Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations Initial Assessment (2012) / Chapter Skim
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5 Prevention
5 Prevention
Pages 165-194
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From page 165... ...
Prevention of PTSD in active-duty personnel is provided via programs aimed at preparing service members for combat and other deployment-related stressors. Some programs focus on reducing the risk of exposure to traumatic events (such as interventions aimed at reducing the risk of military sexual trauma)
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From page 166... ...
And prevention may refer to measures taken to mitigate the consequences of existing symptoms by improving functioning and reducing complications. The latter type of PTSD prevention includes interventions in patients who have subthreshold PTSD symptoms, ASD, and ancillary problems; it provides treatment for clinical PTSD and recurrence prevention through rehabilitation programs.
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From page 167... ...
Those data have been used to inform the development of preventive interventions in both civilian and military personnel. Modifiable factors include unit culture, whereby reporting sexual assault by a fellow service member may considered to be "breaking a code" and may result in ostracization; leadership behavior that may implicitly or explicitly condone, tolerate, or ignore sexual assault and harassment; and facilitating situations such as excessive use of alcohol by any of the involved parties (Allard et al., 2011; Sadler et al., 2001; Street et al., 2009; Suris and Lind, 2008)
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From page 168... ...
. Similar to deployment stressors reported by 1990–1991 Gulf War veterans, OEF and OIF deployment stressors include being in the vicinity of explosions, direct combat duty, witnessing death of a person, being exposed to dead and dismembered bodies, and having a combat-related injury (IOM, 2008)
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From page 169... ...
169 TABLE 5-1 Combat Experiences Reported by Members of the U.S. Army and Marine Corps Following Deployment to Iraq or Afghanistan Army Groups Marine Group % in Afghanistan % in Iraq % in Iraq Experience (n = 1,962)
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This section reviews research on early psychosocial interventions for the prevention of PTSD. First, psychologic debriefing that is usually conducted immediately or within few days after a traumatic event is reviewed and then the literature on cognitive behavioral therapy (CBT)
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From page 171... ...
. The use of CBT in the weeks or days after exposure for people who display symptoms of posttraumatic stress have proved to be effective in RCTs and metaanalytic reviews, but there are no studies of the use of CBT immediately after trauma exposure.
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From page 172... ...
soldiers returning from Iraq who had been exposed to direct combat throughout their deployment. Soldiers received either stress education or Battlemind debriefing (Battlemind is an Army program to foster resilience;
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From page 173... ...
delivered within weeks of a traumatic event may effectively prevent PTSD in survivors of sexual and nonsexual assault (Foa et al., 1995) , motor vehicle incidents, industrial accidents, and traumatic brain injuries (Bryant et al., 1998, 1999, 2003)
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From page 174... ...
A few other non-CBT interventions have been examined as potential preventive treatments for PTSD, but none have been found to be effective in reducing or preventing PTSD symptoms. For example, brief structured writing has been found ineffective in preventing PTSD in two studies (Bugg et al., 2009; van Emmerik et al., 2008)
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From page 175... ...
. Studies using propranolol have had mixed results, and overall the VA/DoD guideline concludes that despite some positive results "the size and weak study designs of the investigations do not allow for definitive conclusions regarding the value of these medications in preventing the development of PTSD symptoms after traumatic events." The use of hydrocortisone has also been studied in small trials.
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From page 176... ...
) is applicable to all service branches and established requirements for the "early detection and management of combat and operational stress reactions in order to preserve mission effectiveness and war fighting capabilities and mitigate the adverse physical and psychological consequences of exposure to severe stress." The goal of CSC programs is to manage combat stress reactions as close to unit level as possible.
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From page 177... ...
Primary prevention within the DoD is intended to promote the skills in at-risk populations necessary to cope with the traumatic experiences associated with combat. A large number of PTSD prevention programs have been developed by each service and are discussed in the RAND report Programs Addressing Psychological Health and Traumatic Brain Injury Among U.S.
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From page 178... ...
RAND recommended that the DoD define resilience, integrate the concept of resilience into policy decisions for each service, strengthen existing resilience programs by evaluating and publishing the evaluations, base the evaluations on such standardized resilience measures as the Global Assessment Tool being developed for the Army's Comprehensive Soldier Fitness program, provide a resource guide to service members and their families, have new programs incorporate factors supported by the most evidence, engage senior military leaders in building resilience, and promote a flexible program curriculum, such as the Marine Corps OSCAR program, to coordinate with existing training and community-based programs (Weinick et al., 2011)
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From page 179... ...
. Resilience training is also used at intervals during deployment to reduce mental health symptoms in a deployed unit overall (Hourani et al., 2011)
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From page 180... ...
; comprehensive resilience modules (formerly known as Battlemind) are online training modules that focus on specific resilience skills using precepts of positive psychology, cognitive restructuring, mindfulness, and research on posttraumatic stress, unit cohesion, occupational health models, organizational leadership, and deployment to prepare service members for military life, combat, and transitioning home; the global assessment tool (GAT)
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From page 181... ...
. The COSC program distinguishes between combat stress and operational stress, with the understanding that the latter can be experienced with or without deployment.
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From page 182... ...
in a review of the literature on sexual trauma in the military reported that the overall prevalence rates of sexual trauma in military personnel and veterans ranges from 20% to 43%. They also found that female respondents who were using VA services reported "significantly higher rates of sexual assault while on active duty compared with current active-duty [respondents]
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From page 183... ...
. The DoD Defense Manpower Data Center tracks the incidence of unwanted sexual contact, which includes unwanted sexual touching, with the Workplace and Gender Relations Survey of Active Duty Members.
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From page 184... ...
• Develop and maintain adaptive beliefs -- Realistic expectations about the experience of combat and ensuing stress reactions bol stered by confidence in coping ability, leadership management, and the value of military service. • Develop workplace-specific comprehensive traumatic-stress man agement programs -- Encouragement of the use and promotion of the benefits of programs tailored to support service members after trauma.
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From page 185... ...
Vet Centers also provide prevention services to veterans who may have been exposed to trauma or who are suffering from PTSD symptoms. The services are available to any veteran and have the advantage of being available for the veterans' families as well as veterans themselves.
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From page 186... ...
In particular, the Army has had a variety of prevention programs including Battlemind and, most recently, the CSF program that will be used for all Army personnel before deployment. The Navy and Marine Corps and the Air Force have similar training.
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From page 187... ...
2008. A randomized controlled trial of exposure therapy and cognitive restructuring for posttraumatic stress disorder.
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From page 188... ...
2003. A randomized controlled trial of cognitive therapy, a self-help booklet, and re peated assessments as early interventions for posttraumatic stress disorder.
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2011. Approaches to the pri mary prevention of posttraumatic stress disorder in the military: A review of the stress control literature.
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2003. Does early psychological intervention promote recovery from posttraumatic stress?
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2009. Psychological resilience and postdeployment social support protect against traumatic stress and depressive symptoms in soldiers returning from Operations Enduring Freedom and Iraqi Freedom.
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2001. The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder in survivors.
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2008. Treating acute stress disorder and posttraumatic stress disorder with cognitive behavioral therapy or structured writing therapy: A randomized controlled trial.
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