Evidence-Based and Evidence-Informed Treatments: A Naturalistic Study of the Impact of Treatment Type on Engagement in Posttraumatic Stress Disorder.

Abstract

Objective: Evidence-based psychotherapies (EBPs) have revolutionized posttraumatic stress disorder (PTSD) treatment, but research suggests more limited engagement and effectiveness in naturalistic settings, relative to randomized controlled trials. Some clinics therefore offer additional evidence-informed options (eg, Skills Training in Affective and Interpersonal Regulation, Acceptance and Commitment Therapy, and Mindfulness Based Stress Reduction), but little research has compared outcomes within a naturalistic setting.

Methods: We completed a retrospective chart review of 480 Veterans presenting to a trauma-focused clinic within a Veterans Affairs Medical Center during 2019. All variables were extracted from the VA medical record. We used logistic or linear regression models, χ², and analysis of variance to examine treatment outcomes differences.

Results: In the year following intake, 71.87% (n = 345) engaged with treatment, and 45.42% (n = 218) received an adequate dose of at least 1 treatment; of those who engaged with treatment, 63.19% received an adequate dose of at least 1 treatment. Veterans attended an average of 8.40 sessions and 1.39 episodes of care. At the person level, rates of engagement and receipt of an adequate dose did not differ by treatment type (odds ratio [OR] = 1.52, P = .17; OR= 1.52, P = .17, respectively). However, those who planned to and/or received at least 1 EBP attended a significantly greater number of total sessions (11.82) relative to those that planned to and/or received evidence-informed psychotherapy (EIP; 7.31; b = 1.69, P = .04). Within episodes of care, rates of engagement did not differ by treatment type (OR = 1.39, P = .14). However, those who planned to and/or received EBP were more likely to receive an adequate dose of treatment (OR = 1.44, P = .04) and attended a significantly greater number of sessions per episode (7.60), relative to EIP (6.00).

Discussion: These data highlight differences in treatment engagement and receipt of an adequate dose of treatment based on intervention-level factors within an active PTSD specialty clinic, which can aid decision-making for patients and providers. Future research is needed to investigate predictors of treatment engagement and outcomes.