Trajectories of Change in Prolonged Exposure for Primary Care

Who Most Likely Benefits?

Rauch, Sheila A. M.
Kim, H. Myra
Acierno, Ron
Ragin, Carly
Wangelin, Bethany
Blitch, Kimberly
Muzzy, Wendy
Hart, Stephanie
Ingham, Grace

Atlanta VA Medical Center, Decatur, Georgia, United States
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
Department of Biostatistics, Center for Statistical and Consulting Research, University of Michigan
Ralph H. Johnson VA Medical Center, Charleston, South Carolina, United States
Faillace Department of Psychiatry, University of Texas Health Science Center, Houston
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina

Jack Tsai served as action editor.

Bethany Wangelin is now at Tailored Brain Health, Professional Limited Liability Company, Greensboro, North Carolina, United States.

The data that support the findings of this study are available upon request from Sheila A. M. Rauch. The data are not publicly available due to privacy or ethical restrictions (https://ClinicalTrials.gov: NCT03581981). The data reported in this article have been previously published and/or were collected as part of a larger data collection as part of a randomized clinical trial. Findings from the data collection have been reported in separate articles. Article 1 (published) focuses on the methodology of the clinical trial and does not include data, while Article 2 (published) focuses on the primary clinical trial function and symptom outcomes, World Health Organization Disability Assessment Schedule 2.0 (function) and Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (posttraumatic stress disorder severity), and the comparative analysis between Prolonged Exposure for Primary Care and treatment as usual. Article 3 (published) reported on retention in therapy for the subset of patients participating during the pandemic. The current article focuses on World Health Organization Disability Assessment Schedule 2.0 (function) and Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders (fifth edition) over time in Prolonged Exposure for Primary Care only to examine whether there are patterns of response within this brief intervention.

The Veterans Administration (VA) had no role in the design or conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the article; and decision to submit the article for publication. Sheila A. M. Rauch receives support from the Wounded Warrior Project, VA, National Institute of Health, Woodruff Foundation, and Department of Defense. Sheila A. M. Rauch receives royalties from Oxford University Press and American Psychological Association Press. H. Myra Kim, Ron Acierno, and Bethany Wangelin have nothing to disclose. Wendy Muzzy receives support from VA and Department of Defense. H. Myra Kim takes responsibility for the integrity of the data and the accuracy of the data analysis.

This work received support from VA Office of Research and Development, Rehabilitation Research and Development Service grant titled “Improving Function Through Primary Care Treatment of PTSD” and U.S. Department of Veterans Affairs (Award No. I01RX002625; principal investigator: Sheila A. M. Rauch). This material results from work supported by resources and the use of facilities at the Atlanta VA Healthcare System and Ralph H. Johnson VA Health Care System.

The authors acknowledge the contribution of Jeffrey Cigrang as a training consultant and collaborator on treatment development. The views expressed in this article are solely those of the authors and do not reflect an endorsement by or the official policy of the VA or the U.S. government.

Sheila A. M. Rauch played a lead role in conceptualization, funding acquisition, investigation, methodology, project administration, supervision, writing–original draft, and writing–review and editing and an equal role in visualization. H. Myra Kim played a lead role in data curation, formal analysis, and visualization and an equal role in conceptualization, funding acquisition, methodology, writing–original draft, and writing–review and editing. Ron Acierno played an equal role in conceptualization, investigation, methodology, writing–original draft, and writing–review and editing. Carly Ragin played a co-lead role in project administration and a supporting role in investigation, writing–original draft, and writing–review and editing. Bethany Wangelin played a lead role in supervision, a supporting role in writing–original draft and writing–review and editing, and an equal role in conceptualization, investigation, and methodology. Kimberly Blitch played an equal role in investigation, writing–original draft, and writing–review and editing. Wendy Muzzy played a co-lead role in project administration and an equal role in conceptualization, investigation, methodology, writing–original draft, and writing–review and editing. Stephanie Hart played an equal role in investigation, writing–original draft, and writing–review and editing. Grace Ingham played a supporting role in writing–original draft and writing–review and editing.

Sheila A. M. Rauch, Emory University School of Medicine, 12 Executive Park, 3rd Floor, Atlanta, GA 30329, United States [email protected]

Received April 4, 2024

revised June 27, 2024

Accepted September 6, 2024

Psychological Trauma: Theory, Research, Practice, & Policy 17(8):p 1799-1807, November 2025. | DOI: 10.1037/tra0001827

Objective: Prolonged Exposure for Primary Care (PE-PC) leverages an opportunity to provide evidence-based posttraumatic stress disorder (PTSD) care in the PC setting where many veterans present for services and can greatly increase treatment access. However, such acute, short-term intervention may not be effective for all PTSD patients. Method: We analyzed data from a randomized clinical trial evaluating PE-PC to determine who may or may not benefit from PE-PC. We identified both PTSD symptom and general functioning trajectories for veterans with chronic PTSD in Veterans Administration primary care settings. Results: For PTSD symptoms, four trajectory patterns emerged, and for functional impairment, three emerged. Demographics, treatment expectancy, and credibility did not predict PTSD symptom or functional impairment trajectories. While baseline depression severity and functioning were initially predictive, only baseline PTSD symptoms were predictive of PTSD symptom trajectories once this variable was considered. Similarly, while baseline depression and PTSD severity were initially predictive of functional trajectories, only baseline function was predictive of function trajectories once this variable was included. Conclusion: PE-PC may be particularly appropriate and effective for veterans presenting to primary care with moderate PTSD symptoms or functional impairment. Replication and examination of trajectories in a larger effectiveness sample is warranted.