Utilization of Evidence-Based Psychotherapy for Posttraumatic Stress Disorder by Rural and Urban Veterans

Rural veterans constitute approximately 28% of the veteran population. Research indicates that rural veterans have more severe posttraumatic stress disorder (PTSD) symptoms, lower health-related quality of life, and receive less psychotherapy than urban veterans. However, little research has focused on service utilization patterns of rural veterans who do initiate psychotherapy. The present study offers a preliminary examination of rural and urban veterans' utilization of psychotherapy services at a large, metropolitan Veterans Affairs (VA) Medical Center. Participants were 156 veterans enrolled in a VA PTSD and anxiety specialty clinic who received individual psychotherapy from providers trained in evidence-based psychotherapies (EBPs) for PTSD. Data extracted from veterans' medical records were used to examine rates of initiation and completion of EBP for PTSD among rural (n = 27) and urban (n = 129) veterans. Rural and urban veterans did not differ on rates of EBP initiation or completion (p > .05). Rural veterans were significantly more likely to receive prolonged exposure therapy, whereas urban veterans were more likely to receive cognitive processing therapy. Although past studies suggest that rural veterans tend to underutilize psychotherapy services, these data suggest that rural veterans who do receive psychotherapy are successfully accessing EBP for PTSD and may be more likely to initiate exposure-based techniques.