Post-Traumatic Stress Disorder Clinical Team (PCT)

There are five overarching principles that guide our specialty care services.

Individuals referred to the PCT should understand that their services will be time-limited. Most Veterans referred to PCT engage in services between 2-4 months. Many Veterans who complete our intensive services are able to discharge from mental health services completely after completing one of our gold-standard treatments. Other Veterans may need additional services in general mental health to address co-occurring disorders (e.g., depression, panic symptoms) or continue to practice skills learned in the PCT. Other Veterans may wish to engage in complementary services such as yoga or tai chi, through our Whole Health Program.

PTSD Clinical Teams are also tasked with prioritizing evidence-based treatments, or those treatments that have been demonstrated effective in reducing symptoms of PTSD. Treatment offered in PCTs are generally those treatments that are outlined in the VA/DOD Clinical Practice Guidelines for PTSD. While many individuals may be interested in more supportive or experimental approaches to treatment, those treatments are generally not provided in a PCT.

PCTs are also designed to be able to treat Veterans with complex mental health symptoms and needs, with minimal barriers to care. This means that Veterans who are also struggling with substance use or other mental health conditions are able to access services. In order to be able to treat complex cases, PTSD teams rely on a team-based approach to care. This means that members of a multidisciplinary team meet regularly to discuss cases and identify best approaches to care. By relying on the entire team to provide clinical recommendations, we ensure Veterans receive the highest quality of care available.

Finally, PCTs incorporate measurement-based care. This means that during your episode of care, your therapist will be carefully monitoring your symptoms and progress to ensure each Veteran is responding appropriately to the treatment. Measurement-based care helps guide and inform treatment.

STEP 1:  First, a Veteran discusses with their provider (often someone they currently see for mental health needs) interest in engaging in trauma-focused care. Veterans interested in a referral to the PCT are willing to work on trauma symptoms directly, and understand that the clinic is designed to provide time-limited and structured services. Veterans who are not ready to discuss their trauma or related symptoms, who would prefer to develop more basic coping skills, should consider a referral to the general mental health clinic. Once educated about the scope of services in the PCT, a referral for the clinic will be placed.

STEP 2:  Once a consult for services is placed, a member of the administrative team will call to schedule the initial evaluation. Veterans can expect to receive a scheduling call within 48 hours. When contacted for scheduling, Veterans can request an in-person or video appointment.

• In the event a Veteran is not contacted promptly, or needs to reschedule an evaluation, they can call the following number for assistance: 210-949-9702

STEP 3: Prior to the first appointment, a Veteran will typically receive a text message or email from the evaluating provider, asking to complete initial forms and assessments. 

• Completion of these forms prior to the initial evaluation will help streamline the first appointment, allowing the provider to spend less time gathering basic information and more time focusing on each Veteran’s unique trauma history and symptoms.

STEP 4: The initial evaluation with a member of the PTSD Clinical Team will take on average 90 minutes. The individual who completes the initial evaluation may or may not be the provider who works with the Veteran in therapy.

• A Veteran can expect to be asked questions including but not limited to:  
  • Medical and mental health history
  • Background about their childhood
  • Their current living situation, marital status and family dynamics
  • An assessment of PTSD symptoms and discussion of the traumatic event that led to the PTSD symptoms

STEP 5: Upon completion of the initial evaluation, if a Veteran is appropriate and interested in services in the PCT, a treatment-planning session will be scheduled. Treatment planning in a collaborative process that relies on shared-decision making to identify a treatment that is the best fit for the Veteran at the current time.

STEP 6: Finally, a Veteran will be matched with a therapist who is trained in the evidence-based protocol that was identified as most appropriate to meet the identified goals. A Veteran may also be transitioned to a different therapist depending on their preference for video versus in-person sessions, or preferences for specific days and times.

Q: Where is the PTSD Clinic physically located?

A: The PTSD Clinic is located at the San Antonio Northwest Health Care Center.

*Please note that all services offered in the PCT can be offered over video, if the clinic is not easily accessible.  Engaging in evidence-based treatments for PTSD over video have been shown to be equally effective as compared to completing the treatments in-person.

We will be working through VA Video Connect (VVC). Visit https://mobile.va.gov/app/va-video-connect for more information about this format for therapy.  

When your appointment is scheduled, a link will be sent to the email address you have provided the VA. If you prefer to use another email, please let your provider know. At the time of the appointment, click the link provided in the appointment. You will also need to enter your physical address prior to entering the virtual room for safety reasons.  

Q: If I have PTSD will I automatically be seen at the PTSD clinic?

A: No, Veterans with PTSD are served throughout our mental health service line, to include within your primary care team! Not all Veterans with a diagnosis of PTSD need to be referred to this level of care, and are generally referred due to symptom severity and/or interest in engaging in a more intensive form of trauma-focused care. The general mental health clinic is staffed with providers who also have expertise in PTSD, and will help develop coping skills and improve emotion regulation. At times, they will also be able to offer similar evidence-based treatments for PTSD.

Veterans primarily interested in group psychotherapy or developing coping skills will generally be a better fit for the General Mental Health Clinics.

