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ViewAttendees 2

Symposia

Trauma and Stressor Related Disorders and Disasters

Determinants of PTSD EBP receipt across the continuum of care: increasing generalizability and addressing structural barriers through adaptation

2 - (SYM 27) Mixed-methods Analysis of the Feasibility, Acceptability, and Considerations for Implementation of Massed Ebps for PTSD into VA Outpatient Clinics

Friday, November 21, 2025
5:18 PM - 5:32 PM CST
Location: Foster 2, Level 2
Keywords: CBT, Implementation, Veterans
Recommended Readings: Maguen S, Madden E, Holder N, et al. Effectiveness and comparative effectiveness of evidence-based psychotherapies for posttraumatic stress disorder in clinical practice. Psychological Medicine. 2023;53(2):419-428. doi:10.1017/S0033291721001628,   Wachen, J.S., Dondanville, K.A., Evans, W.R. et al. Adjusting the Timeframe of Evidence-Based Therapies for PTSD-Massed Treatments. Curr Treat Options Psych 6, 107–118 (2019). https://doi.org/10.1007/s40501-019-00169-9,   Rauch, S. A. M., Venners, M. R., Ragin, C., Ruhe, G., Lamp, K. E., Burton, M., Pomerantz, A., Bernardy, N., Schnurr, P. P., Hamblen, J. L., Possemato, K., Sripada, R., Wray, L. O., Dollar, K., Wade, M., Astin, M. C., & Cigrang, J. A. (2023). Treatment of posttraumatic stress disorder with prolonged exposure for primary care (PE-PC): Effectiveness and patient and therapist factors related to symptom change and retention. Psychological Services, 20(4), 745–755. https://doi.org/10.1037/ser0000783,   Rosen, R. C., Ruzek, J. I., & Karlin, B. E. (2017). Evidence-based training in the era of evidence-based practice: challenges and opportunities for training of PTSD providers. Behaviour research and therapy, 88, 37-48.,  
Abstract Body
While the implementation of massed evidence based treatments (EBTs) for PTSD is increasingly widespread, their use has generally occurred in the context of clinical trials and/or residential or intensive outpatient settings. Few strictly outpatient massed EBT (mEBT) for PTSD programs exist. The Salt Lake City VA PTSD Clinical Team (PCT) has offered outpatient massed Cognitive Processing Therapy and Prolonged Exposure since 2018. A mixed-methods approach was used to understand beliefs about the feasibility and effectiveness of mEBTs for PTSD in an outpatient clinic, as well as factors that influence acceptability and practicality of their implementation. PCT staff without experience with mEBTs (n = 8) completed a Likert scale survey. Overall, respondents did not identify barriers, and they agreed that mEBTs can be delivered appropriately to a range of Veterans, including those with high distress and comorbidities. However, 62.5% reported they do not routinely offer mEBTs during treatment planning. Experienced mEBT providers (n = 3) completed semi-structured interviews about the acceptability, implementation, and practicality of mEBTs in outpatient VA clinics. The systematic thematic analysis led to 26 keywords and 10 codes, and three themes emerged: (a) Veteran and provider satisfaction, (b) Patient and system facilitators, and (c) Barriers and needs. Respondents indicated that both Veterans and providers find mEBTs to be acceptable, practical, and find significant benefits in their implementation. Specifically, they appreciated the reduction of therapy interfering behaviors (e.g., “Managing fewer therapy-interfering behaviors like no shows and cancellations related to avoidance, seem to make a smoother course of treatment”). Providers believed they were providing the “best possible care” when delivering mEBTs. Leadership support to schedule massed patients daily was identified as a critical facilitator of the practicality and implementation of massed EBPs. System barriers that prevent consistent, daily scheduling were frequently identified as a threat to the practicality and implementation of massed EBPs in VA. No specific needs for mEBT-specific training were noted, though variability between respondents was observed regarding volume of between-session practice assignments and use of measurement-based care. Together these mixed methods data provide a framework and considerations for how to create and implement a massed EBP program in a VA outpatient clinic, as well as data to support its feasibility.