Utilization of evidence-based psychotherapies in Veterans Affairs posttraumatic stress disorder outpatient clinics.

Abstract

In response to the growing numbers of veterans with posttraumatic stress disorder (PTSD), the Department of Veterans Affairs (VA) has sought to make evidence-based psychotherapies for PTSD available at every VA facility. We conducted a national survey of providers within VA PTSD clinical teams (PCTs) to describe utilization of Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) and to identify individual and organizational factors associated with treatment uptake and adherence. Participants (N = 128) completed an electronic survey assessing reported utilization of PE and CPT treatments, adherence to treatment manuals, and characteristics of the provider and workplace environment. Participants reported conducting a weekly mean of 4.5 hours of PE, 3.9 hours of CPT (individual format), 1.3 hours of CPT (group format), and 13.4 hours of supportive care. Perceived effectiveness of PE and CPT were significantly associated with utilization of and adherence to those treatments. Reported number of hours conducting supportive care was positively associated with feeling the clinic was not sufficiently staffed (p = .05). Adherence to the PE treatment manual was positively associated with receiving emotional support from co-workers (p<.01). Provider attitudes and organizational factors such as staffing and work relationships may have an important impact on treatment selection and the quality of PTSD care provided in VA PCTs.

On the Implementation of Written Exposure Therapy (WET) with Veterans Diagnosed with PTSD

“…However, regardless of the therapy a client selects it is critical that therapists follow the therapy protocol. Implementation data from VA and DoD (Borah et al, 2013;Finley et al, 2015;Watts et al, 2014)) is making it clear that when PE and CPT are used by providers, critical components are often left out (e.g., the in-vivo hierarchy in PE). The effectiveness of a given treatment is likely dampened when critical components of the treatment are discarded.…”

“…In addition to the efficacy data, there is emerging evidence that VA and DoD providers are infrequently using these treatments even after receiving training in PE and CPT (Borah et al, 2013;Finley et al, 2015;Watts et al, 2014). Finley and colleagues (2015) found that VA providers used supportive-care treatment approaches for veterans presenting for PTSD treatment substantially more often than PE or CPT, citing high-care demands in combination with limited staff resources as a barrier for not using PE and CPT more often.…”

Beyond Binary Thinking: Providing Best Practice Treatment to Veterans with PTSD

“…Furthermore, as we know, there are a multitude of obstacles in the way of veterans receiving (e.g., Shiner et al, 2013), completing (Hembree et al, 2003), and responding to these first-line treatments (Bradley, Greene, Russ, Dutra, & Westen, 2005;Steenkamp et al, 2015). Providers seeking to offer these treatments may also face obstacles, including working in an understaffed clinic with low emotional support from co-workers (Finley et al, 2015). As Finley and colleagues noted, providers were more likely to offer supportive care (i.e., an alternative, second-line, non-preferred treatment) than PE or CPT, which may potentially be associated with these systemic issues.…”

Treating Persons With Traumatic Brain Injury

“…Major systematic and selective reviews of trials now exist [10][11][12][17][18][19][20][21]. Reviewers present trials classified according to the quality of evidence as recommended by the American Academy of Neurology [22]; they also provide recommendations for clinical application or use of methodologies based on these levels of evidence [10,11].…”

“…Due to increased vehicular crash-related TBIs, we have implemented preventive measures regarding drunk driving, seat belt use, and helmet use [12]. To date, multiple social-behavioral, targeted therapeutic rehabilitation, and medication intervention trials have been conducted with both civilian and military TBI populations [10][11][12][17][18][19][20][21].…”