Better Treatment for Veterans with PTSD
Many American veterans and their families must deal with mental health disorders associated with serving in the military. After a trauma or life-threatening event, it is common to have psychological reactions, such as upsetting memories of the event, increased jumpiness, or trouble sleeping. If these reactions do not go away or if they get worse, posttraumatic stress disorder (PTSD) may be diagnosed.
Research has shown that returning veterans suffering with PTSD have a high rate of marital problems and family violence. Their partners have more distress and their children have more behavior problems than do those of veterans without PTSD. Three out of five attempted suicides are made by veterans who have previously been diagnosed with a mental health condition, according to one report.
Comorbidity, the co-occurrence of a psychiatric illness and a general medical and/or a substance use disorder, is the rule rather than the exception among VA patients. Most veterans suffer from more than one type of condition, which presents clinicians with a more complex set of problems than typically represented in research studies.
What is being done to help veterans? Congress established the Mental Illness Research, Education and Clinical Centers (MIRECC) with the goal of researching the causes of and treatments for mental disorders in veterans. The purpose was to produce evidence of successful treatments in an effort to improve mental health services in the military. A second goal was to implement ongoing education to put this new knowledge into routine clinical practice for individuals and families in the Veteran Administration (VA) medical system.
From this research, type of trauma emerged as a significant moderator of intervention effects. In particular, one systematic review found that adults who experienced assault demonstrated the greatest change in PTSD symptoms from pre- to post-test. Gender also emerged as a moderator. Specifically, there was evidence to suggest females responded better to cognitive behavioral training (CBT), a type of therapy often used with PTSD sufferers, than males.
An extensive search yielded eighteen reviews examining the effect of psychological interventions on the prevention of PTSD. Scientist found that CBT interventions administered within 3 months of a traumatic event are effective in preventing PTSD, though in a combat setting, this type of therapy may not be able to be provided. Debriefing interventions administered within 1 month of a traumatic event were not effective in preventing PTSD. In reviews examining children and adolescents, five out of seven studies reported CBT as highly effective in treating PTSD symptoms.
Research, education, and clinical practice efforts that acknowledge the high frequency of comorbidity are likely to be translated into standard practice by health care providers. If researchers neglect to consider comorbidity, they run the risk of developing interventions that do not apply to real patients.
The needs of our nation’s veterans and their families may be best met by creating effective programs to train VA service providers in therapies with proven efficacy. Specialized mental health centers of excellence (MHCoE) are an essential component of the VA’s response to meeting the mental health therapy demand.
If you think you have a psychiatric issue, work with your doctor or other health care professional for an accurate diagnosis and to create a personal health plan.