Christensen, A., Bystritsky, A., Katon,
W., Sullivan, G., & Roy-Byrne, P. P. (2004). Quality of care for primary care patients with
anxiety disorders. American Journal of Psychiatry, 161, 2230-2237.
Taubman-Ben-Ari, O., Rabinowitz, J, Feldman, D., & Vaturi, R. (2001). Posttraumatic stress
disorder in primary-care settings: prevalence and physicians’ detection. Psychological
Medicine, 31, 555-560.
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Appendix A
1. Gender:
Female________
Male_________
2. Ethnicity/Cultural Information: (circle one)
A. Asian-American B. African American C. Caucasian/Non-Hispanic D. Hispanic
E. Arab American
F. Other (Please specify)_________________________________
3. Current Status: Practicing Physician_______ Resident______Medical Student________
4. Country of medical training: (medial school and residency)
A. U.S. B. Other country (please specify) ____________
5. Years in Field:
A. Less than 1 year_____ B. 1-5 years______ C. 6-10_______ D. 10+_____
E. N/A_______
6.
Previous training, if any, in trauma and Posttraumatic Stress: Yes or No (please circle)
If yes, Number of courses_____ Location of training (i.e., medical school, continuing ed.,
etc.)__________________________________________________________
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UDDAT Self-Efficacy Scale
Directions: Please indicate the response that best describes your ability on the following items
according to the scale where 0 = “probably cannot do it”, 3 = “maybe cannot”, 5 = “maybe”,
7 = “probably can do it”, and 10 = “definitely can do it”.
Probably
Cannot Do it
0
1
Maybe Cannot
2
3
Maybe
4
5
Probably Can
6
7
Definitely
Can Do It
8
9
10
Core Area #1: Knowledge in the area of symptom recognition and detection of PTSD
I. In my current practice I am able to:
1. Distinguish between symptoms of PTSD and other anxiety disorders
__________
2. Recognize that current somatic complaints may be related
to previous traumatic events in some patients.
__________
3. Recognize psychological distress in patients without
verbalization by patient
__________
4. Recognize dissociative reactions in my patients
__________
5. Inquire about previous traumatic experiences in patients
who suffer from symptoms of depression and anxiety
__________
6. Distinguish between Acute Post-traumatic Stress &
Chronic Post-traumatic Stress
__________
7. Recognize the defining nature of a “traumatic event”,
which events are considered to be traumatic, according
to AAFP guidelines
__________
8. Administer specialized accommodations
for women who have previously experienced trauma during routine
examinations
__________
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Probably
Cannot Do it
0
1
Maybe Cannot
2
3
Maybe
4
5
Probably Can
6
7
21
Definitely
Can Do It
8
9
10
Core Area #2: Self-efficacy to obtain trauma history using sensitivity
II. In my current practice I can:
1. Assess prior trauma in patients without fear of offending the patient
_________
2. Inquire about previous trauma without fear of legal implications
_________
3. Have access to one or more instruments to assess previous trauma
_________
4. Use sensitivity and empathy when speaking to a patient about
previous trauma
__________
Core Area #3: Self-efficacy to diagnose PTSD in female patients who have not experienced
combat
III. In my current practice, I am able:
1. To accurately diagnose PTSD in female patients who have
not experienced combat according to guidelines approved
by the American Academy of Family Physicians.
_________
2. Make a definitive diagnosis of PTSD primary to comorbid
disorders of anxiety and/or depression
__________
3. Assess and recognize psychiatric and physical symptoms
In patients I diagnosis with PTSD (i.e., substance abuse, depression,
other anxiety disorders, and/or cardiovascular, respiratory conditions)
_________
Core Area #4: Self-efficacy to effectively treat the symptoms of PTSD recommended
guidelines
IV.
In my current practice, I am able:
1. To provide educational resources (hand-outs, etc.) to patients with symptoms
of trauma and PTSD.
_________
2. To refer patients to trauma specialists when I diagnose trauma and or
PTSD in a patient.
_________
Efficacy of a practitioner’s guide
3. To comfortably and accurately educate patients about their
symptoms in relationship to previous trauma.
22
_________
4.
Follow the guidelines established in my profession to initiate the first line of
treatment for patients who suffer from PTSD
_________
5.
Know and prescribe the most appropriate pharmaceutical for my client
with a diagnosis of PTSD.
__________
Efficacy of a practitioner’s guide
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Appendix B
DSM-IV (TR) Diagnostic Criteria for Post-Traumatic Stress Disorder
A. The person has been exposed to a traumatic event in which both of the following were
present:
1. The person experienced, witnessed, or was confronted with an event or events that
involved actual or threatened death or serious injury, or a threat to the physical
integrity of self or others
2. The person’s response involved intense fear, helplessness, or horror.
B. The traumatic event is persistently reexperienced in one (or more) of the following ways:
1. Recurrent and intrusive distressing recollections of the event, including images,
thoughts, or perceptions
2. Recurrent distressing dreams of the event
3. Acting or feeling as if the traumatic event were recurring (includes a sense of reliving
the experience, illusions, hallucinations and dissociative flashback episodes).
4. Intense psychological distress at exposure to internal or external cues that symbolize
or resemble an aspect of the traumatic event.
5. Physiological reactivity
C. Persistent avoidance of stimuli associated with the trauma and numbing of general
responsiveness (not present before the trauma), as indicated by three (or more) of the following:
1. Efforts to avoid thoughts feelings, or conversations associated with the trauma
2. Efforts to avoid activities, places or people that arouse recollections of the trauma
3. Inability to recall an important aspect of the trauma
4. Markedly diminished interest or participation in significant activities
5. Feeling of detachment or estrangement from others
6. Restricted range of affect (e.g., unable to have loving feelings
7. Sense of a foreshortened future (e.g., does not expect to have a career, marriage,
children, or a normal life span)
D. Persistent symptoms of increased arousal not present before the trauma, as indicated by two
(or more) of the following:
1. Difficulty falling or staying asleep
2. Irritability or outbursts of anger
3. Difficulty concentrating
4. Hypervigilance
5. Exaggerated startle response
E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month.
F. The disturbance causes clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
Specify:
1. Acute: if duration of symptoms is less than 3 months
2. Chronic: if duration of symptoms is 3 months or more
Specify: With delayed onset: if onset of symptoms is at least 6 months after the stressor