Introduction
Posttraumatic stress disorder (PTSD) develops because of exposure to a traumatic experience. According to the Institute of Medicine (2012), the vital element of PTSD is the development of the characteristic symptoms that follow exposure to extreme traumatic stressors, including personal experiences. For an event to cause PTSD, it has should have had an actual or implied dire injury or near death experience to the victim. Such events could also threaten one’s physical and psychological integrity. The most common traumatic events happen during military combat, hostage situations, violent assault, torture, terrorist attacks, and disasters. While PSTD is most common and deadly among war veterans, it almost goes untreated thus deserves a sound preventive and curative mechanism to prevent associated detrimental effects.
Research Issue
Besides enhanced suicidal risk, PTSD also has a close association with high social and medical expenses following enhanced risk for crime, job loss, poor task performance, and social discord. For instance, the Institute of Medicine (IOM) estimates the economic impact of PTSD for the Iraqi war veterans’ medical care expenses, loss of life and forgone productivity to be between USD 4 billion to USD 6 billion (Institute of Medicine, 2012). Despite such losses, a lot of PTSD victims do not seek medical attention for fear of stigmatization or delayed diagnosis. For those who do, a majority receive inappropriate care intervention. Also, the major cause of this imbalance in health and human services is that PTSD victims may not have control over their conditions. They act out from the need to defend their threatened life given the memory of impending danger.
Target Population
War veterans are the target or the most at-risk-population for PTSD. The disorder has been one of the most injuries experienced by individuals serving in the US’ active military engagements such as Iraq, Afghanistan, and lately Syria. According to the Institute of Medicine (2012), of over 2 million of active military duty on foreign and local operations since 2003, almost 13 to 20 percent have tested positive for PTSD. Common PTSD stressors among them would include enhanced insurgent attacks following car and suicide bombs, improvised explosive devices (IED), rocket-propelled grenades and sniper attacks. Such forms of attack increase the risk of death and injury thus activate one’s vulnerability to psychological stress. Notably, as implied by IOM, the risk of PTSD among war veterans increases with lengthy deployment, time spent away from base camp, and multiple operations. Ideally, protective factors would include enhanced unit support, exemplary leadership, counseling, and training (Institute of Medicine, 2012).
Literature Review
Numerous PTSD studies address the disorder, some of the interventions, and the effectiveness of early diagnosis on its treatment. For instance, Goodson et al. (2011) conducted a meta-analytic review of PTSD treatment among war veterans in the US. The authors noted that PTSD is significantly high in US veterans exposed to war-associated trauma. These victims go to veteran affairs (VA) facilities for a series of psychotherapeutic treatments. The review quantitatively sampled 24 studies with a cumulative sample size of 1742 study participants. Their analysis reveals an average between-group effects for active treatment. Ideally, the typical VA treated patient had higher chances of survival compared to their control group counterparts. That is, VA facilities have the ability to incorporate all known effective interventions, including pharmacological and non-pharmacological approaches, to PTSD treatment (Goodson, et al., 2011).
Frost, Laska, Wampold (2014) explored evidence-based practice (EBP) associated with present-centered therapy (PCT) in treating PTSD. PCT is a non-trauma centered intervention for PTSD. The procedure’s primary mechanisms find ground in changing present maladaptive behaviors, offering psycho-education, and teaching the utilization of issue solving strategies based on current issues. Frost et al. (2014) meta-analytically reviewed 5 RCTs that considered PCT as compared to other EBPs. They found PCT as efficient as the comparative EBP treatment in three of the total five RCTs. Following the aggregation of results, the effects of PCT about EBP for primary and secondary measures were both insignificant and small. The patient dropout rate upon treatment initiation for PCT was also less than the comparative EBP option. Ideally, PCT is an acceptable and acceptable PTSD treatment (Frost, et al., 2014).
Eftekhari et al. (2013) studied the effectiveness of prolonged exposure (PE) therapy for war veterans with PTSD in large health care settings. The evaluation encompassed 1931 veterans upon an intervention of 804 clinicians at the VA department prolonged exposure training program. Upon the completion of an experiential PE workshop, the clinicians helped implement the practice on veteran patients with PTSD. The results revealed that PE is efficient in reducing the recurrent symptoms of depression and PTSD. Eftekhari et al. (2013) also determined that the percentage of individuals testing positive for the disorder decreased to 46.2 percent from 87.6 percent upon intervention (Eftekhari, et al., 2013).
Bryant et al. (2008) also assessed the efficacy of exposure therapy, also known as trauma-focused cognitive restructuring, in mitigating the occurrence of chronic PTSD. The researchers employed an RCT of individuals experiencing PTSD as regular patients at an outpatient facility. They randomly assigned the patients to 90-minute sessions of either Vivo and imaginal exposure or cognitive restructuring, to baseline assessment, with each group comprising of 30 individuals. The analysis revealed that upon post-treatment, a smaller number of patients in the experimental group had PTSD compared to those undergoing baseline assessment and cognitive restructuring. Bryant et al. (2008) concluded that exposure-based therapy results in a huge reduction in PTSD symptoms in related patients compared to other interventions. However, exposure is overly effective in early intervention for those individuals at high risk of PTSD (Bryant, et al., 2008).
