Transitions to trauma-focused evidence-based psychotherapy for posttraumatic stress disorder from other treatments: a qualitative investigation of clinicians’ perspectives

Many veterans do not initiate trauma-focused evidence-based psychotherapy (TF-EBP) to treat posttraumatic stress disorder (PTSD). Instead, veterans receive other treatments prior to TF-EBP and the process of transitioning to TF-EBP is poorly understood. The goal of the current study was to understand clinicians' beliefs about and approaches to transitioning veterans into TF-EBP. Clinicians (<i>n</i> = 20) with any experience providing TF-EBP from across the national VA healthcare system participated in semi-structured qualitative interviews. Rapid qualitative analysis procedures were used to identify themes: (1) TF-EBP is rarely contraindicated; (2) there is no consensus on treatment alternatives after veterans decline TF-EBP; (3) unstructured therapy can be a barrier to TF-EBP; (4) data from non-TF-EBP can be used to encourage TF-EBP engagement; (5) veterans are poorly informed about PTSD referrals; (6) culturally responsive PTSD care involves asking questions throughout the treatment process; (7) TF-EBP was delivered with attention to how identity may impact treatment; (8) TF-EBP was among the first treatment option offered by all clinicians; (9) veterans initiate TF-EBP when willing; and (10) clinicians developed resources socialize veterans to structured treatment. Since non-TF-EBP approaches may be indicated (or requested) for some veterans, strategies to facilitate transitions to TF-EBP are needed.