# Adapting Treatment Delivery to Improve Retention in Evidence-Based PTSD Treatment

> **NIH VA IK2** · DURHAM VA MEDICAL CENTER · 2024 · —

## Abstract

Background: Effective evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD),
such as Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy, have competency-
based trainings in place and are mandated to be available to Veterans with PTSD in the Veterans Health
Administration (VHA). Despite their effectiveness, at least a third of Veterans will prematurely drop out
of PTSD EBPs, which is associated with poorer clinical outcomes and greater healthcare utilization.
Delivery of PTSD EBPs in a massed format of three or more sessions weekly have demonstrated promise
for increasing treatment retention. It is hypothesized that massed EBPs will be feasible.
Significance/Impact: The current proposal is highly significant: 1) PTSD EBP retention remains low, 2)
prior research aimed to improve retention in PTSD EBPs has yielded only modest improvements, 3)
research on massed treatments for PTSD outside of VHA suggest improved retention, but is limited by
observational design and lack of comparison groups, and 4) PTSD is a high priority HSR&D domain.
Innovation: This CDA-2 application is innovative: 1) it adapts PTSD EBP delivery by increasing the
frequency of delivery, 2) the proposed feasibility randomized clinical trial (RCT) will inform a subsequent
IIR to conduct the first RCT of massed PTSD EBPs in VHA, 3) the first study to examine multiple
stakeholders' preferences, and perceived barriers and facilitators of massed PTSD EBPs, and 4) massed
PTSD EBPs may improve PTSD treatment engagement and improve clinical outcomes.
Specific Aims: Aim 1. Qualitatively explore through semi-structured interviews with stakeholders'
(Veterans [n=16], providers [n=12], and administrators [n=12]) perceived barriers and facilitators to
implementation, and preferences for massed PTSD treatment delivery within VHA PTSD specialty clinics
to inform the development of the massed PTSD treatment program to be piloted in Aim 2.
Aim 2a. Conduct a pilot pragmatic randomized clinical trial (RCT; n=30) to examine the feasibility and
acceptability of massed EBP PTSD treatments (EBP-massed) compared to PTSD EBPs as they are typically
delivered (EBP-TAU) in a VA PTSD Specialty Clinic. In addition, we will gather preliminary data on
satisfaction, completion rates, session attendance, and PTSD, depression, and functioning outcomes.
Aim 2b. Conduct a summative evaluation via qualitative interviews with all Veterans in the pilot trial
(n=30) and with providers (n=4) who delivered massed treatment to contextualize the quantitative
findings and further refine massed PTSD treatments for a future IIR.
Aim 3a. Characterize a national cohort of Veterans who begin 1) massed PTSD EBPs and 2) PTSD EBPs
TAU.
Aim 3b. Among Veterans who initiated treatment, compare treatment completion (i.e., 8 sessions) rates
between those who received massed EBPs and those who received EBP-TAU.
Next Steps/Implementation: In Aim 1, we will conduct semi-structured qualitative inter...

## Key facts

- **NIH application ID:** 10755607
- **Project number:** 5IK2HX003539-02
- **Recipient organization:** DURHAM VA MEDICAL CENTER
- **Principal Investigator:** Stephanie Wells
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2023-01-01 → 2027-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10755607

## Citation

> US National Institutes of Health, RePORTER application 10755607, Adapting Treatment Delivery to Improve Retention in Evidence-Based PTSD Treatment (5IK2HX003539-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10755607. Licensed CC0.

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