In 2006, VA began a national training initiative to help VA clinicians learn two of the most effective types of psychotherapy for treating PTSD, Prolonged Exposure and Cognitive Processing Therapy. Today over 6,000 VA therapists have been trained in these treatments. These therapies are recommended as first-line treatments in all PTSD practice guidelines around the world, including the guideline jointly issued by VA and the Department of Defense. VA requires that all Veterans have access to these treatments, and for good reason. They are effective for Veterans and non-Veterans alike.
Recent concerns raised about Prolonged Exposure therapy and VA wait times for PTSD treatment may deter some Veterans from seeking care that can help them. We regret that any Veteran seeking help at VA has a negative experience. VA seeks to ensure that high quality, timely health care is delivered to every Veteran who needs it. We maintain that this effort is well underway and continues to gain momentum.
Access to care is one of VA’s top priorities for improving Veteran services. Secretary Bob McDonald has re-emphasized this focus on access with the bottom line being Veteran satisfaction (instead of an “average” wait time number that is vulnerable to manipulation). MyVA is the name for this energized internal realignment that will enable all VA services to be viewed and judged through the eyes of the Veteran.
In Prolonged Exposure, patients retell an account of a traumatic experience repeatedly in order to fully process their memory of the experience, which makes it less painful and something that no longer dominates their life. They also are asked to engage in homework listening to a recording of their account, and to visit places that are safe, but which they may have avoided because they are related to their traumatic experience, for example, a crowded shopping center or driving down the street on trash day. VA strives to accurately describe the clinical services we offer, using standardized information sources such as websites, printed materials and prepared verbal explanations. At the outset of Prolonged Exposure, patients are informed that the focus on a traumatic memory may cause a temporary increase in PTSD symptoms. The workbook for therapy says, “You may feel worse before you feel better,” but that this temporary increase is worthwhile.
It is. Most Veterans who receive Prolonged Exposure experience a decrease in PTSD in 10-12 sessions. For example, a study published in 2013 of outcomes for Veterans who received Prolonged Exposure from VA in the national training initiative found that over 60% of the Veterans experienced clinically meaningful improvement in their PTSD symptoms despite the fact that the clinicians were just learning the protocol. An earlier study of women Veterans in 2007 found that over 70 percent experienced clinically meaningful improvement after receiving Prolonged Exposure. Cognitive Processing Therapy is another treatment approach that results in similar levels of improvement. Veterans who are not helped by one treatment are encouraged to try others.
VA’s aim is, and will continue to be, to offer Veterans an increasingly broad range of effective treatment options for PTSD and other conditions. Veterans have a choice of treatments. Along with Prolonged Exposure, Cognitive Processing Therapy, other types of psychotherapy, and medication, VA also offers complementary and alternative therapies such as meditation to allow Veterans a choice of treatment options and help them achieve recovery.
But there is still much to learn, and there are many improvements to make. We welcome feedback from all of our partners —Veterans and their families, treatment professionals, researchers, advocacy groups, and more. Working together, we can help VA accomplish the mission originally described by President Lincoln: “to care for him who shall have borne the battle and for his widow, and his orphan.”
About the Authors: Marsden McGuire, M.D., Deputy Chief Consultant, Mental Health Standards of Care; Paula Schnurr, Ph.D., Acting Executive Director, National Center for PTSD, Tracey L. Smith, Ph.D., Psychotherapy Coordinator (Office of Patient Care Services, Veterans Health Administration, Department of Veterans Affairs)