Cognitive-behavioral therapies (CBTs) can be effective treatments for posttraumatic stress disorder (PTSD) but their effectiveness is limited by high rates of premature dropout. Few studies have compared pretreatment characteristics of treatment completers and dropouts, and only one has examined these factors in Operations Iraqi Freedom and Enduring Freedom (OIF/OEF) Veterans. This study analyzed archival clinical data from 117 OEF/OIF Veterans evaluated and treated through a Veterans Affairs PTSD clinic. High numbers dropped out of treatment (68%). Treatment dropouts (n ϭ 79) and completers (n ϭ 38) differed significantly on Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scales, PTSD symptom severity, and age. Regression analyses identified one MMPI-2 scale, TRT (negative treatment indicators), and age as unique but modest predictors of dropout.

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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.

Traditional masculine socialization presents challenges in psychotherapy, for example, by decreasing the likelihood of help-seeking and by making emotion-laden content more difficult to address. While this has been established in civilian populations, more intense forms of masculine socialization found in military settings may amplify such issues in male veteran populations. Male veterans returning from and Afghanistan (OEF) and Iraq (OIF) exhibit strong traditional masculine socialization and generally present in a unique manner. It is posited that OEF/OIF male veterans' unique presentation is in large part because of an interaction between high degrees of endorsement of traditional masculine gender role norms, relative youth, recency of distressing events, and recent experience in the social context of the military where traditional masculinity is reinforced. The impact of these variables on the psychotherapeutic process for male OEF/OIF veterans is significant and likely adds to ambivalence about change and increases dropout from psychotherapy. Modifications of traditional psychotherapeutic approaches designed to address traditional masculine gender role norms and their many interactions with other variables are discussed.

Studies identifying a high prevalence of posttraumatic stress disorder (PTSD) and low treatment utilization among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans reinforce the need for a greater understanding of the disorder in this population. Although traditional masculine norms have been found to relate to both help seeking and PTSD among civilians, little is known about their impact on war Veterans. The current study examined relationships between masculine behaviors, using the Masculine Behavior Scale (MBS), and PTSD symptoms in OEF/OIF Veterans, drawing on archival clinical data from 69 patients at an outpatient PTSD clinic. Despite a positive trend, total MBS scores were not correlated with overall PTSD severity. However, the MBS subscale Exaggerated Self-Reliance and Control positively predicted hyperarousal symptoms in a hierarchical regression model. Unexpectedly, the MBS subscale Success Dedication negatively predicted avoidance, suggesting that this masculine norm may serve a protective function against avoidance symptoms. Results suggest that elements of masculinity are related to specific PTSD symptom clusters in ways that may be both adaptive and maladaptive. Implications for PTSD treatment are discussed.