Clinical treatment selection for posttraumatic stress disorder: Suggestions for researchers and clinical trainers

Posttraumatic stress disorder (PTSD) disrupts the lives of many Veterans and their families, and multiple treatment options exist. Two evidence-based psychotherapies (EBPs)-cognitive processing therapy (CPT) and prolonged exposure (PE)-are specifically identified by Veterans Affairs (VA) and Department of Defense clinical practice guidelines as first-line treatments. Despite the strong emphasis on training clinicians to provide these EBPs, several questions remain unaddressed. We sought to answer 3 main questions: What associated clinical features are clinicians considering as they select PE or CPT to treat a given patient? What exclusionary criteria are clinicians using? How helpful do clinicians find the extant literature on comorbid conditions and associated clinical features when making treatment decisions? We contacted mental health clinicians who were VA-trained in CPT and PE and requested participation in this online survey. We (a) identified several associated factors that clinicians use to help select between these treatments, (b) determined which associated factors or comorbidities clinicians identified as exclusionary criteria for CPT or PE, and (c) evaluated the perceived utility of research to practicing clinicians. We discuss factors for which clinicians reached a consensus, areas of discrepancy (e.g., substance use), and factors for which further research guidance would be beneficial (e.g., dissociation). Findings imply that VA efforts at disseminating best treatment practices and current PTSD research have been effective. Additionally, findings can help inform treatment guidelines and clinical trainings, as well as highlight gaps in research identified by clinicians.