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Health Systems Research

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CREATE: Evidence-Based Therapies for PTSD

Director: Nina Sayer, Ph.D.

Principal Investigators:

About the CREATE

Post-traumatic stress disorder (PTSD) is a mental health problem that can occur after someone goes through a traumatic and dangerous event, such as physical assault, rape, natural disasters, and war-zone exposure. PTSD is highly prevalent among Veterans, particularly combat Veterans. The lifetime prevalence of PTSD among adults living in the U.S. is 10% for women and 4% for men, but among male combat Veterans, lifetime PTSD rates are as high as 39%. Moreover, 28% of OEF/OIF/OND Veterans have a PTSD diagnosis in their VA medical record. Therefore, treating PTSD is a high priority for VA, and effective evidence-based treatment for PTSD, such as cognitive behavioral therapies and medications, are available.

The overall goal of the EBT4PTSD CREATE is to improve Veterans' access to and engagement in evidence-based PTSD treatments.


Partner Offices

Each CREATE works closely with operational partners throughout the VA System. The partners associated with this CREATE include:


The EBT4PTSD CREATE projects all build on preliminary studies conducted by principal investigators. Earlier results have identified access problems and quality gaps in PTSD care, as well as opportunities for addressing these problems through interventions. Funded projects include:

  • Helping Families Help Veterans with PTSD and Alcohol Abuse: An RCT of VACRAFT
    This project will test an innovative web-based tool that delivers an online version of Community Reinforcement and Family Training (VA-CRAFT) to families to promote Veterans involvement in care for PTSD and problem drinking. This study team's prior work demonstrated the importance of family to the resilience and recovery of formerly deployed service members.
    (PI: Christopher Erbes, Ph.D.)
  • Web and Shared Decision-Making for Reserve/National Guard Women's PTSD Care.
    This project will build on an earlier intervention to address women-specific barriers to care, and will test a strategy to link Veterans with VA healthcare. The earlier intervention, a web-based method of enhancing post-deployment readjustment, was tested in a community sample of Reserve and National Guard servicewomen, and findings indicated that the intervention provided education, decreased mental health stigma, and enhanced access to VA healthcare.
    (PI: Anne G. Sadler, Ph.D., R.N.)
  • Promoting Evidence-Based Pharmacotherapy for PTSD in Community-based Outpatient Clinics (CBOCs).
    This project will test an intervention to enhance CBOC primary care providers' competence in and comfort with PTSD pharmacotherapy. The project stems from a recently completed HSR&D study of treatment participation among 7,645 Veterans diagnosed with PTSD. Results showed that Veterans newly diagnosed in primary care clinics received evidence-based pharmacotherapy for PTSD at one-half the rate as that of Veterans diagnosed with PTSD in mental health clinics. The new CREATE project addresses the demonstrated need for interventions to improve access to and engagement in evidence-based PTSD pharmacotherapy among Veterans diagnosed in CBOCs.
    (PI: Michele R. Spoont, Ph.D.)
  • Promoting Effective, Routine, and Sustained Implementation of Stress Treatment (PERSIST).
    This project seeks to improve the reach of two evidence-based psychotherapies: Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) among Veterans with PTSD, and to ensure sustainability of PE and CPT among providers. The project stems from earlier work that surveyed clinicians about their attitudes and perceived barriers to use of evidence-based psychotherapies. Findings suggested that providers reported using CPT and PE with less than 12% of their current psychotherapy caseload, and that organizational barriers within and across PTSD teams tend to limit the use of evidence-based psychotherapies.
    (PI: Nina A. Sayer, Ph.D., and Craig Rosen, Ph.D.)

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