1001 — Veterans' Perspectives on Initiating Evidence-Based Psychotherapy for PTSD

Hundt NE, Houston COIN; Mott JM, National Center for PTSD, White River Junction; Miles SR, Houston COIN; Arney J, University of Houston Clear Lake; Cully JA, Houston COIN; Stanley MA, Houston COIN;

Objectives:
Evidence-based psychotherapies (EBP) for posttraumatic stress disorder (PTSD) are effective at reducing symptoms and improving quality of life. Nevertheless, few Veterans receive EBP. Previous research has examined barriers and facilitators to PTSD treatment initiation in general, including practical barriers, stigma, and patient attitudinal barriers. However, to the authors' knowledge, no prior study has examined Veterans' self-reported barriers and facilitators to initiating EBP for PTSD. The current study sought to examine this issue using a qualitative methodology in order to inform future efforts to increase utilization of EBP for PTSD.

Methods:
We conducted qualitative interviews with 23 Veterans who completed at least 8 sessions of Prolonged Exposure (PE) or Cognitive Processing Therapy (CPT) in a Veterans Affairs PTSD clinic. Interviews were transcribed and coded for thematic content using grounded theory methodology.

Results:
Veterans reported learning about EBP from therapists, psychiatrists, and other Veterans. Ambivalence and delaying EBP initiation were common. Barriers included fears that EBP would increase symptoms, beliefs that avoidance was helpful, disbelief of the therapy rationale, and less commonly, lack of knowledge about EBP. Facilitators included feeling a "need to talk about it", prior treatment that increased confidence in the ability to handle EBP, prior knowledge of the EBP therapist, provider behaviors that facilitated "buy in", encouragement from other Veterans, and desperation for symptom relief. There were few differences in barriers and facilitators associated with PE and CPT, although Veterans in PE were more likely to express skepticism of the therapy rationale.

Implications:
These results highlight significant ambivalence about EBP initiation and provide insight into the concerns expressed by Veterans.

Impacts:
These data suggest potential interventions to increase uptake of EBP, including obtaining buy-in from the various potential disseminators of information about EBP, employing peer providers to increase the credibility of EBP, and training providers to more effectively "sell" EBP.