Patient perspectives on the effectiveness of written exposure therapy and medication for posttraumatic stress disorder delivered in primary care

Providing posttraumatic stress disorder (PTSD) treatment in primary care is a key strategy for increasing treatment access. This qualitative descriptive study examined patients' perspectives on the effectiveness of written exposure therapy (WET) and antidepressant medications for PTSD delivered in primary care. We interviewed a purposive sample of adult patients with probable PTSD who participated in a pragmatic comparative effectiveness trial in federally qualified health center (FQHC) and Veterans Health Administration (VHA) primary care clinics. The interviews assessed changes experienced during treatment and aspects of treatment that were helpful or could be improved. We analyzed interview transcripts using inductive thematic analysis. Among trial participants who completed interviews (n = 65; FQHC: 46.2%, VHA: 53.8%), 41.5% received WET, 33.8% received medications, and 24.6% received both. Most interviewees reported experiencing positive changes during treatment (e.g., symptoms, habits/activities, empowerment), but some reported experiencing limited changes or negative changes. Interviewees described multiple aspects of WET and medication treatment as helpful (e.g., gaining an understanding of PTSD) and suggested possible improvements (e.g., more WET sessions, more opportunities to talk to clinicians). Some findings were specific to either WET or medications, but most were discussed in relation to both treatment types. The implementation of these treatments in primary care should involve strategies for primary care clinicians to efficiently educate patients about PTSD during both WET and medication treatment, shared decision-making tools that are appropriate for the primary care setting, and effective linkage to specialty mental health care for patients who desire more contact with clinicians.