An investigation of Psychotherapists' clinical decision making for treatment of posttraumatic stress disorder

Research suggested that empirically-supported treatments (ESTs) and available treatment guidelines for posttraumatic stress disorder (PTSD) are underutilized. Evidence suggests that psychotherapists’ attitudes, training in empirically-supported treatments, years of clinical practice, and theoretical orientation influence their utilization more than established guidelines. Limited research investigated the clinical practices of psychotherapists who treat PTSD. In the present study, an attempt was made to investigate psychotherapists’ treatment practices for patients diagnosed with PTSD.

In addition, an attempt was made to determine how theoretical orientation, evidence-supported exposure-based training, and years of clinical training impacted treatment practices. The author-generated demographic and training information questionnaire, informed consent, vignettes, and trauma practices questionnaire (TPQ; Craig & Sprang, 2009) were administered through Psychdata, an online survey website and were distributed via email to program training directors and personal contacts.

One hundred and forty-three participants were included in the final data analysis. A repeated measures analysis of variance (ANOVA) revealed that psychotherapists rated eclectic therapy and cognitive therapy interventions highest for vignettes 1, 2, and 3. A one-way multivariate analysis of variance (MANOVA) revealed that psychotherapists who identified CBT as their primary theoretical orientation rated cognitive therapy higher than psychotherapists who identify with integrative, psychodynamic, or other theoretical orientations. Several one-way MANOVAs were conducted revealing that psychotherapists with no training in evidence-supported treatment (i.e., prolonged exposure [PE], cognitive processing therapy [CPT], or eye movement desensitization and reprocessing [EMDR]) did not rate eclectic therapy higher for vignette 1, 2, or 3. Results indicated that psychotherapists with training in PE or CPT rated cognitive or behavioral therapy interventions highest. Several one-way MANOVAs were conducted revealing that psychotherapists with high years (8-39) of clinical training did not rate eclectic therapy higher for vignette 1, 2, or 3.