Quasi-Experimental Evaluation of the Impact of a Cognitive Behavioral Pretreatment Intervention for Veterans Seeking Psychotherapy

Pretreatment interventions have documented efficacy for reducing initial therapy refusal and early therapy departure. However, these interventions have not been well-studied in diagnostically diverse patient populations or within Veterans Affairs (VA) health care settings. We designed a manualized 4-session group cognitive-behavioral therapy-based pretreatment intervention (PTI) for a diagnostically diverse population of Veterans referred for psychotherapy in a general mental health clinic (MHC) in a large VA hospital. Retrospective record review was used to collect patient data over a period of 6 months after their completion of the PTI. A sample of 50 Veterans who were referred for care at the MHC prior to the implementation of the PTI was used for comparison (NoPTI). Two hundred sixty-six Veterans participated in the PTI. Veterans who participated in the PTI were equally as likely to attend at least one psychotherapy session as NoPTI Veterans, but had more individual and group therapy sessions during the 6-month therapy tracking period. PTI participants were also less likely to have a psychiatric hospitalization during the 6-month therapy tracking period. Study findings suggest that PTIs are a good fit to a VA general mental health setting and effective in bolstering therapy attendance. Limitations and future directions are discussed.