“Beyond Symptom Reduction”: Veteran-Centric Trauma-Focused PTSD Treatment

Veterans’ Perspectives highlights research conducted by HSR and/or QUERI investigators, showcasing the importance of research for Veterans – and the importance of Veterans for research.

In the September - October 2025 Issue:

• Introduction: Trauma-focused psychotherapies have been shown to improve symptoms of post-traumatic stress disorder (PTSD) among Veterans. However, many Veterans with PTSD still do not access or complete these treatments. Better understanding Veterans' goals for PTSD treatment could support patient-centered care.
• The Research: As a first step toward understanding Veterans' goals for PTSD treatment, the research team asked 175 Veterans, each of them seeking trauma-focused psychotherapy through a randomized controlled trial, to list their top three goals for treatment. The Veterans also rated how important each goal was and how confident they were in their ability to achieve each goal.
• Findings: Veterans identified goals across three main areas: (1) improvements in PTSD symptoms, (2) personal well-being and growth, and (3) improvements in social roles and interpersonal functioning.
• Implications: The findings highlight several important implications for Veteran-centric clinical practice and suggest areas for further research.

Introduction

Trauma-focused psychotherapies, such as prolonged exposure (PE) and Cognitive Processing Therapy (CPT), have been shown to improve post-traumatic stress disorder (PTSD) symptoms, and are widely available in VA. However, many Veterans don’t receive these treatments, and a considerable percentage discontinue them before completing a full course of treatment. A better understanding of Veterans’ specific treatment goals may guide learning and shared decision making about which intervention to select and potentially improve Veterans’ interest in continuing trauma-focused treatments.

The Research

The study analyzed data from a randomized controlled trial of 175 Veterans who received prolonged exposure therapy through three delivery modalities: home-based telehealth, office-based telehealth, and in-person home visits. At the baseline assessment, Veterans completed a questionnaire in which they identified three treatment goals in a short-answer format. Veterans also rated how well they could currently perform each goal and how important each goal was to them (both on a scale of 1-10).

Findings

The study’s key finding was that Veterans undergoing PTSD treatment not only want to improve PTSD symptoms but also want to improve their quality of life and relationships. Three main themes for Veterans’ treatment goals were identified:

1. Improvements in PTSD symptoms. Veterans wanted to have fewer PTSD symptoms. They wanted to sleep better, think more constructively, feel fewer negative emotions and more positive emotions, feel less hypervigilant and aroused, and experience fewer unwanted trauma-related memories, reminders, or nightmares. For example, Veterans described the following goals:

• “I want to sleep more than 3 to 4 hours without interruptions.”
• “[I] want to stop having emotional reactions when I think about the past.”
• “I want to go out with wife or friends and not feel that I must have my back to the wall and watch the entrance.”
• “I want to be less aggressive and irritable.”

2. Personal well-being and growth. Veterans expressed a desire to enhance their personal well-being and growth. In addition to wanting to relax, have more fun, and engage in hobbies, Veterans wanted to advance their education and careers. They mentioned that they wanted to go to school, increase their income, or start their own businesses. As one Veteran said:

• “I would like to return to work.”
• “Seeing movies in a movie theater.”

3. Improvements in social roles and interpersonal functioning. Veterans wanted better relationships with partners, friends, and children, and many shared a desire to make new friends or start a romantic relationship. In their existing relationships, many wanted to be more present and emotionally connected.

• “Meet new adults and go on double dates with my husband.”
• “I want to accept and desire sexual advances from my husband.”
• “Be a better role model for my kids.”

Interestingly, while Veterans related their goals as highly important to them, they generally did not feel confident in their ability to achieve these goals prior to therapy.

Implications

The study emphasizes the need to continue improving the extent to which PTSD treatments align with and help Veterans achieve their personal goals.

One implication for clinicians is the importance of collaboration through treatment planning and shared decision making. Clinicians should also anticipate that most patients will have multiple goals, some of which will be achievable by the end of treatment; others longer-term. Accordingly, clinicians should establish realistic expectations with Veterans. The study also suggests that broader outcome assessment tools, focusing not just on symptom reduction but also on well-being and social functioning, may give a more complete picture of PTSD treatment effectiveness.

For researchers, future areas of investigation could include how treatment changes Veterans’ goals, how goals impact the rates at which Veterans complete or discontinue treatment, the relationship between expectations and goal achievement, and whether trauma-focused psychotherapies adequately address functional and well-being outcomes.

This article is adapted from a blog post, “Making the Most of Treatment: Veterans Want to Improve PTSD and Their Functioning During PTSD Treatment,” written by the following investigators:

Stephanie Wells, PhD is a clinical research psychologist at the Durham VA Health Care System, core investigator at the Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), affiliate faculty at VA’s VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), and a psychologist in the Durham VA Trauma Recovery Program.

Marcela (Marci) Weber, PhD is a clinical psychologist investigator at the Central Arkansas Veterans Healthcare System’s (CAVHS) South Central Mental Illness Research, Education and Clinical Center (South Central MIRECC) and Center for Mental Healthcare and Outcomes Research (CeMHOR).

Kathleen Grubbs, PhD is a clinical psychologist investigator at the Central Arkansas Veterans Healthcare System’s (CAVHS) South Central MIRECC and CeMHOR.

Emily Wilhite, PhD is a clinical psychologist at the VA San Diego Healthcare System.

Study Publication

Wells SY, Wilhite ER, Weber MC, … & Grubbs KM, et al. Beyond symptom reduction: Veterans’ goals for post-traumatic stress disorder treatment. Journal of Traumatic Stress. April 2025;38(2):350-375.

References

Maguen S, Holder N, Madden E, et al. Evidence-based psychotherapy trends among posttraumatic stress disorder patients in a national healthcare system, 2001–2014. Depression and Anxiety. April 2020;37(4):356–364.

Myers US, Haller M, Angkaw AC, et al. Evidence-based psychotherapy completion and symptom improvement among returning combat veterans with PTSD. Psychological Trauma. 2019;11(2):216-223.

Schnurr PP, Chard KM, Ruzek JI, et al. Comparison of Prolonged Exposure vs Cognitive Processing Therapy for Treatment of Posttraumatic Stress Disorder Among US Veterans: A Randomized Clinical Trial. JAMA Network Open. January 4, 2022;5(1):e2136921.

Kehle-Forbes SM, Meis LA, Spoont MR, Polusny MA. Treatment initiation and dropout from prolonged exposure and cognitive processing therapy in a VA outpatient clinic. Psychological  Trauma. January 2016;8(1):107-114.

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The views expressed in this publication are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.