PE and CPT as ‘canonized’ VA interventions for PTSDĪs a case in point, consider Prolonged Exposure Therapy (PE Foa, Hembree, & Rothbaum, 2007) and Cognitive Processing Therapy (CPT: Resick,& Schnicke, 1993 Resick, Monson, & Chard, 2016). Once interventions are accepted, they become ‘canonized’ – presumed safety and efficacy without being questioned or revisited/updated. Yet, there also seem to be some intangible aspects – perhaps a political element – involving a lobbying initiative to demonstrate that the new intervention is not only effective, but superior to and more cost-effective than the existing alternatives.
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Meeting the evidentiary standard or burden of proof usually means several large N, randomized studies involving some form of placebo control condition, as well as a no treatment control condition. Bureaucratic ‘red tape’ – originally intended as a method of slowing things down deliberately for careful review in the interest of prudence and safety – is the sine qua non of the VA.Īll decisions pertaining to approval of mental health-related interventions are made by a select committee within the VA Central Office, employing a rigid set of criteria for assessing whether the evidence base is sufficiently rigorous to meet a standard ‘burden of proof’, along with demonstrated cost-effectiveness and facility/uniformity of training/supervision and implementation (termed a ‘roll-out’ initiative). Though there have been recent initiatives to incorporate holistic health practices on a limited scale at each VA Hospital facility (termed ‘whole health’), the VA remains the most conservative of all agencies with regard to policies, rules, and regulations. The structure is strictly hierarchical and top-down, based upon a traditional military-medical model of care. The VA is the largest healthcare provider in the United States, and one of the largest bureaucracies within the Federal Government. In the VA, you go along to get along, get your work done on time without errors, maintain a sizeable workload, and don’t make waves or requests.
Low energy neurofeedback system lens ware ii professional#
Those who try to promote new ideas in a fixed monolithic system risk not only rejection, but damage to their professional reputations and career. Its priorities include meeting congressional mandates, various performance measures, maintaining Joint Commission Accreditation, maintaining at least the minimum level of funding needed to sustain operations, and maintaining the status quo.
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I tried to introduce new interventions into the VA system, and even wrote research proposals, all which met a dead end. I am recently retired after 27 years of full-time employment as a Psychologist in the VA Healthcare system, having worked in several facilities in three southeastern states. I was trained as a Clinical Psychologist in the science-practitioner model in the mid-late 1980s, and would not make such a bold assertion unless years of experience and effort led me to this conclusion. Idealistic practitioner aspirations of introducing qEEG and Neurofeedback into the VA Healthcare System are well-intentioned, but naive and wasted efforts