Provider-Identified Implementation Barriers to Providing Cognitive Processing Therapy in VA: A Review of the Literature and Changes Over Time

Incidents of Posttraumatic Stress Disorder (PTSD) are high, especially in veterans exposed to combat. Strongly supported, efficacious treatment options exist, including Cognitive Processing Therapy (CPT) to treat the disorder and improve outcomes for patients. CPT has been trained widely in the Department of Veterans Affairs (VA). Despite national dissemination and training, utilization rates have been low. Using data from the 2008, 2011, 2014, and 2016 VA Cognitive Processing Therapy Practice Survey, the present study examined the trajectory of provider reported barriers to implementation of CPT across the four survey distributions. The sample was analyzed using frequencies within and across survey years for all variables, multiple regression analysis was used to explore relationships between continuous variables, and cross-tabulation analysis was used to explore relationships between categorical variables. Chi-square tests of independence and logistic regression analyses were then conducted to explore differences in barriers by year and profession. Any barriers with increased likelihood in one or more cohort years were included in a 3-way Chi-Square test of independence to explore the possibility that profession moderates the relationship between barrier and cohort year. Results indicate that CPT trained treatment providers reported a decrease in specific barriers to providing CPT over the course of the dissemination program, and that social work and psychology professions related to increased barriers in the earliest iteration of the survey. The VA CPT implementation program may have had some effect on specific barriers, further study is indicated.