Program Evaluation
The program is committed to evaluating the success of the treatments provided. The program will provide a unique opportunity for continually evaluating the success of this unique program. Outcome data analysis and program evaluation will result in refinements of the program over time.
Information on the level of client symptoms and functioning level with be assessed at the outset of the program and then compared to data at the conclusion of the program and also at a follow up period.
Initial data from the first group of participants is impressive. Very strong gains in PTSD and depression symptom resolution were found (see below). Client satisfaction was also very strong (see What People Say).
Information on the level of client symptoms and functioning level with be assessed at the outset of the program and then compared to data at the conclusion of the program and also at a follow up period.
Initial data from the first group of participants is impressive. Very strong gains in PTSD and depression symptom resolution were found (see below). Client satisfaction was also very strong (see What People Say).
Beck Depression-2 (severity of depression inventory)
pre-test: 26.7
post-test: 11.3
PTSD Checklist (PCL-5)
pre-test: 46.3
post-test: 23.7
NSESSS (Severity of Post-traumatic Stress Symptoms)
pre-test: 2.9
post-test: 1.1
(3=severe) (1=mild)
Target Complaints
post-test: 4.8
(5=a lot better)
pre-test: 26.7
post-test: 11.3
PTSD Checklist (PCL-5)
pre-test: 46.3
post-test: 23.7
NSESSS (Severity of Post-traumatic Stress Symptoms)
pre-test: 2.9
post-test: 1.1
(3=severe) (1=mild)
Target Complaints
post-test: 4.8
(5=a lot better)
Research on Instruments Utilized and Relevance for OSR Program Outcome Measures
PCL-5
Wortmann et al., (2016) investigated the psychometric properties of PCL-5 scores in a
large cohort of military service members seeking PTSD treatment. The PCL-5 scores exhibited
high internal consistency. The PCL-5’s sensitivity to clinical change, pre- to post treatment, was
comparable with that of the PSS-I. The results indicate that the PCL-5 is a psychometrically
sound measure of DSM–5 PTSD symptoms that is useful for identifying provisional PTSD
diagnostic status, quantifying PTSD symptom severity, and detecting clinical change over time
in PTSD symptoms among service members seeking treatment. (PsycInfo Database Record (c)
2020 APA, all rights reserved).
Using the PCL-5 scale, Wortmann et al., (2016) found that participants at baseline
averaged a score of 74, and a score of 24.1 at follow up (having a significance/cut off score of
33). They found that the PCL-5 overall severity and subscale scores demonstrated high internal
consistency at baseline and follow-up, with Cronbach’s alpha values ranging from .75 at baseline
to .95 for the overall scale at follow-up.
Wortmann, J. H., Jordan, A. H., Weathers, F. W., Resick, P. A., Dondanville, K. A., Hall-Clark,
B., Foa, E. B., Young-McCaughan, S., Yarvis, J. S., Hembree, E. A., Mintz, J., Peterson, A. L.,
& Litz, B. T. (2016). Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-
seeking military service members. Psychological Assessment, 28(11), 1392–1403.
https://doi.org/10.1037/pas0000260
Bovin et al., (2016) evaluated the psychometric properties of PCL-5 scores in two
independent samples of veterans who were receiving care at a VA Medical Center. The
researchers found the test-retest reliability to be very strong (r = .86). They found that the PCL-5
is psychometrically sound and, with the establishment of a valid cut off score, well-suited for
assessing PTSD diagnostic status and symptom severity in veterans. Consistent with their
hypotheses, PCL-5 scores had excellent internal consistency.
Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P.
P., & Keane, T. M. (2016). Psychometric properties of the PTSD Checklist for Diagnostic and
Statistical Manual of Mental Disorders–Fifth Edition (PCL-5) in veterans. Psychological
Assessment, 28(11), 1379–1391. https://doi.org/10.1037/pas0000254
DAS-32
Spanier (1976) reported an appropriate level of internal consistency for the whole scale
(Cronbach’s alpha = 0.96) and each of the individual subscales (Cronbach’s alpha: Dyadic
Consensus = 0.90, Dyadic Satisfaction = 0.94, Dyadic Cohesion = 0.86, Affective Expression =
0.73). This study was based on a sample of 218 white married participants and 94 divorced
participants. In a meta-analysis conducted by Graham et al. (2006) that included 128 samples
represented by 25,035 participants, Cronbach’s alpha for the whole scale was 0.92 and the
individual subscales ranged between 0.71 and 0.87.
