# Improving Care for Veterans by Understanding and Facilitating Transition to Recommended PTSD Treatment

> **NIH VA IK2** · VETERANS AFFAIRS MED CTR SAN FRANCISCO · 2024 · —

## Abstract

Background: Posttraumatic stress disorder (PTSD) is one of the most common mental health diagnoses
among Veterans. Cognitive processing therapy (CPT) and prolonged exposure therapy (PE) were widely
disseminated in the Veterans Health Administration (VHA) as recommended PTSD treatments. Despite these
efforts, few post-9/11 Veterans diagnosed with PTSD initiate CPT or PE. In the small percentage of Veterans
who receive these therapies, CPT and PE are rarely the first treatment a Veteran receives. A common
treatment sequence identified in implementation research, begins with “stabilization treatment,” combinations
of psychosocial and medication treatments that prepare Veterans for CPT or PE. A gap in existing research is
how treatment sequences, particularly stabilization treatment, influence initiation of CPT or PE.
Significance/Impact: PTSD is an HSR&D priority condition due to its substantial negative biopsychosocial
impact on Veterans lives. Novel strategies are needed to increase engagement, retention, and improve
outcomes from recommended PTSD treatments, and to reduce disparities in access to this care.
Understanding how to most effectively combine and sequence PTSD treatment is an HSR&D identified area of
interest, and a research gap identified in the VHA PTSD clinical practice guideline.
Innovation: Despite consistently identifying stabilization treatment as a common VHA practice, little research
has investigated this treatment sequence. A novel approach to solving existing limitations in PTSD treatment
delivery involves developing an intervention that both acknowledges the ubiquitous presence and benefits of
stabilization treatment, while facilitating timely transition from stabilization treatment to CPT or PE.
Specific Aims: This CDA-2 aims to improve delivery of PTSD services in the VHA, while simultaneously
providing me with training in health services research methods to support my development into an independent
VHA researcher. The proposed research aims are: (1) To qualitatively understand Veterans’ and clinicians’
perspectives on selecting stabilization treatments and how stabilization treatment serves as a barrier or
facilitator of transition to CPT or PE; (2) To develop and conduct a randomized, pragmatic pilot trial of a brief,
Veteran-centered intervention to support transition from stabilization treatment to CPT or PE; and (3) To
identify sociodemographic disparities in treatment sequences and to determine how treatment sequences
influence time to CPT or PE initiation across the VHA.
Methodology: I will then conduct qualitative interviews with a national sample of Veterans (n=30) and
clinicians (n=20; Aim 1). Using rapid qualitative analysis procedures, I will evaluate how treatment sequences,
particularly stabilization treatment, are chosen and how they serve as a barrier or facilitator of transition to CPT
and PE. I will then use knowledge gained from Aim 1 to develop a health services intervention that facilitates
timely tra...

## Key facts

- **NIH application ID:** 10983287
- **Project number:** 5IK2HX003339-03
- **Recipient organization:** VETERANS AFFAIRS MED CTR SAN FRANCISCO
- **Principal Investigator:** Nicholas Holder
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-05-01 → 2027-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10983287

## Citation

> US National Institutes of Health, RePORTER application 10983287, Improving Care for Veterans by Understanding and Facilitating Transition to Recommended PTSD Treatment (5IK2HX003339-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10983287. Licensed CC0.

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