PTSD In Veterans Research Articles

Using Internal Family Systems Theory in the Treatment of Combat Veterans with Post-Traumatic Stress Disorder and Their Families

As many as one-third of all combat veterans experience symptoms of post-traumatic stress disorder following their service to the military (United States Department of Veterans Affairs 2016). Despite government efforts to provide care for those suffering from PTSD symptoms, veterans still struggle to receive appropriate and effective treatments. Inadequate care often has devastating effects on the veteran and his or her family. Currently, veterans typically receive individual treatments such as cognitive behavioral therapy, exposure therapy, or eye movement desensitization and reprocessing. While the United States Department of Veterans Affairs provides individually focused evidenced based treatments, they do not currently endorse any particular model of family systems therapy for the treatment of PTSD in veterans or their families. The present article aims to demonstrate that Internal Family Systems (IFS), a systemic form of therapy, provides an effective treatment for combat veterans who suffer from PTSD. We propose that IFS’s collaborative approach, less-pathologizing stance, and simple language will resonate with military populations. We also argue that IFS provides a seamless transition between individual and family therapy allowing the therapist to address both the individual and relational effects of PTSD.

The Role of PTSD in Bi-directional Intimate Partner Violence in Military and Veteran Populations: A Research Review.

Evidence supporting the higher prevalence of PTSD linked to combat-related trauma in military personnel and veteran populations is well-established. Consequently, much research has explored the effects that combat related trauma and the subsequent PTSD may have on different aspects of relationship functioning and adjustment. In particular, PTSD in military and veterans has been linked with perpetrating intimate partner violence (IPV). New research and theoretical perspectives suggest that in order to respond effectively to IPV, a more accurate understanding of the direction of the violence experienced within each relationship is critical. In both civilian and military populations, research that has examined the direction of IPV's, bi-directional violence have been found to be highly prevalent. Evidence is also emerging as to how these bi-directional violence differ in relation to severity, motivation, physical and psychological consequences and risk factors. Of particular importance within military IPV research is the need to deepen understanding about the role of PTSD in bi-directional IPV not only as a risk factor for perpetration but also as a vulnerability risk factor for victimization, as findings from recent research suggest. This paper provides a timely, critical review of emergent literature to disentangle what is known about bi-directional IPV patterns in military and veteran populations and the roles that military or veterans' PTSD may play within these patterns. Although, this review aimed to identify global research on the topic, the majority of research meeting the inclusion criteria was from US, with only one study identified from outside, from Canada. Strengths and limitations in the extant research are identified. Directions for future research are proposed with a particular focus on the kinds of instruments and designs needed to better capture the complex interplay of PTSD and bi-directional IPV in military populations and further the development of effective interventions.

The Manual Stimulation of Acupuncture Points in the Treatment of Post-Traumatic Stress Disorder: A Review of Clinical Emotional Freedom Techniques.

Background: The manual stimulation of acupuncture points has been combined with components of cognitive and exposure therapies into a clinical and self-help approach known as Emotional Freedom Techniques (EFT). More than 40 clinical trials and four meta-analytic reviews of EFT treatments have demonstrated large effect sizes with a range of conditions, including pain, PTSD (in both civilian and military veteran populations), phobias, anxiety, and depression. Objective: This review describes the approach, with a focus on PTSD in veterans and service members, provides an overview of how EFT is most commonly applied, and outlines obstacles and cautions related to its implementation. Methods: Peer-reviewed clinical trials and meta-analyses of EFT in the treatment of PTSD are assessed to identify the characteristics of the approach that render it suitable for the treatment of PTSD. Results: The literature demonstrates that remediation of PTSD and comorbid conditions is typically accomplished within brief time frames, ranging from one session for phobias to between four and ten sessions for PTSD. Clinical EFT has been shown to regulate stress hormones and limbic function and to improve various neurologic markers of general health. The epigenetic effects of EFT include upregulation of immunity genes and downregulation of inflammation genes. Six dismantling studies have indicated that the acupressure component of EFT is an active ingredient and not placebo. Conclusions: Seven empirically supported strengths of the approach were identified that make it especially suitable for use with veterans and active military: (1) the depth and breadth of treatment effects; (2) the relatively brief timeframes required for successful treatment; (3) the low risk of adverse events; (4) the minimal training time required for the approach to be applied effectively; (5) the simultaneous reduction of physical and psychologic symptoms; (6) the utility and cost-effectiveness of clinical EFT in a large group format; and (7) the method's adaptability to online and telemedicine applications.

