Changes in Implementation of Two Evidence‐Based Psychotherapies for PTSD in VA Residential Treatment Programs: A National Investigation
Open accessAbstract
There has been little investigation of the natural course of evidence-based treatments (EBTs) over time following the draw-down of initial implementation efforts. Thus, we undertook qualitative interviews with the providers at 38 U.S. Department of Veterans Affairs' residential treatment programs for posttraumatic stress disorder (PTSD) to understand implementation and adaptation of 2 EBTs, prolonged exposure (PE), and cognitive processing therapy (CPT), at 2 time points over a 4-year period. The number of providers trained in the therapies and level of training improved over time. At baseline, of the 179 providers eligible per VA training requirements, 65 (36.4%) had received VA training in PE and 111 (62.0%) in CPT with 17 (9.5%) completing case consultation or becoming national trainers in both PE and CPT. By follow-up, of the increased number of 190 eligible providers, 87 (45.8%) had received VA training in PE and 135 (71.1%) in CPT, with 69 (36.3%) and 81 (42.6%) achieving certification, respectively. Twenty-two programs (57.9%) reported no change in PE use between baseline and follow-up, whereas 16 (42.1%) reported an increase. Twenty-four (63.2%) programs reported no change in their use of CPT between baseline and follow-up, 12 (31.6%) programs experienced an increase, and 2 (5.2%) programs experienced a decrease in use. A significant number of providers indicated that they made modifications to the manuals (e.g., tailoring, lengthening). Reasons for adaptations are discussed. The need to dedicate time and resources toward the implementation of EBTs is noted.
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Items were added to reflect a larger variety of modifications identified through the literature, ongoing observational work, and stakeholder interviews.
“Although many items in this section are unchanged from the original framework, items were added to reflect a larger variety of modifications identified through the literature, ongoing observational work (c.f., [1, 3, 20, 21, 23, 48]), and stakeholder interviews.”
From The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions (2019) · cites this paper as [23]
Other practical constraints play a role in decisions to adapt or modify interventions.
“Other practical constraints play a role in decisions to adapt or modify interventions [2, 15, 19, 23].”
From The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions (2019) · cites this paper as [23]
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References 34 · Cited by 67
Research works printed but not linked: 20
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- Authors
- Cook, J. M., Dinnen, S., Thompson, R., Simiola, V., & Schnurr, P. P.
- Affiliations
- Yale University (US)
- University of Illinois Chicago (US)
- Dartmouth College (US)
- Corresponding author
- Cook, Joan M.
- Venue
- Journal of Traumatic Stress
- Publisher
- Wiley
- Published
- 2014-03-25
- Volume
- 27
- Issue
- 2
- Pages
- 137-143
- ISSN
- 0894-9867 (ISSN-L)
- 1573-6598
- PMC
- PMC4036220
- OpenAlex
- W2156696131
- Cited by
- 67
- References
- 34
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 5 · 2022: 5 · 2021: 3 · 2020: 4 · 2019: 15 · 2018: 10 · 2017: 3 · 2016: 7 · 2015: 6 · 2014: 4
- FWCI
- 12.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Traumatic Stress (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (RC1-MH088454)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- post-traumatic stress disorder, evidence-based psychotherapy, prolonged exposure, cognitive processing therapy, treatment implementation, residential treatment programs, veterans, provider training, treatment adaptation, intervention fidelity, Department of Veterans Affairs
- MeSH terms
- Adult, Aged, Education, Continuing, Health Personnel, Humans, Implosive Therapy, Interviews as Topic, Length of Stay, Male, Middle Aged, Outcome and Process Assessment, Health Care, Residential Treatment, Stress Disorders, Post-Traumatic, United States, United States Department of Veterans Affairs, Veterans, Cognitive Behavioral Therapy, Health Care Surveys, Qualitative Research, Evidence-Based Practice
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