Evidence-based assessment and treatment of military/Veteran PTSD: Reflections on 15 years of practice

This reflection follows 15 years of military/Veteran clinical practice. It identifies special assessment and treatment considerations, with a focus on prolonged exposure therapy for posttraumatic stress disorder, and reviews common assumptions about evidence-based psychotherapy that can hinder practice and patient engagement. The heterogeneity of the Canadian military/Veteran population, and unique nature of military/Veteran service and its impact on mental health, is examined. Key recommendations include underscoring the importance of identifying the index trauma, using outcome monitoring, and understanding the theory of change for each of the gold-standard trauma-focused psychotherapies and the rationale for each intervention so that clinicians can individuate treatments for patients, as clinically required. Common misperceptions and controversies related to trauma-focused psychotherapies are discussed, including the goal of treatment and clinician hesitation to implement evidence-based psychotherapies. The intention of this reflection is to foster discussion, contribute to a greater understanding and deeper appreciation for the uniqueness of military/Veteran patients, and promote advancement and innovation in research and clinical practice.