The Impact of War on Emergence of Depression and Posttraumatic Stress Disorder on Iranian Veterans of Iran-Iraq War

Iran has been involved in many wars throughout its ancient history, a vivid example is the Iran-Iraq war. This imposed war was ongoing during September 1980 – August 1988 (Mohsenian, 2008). ).The main goal of this study was to investigate differences depression and PTSD symptoms in veterans who participated in the Iran-Iraq compared to community sample. The objectives of this research were: 1.Comparing depression in soldiers who are PTSD patients and ordinary people. 2. Comparing PTSD symptoms in soldiers and ordinary people. The research hypotheses were formulated according to the defined objectives. The statistical population included the Iran-Iraq war veterans and the ordinary male individuals within the age range of 25-50 residing in Tehran. . The data analysis for present research was down descriptively. The Foundation of Martyrs and Veterans’ Affairs of the city of Tehran permitted the researcher to select the statistical samples through the families of martyrs and veterans in person. The related questionnaires were handed in to the testees in person. The research objectives and nondisclosure of information were explained to the testees prior to distribution of the questionnaire. The data was collected using a PTSD checklist by Weathers, Litz, Herman, Huska, Kean etal (1993) and the Beck depression inventory. The multivariate effect indicates a significant difference between the depression and PTSD in war veterans and ordinary individuals aged 25-50. Depression and PTSD in Iran-Iraq war veterans it was higher compared to ordinary individuals.

Altered Microstructural Caudate Integrity in Posttraumatic Stress Disorder but Not Traumatic Brain Injury.

ObjectiveGiven the high prevalence and comorbidity of combat-related PTSD and TBI in Veterans, it is often difficult to disentangle the contributions of each disorder. Examining these pathologies separately may help to understand the neurobiological basis of memory impairment in PTSD and TBI independently of each other. Thus, we investigated whether a) PTSD and TBI are characterized by subcortical structural abnormalities by examining diffusion tensor imaging (DTI) metrics and volume and b) if these abnormalities were specific to PTSD versus TBI.MethodWe investigated whether individuals with PTSD or TBI display subcortical structural abnormalities in memory regions by examining DTI metrics and volume of the hippocampus and caudate in three groups of Veterans: Veterans with PTSD, Veterans with TBI, and Veterans with neither PTSD nor TBI (Veteran controls).ResultsWhile our results demonstrated no macrostructural differences among the groups in these regions, there were significant alterations in microstructural DTI indices in the caudate for the PTSD group but not the TBI group compared to Veteran controls.ConclusionsThe result of increased mean, radial, and axial diffusivity, and decreased fractional anisotropy in the caudate in absence of significant volume atrophy in the PTSD group suggests the presence of subtle abnormalities evident only at a microstructural level. The caudate is thought to play a role in the physiopathology of PTSD, and the habit-like behavioral features of the disorder could be due to striatal-dependent habit learning mechanisms. Thus, DTI appears to be a vital tool to investigate subcortical pathology, greatly enhancing the ability to detect subtle brain changes in complex disorders.

Treatment of Co-Morbid Alcohol Use Disorder and PTSD in Veterans

Treatment of Co-Morbid Alcohol Use Disorder and PTSD in Veterans

EFT (Emotional Freedom Techniques) Remediates PTSD and Psychological Symptoms in Veterans: A Randomized Controlled Replication Trial

EFT (Emotional Freedom Techniques) Remediates PTSD and Psychological Symptoms in Veterans: A Randomized Controlled Replication Trial

P.4.f.014 - A comparison of the Korean version of posttraumatic diagnostic scale and clinician administered PTSD scale assessment for PTSD in Korean veterans

P.4.f.014 - A comparison of the Korean version of posttraumatic diagnostic scale and clinician administered PTSD scale assessment for PTSD in Korean veterans

Supplemental Material for Improving Assessment of Race, Ethnicity, and Culture to Further Veteran PTSD Research

Supplemental Material for Improving Assessment of Race, Ethnicity, and Culture to Further Veteran PTSD Research

Can ecstasy treat the agony of PTSD?

