Implementation of Prolonged Exposure in the Military

This study will examine how evidence-based therapies (EBTs) such as Prolonged Exposure (PE)
for posttraumatic stress disorder (PTSD) can be successfully disseminated and implemented in
the Army by comparing two PE training models: Standard PE training (workshop only) and
Extended PE training (workshop plus consultation). Up to 180 mental health providers at three
medium-to large Army installations will be randomly assigned to either Standard PE training
or Extended PE training. All providers will complete a 4-day PE workshop, along with the
distribution of training materials and treatment manuals, conducted at the military site by
the Overall Study PI, Dr. Edna Foa, and her team. Following the 4-day workshop, participants
randomized to the Extended PE training will receive weekly phone consultation with a PE
expert on two PE therapy cases. Participants randomized to the Standard PE training group
will not receive any additional consultation following the workshop. Providers will not be
required to use PE therapy with their patients with PTS symptoms; using PE will be optional.
A major outcome of this study is the proportion of the providers PTSD patients that are
offered PE or PE components. The mental health outcomes of providers' PTS patients will also
be monitored as a second major outcome. Patients seeking treatment from participating
providers will be recruited, consented, and assessed by independent evaluators at two time
points to prospectively assess their response to treatment.

Inclusion Criteria:

- FOR PROVIDERS: 1) Male and female behavioral health providers whose job duties include
providing psychotherapy to adult patients, age ≥ 18,seeking treatment with symptoms of
PTS. Behavioral health providers can include psychologists, social workers,
psychiatric clinical nurse specialists, psychiatrists, and similarly trained
professional providers.2) Twenty percent (or more) of expected caseload comprised of
patients with PTS symptoms according to provider self-report.

- FOR PATIENTS: 1) Male and female patients age ≥ 18. 2) Receiving treatment from one of
the behavioral health providers participating in this study. 3) Significant PTS
symptoms as determined by a score of 25 or higher on The Clinician-Administered PTSD
Scale for DSM-5 (CAPS-5).

Exclusion Criteria:

- FOR PROVIDERS: 1) Definite plans to terminate their position or relocate from the Army
base at some point during the first year following training. 2) Extensive previous
training in Prolonged Exposure (PE), defined as participation in a 4-day PE training
workshop at any point prior to the start of the study, and self-reported use of PE
(including both imaginal and in vivo exposure techniques) to treat 4 or more patients
with PTS symptoms in the past year.

- FOR PATIENTS: 1) Current bipolar disorder I or psychotic disorder (as determined by
the MINI). 2) Evidence of a moderate or severe traumatic brain injury (as determined
by the inability to comprehend the baseline screening questionnaires). 3) Current
suicidal ideation severe enough to warrant immediate attention (as determined by the
MINI and the Beck Scale for Suicidal Ideation).