A naturalistic evaluation of evidence-based treatment for veterans with PTSD.

This naturalistic study of evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) in U.S. veterans examined treatment utilization and completion rates, the characteristics of EBPs in an ecologically valid sample, and the factors associated with premature termination. The study is an extension of previous work by Deviva and colleagues (2017), and was conducted in a Department of Veterans Affairs PTSD clinic that included 130 veterans. A mixed-methods approach was used that involved both quantitative and qualitative analysis of data in the electronic medical record. Variables of interest included treatment selection, dropout rates, symptom severity, and symptom change. The data revealed adequate engagement in the EBPs, high rates of dropout (49.4%), and decreases in PTSD symptoms for treatment completers. Around half of the completers with symptom data demonstrated clinically significant improvement. However, symptom levels were still fairly high at termination, and a majority of the veterans remained in treatment for PTSD after completing an EBP. Staying on protocol, veteran agency in choosing an EBP, and veteran feelings about treatment emerged as salient factors in treatment retention. Meaningful symptom decreases were observed for veterans who were willing to engage in EBPs and who completed the treatment. However, dropout rates were high, and many veterans who completed an EBP were still fairly symptomatic and remained in treatment. This suggests that there may be room for improvement in the treatment of veterans with PTSD. (PsycINFO Database Record (c) 2018 APA, all rights reserved)