IntroductionTwo serotonin reuptake inhibitors (SSRIs) have received FDA indication for treatment of PTSD, however the effectiveness of pharmacotherapy for PTSD is limited. Psychotherapy, including several well established evidence based methods, is the mainstay of PTSD treatment. Despite advances in this area, a significant percentage of PTSD patients are refractory to existing treatments. Recent research has explored the possibility that certain drugs could increase the effectiveness of psychotherapy when administered intermittently in conjunction with psychotherapy sessions. The most robust published. Results to date using this approach have been in early clinical trials of ± 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. These studies primarily involved civilians with treatment-resistant, crime-related PTSD. A more recent phase 2 trial, completed in 2015 yielded equally promising. Results in a cohort of military veterans, police officers and firefighters, mostly veterans from the wars in Iraq and Afghanistan.MethodologyIn these double blind controlled trials subjects with PTSD refractory to prior treatment are randomized to an active dose of MDMA or an active or inactive placebo administered to each individual on only two or three occasions during eight-hour psychotherapy sessions one month apart, in conjunction with preparatory and follow-up psychotherapy sessions. Outcome measures are repeated one or two months after the second MDMA-assisted session before the blind is broken. Subjects who were randomized to full dose MDMA are then eligible for one additional, open label, MDMA-assisted session. Those randomized to placebo or a lower dose of MDMA are eligible for three open-label full dose sessions. Outcome measures are repeated two months following the third MDMA-assisted session. The primary outcome measure is the Clinician Administered PTSD Scale (CAPS). Additional measures include the Beck Depression Inventory-II (BDI-II), Global Assessment of Functioning (GAF), Pittsburgh Sleep Quality Index (PSQI) and Posttraumatic Growth Inventory (PTGI).ResultsIn the original study comparing MDMA with inactive placebo along with the same psychotherapy PTSD was resolved in 83% of the MDMA group vs. 25% of the placebo group receiving the same therapy. Improvement was maintained for at least 74% of subjects at long-term follow-up a mean of 45 months later. In a more recent, unpublished, study both the high dose and the medium dose of MDMA showed large effect sizes in reducing CAPS scores, and improvements in secondary measures: and BDI-II, PSQI, GAF and PTGI.ConclusionEvidence in phase II trials suggest that MDMA-assisted psychotherapy is effective in treating PTSD in both civilians and veterans who have not responded to established treatments. Phase III trials are necessary to definitively establish safety and efficacy of MDMA-assisted psychotherapy for PTSD.Disclosure of interestThe author has not supplied his declaration of competing interest.

Smoking and non-alcohol substance use in veterans with PTSD and alcohol use disorder

Aims: To describe co-occurring non-alcohol substance use in veterans with PTSD and alcohol use disorder (AUD) entering controlled trials of topiramate. Methods: Baseline psychological, alcohol and non-alcohol substance use (NASU) measures are reported for 77 veterans with comorbid AUD and PTSD entering trials of topiramate treatment. PTSD, anxiety, anddepression, aswell as smoking, non-alcohol substance use (NASU) and NASU disorder diagnoses (NASUDs) were calculated. Subjects with andwithout smoking or NASUwere compared on alcohol use, PTSD, depression, and anxiety severity. Results: Mean age was 50.4±12.6, 93.5% were male. 41.6% were Vietnam era and 23.4% were Iraq/Afghanistan veterans. All met criteria for DSM-IV alcohol dependence and PTSD. 58.4% had combat-related PTSD. Mean Clinician Administered PTSD Scale (CAPS) score was 77.9±17.2; mean Beck Depression and Anxiety scores were 22.2±12.3 and 24.4±11.5 respectively. During the past 90 days prior to screening, participants had on average 5.4 drinking days per week, 4.5 heavy drinking days per week and consumed 63.7 drinks per week and 12.9 drinks per drinking day. 57.1% were smokers and 41.6% reported NASU in the past 30 days: 36.4% cannabis, 16.9% cocaine, 5.2% amphetamines, and 3.9% opioids. Urine drug screens were positive for cannabis in 23.4%, cocaine in 6.5%, amphetamines in 3.9%, and opiates in 7.6%. 28.6% met SCID NASUD criteria. Compared to nonsmokers, smokers had more drinks per week (72.7 vs. 51.4, p= .048) and more drinks per drinking day (15.7 vs. 9.4, p= .011) in the past 90 days. Smokers did not have higher mean CAPS, BDI, or BAI scores than nonsmokers. Patients with NASU also had more drinks per week (74.1 vs. 53.5, p= .05); but not higher CAPS, BDI or BAI scores than those negative for NASU. Conclusions: Smoking and other non-alcohol substance use were related with higher amounts of alcohol use but not greater PTSD, depression and anxiety severity in veterans with PTSD and AUD entering pharmacotherapy clinical trials. Financial support: W81XWH-05-2-0094, W81XWH-11-20245, and W81XWH-12-2-0137.

A review of PTSD and shame in military veterans

ABSTRACTTraumatic military experiences can create ethical dilemmas that result in moral injury. Moral injury is strongly correlated with interpersonal problems, social anxiety, isolation, depression, and suicide. Shame, considered the primary component of moral injury, amplifies the impact of trauma across every category. Shame relates to the trauma experience and is fortified by poor homecomings and the years following veterans’ return from battle. Self-criticism acts as a barrier to care and existing assessment and treatment procedures may require modification in order to be fully effective for treating moral injury.

