Factors Associated With Low and High Use of Psychotherapy in Veterans With PTSD

Both low and high utilization of psychotherapy for posttrauamtic stress disorder (PTSD) may be problematic. Low utilization may translate into patients receiving insufficient services to effect clinical change, whereas high utilization may lead to resource depletion as a disproportionate amount of available resources are focused on a small number of patients. This study examined rates and predictors of low and high psychotherapy utilization in a sample of 157 patients enrolled in an outpatient Veterans Affairs (VA) PTSD clinic. Approximately 25% of the sample were low users, receiving fewer than 4 sessions per year, whereas 16% were categorized as high users, receiving 52 or more therapy sessions per year during their course of treatment. Indicators of clinical severity, including comorbidity, global functioning, and number of inpatient admissions, were not associated with low versus high utilization. Age was the only clinical or demographic variable that independently predicted utilization, with older veterans using more services. Qualitative data indicated that social and relational factors, such as lack of social support, may contribute to utilization rates in veterans with PTSD.