Based on a study by Carey et al. (1993) which assessed 158 men and women who
completed the DAS twice two weeks apart, the stability coefficient varied between 0.75
(Affective Expression subscale) to 0.87 (Total score). The analysis was conducted using the
Pearson product-moment correlation coefficients.
According to the developers, who examined the DAS-32 against the Marital Adjustment Scale
(MAT), the DAS-32 showed a sufficient level of construct validity. The Pearson’s correlation
coefficient between these two measures was 0.86, (p < 0.001) among married respondents and
0.88 (p < 0.001) among divorced participants (Spanier, 1976). This study was based on a sample
of 218 white married participants and 94 divorced participants. The DAS-32 is often used as a
gold standard to test the validity of new relationship quality measures.
Johnson and Greenberg (1985) also reported that the DAS-32 was sensitive to change
over time from pre-test to an eight-week post-test (DAS-32: Mean Score increased from 93.9
pre-treatment to 103.9 post-treatment showing significant improvement (p < 0.01)). The design
of this evaluation was a one-group pre/post- test conducted in Canada on the Emotionally
Focused Therapy programme designed to increase couple’s awareness of eachother’s needs and
more articulately communicate them.
This measure is high in brevity as it can be completed in 5-10 minutes.
Total DAS scores have been consistently shown to discriminate between distressed and non-
distressed couples and have been shown to identify couples with a high likelihood of divorce.
GAD-7
The use of GAD-7 across various anxiety disorders is warranted as GAD is an anxiety
disorder with a high degree of comorbidity (Kessler et al., 2012). Further, the main feature of
GAD is worry, which is a process that is found across psychological disorders and is therefore
transdiagnostic (Harvey et al., 2004).
Psychometric evaluations of the GAD-7 suggest that it is a reliable and valid measure of
GAD symptoms in the psychiatric (Kertz et al., 2013; Rutter and Brown, 2017) and general
population (Lowe et al., 2008; Hinz et al., 2017) samples. The GAD-7 has demonstrated good
psychometric properties, including sensitivity and specificity for diagnosing GAD (Spitzer et al.,
2006).
In the study by Spitzer et al., (2006), 965 patients underwent diagnostic interviews to
determine the presence of GAD-diagnosis. The optimal balance between sensitivity and
specificity for the GAD-diagnosis was found to be a cut-off point of >10. Most patients (89%)
with GAD had scores of 10 or greater, whereas most patients (82%) without GAD had scores
less than 10.
Johnson et al., (2019) state that above a threshold of 10, the GAD-7 has a sensitivity of
89% and specificity of 82%. The GAD-7 also has strong psychometric properties when screening
for 3 other anxiety disorders: panic disorder (sensitivity 74%, specificity 81%), social anxiety
disorder (sensitivity 72%, specificity 80%), and post-traumatic stress disorder (sensitivity 66%,
specificity 81%).
The GAD 7 should be used to establish the presence of anxiety disorders using self
reported symptoms experienced in the 2 weeks prior to the assessment. The effectiveness of the
GAD 7 has been proven in outpatient settings. It should not be used to determine historical
symptoms, acute psychosis, depression or suicidal symptoms. It can be used as a diagnostic tool
alongside professional clinical assessment. It may be used to help medical professionals
categorise anxious symptoms, or to deduce the pathway of treatment required for an individual.
The GAD 7 is a widely used, well-validated and highly useful clinical measure of anxiety
disorder symptoms. It has been validated for use in primary care and for use with the general
population. It is favoured due to its brevity and excellence in predicting and grading anxiety
related disorders.
In the study by Johnson et al., (2019), both outpatients and inpatients undergoing
treatment for extreme anxiety completed the GAD-7 at pre-and post-treatment. Measures of
depression, well-being, and other anxiety measures were also completed, making it possible to
investigate convergent and divergent validity. Data was taken from 9 clinics. The alpha for GAD
was α= 0.88 at the start of therapy for the total sample and ranged from 0.83 to α= 0.93 across
units and pre- and post-treatment. The GAD-7 demonstrated good internal consistency and
convergent validity as hypothesized. The alphas were all above 0.82 at intake and post-treatment,
and correlations were large with other measures of anxiety and well-being, indicating high
reliability and validity. The correlations found in this study, ranging from r= 0.70 for anxiety
disorders and from r= 0.62 for related construct are comparable to other studies (Spitzer et al.,
2006; Löwe et al., 2008). Thus, the GAD-7 demonstrated convergent validity. Furthermore,
GAD-7 discriminates well between an anxious and a more general psychiatric population
indicating discriminant validity.