PTSD in the Prison System

The treatment of Veterans with post-traumatic stress disorder in the federal prison system has fallen in quality, if it can ever be said to have been sufficient. This work presents an analysis of PTSD in Veterans, identifies the deficiencies in prison systems to address the mental health aspects of PTSD, and presents solutions to address the needs of our soldiers.

Examination of Prior Experience with Telehealth and Comfort with Telehealth Technology as a Moderator of Treatment Response for PTSD and Depression in Veterans

Telehealth is a method to expand the reach of clinical care for PTSD treatment. However, those with limited prior exposure to telehealth or limited confidence using telehealth may have poorer treatment response. The present study examined familiarity with telehealth as a moderator of treatment response for a behavioral treatment delivered via telehealth. Fifty-nine combat veterans completed eight sessions of exposure-based treatment via telehealth. Familiarity with telehealth and confidence in the technology were assessed at baseline. PTSD and depression symptoms decreased as a result of treatment administered via telehealth. Familiarity with the technology and confidence in the technology were unrelated to symptom change. The lack of a significant relation was maintained after controlling for age. Perceptions of telehealth are unrelated to outcomes for mental health treatment. Clinicians should be confident in using this approach with patients, regardless of their familiarity or comfort with the technology.

Early Treatment Withdrawal from Evidence-Based Psychotherapy for PTSD: Telemedicine and in-Person Parameters

To determine differences in reported barriers to treatment completion associated with telemedicine vs. in-person delivery of evidence-based treatment for PTSD in combat veterans. The present study was derived from two ongoing randomized controlled trials (RCTs) comparing in-person vs. telemedicine delivery of exposure therapy for PTSD. A one-time telephone assessment of participants who dropped out from the treatment phase of these two studies was conducted, with measures focusing on reported reasons for dropout, and perceived comfort and efficacy of the treatment modality. Dichotomous data were analyzed via chi-square and logistic regression; continuous data via ANOVA. Forty-seven of 69 total dropouts participated. There was no difference in rate of dropout between modalities. A greater proportion of participants receiving in-person exposure therapy reported difficulties with logistical aspects of care (e.g., parking), whereas a greater proportion of participants receiving telemedicine therapy reported difficulty tolerating certain stressful aspects of treatment; however, those receiving telemedicine delivered treatment completed more sessions before dropping out. Participants in both conditions reported that they liked and were confident in their therapist Conclusions: Dropout reasons varied according to type of treatment delivery. Recommendations for future research are given in terms of modification of treatment protocol according to delivery modality.

Secondary Traumatic Stress Disorder in War Veterans’ Adult Offspring

The present study focuses on the impact of veteran's traumatic stress and PTSD diagnosis on their offspring's mental and physical health. Results revealed a positive relationship between PTSD in veterans and secondary traumatic stress disorder (STSD) in their offspring. STSD symptoms, psychopathology, physical symptoms and adverse childhood experiences were also positively related, especially, in those with STSD symptoms and STSD diagnosis. Finally, adverse childhood experiences, was not a significant moderator in the relationship between psychopathology and traumatic symptoms. The results support the need for interventions in PTSD war veterans' offspring.

Erratum for “Support Mechanisms and Vulnerabilities in Relation to PTSD in Veterans of the Gulf War, Iraq War and Afghanistan Deployments: A Systematic Review”

Erratum for “Support Mechanisms and Vulnerabilities in Relation to PTSD in Veterans of the Gulf War, Iraq War and Afghanistan Deployments: A Systematic Review”

PTSD, Depression, and Gastrointestinal Symptoms in Veterans of the Afghanistan and Iraq Conflicts: Whatʼs the Relation?

PTSD, Depression, and Gastrointestinal Symptoms in Veterans of the Afghanistan and Iraq Conflicts: Whatʼs the Relation?

Effectiveness of Prolonged Exposure for PTSD in Older Veterans

Exposure-based therapy is an effective treatment for PTSD, including combat-related PTSD. However, questions remain within PTSD treatment literature and among front-line clinicians about the appropriateness of exposure-based therapies for older adults. The current study examined the effectiveness of Prolonged Exposure (PE) in reducing PTSD and depression symptoms in a sample of 65 Veterans age 60 and older who were diagnosed with PTSD via structured clinical interview. In addition to within-subject repeated measure analyses, the entire intent to treat sample was compared to treatment completers. Within group d-type effect sizes across both groups were large (1.13-1.90) and the retention rate was high (85%). Importantly, no adverse medical or psychiatric events were reported over the course of the study. Results are discussed and limitations, along with future directions, are presented.

Editorial Regarding the New DSM-5 Diagnosis of PTSD in Veterans and Non-veterans

Editorial Regarding the New DSM-5 Diagnosis of PTSD in Veterans and Non-veterans