Bringing effective posttraumatic stress disorder treatment to those in need

Effective psychotherapies for posttraumatic stress disorder (PTSD) have existed for over 20 years, but most people with PTSD do not access them. One way to increase access requires moving what works to reduce PTSD symptoms in specialty mental health into other settings, such as primary care. Most people with mental health issues prefer to receive care for those concerns in the primary care setting rather than being referred to a specialty mental health clinic. Prolonged exposure for primary care (PE-PC) was developed to provide PTSD treatment that works in primary care and other integrated care settings. When moving PTSD treatment to primary care, ensuring the treatment model fits the needs of the primary care setting and still delivers large reductions in PTSD is critical.

Although previous clinical trials have already demonstrated the efficacy of PE-PC, in a study recently published in Psychological Servicesopens in new window, Sheila A. M. Rauch and her colleagues investigated how PE-PC works in Veterans Health Administration practice using the training case data of 155 providers and 737 veterans with PTSD. In addition, they examined whether different demographic characteristics affected the size of the reduction in PTSD and depression. After four to eight 30-min sessions, 40% of veterans no longer met PTSD criteria at posttreatment. PE-PC showed significant and large reductions in PTSD and moderate reductions in depression. In addition, these significant reductions in PTSD were similar across genders, ethnicities, and trauma types. PE-PC resulted in similar reductions in PTSD among veterans whether it was delivered by provider trainees who had previous trauma-focused therapy training or by those new to working with trauma, although providers with previous training in multiple trauma-focused models showed better veteran retention. In addition, older veterans were more likely than younger veterans to complete PE-PC. Veterans with military sexual trauma as the trauma targeted in treatment were less likely to complete PE-PC than were those with combat trauma as the target. In addition, veterans who identified as Asian and Pacific Islander were more likely to complete PE-PC than were White veterans. No other ethnic groups differed in retention.

PE-PC provides effective PTSD treatment in a brief model that can exponentially increase access to PTSD treatment. With PE-PC, many clients will remit from PTSD in just four 30-min sessions, and it allows providers to start PTSD treatment quickly in primary care and treat more people in the same session time. In addition, the efficient training model allows for dissemination across settings and sites, and it can enable providers who do not have previous trauma therapy experience to provide PTSD treatment with excellent efficacy. Ongoing efforts to disseminate PE-PC in Veterans Health Administration, Department of Defense, and civilian primary care settings are underway. Providing additional access to care so those with PTSD may choose when and how they receive treatment can greatly reduce the societal costs of PTSD.

This article is in the Clinical Psychology topic area.

Rauch, S. A. M., Venners, M. R., Ragin, C., Ruhe, G., Lamp, K. E., Burton, M., Pomerantz, A., Bernardy, N., Schnurr, P. P., Hamblen, J. L., Possemato, K., Sripada, R., Wray, L. O., Dollar, K., Wade, M., Astin, M. C., & Cigrang, J. A. (2023). Treatment of posttraumatic stress disorder with prolonged exposure for primary care (PE-PC): Effectiveness and patient and therapist factors related to symptom change and retention. Psychological Services, 20(4), 745–755. https://doi.org/10.1037/ser0000783opens in new window

Sheila A. M. Rauch, PhD, ABPP, is deputy director of the Emory Healthcare Veterans Program and director of Mental Health Research and Program Evaluation at the Joseph Maxwell Cleland Atlanta VA Medical Center. For over 20 years, her research has focused on improving care access through alternate treatment models (primary care, massed, telehealth, etc.) and examination of mechanisms of change in effective treatment. She has led several PTSD treatment outcome and mechanisms trials in primary care, other medical settings, and specialty mental health, including pharmaceutical and therapy trials.

Margaret R. Venners, MPH, MSW, is a health science specialist at the National Center for PTSD, Dissemination and Training Division at the VA Palo Alto Healthcare System. She has over 15 years of experience with clinical research, program management, and program evaluation. In her time at the Department of Veterans Affairs, she has worked on several PTSD treatment research studies and projects, including managing the VA Primary Care Mental Health Integration PE-PC Training Program since its inception in 2018. She strongly supports evidence-based treatment for PTSD, trauma-focused therapy, and improving patients’ access to care and treatment.

Carly Ragin, BA, is a clinical research coordinator for the Center for Visual and Neurocognitive Rehabilitation at the Atlanta VA Healthcare System. She serves as the research lab manager for several multisite studies investigating functional pain-management treatment outcomes for veterans with chronic pain, PTSD, and comorbid depressive symptoms. She is also committed to further research exploration of important physical and mental health outcomes for minority patient populations.

