Stephanie Y. Wells, Marcela C. Weber, Kathleen M. Grubbs, & Emily R. Wilhite
Trauma-focused psychotherapies improve posttraumatic stress disorder (PTSD) symptoms and are widely available in the Veterans Affairs Health Care System (VA). While Veterans with PTSD hope to improve their PTSD symptoms and functioning, many Veterans do not receive these treatments or discontinue them before they receive a full course of therapy. Shared decision making about treatment selection and psychoeducation about the selected treatment should involve discussing how each treatment offered pertains to patients’ goals to improve outcomes.
PTSD Treatment Models and Veteran Care Gaps
Trauma-focused psychotherapies improve posttraumatic stress disorder (PTSD) symptoms (Veterans Health Administration and Department of Defense, 2023) and are widely available in the Veterans Affairs Health Care System (VA). However, many Veterans do not receive these treatments (Maguen et al., 2020) or discontinue them before they receive a full course of therapy (Garcia et al., 2011; Steenkamp et al., 2015). Veterans who complete treatment experience greater reductions in PTSD symptoms (Myers et al., 2019) so it is vital to help as many Veterans with PTSD achieve their greatest potential outcomes. One way to help patients get the most out of their treatment is to ensure that PTSD treatments meet individual Veterans’ needs.
New Research
We asked Veterans enrolled in a PTSD treatment study to list their top three goals for trauma-focused treatment. We also asked them to rate how well they felt they could achieve each goal and how important each goal was for them. Participants included one-hundred and seventy five Veterans diagnosed with PTSD and willing to be randomized to receive prolonged exposure therapy across different telehealth or in-person formats. The authors then analyzed the Veterans’ responses to identify themes across Veterans’ stated goals.
Veterans' Identified Goals for PTSD Treatment
Veterans identified goals in three areas:
1) Improvements in PTSD Symptoms,
2) Personal well-being and growth, and
3) Improvements in social role and interpersonal functioning.
Veterans with PTSD hope to improve their PTSD symptoms and functioning during treatment.
Improvements in PTSD Symptoms
Veterans wanted to improve PTSD symptoms during treatment. This included a desire to improve overall sleep quality, have more helpful thinking patterns, feel fewer negative emotions and more positive emotions, feel less hypervigilant and aroused, have fewer unwanted memories, reminders of the trauma, or nightmares, and avoid trauma reminders less.
Personal Well-Being and Growth
Veterans stated that they wanted to improve their well-being and personal growth. Specifically, they wanted to engage in more leisure and have more fun. Veterans also wanted to advance in their education and careers, which included going to school, increasing their income, or starting business ventures.
Improvements in Interpersonal Functioning:
Veterans said that they wanted to improve their existing relationships with their partners, friends, and children. Veterans shared that wanted to make new friends or start a romantic relationship. They also wanted to be able to be more present and emotionally connected in their relationships, such as going to important events, doing activities together, and have stronger connections.
Goals spanned a variety of areas of life, including relationships, work, education, hobbies, and their PTSD symptoms. While Veterans rated their goals as highly important to them, they did not feel confident in their ability to achieve their goals prior to starting therapy. Our findings are similar to prior studies that have found Veterans not only want to improve their PTSD symptoms during PTSD treatment, but also their overall life (e.g., Desai et al., 2016 Rosen et al., 2013).
Clinical Implications
Current PTSD treatments, such as prolonged exposure therapy, can greatly improve PTSD symptoms and have some positive impact on helping Veterans function better in their lives. This study emphasizes the need to continue to improve how much PTSD treatments help Veterans meet their personal goals.
Clinicians should anticipate that most patients will have multiple goals, some of which may be achievable by the end of treatment, and others that may be long-term. Clinicians should collaborate with their patients to identify their specific recovery goals.
Shared decision making about treatment selection and psychoeducation about the selected treatment should involve discussing how each treatment offered pertains to patients’ goals. Clinicians could also assess for Veterans’ confidence in their ability to achieve their goals through treatment. Clinicians can help Veterans track changes in their PTSD and functioning during treatment to see how efforts are benefitting the areas most important to them. Clinicians can routinely check-in with patients about their perceived progress towards their goals.
Discussion Questions
- What might be some important considerations for Veterans and providers when helping Veterans identify goals before treatment?
- How might providers and/or clinics use these findings to inform measurement based care?
About the Authors
Stephanie Wells, PhD is a Clinical Research Psychologist at the Durham VA Health Care System, Core Investigator atDurham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Affiliate Faculty at the VA VISN 6 MIRECC, and a psychologist in the Durham VA Trauma Recovery Program. Her research broadly focuses on improving the effectiveness of and engagement in evidence-based psychotherapies (EBPs) for Veterans with posttraumatic stress disorder (PTSD). Her research has also examined the effectiveness of PTSD EBPs for commonly co-occurring issues, and she is interested in the use of mind-body interventions for PTSD.
Marcela (Marci) Weber, PhD is a clinical psychologist investigator at the Central Arkansas Veterans Healthcare System’s South Central Mental Illness Research, Education and Clinical Center and Center for Mental Healthcare and Outcomes Research. She is also an Assistant Professor in the Department of Psychiatry at the University of Arkansas for Medical Sciences. Her research focuses on patient-centered care, resilience, and Whole Health approaches to prevention and intervention for military service members and veterans exposed to psychological trauma, with an emphasis on rural, Hispanic/Latine, and other underserved populations.
Kathleen Grubbs, PhD is a clinical psychologist and researcher at the Central Arkansas VA Healthcare System (CAVHS) and South Central MIRECC. She is also affiliate faculty of the UAMS Center for Health Services Research. Her research focus is evaluating innovative strategies to improve access to and engagement in care for Veterans with PTSD. Her prior work includes several randomized control trials evaluating telehealth for delivery of Prolonged Exposure and Cognitive Behavioral Conjoint Therapy. Dr. Grubbs is also interested in finding ways to optimize treatment decision-making both before starting and after completing an evidence-based psychotherapy.
Emily Wilhite, PhD is a clinical psychologist at the VA San Diego Healthcare System and a Health Sciences Assistant Clinical Professor in the Department of Psychiatry at the University of California San Diego. Dr. Wilhite works in the Alcohol Drug Treatment Program (ADTP) and Dual Diagnosis Recovery Program (DDRP) where she provides group and individual EBPs for Veterans with substance use disorders (SUD) and comorbid diagnoses and serves as the PTSD/SUD specialist. She has collaborated on research projects for Veterans with posttraumatic stress disorder (PTSD), SUD, and insomnia.
Reference Article
Wells, S. Y., Wilhite, E. R., Weber, M. C., Blakey, S. M., Callaway, C., Kehle‐Forbes, S., ... & Grubbs, K. M. (2025). Beyond symptom reduction: Veterans’ goals for posttraumatic stress disorder treatment. Journal of Traumatic Stress. Advance online publication. https://doi.org/10.1002/jts.23121
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