Sticking it out in trauma-focused treatment for PTSD: It takes a village

Laura A. Meis, Siamak Noorbaloochi, Emily M. Hagel Campbell, Christopher R. Erbes, Melissa A. Polusny, Tina L. Velasquez, Ann Bangerter, Andrea Cutting, Afsoon Eftekhari, Craig S. Rosen, Peter W. Tuerk, Lori B. Burmeister, Michele R. Spoont

Research output: Contribution to journalArticlepeer-review

50 Scopus citations


OBJECTIVE: One in 3 veterans will dropout from trauma-focused treatments for posttraumatic stress disorder (PTSD). Social environments may be particularly important to influencing treatment retention. We examined the role of 2 support system factors in predicting treatment dropout: social control (direct efforts by loved ones to encourage veterans to participate in treatment and face distress) and symptom accommodation (changes in loved ones' behavior to reduce veterans' PTSD-related distress).

METHOD: Veterans and a loved one were surveyed across 4 VA hospitals. All veterans were initiating prolonged exposure therapy or cognitive processing therapy (n = 272 dyads). Dropout was coded through review of VA hospital records.

RESULTS: Regression analyses controlled for traditional, individual-focused factors likely to influence treatment dropout. We found that, even after accounting for these factors, veterans who reported their loved ones encouraged them to face distress were twice as likely to remain in PTSD treatment than veterans who denied such encouragement.

CONCLUSIONS: Clinicians initiating trauma-focused treatments with veterans should routinely assess how open veterans' support systems are to encouraging veterans to face their distress. Outreach to support networks is warranted to ensure loved ones back the underlying philosophy of trauma-focused treatments. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Original languageEnglish (US)
Pages (from-to)246-256
Number of pages11
JournalJournal of Consulting and Clinical Psychology
Issue number3
StatePublished - Mar 2019

Bibliographical note

Funding Information:
This research was supported by grants from the Department of Defense’s Congressionally Directed Medical Research Program (W81XWH-12-1-0619) and the Department of Veterans Affairs (HSR&D CDA 10-035; RRP 12-229). This material is the result of work supported with resources and the use of facilities at the Center for Care Delivery & Outcomes Research and the Minneapolis Veterans Affairs Health Care System. The findings and conclusions in this document are those of the authors and do not represent the views of the Department of Veterans Affairs or the United States government. No investigators have affiliations or financial involvement that conflict with material presented. We thank the HomeFront team for their work in support of this project, especially Karen A. Kattar, Kimberly Stewart, Rebecca Swain, Martina Radic, Kimberly Henriksen, Talee Vang, Lee Kravetz, Tegan Carr, Christopher Hoge, and numerous research assistants who have volunteered on the HomeFront team. We would also like to thank Steffany Fredman for her generous feedback.

Publisher Copyright:
© PsycINFO Database Record 2019 APA. All rights reserved.


  • accommodation
  • dropout
  • evidenced-based treatments
  • PTSD
  • social control
  • Humans
  • Middle Aged
  • Veterans/psychology
  • Male
  • Social Environment
  • Cognitive Behavioral Therapy
  • Stress Disorders, Post-Traumatic/psychology
  • Implosive Therapy
  • Patient Dropouts/psychology
  • Adult
  • Female
  • Surveys and Questionnaires

PubMed: MeSH publication types

  • Journal Article


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