Interventions for PTSD have not been widely tested on military personnel.
Post-traumatic stress disorder (PTSD) occurs in people who have experienced a significant terrifying event in their life.
Symptoms can include night terrors, intrusive thoughts, and a loss of emotional connection with family and friends.
Although there are treatments that are known to improve symptoms, most of the research has been aimed at civilian cases of PTSD.
In the general population, PTSD affects an estimated 7-8 percent of Americans at some point in their lives.
Perhaps unsurprisingly, PTSD is more common in the military; for instance, 15 percent of Vietnam veterans and 11-20 percent of those who served in Iraq have PTSD in a given year.
A recent study, published this week in JAMA Psychiatry, is the largest investigation into PTSD relief among active-duty military service members.
The study examined participants from the United States Army's Fort Hood in Killeen, TX. In particular, the focus was on comparing 6 weeks of cognitive processing therapy (CPT) either in groups or one-on-one
Cognitive processing therapy
CPT was created in the 1980s by the current study's lead author - Patricia Resick, Ph.D. Now based at the Duke University School of Medicine in North Carolina, Resick is a professor of psychiatry and behavioral sciences. Her system was initially designed to treat victims of rape and other interpersonal crime.
CPT delves into how an individual thinks about the traumatic event that preceded PTSD and the way in which it affects emotions. Resick explains the process:
"We look at what people have been saying to themselves about the trauma, which in people with PTSD can be distorted. Many of them think there's something they could have done differently to prevent the trauma. We teach them how to examine their thoughts and feel their natural emotions instead of feelings, such as guilt or blame that may result from distorted thinking."
"We go back and look at the evidence. Once they think in a more balanced, factual way, their emotions and symptoms of PTSD subside," she adds.
To examine how effective CPT could be for military men and women, the researchers teamed up with the South Texas Research Organizational Network Guiding Studies on Trauma And Resilience (STRONG STAR).
STRONG STAR, funded by the U.S. Department of Defense, describe themselves as a "unified effort to defeat combat-related PTSD." As mentioned, there are effective treatments for PTSD, but they have mostly been tested on civilians. STRONG STAR is dedicated to looking at their efficacy, specifically within a military context.
In all, 268 active-duty military service members took part in the trial. They were mostly males with an average age of 33. Roughly half of the group were assigned to group therapy, which entailed 90-minute sessions twice a week for 6 weeks. The others had one-on-one sessions with a therapist in 60-minute slots twice a week for 6 weeks.
Each participant was evaluated by independent experts before the trial, during, and 6 months after; the evaluations measured the severity of the PTSD and other parallel conditions, such as depression and suicidal thoughts.
How effective is CPT?
Everyone involved in the study saw an improvement in a range of PTSD symptoms including nightmares, intrusive thoughts, and being easily startled. In fact, 50 percent of the trial's participants improved so much that they no longer met criteria for a PTSD diagnosis.
"For some of the participants, you can see a change just by looking at them - as though they have been unburdened. Some people think you have to go to therapy for years to address PTSD, but in this large-scale clinical trial with CPT, we saw a large percentage of patients show significant improvements and even recover from PTSD in a matter of weeks."
Patricia Resick, Ph.D.
When group and individual sessions were compared, even at the 6-month mark, no difference was seen between the reductions in suicidal thinking and depression. However, individuals who attended the one-on-one sessions experienced the most significant improvements and in a shorter amount of time.
Neither intervention was perfect, though; many participants still had ongoing symptoms after the treatment had finished. This study can be seen as a first step toward designing the most effective possible treatment for military-based PTSD.
STRONG STAR plan to follow up these findings and expand on them by examining the role of traumatic brain injuries and substance abuse on PTSD outcomes.