What Factors Influence Therapists' Decisions to Use Evidence-Based PTSD Treatment?

What you need to know

• Therapists consider multiple factors when deciding whether to use evidence-based PTSD treatments like Cognitive Processing Therapy (CPT)
• Insurance coverage, organizational support, and client readiness all play important roles in treatment decisions
• More education and system-level changes may help increase access to proven PTSD treatments in community settings

The Complex World of PTSD Treatment Decisions

Imagine you’re a therapist meeting with a new client who has post-traumatic stress disorder (PTSD). You know there are proven treatments available, but how do you decide which one to use? This decision isn’t always straightforward, especially for therapists working in community settings like private practices or outpatient clinics.

While we have effective treatments for PTSD, including Cognitive Processing Therapy (CPT), many people still don’t receive these evidence-based treatments. Understanding why therapists choose certain treatments over others can help us increase access to the most effective care.

The Many Layers of Treatment Decisions

The study revealed that therapists consider factors at multiple levels when deciding whether to use CPT:

At the system level, insurance coverage and referral processes play major roles. Some therapists noted that limited insurance coverage made it difficult to deliver the full course of treatment. Others mentioned challenges with getting appropriate referrals from other healthcare providers who may not understand CPT well.

At the organizational level, leadership support and time constraints matter. Therapists were more likely to use CPT when their workplace leaders encouraged evidence-based treatments. However, high caseloads and limited time for preparation could make implementation challenging.

The Human Element: Provider and Client Factors

Therapist characteristics and beliefs significantly influence treatment decisions. Those with previous cognitive-behavioral therapy training often felt more comfortable using CPT. Interestingly, even therapists initially skeptical of structured treatments often became advocates after seeing positive results.

Client factors also weigh heavily in decision-making. Therapists considered things like:

• Client motivation and readiness
• Cognitive flexibility
• Life stability (housing, employment, support system)
• Type and number of traumas
• Presence of other mental health conditions

Shared Decision-Making and System Challenges

Most therapists emphasized the importance of involving clients in treatment decisions. They typically discussed various treatment options and helped clients choose based on their preferences and circumstances.

However, community settings often lack the integrated resources found in larger institutions like VA hospitals. This can make it harder to address complex client needs before starting trauma-focused treatment. Some therapists noted having to refer clients elsewhere for stabilization before beginning CPT.

What This Means for You

If you’re seeking PTSD treatment or working with someone who is, understanding these factors can help:

For clients:

• Ask about different treatment options available
• Discuss any practical barriers like insurance coverage or scheduling
• Share your preferences and concerns with your therapist

For providers:

• Consider how your own training and beliefs influence treatment decisions
• Look for ways to address system-level barriers in your setting
• Stay informed about the latest research on who can benefit from CPT

For healthcare organizations:

• Provide adequate support and resources for evidence-based treatments
• Consider ways to better integrate services for complex client needs
• Invest in provider training and consultation

Conclusions

• Treatment decisions involve multiple interconnected factors at system, provider, and client levels
• Insurance coverage and organizational support are crucial for implementing evidence-based treatments
• More integrated care and resources could help address barriers to providing proven PTSD treatments in community settings