The Acceptability of Somatic Therapy for PTSD Among Patients at an Urban Safety Net Primary Care Clinic

Abstract

Background: Posttraumatic stress disorder (PTSD) has higher prevalence in safety net settings, which also face structural barriers to the use of gold-standard, exposure-focused treatments. Somatic therapies (STs) are used to treat PTSD with a focus on sensations. STs may be a culturally relevant option not requiring exposure. They have not been rigorously studied. Objective: Assess the acceptability of ST for patients with PTSD and staff in a safety net setting. Methods: We conducted a qualitative study with interviews of patients and staff in a general internal medicine clinic within an urban safety net health system. Patients were eligible if they were seen between October 1st, 2022 and October 31st, 2023, had PTSD in their chart, had one past trauma-related visit with any psychotherapist, and were English-speaking. Staff were eligible if working in a patient-facing role for 6 months in primary care or integrated behavioral health. Transcripts were analyzed using the Consensual Qualitative Research approach. Results: The 14 patients interviewed were diverse in terms of race and traumatic exposures, and most had a chronic pain condition. Childhood sexual abuse was the most common traumatic exposure disclosed. Analysis yielded five major themes: the somatic experience of PTSD, patient perspectives on exposure-based therapy, past experiences with mind and body practices, patient mind and body beliefs, and acceptability of ST. ST was congruent with many patients’ lived experiences and their beliefs about mental health. Challenges faced in seeking care for PTSD, including negative past therapy experiences and poor access, promoted openness to ST. Conclusion: Patients with PTSD and staff found ST acceptable. Further work is needed to develop somatic interventions for PTSD.