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

Abstract

Providers (N = 198) from 38 Department of Veterans Affairs residential posttraumatic stress disorder treatment programs across the United States completed qualitative interviews regarding implementation of 2 evidence-based treatments: prolonged exposure and cognitive processing therapy. As part of this investigation, providers were asked how they decide which patients are appropriate for these treatments. Many indicated that they did not perceive any patient factors that dissuade their use of either evidence-based treatment. However, 3 broad categories emerged surrounding reasons that patients were perceived to be less suitable candidates for the treatments: the presence of psychiatric comorbidities, cognitive limitations, and low levels of patient motivation. Interestingly, providers’ perceived reasons for limited or nonuse of a treatment did not correspond entirely to those espoused by treatment developers. Possible solutions to address provider concerns, including educational and motivational interventions, are noted.

Talking about trauma in therapy: Perspectives from young people with post‐traumatic stress symptoms and first episode psychosis

“…Our results suggest that giving clients a sense of control in treatment by allowing them choice over how and when their trauma memories are shared is a good first step in moving towards more traumainformed early psychosis services (SAMHSA, 2012). More specifically, the importance of readiness to talk about trauma in both the current and in previous studies suggest that motivational enhancement strategies such as motivational interviewing (MI) may play a role in traumaspecific treatments (Cigrang & Peterson, 2017;Cook et al, 2014). MI is designed to explore and resolve ambivalence about behavioural change, and its effectiveness in the treatment of substance abuse is well known (Smedslund et al, 2011).…”

“…This ambivalence also has been described in participants' experience of the exposure component of trauma‐focused CBT (Shearing, Lee, & Clohessy, ). Lack of motivation to engage fully or ambivalence in relation to a behavioural change (ie, talking about trauma) has been conceptualized as a problem of readiness (Cook, Dinnen, Simiola, Thompson, & Schnurr, ; Osei‐Bonsu et al, ).…”

The influence of patient readiness on implementation of evidence-based PTSD treatments in Veterans Affairs residential programs.

“…Of a group of 38 programs, 39% reported delivering CPT or PE to many or all their patients (Cook, Dinnen, Thompson, Simiola, & Schnurr, 2014). In an earlier wave of data collection, many providers indicated that they did not perceive any patient factors that dissuaded their use of either EBT but some noted three broad patient categories they believed might contribute to patients being less suitable candidates for the treatments: the presence of psychiatric comorbidities, cognitive limitations, and low levels of patient motivation (Cook, Dinnen, Simiola, Thompson, & Schnurr, 2014). …”

A Prospective Study of Racial and Ethnic Variation in VA Psychotherapy Services for PTSD

“…Given this nonequivalence, providers must make costbenefit determinations regarding which patients to triage to the more resource-intensive individual psychotherapy rather than to group therapy. Although there have been no direct evaluations of VA PTSD providers' decision-making processes regarding therapy referral decisions, qualitative studies of referrals to the (mostly individual) traumafocused evidence-based psychotherapies have shown that providers are reluctant to refer patients to these treatments if they do not deem the patients to be appropriate candidates for psychotherapy or if they do not consider the patients to be "ready" for the treatment (7)(8)(9). The concept of readiness or appropriateness for psychotherapy is not new or unique to evidence-based manualized psychotherapies; mental health providers commonly make determinations about patient appropriateness for psychotherapy (9)(10)(11).…”