Q: What if I want to try medications to help with my symptoms? 

A: The PTSD clinic does not have prescribing providers on the team, and as such Veterans who may need medications to help support their recovery should discuss this with their primary care physician. Depending on the unique needs of each Veteran, the primary care physician may refer a Veteran to mental health pharmacist for assistance. 

Veterans with complex mental health symptoms, who have not responded to medications offered in the primary care setting, will be referred to the general mental health clinic to receive further evaluation and help from providers who specialize in psychiatric conditions and associated medications.

Q: How long should I expect to be in therapy at the PTSD Program? 

A: Veterans in the traditional outpatient therapy track can expect to be seen x1 weekly (60-90 minutes) for an average of 3-4 months. Veterans who choose our Accelerated PTSD Treatment (APT) Track will be seen x4 weekly (60-90 minutes) for 3-4 weeks.

In Spring 2023, the PTSD Clinical Team developed a fully virtual Accelerated PTSD Treatment (APT) track, that offers our individual gold standard treatments four times per week (Monday – Thursday)! In addition to four individual therapy sessions each week, Veterans who engage in APT will also participate in brief groups before an after each individual session. 

The APT program compresses PTSD treatment from 3-4 months into 2-3 weeks! This means a Veteran will feel better faster. Of note, this compressed treatment model has been demonstrated to be just as effective as traditional outpatient therapy that occurs only once per week. 

If you are interested in a specialized and more condensed treatment program for PTSD please tell your current provider or discuss this at the time of your initial evaluation at the PCT.

Q: What are the hours of the APT Program 

A: The program is Monday through Thursday, from 8am – 2pm. Each day starts with a check-in group, followed by individual therapy (60-90 minutes), dedicated homework time (60-90 minutes), a break for lunch, and concluding the day with a check-out group.

Q: Is there an option to complete the Accelerated PTSD Track in-person? 

A: No. At this time APT is a fully virtual program, taking place on the VA Video Connect Platform. A Veteran who is in need of a more accelerated course of PTSD care should discuss specific needs and interests at the time of the initial consult. 

Q: I don’t really enjoy groups. Do I have to participate in the groups each day? 

A: Yes, groups are currently a required and important part of the APT program. These groups are designed to help provide additional support during this accelerated and highly intense program. Because the groups are focused on building support and helping one another complete challenging homework assignments, most Veterans report both benefiting and enjoying the group component. 

• Discussion of individual traumas does not occur within the group setting. This is to avoid triggering or creating distress amongst fellow group members.
• If you are interested in APT but are concerned you would not be able to participate in all group sessions, please discuss these concerns with your provider. The APT program is designed for flexibility, and will make every attempt to meet each Veteran where they are at.

There are many options for individual treatment at the PCT Clinic. We like to think of our menu of services as being flexible and individualized as well as grounded in the research that has been shown to be most effective. Below you will find a number of resources to help understand more about these treatment modalities and options

Veterans can access  the National Center for PTSD website and watch the Whiteboard videos for live discussion of treatment options. On the left hand side of the website you will see the menu items. Go to “Understanding PTSD Treatment” and then “Talk Therapy.” There you will see the four main trauma-focused treatments for PTSD. You can click on each one for more details. You can also go to the menu item titled “Apps, videos, and more” and then click “Videos.” There you will see short, 2-3 minute videos that give an overview of each treatment options. 

Also under “Apps, videos, and more” you can choose the item called “PTSD Treatment Decision Aid.” This will ask you questions about your needs and preferences. Based upon your answers it will make a suggestion about which treatment you may prefer. 

Here are a few of the PTSD Treatments That Are Available at PCT Clinic

Cognitive Processing Therapy 

Cognitive Processing Therapy for PTSD - PTSD: National Center for PTSD (va.gov) 

There is also an app called CPT Coach, that is a companion to this series and has similar information about CPT in it. Here is a link describing the app in more detail: https://mobile.va.gov/app/cpt-coach  

A handy part of this app is that it has the worksheets and readings that are also found in the workbook that we will send out.  

Prolonged Exposure   

https://www.ptsd.va.gov/understand_tx/prolonged_exposure.asp 

There is also an app called the PE Coach 2, that is a companion to this treatment. Here is a link describing the app in more detail: Mobile App: PE Coach - PTSD: National Center for PTSD (va.gov) 

A handy part of this app is that there is an integrated voice recorder. Record sessions is a required part of the therapy since you will be listening to them between our sessions. Please consider downloading it. If you do not want do download the PE Coach, you will need to use some sort of audio recorder to record the sessions.  

We will send you a PE Workbook .  

Eye Movement Desensitization and Reprocessing (EMDR) 

Visit https://www.ptsd.va.gov/understand_tx/emdr.asp  to learn more.

Written Exposure Therapy (WET) 

Visit https://www.ptsd.va.gov/professional/treat/txessentials/written_exposure_therapy.asp 

Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) 

There is a treatment that addresses substance use and PTSD, called COPE for short. To understand treatment of co-occurring PTSD and substance use disorder in VA, check out this link: https://www.ptsd.va.gov/professional/treat/cooccurring/tx_sud_va.asp