DISCLOSURE ISSUE AT HAND. Treating Combat Veterans with PTSD: Using Group-Based Exposure Therapy

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1 Treating Combat Veterans with PTSD: Using Group-Based Exposure Therapy LAURA M. WELLS, BSN, RN GEORGINE R. BERENT, EdD, RN-BC DISCLOSURE The speakers have no conflicts of interest, commercial support, or off-label use to disclose. ISSUE AT HAND Veterans returning from combat zones in support of Operation Enduring Freedom & Operation Iraqi Freedom are: Often subjected to multiple deployments Resulting in an increased risk for Posttraumatic Stress Disorder With limited success using traditional treatment options Congressional Budget Office. (2012) Wells, Berent 1

2 MULTIPLE EXPOSURE Potential Traumatic Events (PTEs) Combat exposure Norm within military lifestyle Cumulative effects Stress on service members, spouses, children, families, & relationships Risk for acute stress disorder, depression, & Posttraumatic Stress Disorder [Caban, (2011); Frincu-Mallas, (2010); Price, Gros, Strachan, Ruggio, & Acierno, (2013)] Diagnostic Criteria History of exposure Four symptom clusters Duration of symptoms Functioning Not attributable to substance abuse and/or co-morbidities [American Psychiatric Association (2013); U.S. Department of Veterans Affairs (2014)] Criterion A: Stressor Criterion B: Intrusion symptoms Criterion C: Avoidance Criterion D: Negative alterations in cognitions and mood (two required) Criterion E: Alterations in arousal or reactivity (two required) Criterion F: Duration Criterion G: Functional Significance Criterion H: Exclusion Specifications [American Psychiatric Association. (2013); U.S. Department of Veterans Affairs (2014)] Wells, Berent 2

3 Major Revisions New class of trauma and stressor related disorders Four clusters Former Criterion C separated into two criteria Three new symptoms added Clarification of symptom expression Removal of Criterion A2 Clinical subtype [American Psychiatric Association (2013); U.S. Department of Veterans Affairs (2014)] Manualized outpatient program Group therapy twice a week/three hours a day Small group sizes Sixteen-eighteen week outpatient program Three phases Didactic training Exposure therapy Relapse prevention Phase One: Didactic (1-5 Weeks) Group dynamics & stress management techniques Didactic presentations Symptom identification Breathing retraining & grounding Thought stopping Avoidance Member presentation Wells, Berent 3

4 Phase Two: Group Exposure (8-9 Weeks) Alumni sponsorship War-trauma presentation Interviews Recording Responses to presentations Exposure. Phase Three: Relapse Prevention (3 Weeks) Imagined funeral for a fallen comrade Grief and guilt Chaplain and alumni sponsorship Relapse prevention Certificate of completion Discussion Five studies reviewed Findings: A positive reduction in PTSD symptoms post therapy Two studies: Some clients no longer met the diagnostic criteria for PTSD subsequent treatment Two articles: Addressed depression & reported moderate to significant reductions in symptoms GBET: A potentially successful treatment in this particular cohort [Mott et al. (2013); ; Ready, Sylvers et al. (2012); Ready, Thomas et al. (2012); Sutherland et al. (2012)] Wells, Berent 4

5 A LOOK AHEAD Group Based Exposure Therapy Chronic war-related PTSD Clinical Trials Adaptability to civilian services Pre-deployment preparedness REFERENCES American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, (5 th ed.). Washington, DC: Author. Caban, A. (2011). Stressors of multiple deployments. Veterans Journal: Around the Web. Retrieved from ClinicalTrials.gov. Group based exposure therapy for combat-related PTSD. Retrieved from Congressional Budget Office. (2012). The Veterans Health Administration s treatment of PTSD and traumatic brain injury among recent combat veterans. Retrieved from cbofiles/attachments/02-09-ptsd.pdf. Frincu-Mallas, C. (2010). Multiple deployments in soldiers linked to increased risk for PTSD. Medscape Medical News. Retrieved from medscape.com/viewarticle/ Mott, J. M., Sutherland, R. J., Williams, W., Lanier, S. H., Ready, D. J., & Teng, E. J. (2013). Patient perspectives on the effectiveness and tolerability of group-based exposure therapy for posttraumatic stress disorder: Preliminary self-report findings from 20 veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 5(5), doi: /a REFERENCES Price, M., Gros, D., Strachan, M., Ruggio, K., & Acierno, R. (2013). Combat experiences, pre-deployment training, and outcome of exposure therapy for post-traumatic stress disorder in operation enduring freedom and operation Iraqi freedom veterans. Clinical Psychology Psychotherapy, 20(4) doi: /cpp.1768 Ready, D. J., Sylvers, P., Worley, V., Butt, J., Mascaro, N., & Bradley, B. (2012). The impact of group-based exposure therapy on PTSD and depression of 30 combat veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 4(1), doi: /a Ready, D. J., Thomas, K. R., Vega, E. M., Worley, V., & Bradley, B. (2012). Combining group- based exposure therapy with prolonged exposure to treat U.S. Vietnam veterans with PTSD: A Case Study. Journal of Traumatic Stress, 25(5), doi: /jts Ready, D. J., Thomas, K. R., Worley, V., Backscheider, A. G., Harvey, L. A., Baltzell, D., & Rothbaum, B. O. (2008). A field test of group based exposure therapy with 102 veterans with war-related posttraumatic stress disorder. Journal of Traumatic Stress, 21(2), doi: /jts Sutherland, R. J., Mott, J. M., Lanier, S. H., Williams, W., Ready, D. J., & Teng, E. J. (2012). A pilot study of a 12- week model of group-based exposure therapy for veterans with PTSD. Journal of Traumatic Stress, 25(2), doi: /jts U.S. Department of Veterans Affairs (2014). DSM-5 criteria for PTSD. Retrieved from Wells, Berent 5