Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations Initial Assessment (2012) / Chapter Skim
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According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) , PTSD symptoms must be manifested in three clusters: 1.
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This phase 1 report is based on an extensive literature search, including government documents and data; two public information-gathering sessions with presentations from representatives of the DoD, the VA, veterans' organizations, and individual service members and veterans who had PTSD; meetings with a variety of mental health providers and with PTSD patients and their families at U.S. Army base Fort Hood in Killeen, Texas; and information from the Veterans Health Administration provided in response to the committee's request.
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The work of the committee is dependent upon the timely delivery of data, in a usable format, from the DoD and the VA on their current PTSD programs. In phase 1 of the study, the committee will collect data from the DoD and the VA on programs and methods available for the prevention, screening, diagnosis, treatment, and rehabilitation of PTSD.
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More research is needed to link any neurobiologic mechanism to PTSD risk or resilience, to identify environmental and biologic factors that contribute to the onset and severity of PTSD symptoms, to apply biomarkers and neuroimaging models to the diagnosis of PTSD (which would help to reduce the dependence on self-reported symptoms) , and to locate potential targets for future pharmacologic treatment of PTSD or pharmacologic agents that could enhance current treatment therapies.
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Although the VA has a system of specialized treatment programs that focus exclusively on PTSD, most PTSD-related services are offered in general mental health and medical settings, including primary care. The VA also supports Vet Centers that are staffed with social workers, clinical psychologists, mental health counselors, and professionally trained counselors and therapists.
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At present, however, there is no empirical evidence regarding the effectiveness of these approaches. Several of the DoD predeployment PTSD programs also have components to help service members and their families prevent the development of PTSD after deployment, including the Army Comprehensive Soldier Fitness program and the Navy and Marine Corps Families OverComing Under Stress (FOCUS)
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In DoD clinic settings, the PCL is commonly used to screen for PTSD, and the screening results are usually integrated into a more comprehensive assessment and require interpretation by qualified professionals. Service members who received care in an integrated mental health and primary care setting had significantly reduced psychologic distress and improved clinical outcomes.
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The committee considered a wide variety of treatments that are used for PTSD from those with strong evidence bases such as exposure therapies, to pharmacologic agents such as serotonin reuptake inhibitors, and emerging therapies such as complementary and alternative medicines. Psychosocial Therapies The vast majority of treatments that have been examined via randomized controlled trials (RCTs)
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Cognitive processing therapy is a treatment that combines aspects of both cognitive therapy and PE. Other effective treatments include EMDR and imagery rehearsal therapy.
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Nevertheless, the committee heard from numerous service members that they are using CAM treatments and that the treatments help to alleviate their PTSD symptoms. The VA offers a wide variety of CAM treatments at its facilities, and some military bases also offer CAM therapies, including animal-assisted therapy for service members who have mental health disorders.
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No studies have examined treatment protocols that specifically target co-occurring TBI and PTSD symptoms. The effectiveness of CBT to treat both chronic pain and PTSD is supported by empirical evidence.
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The DoD has increased the number of referrals to TRICARE mental health providers in an attempt to reduce waiting times for appointments. The VA has also increased the number of mental health providers and increased training in PTSD treatments for counselors in Vet Centers.
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PTSD screening should be conducted at least once a year when primary care providers see service members at DoD mili tary treatment facilities or at any TRICARE provider locations, as is currently done when veterans are seen in the VA. C. Innovate • C1.
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Effective treatments should be included in updates of the VA/DoD Clinical Practice Guideline for Management of Post-Traumatic Stress. PHASE 2 The committee understood its objectives as given in the Statement of Task to be a comprehensive review and synthesis of the available literature and data on the prevention, screening, diagnosis, treatment, and rehabilitation of PTSD in military and veteran populations.
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The committee has already visited Fort Hood and will visit the other two Army bases in phase 2. Because a large number of marines have deployed to Iraq and Afghanistan, the committee also hopes to visit a Marine Corps base.
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