When the world turned upside down: A Veterans Affairs PTSD specialty clinic in the COVID-19 era

Available options for mental health care have expanded, particularly during the COVID-19 pandemic. As pandemic mitigation measures catalyzed innovation, acceptance of virtually delivered mental health care rose to unprecedented levels. The Veterans Health Administration nationwide system of care was no exception, expanding its use of video-to-home telehealth during the pandemic to meet veteran needs and, in later pandemic years, preferences. This study leverages clinical data to assess the impact of the pandemic on treatment for posttraumatic stress disorder (PTSD) in a single PTSD clinical team at a large Veterans Health Administration hospital between two time periods. Analyses compare data from 2018-2020 (pre-COVID) and 2022-2024 (postpeak COVID) regarding the demographic composition of the clinic's population, modality by which evidence-based psychotherapy (EBP) was delivered within the clinic, veteran treatment engagement, and impacts of EBP on PTSD symptom severity among treatment completers. Results indicate that, inverse to before the pandemic, most treatment provided through the PTSD clinical team post-peak-COVID-19 was delivered through virtual modalities. Importantly, impact of EBP completion on PTSD symptom severity did not differ from pre- to postpeak COVID-19, and although veteran EBP completion rates also did not differ, veterans engaged in a greater average number of EBP sessions post- (vs. pre-) COVID-19. These results suggest that virtually delivered EBP is acceptable to veterans with PTSD and may be associated with increased treatment duration. This study also highlights the importance of clinic-level data analysis in response to historical events. Future opportunities for studies regarding clinic design, treatment approaches, and innovation are also discussed. (PsycInfo Database Record (c) 2026 APA, all rights reserved).