Effectiveness of Treatment of Veterans with PTSD: a Critical Review
Journal Title: Journal of Experiential Psychotherapy - Year 2019, Vol 22, Issue 2
Abstract
Introduction: PTSD impacts physiological, neurological, biochemical and epigenetic systems and is experienced largely unconsciously. Measures of treatment effectiveness vary widely but correspond to whether the modality of treatment creates an experience that is dominantly conscious or non-conscious. Objectives: We evaluate the effectiveness of treatments for PTSD in the veteran population based on an analysis of published research. Methods: A literature scan for PTSD, veterans and military personnel was conducted using CINAHL, PubMed, PILOT, Embase, ResearchGate, ScienceDirect, Wiley, PsycINFO, SpringerLink, ProQuest, PsycNET, MEDLINE, VA.com and Cochrane Library. Results: 1. Pathology is widely described but not related to diagnosis, treatment or measures of treatment efficacy. There are no descriptions of pathogenesis and nothing explicit about causation for veteran populations. 2. Measures of treatment effectiveness are varied and inconsistent. Conscious therapeutic treatments like rational or cognitive behavioral therapy experience low efficacy, refractory response is 30-50%, and non-response is high. 3. Soldiers and veterans diagnosed with PTSD benefit less from psychotherapy than non-military populations. 78% of veterans are still in treatment after four years. 4. The research and treatment field is siloed by specialty and lacks a collaborative approach. Treatment of PTSD is hampered because veterans are reluctant to seek help. Also, PTSD is a multisystem response that is idiosyncratic and manifests in many ways. Conclusions: 1. Treatment of PTSD could be more effective if it moved away from a symptom focused diagnostic process toward an ecology-based, systems approach that focuses on wellness. Collaboration across fields is therefore needed, along with effective comparison between studies against common criteria. 2. Approaches that are unconscious such as Eye Movement Desensitization Reprocessing, Trauma informed Coaching, Virtual Reality and Reconsolidation of Traumatic Memory are highly efficacious but more sparsely studied when compared with Cognitive Behavioral Therapy and Exposure Therapy. 3. Treatments need to consider efficacy, balanced against refractory responses and risks of exacerbating the condition or harming the patient.
Authors and Affiliations
Robert Holmes, Ian Snape
Keywords
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