Ahmadizadeh et al. (2013) assessed the role of cognitive behavioral therapy (CBT) in enhancing the quality of life of veterans found positive for PTSD as compared to other treatments. The authors describe PTSD as a commonly observed disorder in war veterans. They idealize that the condition can result in social, interpersonal, and occupational losses. The article considered the importance of various CBT elements such as problem solution and exposure therapy as revealed on the quality of life in 120 PTSD patients upon service in the Iran/Iraqi war. The authors randomly signed their participants into four groups with an equal number of members; namely, problem-solving, exposure, combined, and control group therapies. The results revealed an equal improvement in the quality of life for all patients across all interventions. That is, all forms of behavioral therapy can help in improving PTSD patients’ QOL (Ahmadizadeh et al., 2013).
Sloan, Bovin, and Schnurr (2012) reviewed group therapy as the treatment for PTSD among war veterans. However, they first identified a research gap in the analysis of the effective use of and the inclusion of group therapy as a priority during the treatment of veterans at VA facilities. Their reviews incorporated a description of various group-based interventions for PTSD as well as available information on the importance of this method for treating the disorder. Based on their literature review, Sloan et al. (2012) revealed group treatment as the most effect of all PTSD interventions. Nonetheless, within the intervention, non-specific treatment is more efficient in treating PTSD than its specifics type. That is, psycho-education and supportive counseling carry the day for VA facilities seeking to treat effectively and manage PTSD among veterans (Sloan et al., 2012).
Jakupcak et al. (2009) particularly concentrated on analyzing PTSD as a precursor to suicidal ideation in soldiers who fought in the Afghanistan and Iraqi wars. They used a sample of 407 participants admitted to the VA psychiatric health care system. Jakupcak et al. (2009) also explored chances that the risk for suicidal tendencies increased following the presence of comorbid psychiatric disorders in war vets with PTSD. Those who tested positive for PTSD had a four times higher likelihood to endorse suicide than their non-PTSD counterparts. Among the positive group, the risk for ideation was five times higher in those with at least two comorbid disorders than those with PTSD as the sole condition. Though shallow on treatment, the findings of this study are ideal for the identification of suicidal tendencies among Afghanistan and Iraqi veterans (Jakupcak, et al., 2009).
Vitzthum et al. (2009) evaluated various characteristics of therapeutic methods utilized on an international front in detecting and treating PTSD among war veterans. They focused on those soldiers that served in the South Eastern Europe and Gulf Wars. The authors describe PTSD among soldiers as a disorder that occurs as a result of a prolonged traumatic event such as being held hostage and killing among others. Soldiers are at a high risk of PTSD but do not receive the required attention to help effect treatment. Effectively discussed are the use of methods such as psychological debriefing, CBT, reprocessing therapy, and virtual therapy. The results show that early PTSD treatment can have both immediate and permanent benefits for affected war veterans. These findings are only effective in cases that allow for early detection before, during, and upon deployment. Virtual therapy is abundantly efficient for preventive and curative purposes. Virtual therapy involves the use of computer simulations depicting a soldier’s deployment region before and after service (Vitzthum et al., 2009).
Finally, in addition to most of the above psychological interventions, the Agency for Healthcare Research and Quality (2011) also looked at some of the pharmacological interventions available for PTSD. Ideally, the most common pharmacotherapies include tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, and monoamine oxidase inhibitors. Other interventions include atypical antipsychotics, anticonvulsants, benzodiazepines, and adrenergic agents. However, the FDA only approves sertraline and paroxetine medications for PTSD treatment. The general expected clinical outcomes for these drugs include symptom reduction, independence, remission, and enhanced QOL (AHRQ, 2011).
Findings
It would be vital to consider the findings that one can draw from the above reports as follows. First, group treatment serves as an effective approach for addressing PTSD. However, the implied effect sizes imply that the procedure might not be as efficient as individual therapy as viewed under Sloan et al. (2012). Nonetheless, most of the group treatments addressed in various studies such as (Ahmadizadeh et al., 2013; Bryant, et al., 2008; Eftekhari, et al., 2013; Frost et al., 2014) demonstrate unique benefits in the treatment procedure. These methods include CBT, interpersonal therapy, psychological debriefing, exposure therapy, reprocessing therapy, and virtual therapy.
Furthermore, there exist significant differences between pharmacological and psychological interventions. For instance, unlike psychological treatments, the pharmacological cures of PTSD have a limitation of two classes, namely paroxetine and sertraline based on FDA approvals. Contrarily, the psychological treatment options for PTSD are limitless and equally as effective on individuals and combinational basis. Finally, if untreated with the timeliness it deserves, as seen in Vitzthum et al. (2009), the condition than destroy relationships and turn veterans into criminals.
