Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

VA Health Systems Research

Go to the VA ORD website
Go to the QUERI website

IIR 21-035 – HSR Study

IIR 21-035
Direct to consumer marketing to engage Veterans in evidence-based psychotherapies for PTSD
Natalie E Hundt, PhD
Michael E. DeBakey VA Medical Center, Houston, TX
Houston, TX
Funding Period: October 2022 - September 2025


Evidence-based psychotherapies (EBP) are the most effective treatments for posttraumatic stress disorder (PTSD; APA, 2017; VA/DoD, 2017) and yet remain significantly underutilized (Hundt et al., 2017; Kehle-Forbes et al., 2016). Patient level barriers to EBP use including patient knowledge about EBPs, stigma, and concerns about treatment effectiveness or treatment demands (e.g., Hundt et al., 2015). Interventions that increase the rate of EBP initiation in Veterans with PTSD can substantially improve symptom burden, functioning, and quality of life (APA, 2017). Direct to consumer (DTC) marketing strategies, in which a service or product is advertised directly to the end user rather than a health care provider, are frequently used and highly effective at driving demand for psychotropic medications (e.g., Avery et al., 2012; Woloshin et al., 2001). DTC marketing may be particularly effective for EBPs because advertisements can directly target some of the primary barriers to EBP use. However, the limited existing studies on DTC marketing for mental health have focused on patient- reported intentions to engage in treatment, rather than actual therapy-seeking behaviors (e.g., Brecht et al., 2017; Gallo et al., 2013). Second, no studies have systematically compared different DTC marketing messages. This is an important omission because not all message types work for all products and for all consumers (Belch & Belch, 2017; Ogivy, 1985). Third, most prior studies of DTC advertising for psychotherapy have presented their messaging to the general population, rather than selecting for participants who need psychotherapy, which limits the applicability of their conclusions to target populations, and no studies have specifically focused on Veterans or those with PTSD. Guided by the Theory of Planned Behavior (TPB; Ajzen, 1991) and Veteran and provider stakeholder feedback, the current study proposes to develop and test different versions of DTC advertising messages aimed at increasing engagement in EBPs for PTSD. Although VA has invested considerable resources in advertising campaigns for mental health, PTSD education and outreach materials, no research has examined which strategies would be most effective at increasing Veteran initiation of psychotherapy. Having this information would help VA focus its limited financial resources on the most effective DTC advertising strategies and messages, which has the potential to engage more Veterans in the most effective treatments and reduce the burden of untreated PTSD (e.g., Zatzick et al., 1997; 2008; Kessler, 2000). This proposal aligns with the 2019 VA priorities emphasizing research on high priority mental health conditions, such as PTSD, and increasing return on investment in EBP training and increasing efficiency by facilitating uptake of the most effective treatments for PTSD. In pilot work, Veterans, family members, providers, and Veterans’ Service Organization members provided feedback on which DTC advertising strategies would be most compelling to them. Based upon these early qualitative insights, preliminary work, input from national partners, and our theoretical model, we have selected advertising strategies that qualified for further testing on a larger scale. These include the testimonial strategy, the utility strategy, and the compare/contrast strategy. In the course of the proposed study, we will develop brief advertising videos with iterative feedback from Veteran, family member, and provider stakeholders and test the effectiveness of these DTC advertisements in a RCT with Veterans who screened positive for PTSD but are not currently in psychotherapy. Primary outcomes will include Veteran attitudes about psychotherapy, intention to seek psychotherapy, and initiation of a referral for psychotherapy. The results of this study will provide invaluable information to help VA target its limited advertising and outreach budget to the most effective strategies and messages for Veterans.

External Links for this Project

NIH Reporter

Grant Number: I01HX003475-01A2

Dimensions for VA

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

Learn more about Dimensions for VA.

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.
    Search Dimensions for this project


Journal Articles

  1. Kamdar NP, Khan SP, Brostow DP, Spencer L, Roy S, Sisson A, Hundt NE. A Systematic Review of the Association Between Modifiable Social Determinants and Mental Health in post-9/11 Veterans. Journal of military, veteran and family health. 2023 Feb 6; 9(3):8-26. [view]
  2. Cully JA, Hundt NE, Fletcher T, Sansgiry S, Zeno D, Kauth MR, Kunik ME, Sorocco K. Brief Cognitive-Behavioral Therapy for Depression in Community Clinics: A Hybrid Effectiveness-Implementation Trial. Psychiatric services (Washington, D.C.). 2023 Sep 7; appips20220582. [view]
  3. Hertz AG, Dawson DB, Rassu FS, Ecker AH, Helm A, Hundt NE, Fletcher TL. Delivery of Exposure and Response Prevention Among Veterans with Obsessive-Compulsive Disorder. The journal of behavioral health services & research. 2023 Oct 1; 50(4):514-523. [view]
  4. Boykin DM, Thomas KL, Hundt N, Asghar-Ali AA, Bryan JL. Narrowing the Treatment Gap: A Call to Increase Use of Direct-to-Consumer Marketing in Psychotherapy Practice and Research. Journal of cognitive psychotherapy. 2023 Jun 27. [view]
  5. Ecker AH, Cully JA, Cucciare MA, Hundt NE. Patient and Provider Perspectives on Treating Substance Use Disorder and Co-Occurring Anxiety and Posttraumatic Stress Disorders in the Veterans Affairs Healthcare System. Journal of Veterans Studies. 2023 Jun 1; 9(1):171-180. [view]

DRA: Mental, Cognitive and Behavioral Disorders
DRE: TRL - Applied/Translational
Keywords: PTSD, Utilization
MeSH Terms: None at this time.

Questions about the HSR website? Email the Web Team

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.