Combat Trauma

Analysis of PTSD Treatments

Article Review on Effective Strategies in the Treatment of Post Traumatic Stress Disorder

Daniel R. Gaita, MA

September 15th, 2016

Effective Treatment For PTSD

 

Identification of Article Importance

 

This paper covers a critical review (Dworkin, 2011), of seventeen published studies specific to psychosocial interventions between 2000-2010 for veterans with Post Traumatic Stress Disorder (PTSD)

Specialty Population Served

The article we have selected for this work is a focused critical review of the psychosocial interventions currently being administered for veterans with PTSD.

Explanation of Chosen Treatment

We have chosen Cognitive Processing Therapy due to repeated efficacy in findings using data collected from the Clinician Administered PTSD Scale (CAPS) across multiple studies referred to in the Dworkin, 2011 article and in addition to supportive data in its use in group and video teleconferencing group settings. (Morland, Hynes, Mackintosh, Resick, & Chard, 2011).

Measuring PTSD symptoms with CAPS.

Clinician Administered PTSD Scale (CAPS). The CAPS is a 30-item scale that measures the existence and intensity of the 17 symptoms of PTSD as stated in the DSM- IV (Blake et al., 1995). The CAPS is completed by way of a mental health professional interviewing a subject with the use of the scale (Blake et al., 1995). Severity scores of 0-19 = asymptomatic/few symptoms, 20-39 = mild PTSD/sub threshold, 40-59 = moderate PTSD/threshold, 60-79 = severe PTSD symptomatology, and > 80 = extreme PTSD symptomatology," (Weathers, Keane, & Davidson, 2001, p. 135). Change in scores representing a decrease or increase in CAPS scores ranging from 10 to 15 have been recommended or used as interpretations of clinical significance (Weathers et al, 2001; Ready, Thomas, Worley, Backscheider, Harvey, Baltzell, & Rothbaum, 2008).

Evaluation of findings.

Following an evaluation of clinician administered PTSD Scale (CAPS) scores, pre and post treatment, specific to their utilization in data collection for Cognitive Processing Theory (CPT), Exposure Therapy, Present Centered Therapy, Skill Building focused CBT and Multimodal Therapy, the extensive review of psychosocial interventions provided in the Dworkin, 2011 analysis demonstrate greater short and long term efficacy in treating PTSD with the use of Cognitive Processing Therapy (CPT) and exposure-like therapies.

 Article Summary and Analysis

How Techniques Apply

CPT focuses on creating a detailed account of one's trauma in order to alter maladaptive accommodations and assimilations by reconstructing them in more adaptive ways for the individual, which is theorized to allow a person to confront and reduce symptoms acquired from trauma (Sobel et al., 2009).

Description of Therapeutic Application

CPT is a recovery-focused therapy, which works off both collaboration and informed choice, uses a twelve-session protocol implemented either individually, in-group, or both and may or may not include trauma focused cognitive therapy. However, it can be implemented without traumatic accounts (Resick, Monson, & Chard, 2008).

Critical Analysis

The results of CPT for both Vietnam and Operation Iraqi Freedom and Enduring Freedom (OIF/OEF) veterans showed no significant differences between groups but did demonstrate treatment efficacy across both populations with CAPS score of 71.88 reduced to 31.50 for OIF/OEF and 66.48 reduced to 42.50 for Vietnam Veterans. Similar findings of overall CAPS score reductions were replicated across multiple studies (Dworkin, 2011).

Key Finding for Future Research

Of importance to note is the rapid increase in suicide rates among female U.S. Veterans by the Department of Veterans Affairs (Thompson, 2016), yet very little data is presented across all 17 published studies cited in the Dworkin review of psychosocial interventions on female study subjects.  While CPT had been initially conducted with rape victims and has since been used successfully with a range of other traumatic events (Resick, Monson, & Chard, 2008) we will need more research as it applies to women in the armed forces as they take up a growing number of newly opened positions in the combat arms sectors. Effective treatment interventions for combat trauma will be instrumental in ensuring the long-term mental health of female veterans equally to their male counterparts.

Application to Selected Population

Today, CPT is widely used through the Department of Veterans Affairs (VA) mental health sector and made widely available for use and implementation globally. They currently provide the following link, http://alrest.org/pdf/CPT_Manual_-_Modified_for_PRRP(2).pdf to the actual Veterans and Military CPT Manual (Resick, Monson, & Chard, 2008), being implemented in providing CPT treatment for PTSD through the United States Veterans Affairs healthcare system as well as other helpful instructional video series provided by the National Center for PTSD and the U.S. Department of Veterans Affairs here, http://www.ptsd.va.gov/professional/continuing_ed/flash-files/CPT/Player/launchPlayer.html?courseID=1568&courseCode=PTSD101_cpt specific to CPT implementation guidelines currently in effect.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Blake, D. D., Weathers, F. W., Nagy, L. M, & Kaloupek, D. G. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8(1), 75-90. doi: 10.1002/jts.2490080106.

Dworkin, D. (2011). A critical review of psychosocial interventions for veterans with posttraumatic stress disorder (Order No. 1493116). Available from ProQuest Dissertations & Theses Full Text; ProQuest Dissertations & Theses Global. (866298062). Retrieved from http://libproxy.usc.edu/login?url=http://search.proquest.com.libproxy2.usc.edu/docview/866298062?accountid=14749

Morland, L. A., Hynes, A. K., Mackintosh, M.-A., Resick, P. A. and Chard, K. M. (2011), Group cognitive processing therapy delivered to veterans via telehealth: A pilot cohort. J. Traum. Stress, 24: 465–469. doi:10.1002/jts.20661

Ready, D. J., Thomas, K. R, Worley, V., Backscheider, A. G., Harvey, L. A. C, Baltzell, D., & Rothbaum, B. O. (2008). A field test of group based exposure therapy with 102 veterans with war-related posttraumatic stress disorder. Journal of Traumatic Stress, 21(2), 150-157. doi: 10.1002/jts.20326.

Resick, P.A., Monson, C.M., & Chard, K. M. (2008). Cognitive Processing Therapy: Veteran/Military Manual. Veterans Administration. Retrieved from: http://alrest.org/pdf/CPT_Manual_-_Modified_for_PRRP(2).pdf

Sobel, A. A., Resick, P. A., & Rabalais, A. E. (2009). The effect of cognitive processing therapy on cognitions: Impact statement coding. Journal of Traumatic Stress, 22(3), 205-211.

Thompson, C., (2016). VA Suicide Prevention Program, Facts about Veteran Suicide, Suicide. Prevention and Community Engagement. Retrieved from: http://www.va.gov/opa/publications/factsheets/Suicide_Prevention_FactSheet_New_VA_Stats_070616_1400.pdf

Weathers, F. W., Keane, T. M., & Davidson, J. R T. (2001). Clinician-administered PTSD scale: A review of the first ten years of research. Depression & Anxiety, 13(3), 132-156.