(PS11-A22) Clinician Decision-making for PTSD Therapy

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after exposure to a traumatic event (e.g., sexual assault, combat). Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) are two trauma-focused therapies that have been shown to successfully improve PTSD symptoms in standard outpatient and massed-treatment programs. Given the equal empirical efficacy of these treatments, clinicians often rely on idiosyncratic patient and/or provider factors to inform their decision-making process for choosing between CPT and PE. Research has begun to explore the specific patient characteristics (e.g., personal preference, level of comfort discussing the trauma, trauma type, symptom severity, patient readiness) and provider characteristics (e.g., personal preference, self-efficacy with each modality, training) that influence treatment modality choice. However, no studies have directly analyzed clinicians’ decision-making processes as they choose between CPT and PE. The current study seeks to bridge this gap in the literature by analyzing how clinicians choose between these two treatment modalities for veterans with PTSD in an intensive two-week treatment program.

Seven clinicians (psychologists and social workers) participated in semi-structured interviews within 24-72 hours of choosing a treatment modality. Both quantitative and qualitative questions were used to ask clinicians about provider (e.g., “Are you trained in both CPT and PE”) and patient (e.g., “On a scale from 1-5, to what extent did the patient’s personal preference impact your decision to use CPT or PE”) factors. The patient-specific questions were repeated for each patient seen, in an effort to assess granular decision-making processes. The quantitative data has been analyzed, and qualitative data analysis is underway.

All 7 providers were trained in both CPT and PE: 3 felt more comfortable providing PE, 1 felt more comfortable providing CPT, and 3 felt equally comfortable providing both. Data regarding the perceived efficacy of each modality varied; most providers cited research suggesting that both are equally efficacious, however, some felt more favorable toward PE, especially in the two-week massed treatment setting (e.g., daily vs weekly sessions). Nevertheless, for the 14 patients discussed, these 7 providers chose to deliver CPT with 10 patients and PE with 4 patients.

Regarding patient characteristics, patient preference and the relative prominence of certain PTSD symptom clusters (e.g., negative cognitions vs avoidance or intrusions) emerged as important factors in the decision-making process. Other noted, but less important considerations were trauma type, number and diversity of traumas, patient readiness, patient willingness to discuss the trauma, treatment history, comorbidities, and demographic characteristics.

Many factors influence providers' decision-making around which trauma-focused-treatment to employ for a given patient. Enhanced understanding of the most prominent factors will guide future outcome studies and may ultimately inform greater standardization of the decision-making process, to maximize the likelihood of successful outcomes for patients seeking treatment for PTSD.