Which patients initiate cognitive processing therapy and prolonged exposure in department of veterans affairs PTSD clinics?

Craig S. Rosen, Nancy C. Bernardy, Kathleen M. Chard, Barbara A Clothier, Joan M. Cook, Jill Crowley, Afsoon Eftekhari, Shannon M Kehle-Forbes, David C. Mohr, Siamak Noorbaloochi, Robert J. Orazem, Josef I. Ruzek, Paula P. Schnurr, Brandy N. Smith, Nina A Sayer

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


The United States Department of Veterans Affairs (VA) provides Cognitive Processing Therapy (CPT) and Prolonged Exposure therapy (PE) for PTSD at all of its facilities, but little is known about systematic differences between patients who do and do not initiate these treatments. VA administrative data were analyzed for 6,251 veterans receiving psychotherapy over one year in posttraumatic stress disorder (PTSD) specialty clinics at nine VA medical centers. CPT and PE were initiated by 2,173 (35%) patients. Veterans’ probability of initiating either CPT or PE (considered together) was 29% lower (adjusted odds ratio =.61) if they had a psychiatric hospitalization within the same year, and 15% lower (AOR =.78) if they had service-connected disability for PTSD. Veterans’ probability of starting CPT or PE was 19% lower (AOR =.74) if they were Hispanic or Latino, 10% lower (AOR =.84), if they were male rather than female, and 9% lower (AOR =.87) if they were divorced, separated or widowed rather than currently married. Probability of receiving CPT or PE was also lower if verans had more co-occurring psychiatric diagnoses (AOR per diagnosis =.88), were older (AOR per every five years =.95), or lived further away from the VA clinic (AOR per every ten miles =.98). Nonetheless, most patients initiating CPT or PE had two or more comorbidities and were service-connected for PTSD. Observed gender, age and ethnic differences in initiation of CPT and PE appear unrelated to clinical suitability and warrant further study.

Original languageEnglish (US)
Pages (from-to)53-60
Number of pages8
JournalJournal of Anxiety Disorders
StatePublished - Mar 2019

Bibliographical note

Funding Information:
This research was supported by a grant from Health Services Research & Development, U.S. Department of Veterans Affairs, CRE-120-021, Promoting Effective, Routine, and Sustained Implementation of Stress Treatments (PERSIST) , awarded to the first and last authors. The views expressed here are those of the authors and do not represent the position of the U.S. Department of Veterans Affairs.

Publisher Copyright:
© 2018


  • Evidence-based practices
  • Implementation
  • Mental health services
  • Posttraumatic stress disorder
  • Psychotherapy


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