Wolfe William R, Staudenmeyer Anna, Cloitre Marylene, Hubbard Asale, Schmitz Martha, Mohlenhoff Brian, Maguen Shira, Neylan Thomas C
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th St., San Francisco, CA 94107, USA; San Francisco Veterans Affairs Health Care System, 4150 Clement St (116P), San Francisco, CA 94121, USA.
San Francisco Veterans Affairs Health Care System, 4150 Clement St (116P), San Francisco, CA 94121, USA.
Psychiatry Res. 2025 Sep;351:116612. doi: 10.1016/j.psychres.2025.116612. Epub 2025 Jun 24.
Posttraumatic stress disorder (PTSD) is a disabling condition costing the Veterans Administration (VA) $5 billion annually in disability compensation. Despite system-wide dissemination of Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) since 2007, only a small minority of veterans complete these treatments. We investigated the impact of sequenced treatment on initiation of and retention in CPT and PE across self-reported race and ethnicity, as well as recent heavy drinking and suicidal ideation (SI).
VA administrative data were used to assess the impact of sequenced psychotherapy (SP), in which ≥ 8 sessions of non-trauma-focused individual (SPI) or group (SPG) psychotherapy was delivered before trauma-focused care, on initiation and retention in CPT and PE over two years from PTSD treatment initiation. Results were analyzed by self-reported race and ethnicity, heavy drinking (AUDIT-C ≥6), and SI (PHQ9 Q9>1).
Nationwide, 12.9 % of veterans who entered care for PTSD between 10/1/2014 and 11/30/2020 (n = 490,097) initiated VA-disseminated evidence-based treatment within 21 months (9.5 % CPT, 3.4 % PE). Among those, treatment retention (≥ 8 sessions) was 46.4 % and 42.3 %, respectively. SPI and SPG were associated with 0.4-6.8 % increases in CPT and PE initiation across racial/ethnic and risk groups. SPI was associated with increased CPT and PE retention of 8.0 % and 8.2 %; for SPG, retention increases were 3.4 % and 8.7 %. Strikingly, Hispanic White veterans with heavy drinking had 21.7 % increased CPT retention following SPG.
Sequential individual and group psychotherapy may improve initiation and completion of CPT and PE, particularly for certain minoritized and high-risk groups.