Johnson, Sverre & Ulvenes, Pål & Oktedalen, Tuva & Hoffart, Asle. (2019). Psychometric
Properties of the General Anxiety Disorder 7-Item (GAD-7) Scale in a Heterogeneous
Psychiatric Sample. Frontiers in Psychology. 10. 10.3389/fpsyg.2019.01713.
BECK-2
Current treatment guidelines for posttraumatic stress disorder (PTSD) recognize that
severe depression may limit the effectiveness of trauma-focused interventions, making it
necessary to address depression symptomatology first. Posttraumatic stress disorder has also
been found to be comorbid with depression. Therefore, it is important to look for potential
depression in patients coming for treatment with PTSD.
Wang et al., (2013) conducted a metanalysis to analyze the psychometric properties of
the Beck Depression Inventory-ll as a self-report measure of depression in a variety of settings
and populations. The internal consistency was described as around 0.9 and the retest reliability
ranged from 0.73 to 0.96. The correlation between BDI-II and the Beck Depression Inventory
(BDI-I) was high and substantial overlap with measures of depression and anxiety was reported.
The criterion-based validity showed good sensitivity and specificity for detecting depression in
comparison to the adopted gold standard. The BDI-II is a relevant psychometric instrument,
showing high reliability, capacity to discriminate between depressed and non-depressed subjects,
and improved concurrent, content, and structural validity. Based on available psychometric
evidence, the BDI-II can be viewed as a cost-effective questionnaire for measuring the severity
of depression, with broad applicability for research and clinical practice worldwide.
Wang, Y.-P., & Gorenstein, C. (2013). Psychometric properties of the Beck Depression
Inventory-II: A comprehensive review. Revista Brasileira de Psiquiatria, 35(4), 416–431.
https://doi.org/10.1590/1516-4446-2012-1048
The study conducted by Bryant et al., (2005) found the BDI-ll to be sensitive to
intervention effects in randomized trials with individuals diagnosed with PTSD. Prior to
treatment, participants averaged a score of 17.75 on the BDI-II scale. Post treatment, patients
averaged 8.50. Bryant et al., (2005) found the scale had great detectability and specificity.
What is reasonable to expect in a 20-day treatment
A recent meta-analysis suggested that approximately 23% of Operation Enduring Freedom and
Operation Iraqi Freedom veterans suffer from posttraumatic stress disorder (PTSD; Fulton et al.,
2015). Although evidence-based treatments (EBTs), such as cognitive processing therapy (CPT),
have been shown to be effective for the treatment of PTSD in veterans, only a relatively small
number of veterans receive these treatments. Although research has shown that providers are
likely to offer EBTs as first-choice interventions when they are trained in them (Hundt, Harik,
Barrera, Cully, & Stanley, 2016), data from outpatient settings in the Department of Veterans
Affairs (VA) report the national average for EBT penetration to be around 20% (Sayer et al.,
2017). Other studies have suggested that between 6.3% and 11.4% of veterans seen in VA clinics
receive EBTs (Mott et al., 2014; Shiner, Drake, Watts, Desai, & Schnurr, 2012). However,
research suggests that even among those who initiate treatment, the majority of individuals
receiving cognitive– behavioral interventions for PTSD discontinue treatment prior to receiving
an adequate dose, which has been defined as eight or more sessions. Thus, it is important to
identify alternative methods to deliver EBTs to improve treatment uptake and completion.
One alternative is to deliver EBTs in intensive treatment programs (ITPs). Through ITPs,
veterans have the opportunity to receive EBTs in a shorter amount of time (i.e., 2 to 3 weeks)
compared to outpatient care where EBTs are commonly delivered once per week over several
months. Recent research has demonstrated that ITPs can produce similar PTSD symptom
reductions to those obtained in relatively highly controlled EBT efficacy trials with weekly
therapy sessions (Beidel et al., 2017; Foa et al., 2018; Zalta et al., 2018).
Brief ITPs may reduce barriers to treatment that have been identified both in standard outpatient
settings and in longer-term residential programs, including avoidance, and practical barriers, including
employment and transportation (Hundt et al., 2014; Johnson et al., 2016; Keller & Tuerk, 2016). Housing
veterans at the treatment facility during the course of an ITP may reduce logistical concerns that
are often raised as reasons for not initiating EBTs (Keller & Tuerk, 2016) and may increase
veterans’ ability to focus on treatment by reducing psychosocial stressors as well as reducing
opportunities for avoidance and missed treatment sessions.
