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Objective: Emerging research shows that event centrality, or the degree to which trauma is perceived as integral to one’s worldviews and personal identity, has a substantial impact on trauma recovery. Given that high centrality fosters both distress and growth, additional research on potential moderators that could better distinguish the course of adjustment is needed. This study examined whether differences in psychological flexibility (or the ability to persist in a behavior despite urges to do otherwise) impacted posttraumatic stress symptoms (PTS) and perceived posttraumatic growth (PTG) as event centrality increased. Method: One-hundred and 25 college students (52% female) with a history of trauma exposure were recruited from a large Midwestern university. Participants completed an electronic survey for course credit. Results: There was a significant interaction between event centrality and psychological flexibility on PTS severity (B = 2.10, p = .003). A simple slopes analysis revealed that low psychological flexibility was associated with greater PTS severity as event centrality increased. Although event centrality and psychological flexibility independently predicted perceived PTG, no interaction effect was observed (B = −4.68, p = .080). Conclusion: This suggests that while differences in psychological flexibility may influence PTS severity following highly centralized traumatic experiences it has a more complicated relationship with perceived PTG that requires further investigation. Clinical implications are discussed.

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Background: The Veterans Health Administration (VHA) has pioneered the implementation of video to home (VTH) technology to increase access to mental health treatments for Veterans facing barriers to receiving in-person care, particularly for posttraumatic stress disorder (PTSD). Randomized controlled trials have established the noninferiority of evidence-based psychotherapies (EBPs) for PTSD delivered through VTH, compared to in-person delivery. Less is known about the use of VTH to deliver EBPs for PTSD in routine clinical practice. Objective: We examined the provision of EBPs for PTSD delivered via VTH at a large Southwestern VHA PTSD outpatient clinic. Methods: Data were obtained from chart review of the electronic medical records of Veterans receiving at least one session of Cognitive Processing Therapy or Prolonged Exposure via VTH in the VHA PTSD clinic during the study time frame. Results: Fourteen providers (including six psychology trainees) delivered EBPs for PTSD via VTH between 2016 and 2018. Providers treated 74 Veterans (33.8% women) from diverse sociocultural backgrounds who ranged in age from 25 to 79. Each provider treated about 3.08 (± 2.18) Veterans using VTH, not including one provider who saw more than 30. A hybrid approach, in which VTH-delivery was coupled with in-person delivery, was used with 70.3% of Veterans across treatment (including sessions completed before initiation and after termination of the EBP). This demonstrates the versatility of VTH for meeting individual patient needs. Most EBP sessions (85.4%) were conducted over VTH. Despite Veterans attending an average of 6.85 (± 4.88) EBP sessions, 50% terminated before session 7. This dropout rate is consistent with national and local EBP completion averages within the VHA. Veterans receiving Cognitive Processing Therapy via VTH were more likely to complete treatment than those receiving Prolonged Exposure. No other patient factors predicted attrition.