Table 2.

VA PTSD Residential Treatment Provider Decision-Making for Choosing Prolonged Exposure and Cognitive Processing

What is the type and nature of index trauma and trauma memory?

PE: single incident trauma; memory for event is intact

CPT: more than one trauma; memory for event(s) may be limited

What are the primary symptoms for the patient?

PE: avoidance and hyperarousal symptoms; fear reactions

CPT: dissociative symptoms; guilt and self-blame reactions; moral injuries

What is the patient’s cognitive or personality type?

PE: those who intellectualize; those who are resistant to challenging beliefs

CPT: those who are insightful and “psychologically-minded”

Has the patient received a course of either CPT or PE before?

PE/CPT: If patient has unresolved symptoms after one course of treatment, may want to offer the alternative treatment modality

After providing psychoeducation about both treatments, which does the patient prefer?

PE/CPT: May want to defer to patient’s choice due to “buy in”

What is the patient’s problem and what are their goals?

PE/CPT: Choose the EBP most in line with conceptualization of patient’s problem and the patient’s goals

Note. This decision-tool is based solely on real-world provider responses to a semi-structured interview and is not necessarily supported by randomized control trials or dismantling studies.