Similar to longer-term residential programs, ITPs also provide an opportunity to offer adjunctive treatments
that may improve retention, such as mindfulness, yoga, and skills groups (Cushing & Braun, 2018; Staples,
Hamilton, & Uddo, 2013). Compared to longer term residential treatment programs, which often
span over the course of several weeks (i.e., 4 –12 weeks; Cook et al., 2013), participating in a
brief ITP for 3–4 weeks may be more feasible for veterans, as there is less potential for conflict
with other responsibilities, such as family duties or work schedules. Moreover, the short
timeframe may seem less daunting for veterans compared to longer-term residential programs or
weekly therapy for several weeks and may provide veterans with a sense of being able to
accomplish treatment relatively quickly, which in turn may reduce treatment avoidance.
PCL-5
Wortmann et al., (2016) investigated the psychometric properties of PCL-5 scores in a
large cohort of military service members seeking PTSD treatment. The PCL-5 scores exhibited
high internal consistency. The PCL-5’s sensitivity to clinical change, pre- to post treatment, was
comparable with that of the PSS-I. The results indicate that the PCL-5 is a psychometrically
sound measure of DSM–5 PTSD symptoms that is useful for identifying provisional PTSD
diagnostic status, quantifying PTSD symptom severity, and detecting clinical change over time
in PTSD symptoms among service members seeking treatment. (PsycInfo Database Record (c)
2020 APA, all rights reserved).
Using the PCL-5 scale, Wortmann et al., (2016) found that participants at baseline
averaged a score of 74, and a score of 24.1 at follow up (having a significance/cut off score of
33). They found that the PCL-5 overall severity and subscale scores demonstrated high internal
consistency at baseline and follow-up, with Cronbach’s alpha values ranging from .75 at baseline
to .95 for the overall scale at follow-up.
Wortmann, J. H., Jordan, A. H., Weathers, F. W., Resick, P. A., Dondanville, K. A., Hall-Clark,
B., Foa, E. B., Young-McCaughan, S., Yarvis, J. S., Hembree, E. A., Mintz, J., Peterson, A. L.,
& Litz, B. T. (2016). Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-
seeking military service members. Psychological Assessment, 28(11), 1392–1403.
https://doi.org/10.1037/pas0000260
Bovin et al., (2016) evaluated the psychometric properties of PCL-5 scores in two
independent samples of veterans who were receiving care at a VA Medical Center. The
researchers found the test-retest reliability to be very strong (r = .86). They found that the PCL-5
is psychometrically sound and, with the establishment of a valid cut off score, well-suited for
assessing PTSD diagnostic status and symptom severity in veterans. Consistent with their
hypotheses, PCL-5 scores had excellent internal consistency.
Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P.
P., & Keane, T. M. (2016). Psychometric properties of the PTSD Checklist for Diagnostic and
Statistical Manual of Mental Disorders–Fifth Edition (PCL-5) in veterans. Psychological
Assessment, 28(11), 1379–1391. https://doi.org/10.1037/pas0000254
DAS-32
Spanier (1976) reported an appropriate level of internal consistency for the whole scale
(Cronbach’s alpha = 0.96) and each of the individual subscales (Cronbach’s alpha: Dyadic
Consensus = 0.90, Dyadic Satisfaction = 0.94, Dyadic Cohesion = 0.86, Affective Expression =
0.73). This study was based on a sample of 218 white married participants and 94 divorced
participants. In a meta-analysis conducted by Graham et al. (2006) that included 128 samples
represented by 25,035 participants, Cronbach’s alpha for the whole scale was 0.92 and the
individual subscales ranged between 0.71 and 0.87.
Based on a study by Carey et al. (1993) which assessed 158 men and women who
completed the DAS twice two weeks apart, the stability coefficient varied between 0.75
(Affective Expression subscale) to 0.87 (Total score). The analysis was conducted using the
Pearson product-moment correlation coefficients.
According to the developers, who examined the DAS-32 against the Marital Adjustment Scale
(MAT), the DAS-32 showed a sufficient level of construct validity. The Pearson’s correlation
coefficient between these two measures was 0.86, (p < 0.001) among married respondents and
0.88 (p < 0.001) among divorced participants (Spanier, 1976). This study was based on a sample
of 218 white married participants and 94 divorced participants. The DAS-32 is often used as a
gold standard to test the validity of new relationship quality measures.
