Michael E. DeBakey VA Medical Center

A ten-year question, narrowed to one variable

DeBakey had already solved the harder half of the problem. Across earlier VA studies, only 6 to 13 percent of patients with PTSD received prolonged exposure or cognitive processing therapy. A chart review of DeBakey’s own PTSD clinic found 52 percent of Veterans evaluated there began one of those therapies within a year, a fivefold increase over the same clinic’s earlier utilization, attributed to changes in clinical structure, training and clinician support.

Supply was not the constraint. Demand was.

The clinic’s own research had already named why: stigma, reluctance to revisit trauma, doubt that therapy works, distance, and not knowing which treatments exist. In 2015 the study’s principal investigator put it in plain marketing terms, telling VA Research that the system has to sell itself and the treatment it provides. Later VA interviews with Veterans about how these therapies should be marketed returned findings any strategist would recognize. Effectiveness was the strongest claim. Overstated promises destroyed credibility. Veterans could not tell these therapies apart from counseling they had already tried. Nearly all of them found another Veteran’s first-person account more persuasive than statistics or expert endorsement.

When the project’s stakeholders ranked nine marketing approaches, testimonial led with nine of thirteen votes. Compare-and-contrast and utility tied at six. Those three became the axes of the experiment.

By 2023 the team had published the argument outright: direct-to-consumer marketing should be used to move knowledge, attitude, preference and demand for psychotherapy the way it has long been used for medication. The study we were hired into is the test of that argument.

A decade of research narrowed the question to which message works. We built the messages that answer it.

Where the evidence stands

The six videos are the experimental intervention in a funded VA health services research study, IIR 21-035, based at the Houston medical center, with a reported total award of $922,673 and a funding period running through September 2026.

VA states the purpose in marketing language: determine which direct-to-consumer messages are most effective at getting Veterans who screen positive for PTSD, and are not receiving psychotherapy, to initiate evidence-based treatment, so that limited outreach dollars go to the messages that actually work. No studies have systematically compared different DTC marketing messages, and no studies had tested these approaches with Veterans with PTSD.

VA describes the problem plainly: no research had systematically compared direct-to-consumer marketing messages, and none had tested these approaches with Veterans living with PTSD. STRIVE3 produced the instruments built to answer it.

The national benchmark sharpens the question. AboutFace, VA’s testimonial video platform, has run since 2012. A randomized evaluation published in 2025 assigned 330 Veterans to AboutFace or a psychoeducational brochure and found no significant difference in treatment initiation overall, roughly 83 percent against 80 percent. Among Veterans who actually spent fifteen minutes or more with the content, initiation was significantly higher, treatment began about six days sooner, and they completed roughly one additional session, with better outcomes the longer they engaged.

Read together, the finding is that Veteran storytelling works when it is engaged with. Which message architecture earns that engagement is the open question. It is the question these six videos were built to answer.

Findings from IIR 21-035 belong to VA and had not been published as of this writing. We claim the design contribution and the production, not the results. Sources: VA research project record; published VA studies of PTSD treatment initiation, treatment marketing and AboutFace.