Gretchen Ruhe, BS, is a clinical research coordinator with 12 years of experience coordinating mental health research for the Department of Veterans Affairs and Department of Defense.

Kristen E. Lamp, PhD, is a clinical psychologist on the PTSD Clinical Team of the Atlanta VA Healthcare System. She contributes to national PTSD evidence-based treatment training and implementation efforts, supports projects within the VA PTSD Mentoring Program, and serves as a local site investigator on multisite PTSD treatment clinical trials. Her research interests include improving treatment completion rates and treatment outcomes in evidence-based treatments for PTSD and program evaluation.

Mark Burton, PhD, is a clinical psychologist. He is the founder of Expand Psychotherapy and cofounder of the Mind Body Behavioral Institute, organizations that offer consultation and training in evidence-based practice for anxiety and mood disorders. His research focuses on mechanisms of change in exposure-based treatments.

Andrew Pomerantz, MD, was a primary care physician in Vermont for 12 years prior to becoming a psychiatrist and joining the White River Junction VA Medical Center, where he served as chief of mental health for nearly 20 years. He then served as national director of integrated services in the VA’s Office of Mental Health and Suicide Prevention for 10 years. He has been a champion for mental health care and access for his entire career.

Nancy Bernardy, PhD, is a clinical psychologist who retired after more than 30 years of clinical, administrative, and research work in the Department of Defense and the Veterans Health Administration. Prior to retiring, she served as the director of the National Center for PTSD and VA PTSD Mentoring Program, where her focus was on improving delivery of PTSD evidence-based treatments in clinics nationally.

Paula P. Schnurr, PhD, is a psychologist who serves as the executive director of the National Center for PTSD in the Veterans Health Administration. She is a professor of psychiatry in the Geisel School of Medicine at Dartmouth.

Jessica L. Hamblen, PhD, is a clinical psychologist and the deputy for education at the National Center for PTSD. She is also an associate professor at the Geisel School of Medicine at Dartmouth. Her primary research interests are to develop, evaluate, and disseminate evidence-based treatments for PTSD as well as strategies to encourage trauma survivors to engage in these treatments.

Kyle Possemato, PhD, is a clinical psychologist and the associate director for research at the VA Center for Integrated Healthcare. Her research focuses on developing, testing, and implementing psychological interventions that increase patient engagement and can be delivered in integrated care settings.

Rebecca Sripada, PhD, is an associate professor in the University of Michigan Department of Psychiatry, a research scientist in the VA Center for Clinical Management Research, and a licensed psychologist with 15 years of experience delivering evidence-based treatment to individuals with PTSD. She is currently conducting three clinical trials to adapt and optimize evidence-based PTSD interventions for different settings and patient populations. The overarching goals of her research program are to improve the effectiveness and efficiency of evidence-based psychotherapy and to improve training and support for therapists providing these treatments.

Laura O. Wray, PhD, is a clinical psychologist who retired after more than 30 years of clinical, administrative, and research work in the Veterans Health Administration. Prior to retiring, she served as the executive director of the VA Center for Integrated Healthcare, where her research focused on implementation science related to mental health primary care integration and using pharmacogenetics in mental health care.

Katherine Dollar, PhD, ABPP, is a clinical health psychologist and the executive director of the VA Center for Integrated Healthcare. Her primary research and program implementation interests include investigating the use of evidence-informed implementation support strategies—for example, external and internal facilitation—to increase the use of evidence-based interventions in clinical practice among mental health clinicians working in medical settings.

Michael Wade, MS, is a biostatistician for the VA Center for Integrated Healthcare. He supports the development, assessment, and implementation of psychological interventions used in integrated care settings.

Millie C. Astin, PhD, is a clinical psychologist with 30 years of treatment outcome experience. For over 15 years, she has worked for the Department of Veterans Affairs and been involved in PTSD dissemination efforts and multiple multisite VA treatment outcome studies. She is currently the clinical director of the PTSD Clinical Team Program at the Atlanta VA Healthcare System.

Jeffrey A. Cigrang, PhD, ABPP, led the original investigation of PE-PC with military service members. He served as a professor in the School of Professional Psychology, Wright State University, from 2014 to 2022 after a 24-year active-duty career as a clinical psychologist in the United States Air Force. In 2023, he joined the Hematology and Oncology Service at the Dayton Veterans Affairs Medical Center.