Johnson and Greenberg (1985) also reported that the DAS-32 was sensitive to change
over time from pre-test to an eight-week post-test (DAS-32: Mean Score increased from 93.9
pre-treatment to 103.9 post-treatment showing significant improvement (p < 0.01)). The design
of this evaluation was a one-group pre/post- test conducted in Canada on the Emotionally
Focused Therapy programme designed to increase couple’s awareness of eachother’s needs and
more articulately communicate them.
This measure is high in brevity as it can be completed in 5-10 minutes.
Total DAS scores have been consistently shown to discriminate between distressed and non-
distressed couples and have been shown to identify couples with a high likelihood of divorce.
GAD-7
The use of GAD-7 across various anxiety disorders is warranted as GAD is an anxiety
disorder with a high degree of comorbidity (Kessler et al., 2012). Further, the main feature of
GAD is worry, which is a process that is found across psychological disorders and is therefore
transdiagnostic (Harvey et al., 2004).
Psychometric evaluations of the GAD-7 suggest that it is a reliable and valid measure of
GAD symptoms in the psychiatric (Kertz et al., 2013; Rutter and Brown, 2017) and general
population (Lowe et al., 2008; Hinz et al., 2017) samples. The GAD-7 has demonstrated good
psychometric properties, including sensitivity and specificity for diagnosing GAD (Spitzer et al.,
2006).
In the study by Spitzer et al., (2006), 965 patients underwent diagnostic interviews to
determine the presence of GAD-diagnosis. The optimal balance between sensitivity and
specificity for the GAD-diagnosis was found to be a cut-off point of >10. Most patients (89%)
with GAD had scores of 10 or greater, whereas most patients (82%) without GAD had scores
less than 10.
Johnson et al., (2019) state that above a threshold of 10, the GAD-7 has a sensitivity of
89% and specificity of 82%. The GAD-7 also has strong psychometric properties when screening
for 3 other anxiety disorders: panic disorder (sensitivity 74%, specificity 81%), social anxiety
disorder (sensitivity 72%, specificity 80%), and post-traumatic stress disorder (sensitivity 66%,
specificity 81%).
The GAD 7 should be used to establish the presence of anxiety disorders using self
reported symptoms experienced in the 2 weeks prior to the assessment. The effectiveness of the
GAD 7 has been proven in outpatient settings. It should not be used to determine historical
symptoms, acute psychosis, depression or suicidal symptoms. It can be used as a diagnostic tool
alongside professional clinical assessment. It may be used to help medical professionals
categorise anxious symptoms, or to deduce the pathway of treatment required for an individual.
The GAD 7 is a widely used, well-validated and highly useful clinical measure of anxiety
disorder symptoms. It has been validated for use in primary care and for use with the general
population. It is favoured due to its brevity and excellence in predicting and grading anxiety
related disorders.
In the study by Johnson et al., (2019), both outpatients and inpatients undergoing
treatment for extreme anxiety completed the GAD-7 at pre-and post-treatment. Measures of
depression, well-being, and other anxiety measures were also completed, making it possible to
investigate convergent and divergent validity. Data was taken from 9 clinics. The alpha for GAD
was α= 0.88 at the start of therapy for the total sample and ranged from 0.83 to α= 0.93 across
units and pre- and post-treatment. The GAD-7 demonstrated good internal consistency and
convergent validity as hypothesized. The alphas were all above 0.82 at intake and post-treatment,
and correlations were large with other measures of anxiety and well-being, indicating high
reliability and validity. The correlations found in this study, ranging from r= 0.70 for anxiety
disorders and from r= 0.62 for related construct are comparable to other studies (Spitzer et al.,
2006; Löwe et al., 2008). Thus, the GAD-7 demonstrated convergent validity. Furthermore,
GAD-7 discriminates well between an anxious and a more general psychiatric population
indicating discriminant validity.
Johnson, Sverre & Ulvenes, Pål & Oktedalen, Tuva & Hoffart, Asle. (2019). Psychometric
Properties of the General Anxiety Disorder 7-Item (GAD-7) Scale in a Heterogeneous
Psychiatric Sample. Frontiers in Psychology. 10. 10.3389/fpsyg.2019.01713.
BECK-2
Current treatment guidelines for posttraumatic stress disorder (PTSD) recognize that
severe depression may limit the effectiveness of trauma-focused interventions, making it
necessary to address depression symptomatology first. Posttraumatic stress disorder has also
been found to be comorbid with depression. Therefore, it is important to look for potential
depression in patients coming for treatment with PTSD.
