Symposia
Trauma and Stressor Related Disorders and Disasters
Sarah B. Campbell, Ph.D.
Staff Psychologist, PTSD Outpatient Clinic
VA Puget Sound Health Care System
Seattle, Washington
Tracy Simpson, PhD
Staff Psychologist
VA Puget Sound Health Care System
Seattle, Washington
John Fortney, PhD
Core Investigator
VA Puget Sound Health Care System
Seattle, Washington
Veterans are disproportionately diagnosed with posttraumatic stress disorder (PTSD), with a median point prevalence of 24.5% in primary care (Spottswood et al., 2017). Among the more pervasive concerns for those with PTSD is lack of social support (Zalta et al., 2021), and improving social support is a chief patient-reported treatment goal (Rosen et al., 2013). Accordingly, building a support network and boosting sense of community while addressing PTSD symptoms should be a patient-centered treatment option. Situating such options in primary care (PC) may result in greater treatment access and engagement than current evidence-based psychotherapies for PTSD, which are delivered in specialty mental health settings and have low initiation and high drop-out (Kehle-Forbes et al., 2016). Nearly 60% of veterans receive initial mental health contact in PC, and 40% of veterans receive same-day psychotherapy in primary care mental health integration (PCMHI) after screening positive in a PC visit (Bohnert et al., 2016). Thus, expanding PCMHI treatments for PTSD meets treatment-seekers where they are, enabling prompt response to the critical issues of comorbid low social support and PTSD.
We piloted a 4-6 session PCMHI intervention called Behavioral Activation and Social Engagement for PTSD (BASE for PTSD; Campbell et al., 2020), which showed promise for engaging veterans. Of those eligible, 21 veterans enrolled (87.5%), 19 completed the first four sessions (90%), and 16 completed six sessions, including two optional booster sessions. Veterans brought at least partially completed homework to ~61% of sessions. The present study describes results of stakeholder qualitative interviews conducted with veterans and PCMHI psychologists at the local VA medical center to better understand how BASE could complement existing PTSD offerings.
We used rapid content analysis (Hamilton, 2013) to identify themes related to engagement in and improvement from BASE (participants, n=14) as well as comprehensibility and feasibility of BASE (providers, n=8). Several veterans described progress in their social engagement (e.g., “The therapy overall allowed me to start participating socially more than I had been able to before.”) and noted the idiographic approach to values and social relationships encouraged engagement. Providers thought the focus was important and offered suggestions for improvement. We will discuss how emphasizing social support’s link to valued goals and treating PTSD in PCMHI may be two promising strategies to engage veterans in PTSD treatment.