Evidence‐based psychotherapy trends among posttraumatic stress disorder patients in a national healthcare system, 2001–2014

Abstract

Background Although evidence‐based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) were implemented starting in 2005 in the veterans health administration (VHA), the largest national healthcare system in the U.S., the rate of initiation (uptake) and prevalence of these treatments in each calendar year have not been determined. We aimed to elucidate two metrics of EBP utilization, uptake and prevalence, following implementation. Methods Cohort study of Iraq and Afghanistan veterans in VHA (N = 181,620) with a PTSD diagnosis and ≥1 psychotherapy‐coded outpatient visit from 2001 to 2014. Using natural language processing techniques, annual and cumulative uptake and prevalence rates from 2001 to 2014 were calculated for each of the two EBPs for PTSD, cognitive processing therapy (CPT) and prolonged exposure (PE) therapy. Results Annual uptake of CPT increased during most years, reaching a maximum of 11.1%. Annual uptake of PE showed little change until 2008 and then increased, reaching a maximum of 4.4%. The annual prevalence of CPT increased throughout the study, reaching a maximum of 14.6%. The annual prevalence of PE increased to a maximum of 5.0% in 2010, but then flattened and declined. Annual uptake of minimally adequate CPT increased a to maximum of 5% in 2014. Annual uptake of minimally adequate PE increased to a maximum of 1.2% in 2010. The cumulative prevalence of CPT was 19.9% and cumulative prevalence for PE was 7.5%. Conclusions Access to EBPs for PTSD modestly increased for Iraq and Afghanistan veterans after nationwide implementation efforts. Further expanding the reach to veterans is critical, given low rates of minimally adequate EBPs for PTSD.

Neural response to trauma‐related and trauma‐unrelated negative stimuli in remitted and persistent pediatric post‐traumatic stress disorder

“…The current findings support that trauma-unrelated negative stimuli, rather than trauma stimuli, play an important role in PTSD remission. Though most effective therapies for PTSD are trauma-focused (Helpman et al, 2016;Hinton et al, 2009;Maguen et al, 2019;, nontrauma -focused interventions (such as Dialectical Behavioural Therapy, Yoga, and art therapy) are emerging (Racco & Vis, 2015). Kaczkurkin et al (2017) argued that because of the important role of maladaptive generalization in the pathological mechanism of PTSD, future psychotherapy may also involve trauma-like stimulation (generalized stimulation).…”

“…The current findings support that trauma‐unrelated negative stimuli, rather than trauma stimuli, play an important role in PTSD remission. Though most effective therapies for PTSD are trauma‐focused (Helpman et al., 2016 ; Hinton et al., 2009 ; Maguen et al., 2019 ; Mavranezouli, Megnin‐Viggars, et al., 2020 ; Mavranezouli, Megnin‐Viggars, et al., 2020 ), nontrauma ‐focused interventions (such as Dialectical Behavioural Therapy, Yoga, and art therapy) are emerging (Racco & Vis, 2015 ). Kaczkurkin et al.…”

“…Trauma‐unrelated conditions cannot measure traumatic fear‐related processes, while trauma‐related stimuli would induce negative emotion and trauma‐specific fear in patients with PTSD (van Rooij et al., 2015 ). Presumably, the trauma‐specific component should be particularly meaningful in the PTSD‐remittance mechanism, because most effective therapies are trauma‐focused, such as cognitive‐behavioral therapy (CBT; Hinton et al., 2009 ), eye movement desensitization and reprocessing (EMDR; Mavranezouli, Megnin‐Viggars, et al., 2020 ; Mavranezouli, Megnin‐Viggars, et al., 2020 ) and prolonged exposure therapy (PE; Helpman et al., 2016 ; Maguen et al., 2019 ). To study this critical component for remittance, trauma‐related versus unrelated stimuli must be applied.…”

A review of the referral process for evidence-based psychotherapies for PTSD among veterans.

“…The availability of EBPs for PTSD is constrained by the number of providers who deliver these treatments (Borah et al, 2013, 2017). Challenges may arise when initial patient access to care is prioritized over availability of EBPs (Maguen, Holder, Madden, et al, 2020). Availability greatly affects wait times, which may reduce engagement; one study demonstrated that longer wait times from referral to intake and from referral to treatment were both associated with lower engagement in EBPs for PTSD (Possemato et al, 2018).…”

Neural Response to Trauma-Related and Trauma-Unrelated Negative Stimuli in Remitted and Persistent Pediatric Posttraumatic Stress Disorder

“…(van Rooij et al, 2016) However, the trauma-speci c component should be particularly meaningful in the PTSD-remittance mechanism because most effective therapies are trauma-focused, such as cognitive-behavioral therapy (CBT), (Hinton, Hofmann, Pollack, & Otto, 2009) eye movement desensitization and reprocessing (EMDR), (Mavranezouli et al, 2020) and prolonged exposure therapy (PE). (Helpman et al, 2016;Maguen et al, 2019) To study this critical component for remittance, traumarelated stimuli must be applied, and more trauma-speci c brain activity may be re ected in the contrast of trauma-related vs. unrelated conditions. However, no research used both conditions.…”