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In Their Own Words: Veteran Experiences with Evidence-Based Treatments for PTSD in the Veterans Health Administration

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Abstract

The aim of the present study was to increase the understanding of veteran experiences with receiving an evidence-based psychotherapy (EBPs) for PTSD (Cognitive Processing Therapy and Prolonged Exposure therapy) in the Veterans Affairs Healthcare System (VA). Eighteen veterans who participated in the study were being seen in the outpatient PTSD clinic at a New England VA and had elected to participate in an EBP. The study assessed veteran experiences with, and outcomes from, treatment through the use of both quantitative and qualitative assessment tools. A rigorous data analytic approach, Consensual Qualitative Research, was applied to narrative data. Results fell into seven domains: Previous EBP & Outcome, Barriers to Treatment, Treatment Process, Treatment Outcome, Treatment Drop Out, and Feelings about Treatment. Overall, veterans reported diverse reactions to the EBPs for PTSD and identified both positive and negative aspects of the treatments. They identified multiple barriers to treatment completion and provided insight into their thoughts and feelings during the treatment protocol. Veterans who chose to drop out of treatment prematurely identified the factors that contributed to this decision. In this way, the study offers an initial but important look at veteran perceptions of and experiences with EBPs for PTSD.

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Data Availability

The dataset for this study is not stored in a data repository. However, the dataset for this study is fully accessible and will be made available upon request. Please email the corresponding author to obtain the data.

Notes

  1. The sample contained one outlier who endorsed a 56-point drop on the PCL from intake to termination and produced a score of “0” on the termination PCL. Removing this case from the analysis would result in a mean symptom drop of 14 points.

  2. Refers specifically to Cognitive Processing Therapy or Prolonged Exposure therapy.

  3. Refers specifically to Cognitive Processing Therapy or Prolonged Exposure therapy.

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Acknowledgements

The authors would like to sincerely thank the clinicians and veterans who contributed to this study. We are grateful for their participation and very much appreciate their valuable insights.

Funding

This research was partially supported by the VA Connecticut Psychology Department Bell Kerns Research Award.

Author information

Authors and Affiliations

  1. VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, USA

    Jennifer M. Doran, McKenna O’Shea & Ilan Harpaz-Rotem

  2. Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA

    Jennifer M. Doran & Ilan Harpaz-Rotem

  3. Roosevelt University, Chicago, IL, USA

    McKenna O’Shea

  4. Northeast Program Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, USA

    Ilan Harpaz-Rotem

Authors
  1. Jennifer M. Doran
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  2. McKenna O’Shea
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  3. Ilan Harpaz-Rotem
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Corresponding author

Correspondence to Jennifer M. Doran.

Ethics declarations

This Study and its Procedures Were Performed in Compliance with the Tenets of the Declaration of Helsinki

Conflict of Interest

The authors declare that they have no conflict of interest.

Disclosures

The authors have no relevant financial or non-financial interests to disclose.

Ethics Approval/IRB Approval

Approval was obtained by the Human Subjects Committee of the VA Connecticut Medical Center.

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Informed consent was obtained from all individual participants included in the study.

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Appendix 1

Appendix 1

Veteran Pre-Treatment Interview

I am going to ask you a few questions about your choice to begin an evidence-based, trauma-focused treatment for PTSD Footnote 2 and any concerns that you might have about it. Do you have any questions for me before we begin?

  1. 1.

    When did you decide to begin a trauma-informed treatment?

  2. 2.

    When did you first learn about the treatment options available for PTSD?

  3. 3.

    How long did you consider beginning a trauma-informed treatment before making the decision to do so?

  4. 4.

    What factors contributed to your decision to begin a trauma-informed treatment?

  5. 5.

    What do you know about trauma-informed treatments for PTSD?

  6. 6.

    Have you ever previously engaged in a trauma-informed treatment? (If yes: How did it go?)

  • 6a. Did you complete the treatment? (If no: What got in the way or What factors led you to drop out?)

  1. 7.

    Do you have any concerns or negative thoughts or feelings about beginning a trauma-informed treatment? (If yes: What are they?)

  • 7a. (If yes to above) Have you discussed your concerns with anyone? How did that go?

  1. 8.

    On a scale of 1–10, how committed do you feel to completing the treatment, with “1” being not at all committed and “10” being totally committed.

  2. 9.

    Do you feel that there are any barriers in the way that might interfere with you being able to complete the treatment?

  3. 10.

    Is there anything you wish that your therapist knew about you in advance, or anything you are hoping that they will do or say during your treatment?

Veteran Post-Treatment Interview

I am going to ask you a few questions about your experience in an evidence-based, trauma-focused treatment for PTSD Footnote 3 to find out what went well and what could have been better. Do you have any questions for me before we begin?

  1. 1.

    Which trauma-informed treatment did you complete (CPT or PE)? Why? Did you have a preference for one over the other?

  2. 2.

    Can you provide me with a brief overview of how things went in the treatment?

  • 2a. What went well? What could have gone better?

  1. 3.

    Did you have any negative feelings about the treatment or your therapist during the therapy?

  • 3a. If yes to above: Did you express these feelings to your therapist? (If yes: What happened? How did he/she respond?)

  1. 4.

    Do you feel that you benefitted from the treatment? (If yes: How so?)

  2. 5.

    Did you complete a full course of the treatment? (If no, add “drop questions” below)

  • 5b (If yes): Was there ever a time where you felt like quitting or dropping out? What happened? What made you decide to stay?

  1. 6.

    Do you feel that the treatment resolved your PTSD? (If no: Are you still experiencing symptoms of PTSD? What do you still need to work on?)

  2. 7.

    How did you feel about the length of treatment? (Too long/too short/just right?)

  3. 8.

    What about the treatment worked well for you? Was there anything that did not work so well, or anything you wish had been done differently?

  4. 9.

    Do you feel that there are important issues or concerns about your experience that were not addressed in the therapy? (Please describe.)

  5. 10.

    Are there traumatic experiences you had, or parts of your trauma, that you were not comfortable sharing or bringing up with your therapist?

  • 10a. Have you ever told anyone about these experiences?

  • 10b. Do feelings of guilt and shame get in the way of sharing these experiences?

  1. 11.

    Did your therapist check-in with you about your thoughts and feelings about the treatment? (Do you feel that he/she responded to your feelings or concerns?)

  2. 12.

    Is there anything that you think could be improved about the treatment you were offered?

  3. 13.

    How do you feel about the [type of EBP received] treatment? Would you recommend it to other veterans?

Drop Out Questions

I am interested in understanding more about why you decided to end the treatment before completing all of the sessions. We know that some veterans choose not to complete the treatment, but we don’t understand why that is. Any information you could provide about what happened would be very helpful. This information will not be shared with your clinician or anyone outside of the research team.

  1. 1.

    Why did you decide to end therapy before you completed the protocol? What factors led up to this decision?

  2. 2.

    Did you discuss wanting to drop out with your therapist before you dropped out? (If yes: How did that conversation go?)

  3. 3.

    Was there anything that would have made you continue the treatment?

  4. 4.

    Do you think you will try a trauma-informed treatment again in the future? Why or why not?

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Doran, J.M., O’Shea, M. & Harpaz-Rotem, I. In Their Own Words: Veteran Experiences with Evidence-Based Treatments for PTSD in the Veterans Health Administration. Psychiatr Q 92, 961–980 (2021). https://doi.org/10.1007/s11126-020-09861-z

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