Heuristic recommendations to advance knowledge about personalizing PTSD treatment via practice-based research

The development and dissemination of evidence-based psychotherapies (EBPs) has revolutionized treatment for posttraumatic stress disorder (PTSD). However, when EBPs fail or are otherwise not a good fit, providers are left with few evidence-based options for personalizing treatment to meet unique patient needs. Further, there is little recourse for real-world, clinically relevant knowledge to inform and confirm research hypotheses regarding intervention effectiveness and its moderators. In this paper, we review the research and clinical context barriers to evidence-based idiographic treatment planning and generating iterative, ecologically valid, and locally actionable practice-based research. We propose a localized learning healthcare approach that foregrounds the needs of providers and patients and generates continuous practice-based evidence from real-world care. We provide recommendations to advance this approach that prioritize systematic evaluation of its feasibility and utility, and the enhancement of measurement-based care infrastructure through using clinical dashboards and benchmarks for change, balancing standardized and flexible assessment, tracking interventions, and addressing barriers to implementation and compliance. We frame our recommendations within the context of the United States Department of Veterans Affairs network of PTSD specialty care clinics, given that this network is exceptionally well-suited to be at the forefront of a new practice-based research paradigm.