Post-traumatic stress disorder (PTSD) is a psychological condition that triggers from a traumatic experience that tampers with the persons physical and, or psychological integrity (Campanini et al., 2010). Traumatic event leave victims with feeling of anger, agitation, despair or horror, depending on the incident. PTSD causes interpersonal impairment, low self-esteem, anti-social behavior, and social isolation. Successful PTSD treatments must break down these barriers in order to get to the core of the traumatic issues and repair the individual from inside out. Mindfulness meditations techniques can help with the stress related aspects of PTSD but not with the underlying impaired reaction to a traumatic event (King et al. 2013).
Group processing is beneficial because it provides the best approach for the treatment of PTSD cases regardless of the psychological method adopted for treatment. Cognitive models as well as behavioral models of therapy acknowledge that individuals with PTSD show improved outcomes within group settings. The positive outcomes of group processing for PTSD veterans arises from the comradery of shared experiences. Individuals find solace in recounting their personal war- related traumatic experiences and listening to others’ experiences. Group sessions increase individual capacity for empathy allows the person to voice their fears and struggles without fear of judgment (Campanini et al., 2010).
Studies have shown that individual cognitive-behavioral therapy with directed exposure to a person’s traumatic events is effective in treating PTSD. Additional studies have devised improved versions of trauma exposure therapy. Manualized focus group therapy (TFGT) is designed as an efficient method of conducting guided exposure (Foy et al. 2002). TFGIT is an excellent example of how group processing helps veterans going through PTSD.
The primary objective of TFGT is to combat PTSD by equipping patients with the tools to control the symptoms of PTSD. TFGT improves self-control and the quality of life of the individual therefore taking precedence over any other therapies that only target the immediate symptoms of PTSD (Foy et al. 2002). By improving the quality of life, focusing first on dealing with the chronic symptoms of PTSD, TFGT increases the probability of members staying on to work on their long-term wellness goals.
TFGT features an autobiographical approach in which an individual self-assesses and a group concept in which members bear witness to the individual narrative in a non-judgmental environment (Foy et al. 2002). Members give account of life changing events and experiences to their group members in moderated sessions. In cognitive behavioral terms, repeated exposure to traumatic memories helps to reduce fear and lead to desensitization of trauma cues (Foy et al. 2002). Prolonged exposure also corrects faulty perceptions and generalized fears from traumatic experiences. Members spend about one third of TFGT therapy on individual accounts of combat-related traumatic memories. The rest of the time is dedicated to group sessions, where the facilitators guides the cognitive restructuring process (Foy et al. 2002).
The second advantage of group processing is that it is effective for increasing the outcomes of alternative PTSD therapies. Exposure therapies are the gold standard in PTSD treatment, however, some patients actively avoid exposure treatment because it makes them uncomfortable. Remission rates for exposure therapy when used on PTSD cases stands at an unacceptable 40-45%. Campanini et al. (2010) discovered that group therapy is efficient when used in conjunction with interpersonal therapy (IPT) for major depressive disorders (MDDs). They found that when applied as a group treatment for PTSD, IPT significantly reduces depression, increases interpersonal functioning, and alleviates the severity of PTSD symptoms. The justification for adopting IPT in PTSD treatment is that PTSD is caused by life events which IPT attempt to solve. IPT uses group focus to resolve PTSD issues with people avoidance and suspicion. IPT provides a supporting framework within a group of PTSD individuals to correct various interpersonal impairments and build strong and healthy relationships within the group and later with other people in their lives. IPT group therapy for PTSD is suited best for patients who have not responded to medication and other therapies.
Group processing not only effective for immediate PTSD concerns but also for issues that individuals experience indirectly as a result of PTSD. Casselman & Pemberton (2010) quotes Sayers et al (2009) in acknowledging that parenting can cause mental health problems in veterans. The parental responsibilities could be causing serious mental health issues to parents because 52% of men and 65% of women with major mental illness have children (Casselman & Pemberton, 2010). Unfortunately, majority of PTSD treatments rarely address the impact of parental responsibility on veterans and even less on effect of PTSD on women and their role as primary caregivers (Castillo et al 2014).
