Challenges and Successes in Dissemination of Evidence-Based Treatments for Posttraumatic Stress: Lessons Learned From Prolonged Exposure Therapy for PTSD

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Each year, millions of individuals experience a trauma — whether it is a car accident, an assault, an injury, or a natural disaster. Although many individuals recover from a traumatic event, others go on to develop posttraumatic stress disorder (PTSD) — an anxiety disorder characterized by severe and persistent stress reactions in response to the trauma.

The individual and societal effects of PTSD are great; therefore, it is imperative to treat PTSD using the best and most effective methods available, as backed by psychological science. In this report, Edna B. Foa (University of Pennsylvania), Seth J. Gillihan (University of Pennsylvania), and Richard A. Bryant (University of New South Wales) review research examining evidence-based treatments (EBTs) for PTSD and the challenges disseminating these treatments on a local, national, and international scale.

One EBT specifically identified by the authors as having consistent success in reducing PTSD symptoms is a type of cognitive behavioral therapy known as prolonged exposure (PE). In PE therapy, individuals are asked to approach — in both imaginary and real-life settings — situations, places, and people they have been avoiding. The repeated exposure to the perceived threat disconfirms individuals’ expectations of experiencing harm and over time leads to a reduction in their fear.

Despite the existence of highly effective treatments such as PE therapy, few clinicians use such treatments. Why might this be the case? The authors cite lack of training in EBTs, skepticism that EBTs work better than currently used treatments, and significant costs associated with dissemination models.

Although there are many barriers to adopting and spreading the use of EBTs, the authors describe several examples of their own successful dissemination of PE therapy in both developed and developing countries. These real-world examples highlight the barriers that can occur during the dissemination of EBTs and provide guidance on how common obstacles can be overcome.

Although the authors have had success disseminating PE therapy on a smaller scale, larger scale dissemination efforts will require the cooperation of many different agencies, including training and professional organizations, government agencies, insurers, health care providers, and the media. Working together, these organizations can help spread the use of effective treatments for PTSD and reduce the individual and public health burden associated with this disorder.

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Editorial: Achieving the Promise of Evidence-Based Psychotherapies for Posttraumatic Stress Disorder and Other Mental Health Conditions for Veterans

By Bradley E. Karlin, U.S. Department of Veterans Affairs, and Madhulika Agarwal, Deputy Under Secretary for Health for Policy and Services, U.S. Department of Veterans Affairs

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