Evaluation
Three theories are common from most of the above reviews and discussions. First, the CBT theory utilizes the principles of conditioning and learning to help treat disorders. The theory encompasses components from cognitive and behavioral therapy. CBT allows for the usage of elements such as exposure, restructuring, and coping skills both on individual and combinational statuses. As part of the application process, CBT is ideal for both individual and group therapy (Agency for Healthcare Research and Quality, 2011).
Group therapy encompasses an array of theoretical therapies as opposed to specific interventions. Group-oriented therapy varies both in theory and practice as per its emphasis on educational, team dynamics, behavioral skills, and cognitive skills. The application of this concept to PTSD focuses on the importance of social support on the cost-effectiveness of care, chances to acquire new behavior, coping skills, peer feedback, and team dynamics (Agency for Healthcare Research and Quality, 2011).
Exposure-based therapy looks at how individuals confront traumatic stimuli on a continuous basis until they contain PTSD levels. The exposure relies on the psychological imagery from the patient’s memory or the introduction of relevant scenes as identified by the therapist. In the military perspective, exposure happens from similar events through film and picture. The objective of this method is to extinguish any form of conditional response that individuals have to traumatic events (Agency for Healthcare Research and Quality, 2011).
Implication
PTSD is a vital health and human services problem idealized through its incidence rate among war veterans. This realization implies that in addition to such reviews, greater attention is important in identifying the EBP treatment procedures that would help in addressing PTSD. The other part of this need is that the country has an active engagement in military deployments during past and present events. Currently, there is an increasing number of military deployments to terror-torn Iraq, Syria, Egypt, and Nigeria.
Also vital noting is that this discussion opens up the importance of VA therapists to recognize the need for early detection and prevention measures. Already, the studies reveal issues as suicidal ideation as part of the detrimental effects of unchecked PTSD. Thus, health and human services professionals should consider applying preventive and curative measures on a multi-interventional approach as a way of effectively treating PTSD. For instance, individual PE would easily blend with group treatment to optimize the impacts of treatment.
Conclusion
While PSTD is most common and deadly among war veterans, it almost goes untreated thus deserves a sound intervention mechanism to prevent associated detrimental effects. In this view, the study focused on the different measures VA facilities use to manage PTSD victims upon successful deployment. The scientific literature reviewed shows that PTSD would most likely go unchecked for most soldiers. Nonetheless, the findings reveal the importance of early detection and treatment. The eventual recommendation is that health and human services departments should consider multimodal approaches when treating PTSD to ensure efficacy.
References
Agency for Healthcare Research and Quality. (2011). Psychological Treatments and Pharmacological Treatments for Adults with Post-traumatic Stress Disorder (PTSD). Rockville, MD: Agency for Healthcare Research and Quality .
Ahmadizadeh, M., Ahmadi, K., Anisi, J., & Ahmadi, A. (2013). Assessment of Cognitive Behavioral Therapy on Quality of Life of Patients with Chronic War-related Post-traumatic Stress Disorder. Indian Journal of Psychological Medicine, 35 (4), 341-345. doi:10.4103/0253-7176.122222
Bryant, R. A., Mastrodomenico, J., Felmingham, K. L., Hopwood, S., Kenny, L., Kandris, E., . . . Creamer, M. (2008). Treatment of acute stress disorder: a randomized controlled trial. Archives of General Psychiatry, 65 (6), 659-669. doi:10.1001/archpsyc.65.6.659
Eftekhari, A., Ruzek, J., Crowley, J., Rosen, C., Greenbaum, M., & Karlin, B. (2013). Effectiveness of national implementation of prolonged exposure therapy in Veterans Affairs care. JAMA Psychiatry, 70 (9), 949-955. doi:10.1001/jamapsychiatry.2013.36
Frost, N. D., Laska, K., & Wampold, B. (2014). The evidence for present-centered therapy as a treatment for posttraumatic stress disorder. Journal of Traumatic Stress, 27 (1), 1-8. doi:10.1002/jts.21881
Goodson, J., Helstrom, A., Halpern, J. M., Ferenschak, M., Gillihan, S., & Powers, M. B. (2011). Treatment of posttraumatic stress disorder in U.S. combat veterans: a meta-analytic review. Journal of Psychological Reports, 109 (2), 573-599.
Jakupcak, M., Cook, J., Imel, Z., Fontana, A., Rosenheck, R., & McFall, M. (2009). Posttraumatic Stress Disorder as a Risk Factor for Suicidal Ideation in Iraq and Afghanistan War Veterans. Journal of Traumatic Stress, 22 (4), 303-306.
Sloan, D., Bovin, M., & Schnurr, P. (2012). Review of group treatment for PTSD. Journal of Rehabilitation Research & Development (JRRD), 49 (5), 689–702.
Vitzthum, K., Mache, S., Joachim, R., Quarcoo, D., & Groneberg, D. (2009). Psychotrauma and effective treatment of post-traumatic stress disorder in soldiers and peacekeepers. Journal of Occupational Medicine and Toxicology, 4 (21). doi:10.1186/1745-6673-4-21
