Graduate Training and Provider Concerns About Distress and Comprehension in PTSD Treatment Choice: A Mediation Analysis

The Veterans Health Administration (VHA) recommends that patients with posttraumatic stress disorder (PTSD) receive either of the 2 frontline evidence-based psychotherapies, cognitive processing therapy (CPT) and prolonged exposure (PE). However, VHA providers have reported low use of these treatments, and voiced their concerns over exposing patients to distress in PE and their patients not understanding CPT. In the current study, we surveyed VHA providers (N = 225) in PTSD clinical teams across the United States on their graduate school training experience in structured cognitive-behavioral therapy protocols, agreement with the 2 provider concerns, and use of the 2 treatments. Results from our mediation analyses indicated that graduate school training in structured protocols led to lower discomfort of exposing patients to distress during PE, and in turn, greater PE utilization. However, there was no significant relationship between graduate school training and CPT utilization. Findings suggest an important role for graduate training in the uptake of guideline recommended treatment for PTSD at VHA. Impact Statement Providers who received graduate school training in structured psychotherapy protocols endorse less concern about using prolonged exposure. Findings suggest an important role for graduate training in the uptake of guideline recommended treatments for posttraumatic stress disorder (PTSD) at the Veterans Health Administration, and that addressing provider concerns over their use may increase utilization.