Provider Factors Predict Use of Evidence-Based Psychotherapies in Veterans Affairs Posttraumatic Stress Disorder Specialty Programs: The Role of Profession, Theoretical Orientation, and Training

Although a large body of research indicates that evidence-based psychotherapies for posttraumatic stress disorder (PTSD) such as prolonged exposure (PE) and cognitive processing therapy (CPT) are both effective and efficacious in veteran populations, less is known about provider factors that impact decisions to utilize these treatments. The current study aims (a) to describe use of CPT, PE, and "other" psychotherapies among Veterans Health Administration (VHA) PTSD specialty care providers, and (b) to examine whether factors such as theoretical orientation, occupation, graduate training in cognitive-behavioral therapy, and having received VHA training are associated with providers' use of specific PTSD treatments. VHA providers in PTSD clinical teams were invited to participate in a national survey (n = 259, response rate = 24.2%) assessing provider demographics, treatment preferences, and treatment use. Overall, providers reported using CPT and PE for PTSD for a relatively low percentage of their clinical time (mean of 38.8% for CPT and 19.8% for PE), relying more heavily on use of "other" psychotherapies (mean of 44.8%) in patient care. VHA evidence-based psychotherapy training emerged as a predictor of time spent administering CPT or PE. Having a cognitive- behavioral therapy theoretical orientation was associated with time spent conducting CPT, but not PE, whereas identification with "other" orientation was associated with time spent conducting psychotherapies other than CPT or PE.