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Publication Briefs

Clinician Burnout Associated with Lower Odds of Clinically Meaningful Improvement Among Veterans with PTSD

Clinician burnout is widespread and may affect quality of care. Health systems need information about whether reducing burnout may be important for treatment effectiveness. This study used survey and electronic health record data to evaluate the association between therapist burnout and the effectiveness of guideline-recommended trauma-focused psychotherapies for PTSD. Participants were 165 VA therapists (most were psychologists or social workers; 54% female, 88% white) who completed a survey burnout measure between May 2 and October 8, 2019, and 1,268 Veterans (76% male, 26% racial minorities) who received trauma-focused psychotherapies from those therapists in the following year. Veterans’ outcome data was collected through December 31, 2020. The primary outcome was clinically meaningful improvement in Veterans’ PTSD symptoms, defined as ≥ 15-point reduction in PCL-5 scores. Therapist burnout was defined as a score ≥ 3 on a 5-point validated burnout measure.


  • Therapist burnout was prospectively associated with reduced effectiveness of guideline-recommended psychotherapies for PTSD.
  • The proportion of Veterans who experienced clinically meaningful improvement in PTSD symptoms was 28% among therapists who reported burnout vs. 37% among therapists without burnout.
  • Veteran dropout before completing 8 sessions (46%) and session spacing (protocols recommend weekly sessions) were associated with reduced odds of improved symptoms. Every additional three days between sessions decreased the odds of improvement by almost 20%.
  • Therapists’ mean adherence was not associated with the odds of clinically meaningful improvement.
  • Adjusting for dropout or session spacing did not meaningfully alter the magnitude of the association between burnout and clinically meaningful improvement.
  • Among the therapists, 35% reported burnout, while 34% of Veterans overall experienced clinically meaningful improvement.


  • Interventions to reduce therapist burnout might result in more Veterans experiencing clinically meaningful improvement in PTSD symptoms from evidence-based psychotherapies.


  • A stronger design would have included repeated assessments of burnout using a more comprehensive, continuous measure, and would have evaluated how changes in burnout were associated with therapy delivery and Veteran outcomes.
  • The therapist sample was homogenous regarding race and ethnicity.
  • Factors other than burnout may have accounted for the difference in Veteran outcomes.

This study was funded by HSR (IIR 17-178). Drs. Sayer, Kaplan, and Nelson are with HSR’s Center for Care Delivery and Outcomes Research (CCDOR).

Sayer NA, Kaplan A, Nelson DB, et al. Clinician Burnout and Effectiveness of Guideline-Recommended Psychotherapies. JAMA Network Open. April 17, 2024;7(4):e246858.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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