A Clinician/Researcher Partnership to Understand Patterns and Predictors of Trauma-Focused Psychotherapy and Nontrauma-Focused Psychotherapy Use Among Veterans With PTSD

Post-traumatic stress disorder (PTSD) is common in veterans, and trauma-focused evidence-based psychotherapies (TF-EBP) have the strongest evidence for reducing PTSD and improving functioning. However, most veterans with PTSD do not receive TF-EBP. Extensive research focuses on why this gap between scientific recommendations and clinician practice exists. This study adds an unique perspective by reporting on a program evaluation that was jointly designed and implemented by Veterans Affairs researchers and PTSD Clinic providers to increase shared understanding about patterns and predictors of TF-EBP and non-TF-EBP use and interpret results in light of clinic contextual factors. The evaluation describes the psychotherapy utilization patterns of 242 veterans' who were referred to the PTSD clinic and investigates what patient characteristics predict psychotherapy use over the next year. Most veterans (87%) received psychotherapy: 27% received at least one session of TF-EBP and 14% received an adequate dose of TF-EBP. Veterans who started TF-EBP were significantly more likely to receive eight sessions compared to veterans getting non-TF-EBP. Core PTSD symptoms predicted more psychotherapy use, while negative beliefs about oneself/the world predicted less psychotherapy use. Clinicians were more likely to recommend TF-EBP when veterans endorsed feeling guilt/shame in reaction to their emotions. Referral from integrated primary care-mental health providers rather than specialty mental health providers predicted more overall psychotherapy sessions. Clinicians interpret results in line with contextual factors that promote delivery of non-TF-EBP. More clinician engagement in the research process can improve the clinical relevance of research and help bridge the gap between scientific and practice. Impact Statement A program evaluation of a Veterans Affairs (VA) PTSD clinic was jointly designed and implemented by clinicians and researchers to understand patterns and predictors of trauma-focused evidence-based and nontrauma-focused evidence-based psychotherapy use. Suicidal ideation and childhood trauma predicted less evidence-based psychotherapy while being married/partnered and struggling with PTSD startle reactions predicted more. Results are interpreted within the real-world context of a VA PTSD clinic.