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Comment & Response |

Treatment Options for Veterans With Posttraumatic Stress Disorder

Harold Kudler, MD1; Kristine Day, PhD2; Paula P. Schnurr, PhD3
[+] Author Affiliations
1Mental Health Services, Department of Veterans Affairs, Washington, DC
2National Evidence-Based Psychotherapy Program, Department of Veterans Affairs, Washington, DC
3National Center for PTSD, Department of Veterans Affairs, Washington, DC
JAMA Psychiatry. 2016;73(7):756-757. doi:10.1001/jamapsychiatry.2016.0746.
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To the Editor While we agree with many points raised by Steenkamp1 and Yehuda and Hoge,2 their Viewpoint articles published in JAMA Psychiatry inaccurately characterize policy and practice regarding evidence-based psychotherapy (EBP) within the Veterans Health Administration (VHA).

Overall, the authors suggest that VHA narrowly focuses on 2 treatments for posttraumatic stress disorder (PTSD) and that veteran preferences are not considered when initiating treatment. Yehuda and Hoge2 refer to “settings such as Veterans Affairs (VA), where they are mandated by policy to provide prolonged exposure or cognitive processing therapy (CPT) as first-line treatments for veterans with PTSD.” This is not correct. The VHA’s Uniform Mental Health Services Handbook3(p31) states that, “All veterans with PTSD must have access to Cognitive Processing Therapy (CPT) or Prolonged Exposure Therapy… [Facilities] must provide adequate staff to allow the delivery of evidence-based psychotherapy when it is clinically indicated for their patients.” The VHA’s intent is to ensure that veterans have the opportunity to learn about and access core EBPs for PTSD, depression, and serious mental illness. The handbook does not restrict clinicians to providing only these treatments. Other guidance4(p2,6) emphasizes that “the specific EBPs being nationally disseminated in VHA…do not represent all EBPs or potentially-appropriate treatment options for Veterans…it is encouraged that medical facilities have other appropriate EBPs and other psychotherapies and psychosocial treatments available in addition to the EBPs identified.”


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July 1, 2016
Barbara O. Rothbaum, PhD, ABPP
1Emory University, Psychiatry and Behavioral Sciences, Atlanta, Georgia
JAMA Psychiatry. 2016;73(7):756. doi:10.1001/jamapsychiatry.2016.0563.
July 1, 2016
Rachel Yehuda, PhD; Charles W. Hoge, MD
1James J. Peters Veterans Affairs Medical Center, Bronx, New York2Icahn School of Medicine at Mount Sinai, New York, New York
3Walter Reed Army Institute of Research, Silver Spring, Maryland
JAMA Psychiatry. 2016;73(7):758. doi:10.1001/jamapsychiatry.2016.0572.
July 1, 2016
Maria M. Steenkamp, PhD
1Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Brain Injury, New York University Langone School of Medicine, New York, New York2Department of Psychiatry, New York University, New York
JAMA Psychiatry. 2016;73(7):757-758. doi:10.1001/jamapsychiatry.2016.0573.
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