Initiating Cognitive Processing Therapy (CPT) in Community Settings: A Qualitative Investigation of Therapist Decision-Making

Abstract

Various organizations have provided treatment guidelines intended to aid therapists in deciding how to treat posttraumatic stress disorder (PTSD). Yet evidence-based psychotherapies (EBPs) for PTSD in the community may be difficult to obtain. Although strides have been made to implement EBPs for PTSD in institutional settings such as the United States Veterans Affairs, community uptake remains low. Factors surrounding clients’ decisions to enroll in EBPs have been identified in some settings; however less is known regarding trained therapists’ decisions related to offering trauma-focused therapies or alternative treatment options. Thus, the aim of the current study was to examine therapist motivations to initiate CPT in community settings. The present study utilizes data from a larger investigation aiming to support the sustained implementation of Cognitive Processing Therapy (CPT) in community mental health treatment settings. Enrolled therapists participated in phone interviews discussing their opinions of CPT, preferred treatments for PTSD, and process in assessing appropriate PTSD treatments for clients. Semi-structured interviews (N = 29) were transcribed and analyzed using a directed content analysis approach. Several themes emerged regarding therapists’ decision-making in selecting PTSD treatments. Therapist motivations to use EBPs for PTSD, primarily CPT, were identified at the client (e.g., perceived compatibility with client-level characteristics), therapist (e.g., time limitations), and clinic levels (e.g., leadership support). The results provide insight into the complex array of factors that affect sustainability of EBPs for PTSD in community settings and inform future dissemination of EBPs, including training efforts in community settings.

Multilevel factors in providers’ decisions to utilize CPT in military- and veteran-serving treatment settings.

“…It is likely that veteran- and military-serving programs are uniquely resourced and somewhat standardized across locations as compared to nongovernmental settings. In fact, while there is some consistency between government and community providers, some barriers and facilitators, including policy, reimbursement, and the degree of fragmentation within the system of care, appear to be unique to the systems within which they work (Loskot et al, 2021; Thomas et al, in press). Future research on system-level differences may include providers from organizations not yet using CPT or other PTSD EBPs to yield additional information about how these barriers may impact disparities in patients being offered these treatments.…”

“…In the present study, only interviews from the veteran and military-serving sites are included to better examine the factors influencing CPT implementation in these settings. Thomas et al (in press) use a similar methodology to examine the private practices and community clinics in the United States and Canada. The parent study was designed to examine whether certain types of provider support and quality improvement strategies influence providers’ delivery of treatment for their PTSD patients, along with the quality in which they deliver CPT (i.e., fidelity to the manual, working alliance).…”