Provider perspectives on choosing prolonged exposure of cognitive processing therapy for PTSD: A national investigation of VA residential treatment providers.

Abstract

As part of a longitudinal mixed-methods investigation on implementation of 2 evidence-based psychotherapies (EBPs) for Posttraumatic Stress Disorder, 164 mental health providers from 38 Department of Veterans Affairs (VA) residential treatment programs across the United States were asked questions about their decision making for using Prolonged Exposure and Cognitive Processing Therapy. Many providers viewed both EBPs as equally efficacious and encouraged veterans to decide for themselves which treatment they wished to engage in. Some providers said that it was hard to know which EBP would be the most effective for a given patient, and that occasionally they started work with a veteran thinking that a particular EBP would work and were surprised when the veteran did not receive the full potential benefit of the intervention. Other providers noted that their decision making regarding which EBP to use depended on the type and nature of the veterans' index trauma, memory of the trauma, and traumatic stress symptoms (e.g., fear vs. guilt). Additional factors that impacted the choice of EBP included whether the patient already had one of the treatments before or if a provider deemed one as more compatible with their previous training. Implications for clinical practice as well as the design and improvement of training and implementation efforts are discussed.

Barriers and facilitators of healthcare provider uptake of clinical practice guideline recommendations for the management of common mental health concerns: A qualitative evidence synthesis.

“…Eleven studies examined barriers and facilitators to the delivery of EBTs for the treatment of PTSD (Cook et al, 2013, 2014, 2015, 2017, 2018; Finley et al, 2020; Hamblen et al, 2015; Marques et al, 2016; Simiola et al, 2019; Wilson, 2020; Zubkoff et al, 2016). Studies were conducted in Veterans Affairs residential PTSD treatment facilities ( n = 7), outpatient Veterans Affairs specialty clinics, ( n = 2), a community healthcare center ( n = 1), and variable settings ( n = 1), refer to Table 1.…”

“…We identified 19 review findings that were categorized under five themes. A summary of review findings can be located in Table 2, profiles of evidence can be located in Supplemental Cook et al, 2015;Finley et al, 2020;Simiola et al, 2019;Wilson, 2020). Only one study reported on the number of providers that endorsed this theme (n = 60; Simiola et al, 2019).…”

“…A summary of review findings can be located in Table 2, profiles of evidence can be located in Supplemental Cook et al, 2015;Finley et al, 2020;Simiola et al, 2019;Wilson, 2020). Only one study reported on the number of providers that endorsed this theme (n = 60; Simiola et al, 2019). Providers noted that receiving training in CPT and PE for veterans with PTSD facilitated comfort in delivering these treatments.…”

Supervising trauma treatment: The contextual trauma treatment model applied to supervision.

“…Detailed explanation of the underlying theory, empirically supported mechanisms of action, and the treatment protocol of each are provided. There is strong emphasis on the need for informed consent and adaptation of these approaches to the individual characteristics of each client (Simiola, Ellis, Thompson, Schnurr, & Cook, 2019).…”

Trauma treatment: The need for ongoing innovation.

“…Innovations in dissemination of CBT treatments by Ruzek (2019) are presented in an article that covers a wide variety of issues that can certainly serve as a model for future dissemination efforts. Finally, we include a national treatment study by Simiola, Ellis, Thompson, Schnurr, and Cook (2019) on provider perspectives on choosing prolonged exposure or cognitive processing therapy for PTSD in Department of Veterans Affairs residential treatment settings. This study identified many factors that influence decision-making concerning patient-level factors and treatment choice and suggests the potential future development of algorithms or decision trees to assist the clinician and patient in shared decision-making.…”