Veterans with PTSD Experience Rare but Significant Symptom Worsening During Treatment

Strategic Insights -

Researchers from the San Francisco Veterans Affairs Health Care System have reported new findings on the frequency and correlates of reliable symptom worsening during treatment for post-traumatic stress disorder (PTSD) in veterans. According to the study published in the Journal of Affective Disorders, 22.9% of veterans experienced reliable symptom worsening, defined as a 10-point increase on the PTSD Checklist for DSM-5 (PCL-5) from baseline. The research team used national electronic health record data from the Veterans Health Administration to identify 25,768 veterans who initiated PTSD evidence-based psychotherapy (EBP) between 2018 and 2023.

Key Takeaways:

  • 22.9% of veterans experienced reliable symptom worsening during PTSD EBPs, with most demographic, military, clinical, and service delivery characteristics being poorly associated with this outcome.
  • Receipt of a first PTSD EBP session in an inpatient setting was associated with a lower likelihood of experiencing reliable symptom worsening, with a marginally significant probability ratio (MPOR) of 0.73 (90% CI = 0.66, 0.81).
  • The study suggests that further research is needed to understand the drivers of reliable symptom worsening and to compare rates observed in the current study to reliable symptom worsening that occurs naturally over time and during any PTSD treatment.
  • The study highlighted the importance of considering the context in which PTSD EBPs are provided, including the setting and the characteristics of the patient and the provider.

Statistics:

  • 22.9% of veterans experienced reliable symptom worsening during PTSD EBPs.
  • 25,768 veterans initiated PTSD EBPs between 2018 and 2023.
  • 90% CI = 0.66, 0.81 for the association between inpatient setting and lower likelihood of experiencing reliable symptom worsening.

Sources:

NewsRx. Findings in the Area of Post-Traumatic Stress Disorders Reported from San Francisco Veterans Affairs Health Care System (Reliable Symptom Worsening Among Veterans Receiving Cognitive Processing Therapy or Prolonged Exposure Therapy for ...). Mental Health Weekly Digest. October 20, 2025; p 77.

Reliable Symptom Worsening Among Veterans Receiving Cognitive Processing Therapy or Prolonged Exposure Therapy for Posttraumatic Stress Disorder In Routine Veterans Health Administration Care. Journal of Affective Disorders, 2025;387.

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References:

  • NewsRx. Findings in the Area of Post-Traumatic Stress Disorders Reported from San Francisco Veterans Affairs Health Care System (Reliable Symptom Worsening Among Veterans Receiving Cognitive Processing Therapy or Prolonged Exposure Therapy for ...). Mental Health Weekly Digest. October 20, 2025; p 77.
  • Reliable Symptom Worsening Among Veterans Receiving Cognitive Processing Therapy or Prolonged Exposure Therapy for Posttraumatic Stress Disorder In Routine Veterans Health Administration Care. Journal of Affective Disorders, 2025;387.