Wang et al., (2013) conducted a metanalysis to analyze the psychometric properties of
the Beck Depression Inventory-ll as a self-report measure of depression in a variety of settings
and populations. The internal consistency was described as around 0.9 and the retest reliability
ranged from 0.73 to 0.96. The correlation between BDI-II and the Beck Depression Inventory
(BDI-I) was high and substantial overlap with measures of depression and anxiety was reported.
The criterion-based validity showed good sensitivity and specificity for detecting depression in
comparison to the adopted gold standard. The BDI-II is a relevant psychometric instrument,
showing high reliability, capacity to discriminate between depressed and non-depressed subjects,
and improved concurrent, content, and structural validity. Based on available psychometric
evidence, the BDI-II can be viewed as a cost-effective questionnaire for measuring the severity
of depression, with broad applicability for research and clinical practice worldwide.
Wang, Y.-P., & Gorenstein, C. (2013). Psychometric properties of the Beck Depression
Inventory-II: A comprehensive review. Revista Brasileira de Psiquiatria, 35(4), 416–431.
https://doi.org/10.1590/1516-4446-2012-1048
The study conducted by Bryant et al., (2005) found the BDI-ll to be sensitive to
intervention effects in randomized trials with individuals diagnosed with PTSD. Prior to
treatment, participants averaged a score of 17.75 on the BDI-II scale. Post treatment, patients
averaged 8.50. Bryant et al., (2005) found the scale had great detectability and specificity.
What is reasonable to expect in a 20-day treatment
A recent meta-analysis suggested that approximately 23% of Operation Enduring Freedom and
Operation Iraqi Freedom veterans suffer from posttraumatic stress disorder (PTSD; Fulton et al.,
2015). Although evidence-based treatments (EBTs), such as cognitive processing therapy (CPT),
have been shown to be effective for the treatment of PTSD in veterans, only a relatively small
number of veterans receive these treatments. Although research has shown that providers are
likely to offer EBTs as first-choice interventions when they are trained in them (Hundt, Harik,
Barrera, Cully, & Stanley, 2016), data from outpatient settings in the Department of Veterans
Affairs (VA) report the national average for EBT penetration to be around 20% (Sayer et al.,
2017). Other studies have suggested that between 6.3% and 11.4% of veterans seen in VA clinics
receive EBTs (Mott et al., 2014; Shiner, Drake, Watts, Desai, & Schnurr, 2012). However,
research suggests that even among those who initiate treatment, the majority of individuals
receiving cognitive– behavioral interventions for PTSD discontinue treatment prior to receiving
an adequate dose, which has been defined as eight or more sessions. Thus, it is important to
identify alternative methods to deliver EBTs to improve treatment uptake and completion.
One alternative is to deliver EBTs in intensive treatment programs (ITPs). Through ITPs,
veterans have the opportunity to receive EBTs in a shorter amount of time (i.e., 2 to 3 weeks)
compared to outpatient care where EBTs are commonly delivered once per week over several
months. Recent research has demonstrated that ITPs can produce similar PTSD symptom
reductions to those obtained in relatively highly controlled EBT efficacy trials with weekly
therapy sessions (Beidel et al., 2017; Foa et al., 2018; Zalta et al., 2018).
Brief ITPs may reduce barriers to treatment that have been identified both in standard outpatient
settings and in longer-term residential programs, including avoidance, and practical barriers, including
employment and transportation (Hundt et al., 2014; Johnson et al., 2016; Keller & Tuerk, 2016). Housing
veterans at the treatment facility during the course of an ITP may reduce logistical concerns that
are often raised as reasons for not initiating EBTs (Keller & Tuerk, 2016) and may increase
veterans’ ability to focus on treatment by reducing psychosocial stressors as well as reducing
opportunities for avoidance and missed treatment sessions.
Similar to longer-term residential programs, ITPs also provide an opportunity to offer adjunctive treatments
that may improve retention, such as mindfulness, yoga, and skills groups (Cushing & Braun, 2018; Staples,
Hamilton, & Uddo, 2013). Compared to longer term residential treatment programs, which often
span over the course of several weeks (i.e., 4 –12 weeks; Cook et al., 2013), participating in a
brief ITP for 3–4 weeks may be more feasible for veterans, as there is less potential for conflict
with other responsibilities, such as family duties or work schedules. Moreover, the short
timeframe may seem less daunting for veterans compared to longer-term residential programs or
weekly therapy for several weeks and may provide veterans with a sense of being able to
accomplish treatment relatively quickly, which in turn may reduce treatment avoidance.