Treating posttraumatic stress disorder in Veterans Affairs Primary Care Mental Health Integration settings: What psychological interventions are being used in standard practice?

Abstract

Introduction: Posttraumatic stress disorder (PTSD) among primary care patients is common, associated with negative health outcomes, and has inadequate rates of mental health treatment. Evidence-based interventions for PTSD that are appropriate for Primary Care Mental Health Integration (PCMHI) settings have been developed but are not yet widely disseminated. Therefore, the nature of psychological interventions to treat PTSD in PCMHI settings is largely unknown.

Method: The study describes the content of 223 PCMHI sessions delivered as part of normal clinical care for 88 patients with PTSD across two Veterans Health Administration (VHA) health care systems. Session notes were coded using a general inductive approach for (a) assessment content, (b) problem focus, (c) interventions delivered, and (d) referrals to behavioral health services.

Results: Assessment was typically included in sessions, but repeated administration of self-report measures was less common. Sessions were most commonly focused on PTSD, stress, and sleep. Common interventions delivered were recommending specific self-help tools (e.g., apps and websites), recommending relaxation strategies, and providing psychoeducation about PTSD and PTSD treatment. Almost half (48%) of patients were referred to additional behavioral health services.

Conclusion: Veterans Health Administration PCMHI providers are routinely delivering evidence-informed interventions for PTSD. However, there is room for improvement in adhering to measurement-based care principles and delivering interventions with the strongest evidence for reducing PTSD. The methods of this study can be used to engage in quality improvement efforts to enhance the quality of PCMHI services for PTSD. (PsycInfo Database Record (c) 2026 APA, all rights reserved).