Veterans with PTSD reported greater parental challenges, dysfunctional families, and marital problems (Casselman &Pemberton 2010). Veterans with PTSD expose greater aggression and hostility towards their children compared to those without PTSD. Studies suggest that there is need for veteran PTSD parent to learn parenting tools during therapy. Casselman and Pemberton recommended acceptance and commitment therapy (ACT) because it promotes psychological flexibility with value driven behavioral change goals. Additionally, ACT group sessions provide psychoeducation to address any parenting knowledge gaps and equips the veterans with the tool to implement them with their children (Casselman &Pemberton 2010).
The study of the impact of parenting roles on PTSD exposed the need for family oriented therapy for veterans. Family therapy for veterans will increase the positive outcomes of group processing while improving family cohesion at the same time (Casselman &Pemberton 2010). PTSD patients often lock out their families in addition to the rest of the world. Therefore, while PTSD group therapies builds rapport among veterans, there is an urgent need to develop family oriented therapies that will restore familial cohesion and build support with the veterans (Casselman &Pemberton 2010).
The disadvantage with group processing, even for IPT, is that therapy alone cannot resolve PTSD without the psychosocial support of the veteran’s family and friends (Campanini et al., 2010). Working with strangers alone event though they help each other through the most traumatizing moments of their lives does not help veterans to become better friends, parents or spouses.
Another disadvantage is that there could be scheduling challenges with a large group (Wisner et al., 2015). Some members may not be available during all the scheduled meeting times because of personal engagements. Others may come for some sessions and avoid others thus interfering with the effectiveness of group therapy and the expected outcomes (Campanini et al., 2010).
Finally, and perhaps most significantly, is that some individuals dislike group settings for various reasons. Such people will avoid meetings or attend them and shut down or lie just to avoid exposing themselves to the group (Campanini et al., 2010). Such individuals often show resistance to groups even before attending a single session (Wisner et al., 2015). They are motivated may be uncomfortable with the idea of opening up to a group of strangers about events that have affected their lives profoundly (Wisner et al., 2015). Psychologists advise group facilitators to be patient with such individuals and not to give up easily on them. This is because once they agree to attend sessions; many find them to be pleasant and valuable to their recovery (Campanini et al., 2010).
References
Campanini, R. B., Schoedl, A. F., Pupo, M. C., Costa, A. H., Krupnick, J. L., & Mello, M. F. (2010). Efficacy of interpersonal therapy-group format adapted to post- traumatic stress disorder: an open-label add-on trial. Depression & Anxiety (1091-4269), 27(1), 72-77.
Casselman, R. B., & Pemberton, J. R. (2015). ACT-Based Parenting Group for Veterans With PTSD: Development and Preliminary Outcomes. American Journal Of Family Therapy, 43(1), 57-66.
Castillo, D. T., Lacefield, K., Baca, J. C., Blankenship, A., & Qualls, C. (2014). Effectiveness of Group-Delivered Cognitive Therapy and Treatment Length in Women Veterans with PTSD. Behavioral Sciences (2076-328X), 4(1), 31-41.
Foy, D. W., Ruzek, J. I., Glynn, S. M., Riney, S. J., & Gusman, F. D. (2002). Trauma Focus Group Therapy for Combat-Related PTSD: An Update. Journal Of Clinical Psychology, 58(8), 907-918.
King, A. P., Erickson, T. M., Giardino, N. D., Favorite, T., Rauch, S. A., Robinson, E., & Liberzon, I. (2013). A PILOT STUDY OF GROUP MINDFULNESS-BASED COGNITIVE THERAPY (MBCT) FOR COMBAT VETERANS WITH POSTTRAUMATIC STRESS DISORDER (PTSD). Depression & Anxiety (1091- 4269), 30(7), 638-645.
Wisner, B. L., Krugh, M. E., Ausbrooks, A., Russell, A., Chavkin, N. F., & Selber, K. (2015). An Exploratory Study of the Benefits of a Mindfulness Skills Group for Student Veterans. Social Work In Mental Health, 13(2), 128-144.
