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Comment & Response
July 2016

Treatment Options for Veterans With Posttraumatic Stress Disorder—Reply

Author Affiliations
  • 1James J. Peters Veterans Affairs Medical Center, Bronx, New York
  • 2Icahn 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

In Reply We are all on the same team working to optimize care for service members and veterans with posttraumatic stress disorder (PTSD). We all understand that clinical practice guidelines support a wide range of evidence-based treatment options, including prolonged exposure (PE) and cognitive processing therapy (CPT), and that clinical judgment and patient preferences are paramount. Nonetheless, Veterans Health Administration (VHA) and Department of Defense clinicians are continually besieged with admonishments, such as those in the 2014 Institute of Medicine report, that they must preferentially use PE or CPT. Indeed, when Institute of Medicine committee members visited one of the author’s (R.Y.) facilities, presumably to understand best practices, it was suggested that not offering PE for PTSD is like not offering insulin for diabetes. This devalues other well-validated treatments and undermines ongoing efforts incorporating patient-centered goals, recovery-oriented models, and collaborative interventions.1,2 The VHA Uniform Mental Health Services and Local Implementation handbooks identify PE and CPT as the only “specific” and “standard-of-care” evidence-based PTSD treatments that veterans must have access to in VHA facilities. Although these policies do not technically prohibit other psychotherapies, they effectively do so. There is potential for great harm (clinically, ethically, and legally) when health policies define standards of care inconsistent with clinical realities and guidelines.

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