# Improving Function Through Primary Care Treatment of PTSD

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2020 · —

## Abstract

Posttraumatic stress disorder (PTSD) is a debilitating and costly mental health issue (Greenberg, Sisitsky
et al. 1999, Hoge, Terhakopian et al. 2007). RAND reported an estimated two-year cost of $4.0 to $6.2
billion US dollars for mental health issues from the current conflicts in Iraq and Afghanistan and further
estimated that providing evidence-based treatments for PTSD and depression could save an estimated
$86.2 million (Tanielian, et al. 2008). Even modest reductions in PTSD severity have been related to
increased probability of positive function outcomes (Smith, et al. 2005). Prolonged Exposure (PE)
therapy (Foa, et al. 2000, Foa, et al. 2005, Schnurr, et al. 2007) is an effective, first-line treatment for
PTSD (IOM 2007, VA/DOD 2010). While highly effective, PE is provided in specialty mental health
settings typically in 8 to 15, weekly 90 minute individual sessions. Veterans with PTSD are often reluctant
to seek care in specialty mental health, and, as a result, many are treated solely in primary care and do not
have access to this effective intervention (Possemato, et al. 2011). While the DoD and VA have actively
integrated behavioral health providers into their primary care clinics (Maguen, et al. 2010, Seal, et al.
2011), current behavioral interventions for PTSD in primary care are often inconsistent with clinical
practice guidelines and/or not effective (Possemato, et al. 2011). Since functional outcomes are critical, we
intend to extend beyond assessing the impact of PE-PC on clinical outcomes to function. Thus, there is a
clear and urgent need to further develop, validate, and disseminate evidence-based psychotherapeutic
treatments for PTSD in integrated VHA PC-MHI with a focus on functional outcomes. To fill this need
and gap in care the study investigators developed a Brief Prolonged Exposure for Primary Care (PE-PC)
treatment protocol with 4, 30-minute sessions for use in a stepped care model. A pilot study in military
treatment facilities found PE-PC resulted in reductions in PTSD that were maintained at 6- and 12-month
follow-up (Cigrang, et al, 2015). Preliminary results from a randomized controlled trial (RCT; PI: Cigrang;
CoI: Rauch) of PE-PC compared to minimal attention control (MAC, including continuation of any PC
initiated treatment) found a significantly larger reduction in PTSD severity (measured by PCL) in PE-PC
than MAC (between group d = .78, p = .01). The strength of these initial findings is limited by lack of
functional outcomes and examination of impact in VHA. While Service Members and Veterans have many
similarities, potential differences in motivation for treatment and other factors may influence the efficacy of
the protocol especially when examining changes in function. The proposed study will randomize 120
Veterans at Ralph H. Johnson VAMC presenting in primary care with PTSD who meet minimal
inclusion/exclusion criteria to 6 weeks of PE-PC or PC-MHI-treatment as usual (TAU). Recruitment will
occur over ...

## Key facts

- **NIH application ID:** 10020208
- **Project number:** 5I01RX002625-03
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** SHEILA A.M. RAUCH
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-10-01 → 2022-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10020208

## Citation

> US National Institutes of Health, RePORTER application 10020208, Improving Function Through Primary Care Treatment of PTSD (5I01RX002625-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10020208. Licensed CC0.

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