A Formative Evaluation of Two Evidence‐Based Psychotherapies for PTSD in VA Residential Treatment Programs

Abstract

Thirty-eight U.S. Department of Veterans Affairs (VA) residential treatment programs for posttraumatic stress disorder (PTSD) participated in a formative evaluation of their programmatic services, including evidenced-based treatments (EBTs), between July 2008 and March 2011. Face-to-face qualitative interviews were conducted with over 250 staff by an independent psychologist along with on-site participant observations. This evaluation coincided with a national VA dissemination initiative to train providers in two EBTs for PTSD, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). A substantial proportion of eligible (based on professional background) residential treatment providers received training in PE (37.4%) or CPT (64.2%), with 9.5% completing case consultation or becoming national trainers in each therapy respectively. In semi-structured interviews, providers reported that their clinical programs had adopted these EBTs at varying levels ranging from no adoption to every patient receiving the full protocol. Suggestions for improving the adoption of PE and CPT are noted, including distilling manualized treatments to essential common elements.

Residential treatment for posttraumatic stress disorder in the Department of Veterans Affairs: A national perspective on perceived effective ingredients.

“…These findings may help explain why the use of PE and CPT in residential treatment was not universal (Cook et al, 2013). In the study, use occurred on a continuum from no adoption to treatment became the core of programming to “de-adoption” (abandoning a treatment after initial adoption; Massatti, Sweeney, Panzano, & Roth, 2007).…”

“…To gain provider insights into perceived successful programming, a formative evaluation of VA residential PTSD programs was conducted (Cook et al, 2011). The purpose of this article was to report on the frequency and percentage of ingredients of perceived effective treatment as indicated by PTSD residential treatment staff.…”

Trauma Informed Guilt Reduction Therapy With Combat Veterans

“…TrIGR may be appropriate for patients who have multiple or subthreshold diagnoses as it is designed to be transdiagnostic and address a specific source of distress rather than a specific disorder. The protocol may also be suitable for residential or intensive PTSD treatment settings where brief protocols and adjunctive treatments fit well into the milieu and longer treatments have proven challenging to implement to fidelity due at least in part to the intensive nature of treatment and short length of stays (Cook et al, 2013). Finally, TrIGR may be helpful to therapists treating PTSD or depression in that many of the strategies suggested in the TrIGR manual fit into existing models of treatment.…”

VA residential provider perceptions of dissuading factors to the use of two evidence-based PTSD treatments.

“…Complete descriptions of the development process as well as copies of the survey and semistructured interview guide are reported elsewhere (Cook et al, 2013). In brief, we conducted a systematic review of the literature to operationalize constructs presented in the evidence-based framework of implementation of health care interventions by Greenhalgh et al (2005).…”

“…Indeed, this is true in the face of the VA mandate that all veterans receiving outpatient or residential care are to have access to PE or CPT (U.S. Department of Veterans Affairs, 2010). For example, in a national investigation of VA PTSD residential programs, use of PE and CPT was not universal, with some programs not adopting these treatments at all (Cook et al, 2013). Furthermore, although several VA residential programs were delivering a full protocol of CPT to all patients, no program offered PE to all patients.…”