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The Association Between Service Connection and Treatment Outcome in Veterans Undergoing Residential PTSD Treatment

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Abstract

The Department of Veterans Affairs has invested significant time and resources into the treatment of posttraumatic stress disorder (PTSD). Despite concerted efforts, a significant portion of patients do not respond optimally to trauma-focused treatment. One of the factors that has been hypothesized to be associated with treatment response is participation in the Veterans Benefits Administration service-connected disability process. This factor may be particularly relevant in the residential treatment setting, where most participants are engaged in the compensation seeking process. We conducted a retrospective chart review of 105 veterans who completed Cognitive Processing Therapy (CPT) in a residential rehabilitation program. ANCOVAs that adjusted for baseline PTSD severity compared symptom change between those who were and were non-compensation seeking at the time of treatment. Compensation seeking status was associated with significantly less symptom improvement over the course of CPT after adjusting for baseline PTSD severity (F(1, 102) = 4.29, p < .001, η2 = .03). Sensitivity analyses did not detect a similar effect during a prior coping skills phase of treatment. During CPT, clinically significant change was met by 66.7% of non-compensation seeking veterans (M = –15, SD = 14.56) and by 40.1% of the compensation seeking group (M = –7.1, SD = 12.24). Compensation-seeking may be associated with reduced response to trauma-focused treatment in certain settings. Future research is needed to better understand the mechanisms underlying this effect.

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Data is not available for use outside the VA.

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Acknowledgements

Thank you to Jamie Bourgoin, Janet Jonatzke, Zachary Kribs, Emily Morlock, Oren Shewach, and Elise Trim for their valuable contributions to the current manuscript.

Funding

Dr. Sripada is supported by CDA 15–251, IK2 HX-002095–01 from the United States (U.S.) Department of Veterans Affairs Health Services R&D (HSRD) Service.

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Authors and Affiliations

  1. Psychology Service, Battle Creek VA Medical Center, 5500 Armstrong Road, Battle Creek, MI, 49037, USA

    Jessica L. Rodriguez, Holloway N. Marston, Chelsea E. Sage-Germain, Theodore P. Wright & Scott A. Driesenga

  2. VA Center for Clinical Management Research, VA Ann Arbor Healthcare System/Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA

    Andrew C. Hale & Rebecca K. Sripada

  3. Department of Psychology, Converse College, Spartanburg, SC, USA

    Shannon M. Martin

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  1. Jessica L. Rodriguez
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Correspondence to Jessica L. Rodriguez.

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The current study was completed following approval by the local VA Human Subjects Institutional Review Board and Research and Development Committee. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki.

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Given the retrospective nature of the current study, a waiver of informed consent was obtained.

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Rodriguez, J.L., Hale, A.C., Marston, H.N. et al. The Association Between Service Connection and Treatment Outcome in Veterans Undergoing Residential PTSD Treatment. Psychiatr Q 93, 285–296 (2022). https://doi.org/10.1007/s11126-021-09940-9

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