Characteristics of U.S. Veterans Who Begin and Complete Prolonged Exposure and Cognitive Processing Therapy for PTSD

Abstract

This retrospective chart-review study examined patient-level correlates of initiation and completion of evidence-based psychotherapy (EBP) for posttraumatic stress disorder (PTSD) among treatment-seeking U.S. veterans. We identified all patients (N = 796) in a large Veterans Affairs PTSD and anxiety clinic who attended at least 1 individual psychotherapy appointment with 1 of 8 providers trained in EBP. Within this group, 91 patients (11.4%) began EBP (either Cognitive Processing Therapy or Prolonged Exposure) and 59 patients (7.9%) completed EBP. The medical records of all EBP patients (n = 91) and a provider-matched sample of patients who received another form of individual psychotherapy (n = 66) were reviewed by 4 independent raters. Logistic regression analyses revealed that Iraq and Afghanistan veterans were less likely to begin EBP than veterans from other service eras, OR = 0.48, 95% CI = [0.24, 0.94], and veterans who were service connected for PTSD were more likely than veterans without service connection to begin EBP, OR = 2.33, 95% CI = [1.09, 5.03]. Among those who began EBP, Iraq and Afghanistan veteran status, OR = 0.09, 95% CI = [0.03, 0.30], and a history of psychiatric inpatient hospitalization, OR = 0.13, 95% CI = [0.03, 0.54], were associated with decreased likelihood of EBP completion.

Substance use disorders and PTSD: Examining substance use, PTSD symptoms, and dropout following imaginal exposure

“…This differs from research on PE in Veterans that demonstrates most participants drop out of treatment prior to session four (Garcia, Kelley, Rentz, & Lee, 2011; Mott et al, 2014). This discrepancy may be because exposures were implemented later in the COPE treatment following implementation of coping skills training (i.e., at session 4 versus session 3).…”

Integrated Cognitive Behavioral Therapy (ICBT) For PTSD and Substance Use in Iraq and Afghanistan Veterans: A Feasibility Study

“…A recent study examining engagement and completion of evidence-based psychotherapy (EBP) for PTSD with Veterans found dropout rates of 50% and 30.9% for CPT and PE, respectively [38]. Of note, OEF/OIF/OND status was a significant predictor of EBP non-completion.…”

A Quantitative Test of an Implementation Framework in 38 VA Residential PTSD Programs

“…Similarly in one large Midwestern VA PTSD outpatient clinic, although 70 % of the veterans who initiated PE or CPT completed the treatment, only 11 % began this type of treatment (Mott et al 2014). However to date, there has been limited evaluation of PE and CPT implementation more broadly across VA treatment settings (Eftekhari et al 2013; Karlin et al 2010).…”