Hector Garcia

U.S. Department of Veterans Affairs | VA · Texas Valley Coastal Bend Veterans Health Care System

Despite being recommended as first-line treatments for posttraumatic stress disorder (PTSD) by the Veterans Health Administration (VHA), the two evidence-based psychotherapies (EBPs), cognitive processing therapy (CPT) and prolonged exposure (PE), remain underutilized. Provider perceptions of certain clinical characteristics may pose barriers to EB...

The Veterans Health Administration (VHA) recommends that patients with posttraumatic stress disorder (PTSD) receive either of the 2 frontline evidence-based psychotherapies, cognitive processing therapy (CPT) and prolonged exposure (PE). However, VHA providers have reported low use of these treatments, and voiced their concerns over exposing patien...

Objective: Although efforts to implement evidence-based psychotherapies (EBPs) require understanding how providers view and initiate these interventions, little is known regarding provider treatment selection in posttraumatic stress disorder (PTSD) care. The current study examines how specialty PTSD clinic providers within the Veterans Health Admi...

Introduction Among US veterans, posttraumatic stress disorder (PTSD) is a high-prevalence condition; more than a million veterans of all combat eras are service-connected for this condition. Research on factors driving veterans’ decision-making regarding preferred setting for PTSD care has been limited. The purpose of this study was to understand f...

Objective: A growing empirical literature demonstrates that evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) are effective for veterans. However, use of EBPs for PTSD in the Veterans Health Administration (VHA) remains low, and providers cite patient preference as a factor impacting EBP utilization. The purpose of thi...

Psychiatrists in the Veterans Health Administration (VHA) are susceptible to professional burnout due to the unique needs of veterans combined with high organizational demands. The current study examined the mediating role of organizational factors in the direct relationship between providing primarily pharmacological intervention and professional...

Background and objectives Prior research suggests a link between occupational burnout and perceived vulnerability to organizational oversight. The purpose of this exploratory study was to examine the relationship between perceptions of political and bureaucratic oversight (e.g., by Congress, media, or policies, rules, and performance metrics) and o...

Implementation of the Veterans Choice Program (VCP) allows Veterans to receive care paid for by the Department of Veterans Affairs (VA) in community settings. However, the quality of that care is unknown, particularly for complex conditions such as posttraumatic stress disorder (PTSD). A cross-sectional survey was conducted of 668 community primary...

Introduction: Post-traumatic stress disorder (PTSD) affects nearly one-fifth of Iraq and Afghanistan Veterans (IAV). The Department of Veterans Affairs (VA) has invested in making evidence-based psychotherapies for PTSD available at every VA facility nationwide; however, an unknown number of veterans opt to receive care in the community rather tha...

Significant changes in national health policy, like the Veterans Choice Act, have created growing opportunities for veterans to receive care outside of the Veterans Administration (VA), yet little is known about the attitudes and practices in PTSD care of community providers, particularly their use of evidence-based psychotherapies (EBPs). The auth...

Background: In 2014, the Department of Veterans Affairs (VA) implemented the Veterans Choice Program (VCP) to provide reimbursement for community-based care to eligible veterans. Inadequate networks of participating providers may impact the utility of VCP for veterans with posttraumatic stress disorder (PTSD), a complex condition occurring at lowe...

Research suggests that mental health workers are at high risk for burnout, and that burnout can increase staff turnover and reduce quality of care. The Veterans Administration (VA) employs over 3000 psychiatrists across the United States, but little is known about burnout in this population. This study was conducted to examine predictors of burnout...

This preliminary study examined the relationship between burnout and the use of evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) among Veterans Health Administration (VHA) mental health clinicians. Recruitment was directed through VHA PTSD Clinical Teams (PCTs) across the United States based on a nationwide mailing lis...

Objective Prolonged exposure (PE) and cognitive processing therapy (CPT) – post-traumatic stress disorder (PTSD) treatments now available at the Veterans Health Administration (VHA) – expose the provider to graphic traumatic material. Little is known about the impact of traumatic material on VHA providers. The purpose of this study was to examine t...

This book uses evolutionary psychology as a lens to explain religious violence and oppression. The author, a clinical psychologist, examines religious scriptures, rituals, and canon law, highlighting the many ways in which our evolutionary legacy has shaped the development of religion and continues to profoundly influence its expression. The book f...

In response to the growing numbers of veterans with posttraumatic stress disorder (PTSD), the Department of Veterans Affairs (VA) has sought to make evidence-based psychotherapies for PTSD available at every VA facility. We conducted a national survey of providers within VA PTSD clinical teams (PCTs) to describe utilization of prolonged exposure (P...

Mental health providers employed specifically by the Veterans Health Administration to treat posttraumatic stress disorder (PTSD) may be at increased risk for burnout due to both organizational and patient care stressors. Usage of caffeine, alcohol, and tobacco products may increase as a means to cope with burnout and stress. This cross-sectional s...

In an effort to improve our understanding of perceived treatment barriers among veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) relative to other era veterans, the current study examined veteran attitudes and beliefs about mental health treatment and treatment-seeking, and perceived patient and institution-level logistical barri...

The purpose of this study was to conduct the first assessment of burnout among Veterans Health Administration (VHA) mental health clinicians providing evidence-based posttraumatic stress disorder (PTSD) care. This study consisted of 138 participants and the sample was mostly female (67%), Caucasian (non-Hispanic; 81%), and married (70%) with a mean...

The association between endorsement of emotional “toughness” (i.e., extreme self-reliance and the suppression of outward displays of emotional distress) and likelihood for screening positive for mental health conditions was examined in a male sample of 198 Iraq and Afghanistan veterans presenting for postdeployment Veteran Affairs health care. Afte...

To evaluate the clinical utility of a new scale assessing Self-Efficacy for Life Tasks (SELT), we examined whether SELT was associated with postdeployment symptoms among male U.S. veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). A total of 41 OEF/OIF veterans completed the SELT scale and measures of post-traumatic str...

Cognitive–behavioral therapies (CBTs) can be effective treatments for posttraumatic stress disorder (PTSD) but their effectiveness is limited by high rates of premature dropout. Few studies have compared pretreatment characteristics of treatment completers and dropouts, and only one has examined these factors in Operations Iraqi Freedom and Endurin...

Studies identifying a high prevalence of posttraumatic stress disorder (PTSD) and low treatment utilization among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans reinforce the need for a greater understanding of the disorder in this population. Although traditional masculine norms have been found to relate to both help s...

Traditional masculine socialization presents challenges in psychotherapy, for example, by decreasing the likelihood of help-seeking and by making emotion-laden content more difficult to address. While this has been established in civilian populations, more intense forms of masculine socialization found in military settings may amplify such issues i...

Our study examined Minnesota Multiphasic Personality Inventory-2 (MMPI-2) F-family validity scales (F, Fb, F-K, Fp) in treatment-seeking veterans diagnosed with posttraumatic stress disorder (PTSD) related to Operation Enduring or Iraqi Freedom (OEF/OIF). Seventy-nine percent of veterans had F T scores over 65, 54% elevated F over 80 T; and 71% ele...

Bridget" was my first cognitive behavioral therapy (CBT) case and assigned to me in my second year of doctoral training as part of a clinical practicum. She was a 21-year-old undergraduate student who presented with depression and obsessive-compulsive disorder (OCD), in which the obsessions were religious in nature and the compulsions were rituals...

This response to the commentaries of Mandala (2008) and of Deacon and Nelson (2008) focuses on the utility of treatments nested within different theoretical schools of thought. Here I concentrate on the use of self as clinical tool, and the need to define variables and concepts in treatment so that they can be methodically utilized. I also choose t...