5 - (OP23) Which Psychotherapies Are Used to Treat PTSD? A Survey of US Mental Health Providers

Background: Understanding psychotherapy practices for PTSD, including evidence-based psychotherapy (EBP) implementation, is essential for improving mental healthcare quality. However, which psychotherapies providers use to treat PTSD is largely unknown. In 2004, Becker et al. reported lower use and more negative perceptions of exposure therapy for PTSD among community psychologists compared to "behaviorally trained" psychologists in the Association for Cognitive and Behavioral Therapies (ABCT). Since then, a few studies have estimated the use of specific PTSD EBPs (e.g., Kline et al., 2021), but more comprehensive data on treatment practices for PTSD in the community is lacking. This study aimed to replicate and expand Becker et al. (2004) by examining the use of a wide range of PTSD treatments and perceptions of EBPs among psychologists, clinical social workers, counselors, and ABCT members.

Method: Potential participants were emailed a unique link to an online survey and offered a $20 electronic gift card as compensation. Mental health providers who regularly treat PTSD (N = 688) were sampled from U.S. state licensing boards for psychologists (n = 242), clinical social workers (LCSWs) (n = 186), professional counseling (LPCs) (n = 176), and from ABCT (n = 84). T-tests were used to compare groups.

Results: Nearly half the sample (48.8%) reported cognitive behavioral as their primary theoretical orientation (22.7% endorsed eclectic) and most respondents (60%) worked in private practice. The treatments most often used regularly were cognitive behavioral therapy (CBT) (55.2%), mindfulness approaches (37.7%), cognitive processing therapy (CPT) (15.1%), eye movement desensitization and reprocessing (EMDR) (15%), acceptance and commitment therapy (13.6%), supportive therapy (13.1%), and prolonged exposure (PE)(12.5%). Replicating Becker et al. (2004), ABCT members were more likely to use PE than general sample psychologists (p = .001) and all other respondents (p < .001). ABCT members were also more likely to use CPT (p < .001) and less likely to use EMDR (p < .001) compared to other respondents. EBP use across provider types showed the highest use of PE and CPT among ABCT members, followed by psychologists, then LCSWs, and lowest among LPCs. For EMDR, this pattern was reversed: use was highest among LPCs, then LCSWs, then psychologists, and lowest among ABCT members. Among those trained in the respective interventions, ABCT members reported significantly fewer perceived contraindications to delivering CPT and PE than other respondents. There were no differences in perceived contraindications for EMDR.

Conclusions: Half the sample used CBT regularly, whereas only one in seven providers reported regular use of either PE, CPT, or EMDR. ABCT members reported higher use and more positive perceptions of PE and CPT compared to other providers, suggesting that organizations dedicated to evidence-based cognitive and behavioral therapies may support EBP use through training opportunities and shared community. In contrast, use of EMDR, a non-CBT EBP, was lower among ABCT members. These findings underscore the importance of considering provider type and professional organization membership when examining PTSD treatment implementation.