Dissemination of evidence‐based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration

Abstract

Unlike the post-Vietnam era, effective, specialized treatments for posttraumatic stress disorder (PTSD) now exist, although these treatments have not been widely available in clinical settings. The U.S. Department of Veterans Affairs (VA) is nationally disseminating 2 evidence-based psychotherapies for PTSD throughout the VA health care system. The VA has developed national initiatives to train mental health staff in the delivery of Cognitive Processing Therapy (CPT) and Prolonged Exposure therapy (PE) and has implemented a variety of strategies to promote local implementation. In this article, the authors examine VA's national CPT and PE training initiatives and report initial patient, therapist, and system-level program evaluation results. Key issues, lessons learned, and next steps for maximizing impact and sustainability are also addressed.

Dissemination and experience with cognitive processing therapy

“…To that end, in 2006, VA established a national CPT training initiative with the goal of disseminating and implementing CPT throughout the VA healthcare system (see Karlin et al [9]). As of August 31, 2011, the CPT rollout trainers have provided training to over 3,000 mental health staff through 61 rollout and 59 nonrollout workshops.…”

“…After completing the training requirements, they can formally apply to be designated as a "CPT provider." Initial program evaluation data described elsewhere [9] have indicated that the training and implementation of CPT has yielded significant and positive therapist, patient, and system outcomes. Next, we report on expanded program evaluation data.…”

Evidence-Based Practices, Ethical Considerations, and Advocacy Efforts to Reduce Mental Health Stigma in Veterans with Post-Traumatic Stress Disorder

“…Karlin et al [6] indicate that due to the VA's push for specialized treatment for veterans, both CPT and PE have been validated and supported as the evidence-based practices of choice. Regardless of treatment, accurate, appropriate, and clinically sound case conceptualization is the most important factor in determining programming [28].…”

“…Clinicians who treat veterans need continuing education (CE) to learn how to best address their unique behavioral health needs [6]. This is achieved through reading relevant journals, attending seminars, and registering with support organizations.…”

“…Trauma is generalized to stimuli through secondorder classical conditioning and negatively reinforced by avoidance [5]. Once this occurs, complications result, such as heightened arousal states, inability to complete tasks, inability to withstand environmental cues, or reliving the trauma [6].…”