Military Behavioral Health Providers' Attitudes and Use of Evidence-Based Treatments for PTSD
Military personnel are at substantial risk for developing posttraumatic stress disorder (PTSD) as a result of combat-related trauma experienced during deployment to Iraq and Afghanistan. To support their need for effective care, hundreds of Department of Defense providers have been trained in evidence-based treatments for PTSD specifically, Cognitive Processing Therapy (CPT) and Prolonged Exposure therapy (PE). Despite wide scale dissemination efforts, a recent study reported that less than 25% of patients needing PTSD treatment are receiving an evidence-based treatment. Prior research has documented significant barriers to providers' adoption of manualized therapies among civilian providers. The objectives of this study were to (1) to examine usage levels of CPT and PE by providers at an Army medical center, (2) to identify barriers to their use; and (3) to compare provider attitudes toward CPT and PE. Understanding providers' attitudes and perceived barriers toward CPT and PE can inform methods for increasing provider adoption of these much needed treatment options.
The sample for this study included providers who treat soldiers at an Army Medical Center. A one-time 67-item survey was administered electronically. 150 providers were invited to complete the survey; 72 responded, a 48% response rate. Four items asked providers to report their primary treatment approach for PTSD. The Attitudes toward Specific PTSD Treatmentsscale was administered to compare provider attitudes PE and CPT. The 9-item scale included qualities of each treatment type, including likeability, ease of use, theoretical basis, and no perceived harm to patient. Two items for each PTSD treatment type assessed participants’ perceived barriers to use of the treatments.
The most commonly reported treatment approaches were cognitive behavioral therapy (37.3%), Eye Movement Desensitization and Reprocessing (EMDR) (17.9%), and Cognitive Processing Therapy (individual format) (11.9%). Only 3.0% reported PE as their primary approach. Regarding likeability of each treatment approach, 47.9% of respondents endorsed CPT, whereas only 22.8% of providers responded favorably about the likeability of PE. Providers also reported different levels of agreement about the strength of research evidence for each treatment. 55.6% believed that CPT has sufficient research support, while 37.5% agreed that PE has good scientific support. A starker difference between the two treatment types existed between providers' belief that each treatment would do no harm to patients; 59.2% reported that CPT would not harm patients, while only 18.3% of providers agreed that "patients can receive PE with little to no harm." Despite differences in attitudes towards PE and CPT, the two most endorsed barriers to greater use of the treatments were the same: lack of adequate training--reported by 36.5% about CPT and reported by 50% about PE.
Conclusions and Implications:
Effective dissemination efforts for PE and CPT will need to address providers' perceived barriers and attitudes toward specific treatments. There is a clear preference for CPT over PE based on providers' attitudes and reported barriers. In order to promote the adoption of effective treatments, effective dissemination requires attention to provider characteristics and preferences.