Mental Health Providers’ Decision-Making Around the Implementation of Evidence-Based Treatment for PTSD

  • Princess E. Osei-Bonsu
  • Rendelle E. Bolton
  • Shannon Wiltsey Stirman
  • Susan V. Eisen
  • Lawrence Herz
  • Maura E. Pellowe


It is estimated that <15% of veterans with posttraumatic stress disorder (PTSD) have engaged in two evidence-based psychotherapies highly recommended by VA—cognitive processing therapy (CPT) and prolonged exposure (PE). CPT and PE guidelines specify which patients are appropriate, but research suggests that providers may be more selective than the guidelines. In addition, PTSD clinical guidelines encourage “shared decision-making,” but there is little research on what processes providers use to make decisions about CPT/PE. Sixteen licensed psychologists and social workers from two VA medical centers working with ≥1 patient with PTSD were interviewed about patient factors considered and decision-making processes for CPT/PE use. Qualitative analyses revealed that patient readiness and comorbid conditions influenced decisions to use or refer patients with PTSD for CPT/PE. Providers reported mentally derived and instances of patient-involved decision-making around CPT/PE use. Continued efforts to assist providers in making informed and collaborative decisions about CPT/PE use are discussed.


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Copyright information

© National Council for Behavioral Health (outside the USA) 2016

Authors and Affiliations

  • Princess E. Osei-Bonsu
    • 1
    • 2
    • 3
  • Rendelle E. Bolton
    • 4
  • Shannon Wiltsey Stirman
    • 5
  • Susan V. Eisen
    • 6
  • Lawrence Herz
    • 7
  • Maura E. Pellowe
    • 7
  1. 1.Center for Chronic Disease Outcomes Research (CCDOR)Minneapolis VA Health Care SystemMinneapolisUSA
  2. 2.Center for Chronic Disease Outcomes Research (CCDOR)Minneapolis VA Health Care SystemMinneapolisUSA
  3. 3.Department of MedicineUniversity of MinnesotaMinneapolisUSA
  4. 4.Center for Healthcare Organization and Implementation Research (CHOIR)Edith Nourse Rogers Memorial Veterans HospitalBedfordUSA
  5. 5.Dissemination and Training Division, National Center for PTSDVA Palo Alto Healthcare SystemPalo AltoUSA
  6. 6.Department of Health Policy and ManagementBoston University School of Public HealthBostonUSA
  7. 7.Mental Health Service LineEdith Nourse Rogers Memorial Veterans HospitalBedfordUSA

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