Posttraumatic stress disorder treatment outcomes for events related to institutional betrayal

Institutional betrayal can occur when an organization fails to prevent or respond appropriately to traumatic events perpetrated within its ranks. This experience of violated trust can exacerbate posttraumatic stress disorder (PTSD) symptoms and related sequelae. The primary aim of this quality assurance project was to preliminarily assess whether our standard treatment approach and treatment dosing (single-treatment protocol, 12-15 sessions) was sufficient for patients presenting with institutional betrayal. We compared outcomes for individuals presenting for care following institutional betrayal events (n = 57) with outcomes for a control group of randomly selected nonbetrayed patients (n = 57). Individuals who endorsed a history of sexual abuse were excluded to better isolate the impact of institutional betrayal versus interpersonal factors. Betrayed individuals were more likely to leave treatment before the third session, Cramer's V = .206, particularly betrayed men, Cramer's V = .303, and betrayed Black patients, Cramer's V = .155. Betrayed patients who remained in treatment required additional and different treatment protocols to meet their goals (e.g., written exposure therapy plus cognitive processing therapy [CPT] vs. CPT alone; prolonged exposure [PE] plus CPT vs. CPT alone), Cramer's V = .276. Nevertheless, repeated-measures analyses of variance demonstrated a significant decrease in PTSD, η_p ²  = .61, and depressive symptoms, η_p ²  = .52, regardless of betrayal trauma history. Although evidence-based treatments can help many individuals, these findings raise clinically significant concerns and underscore the detrimental effect of institutional betrayal, justifying future research to improve patient retention in treatment for this specific presentation.