Clinical Topics

Intensive Short-Term Therapy More Effective for PTSD in Veterans

by Brenda Mooney

November 8, 2018
A study at the Road Home Program at Rush University Medical Center, shown here, suggests that short-term intensive outpatient treatment might be more effective for post-traumatic stress disorder (PTSD) in military veterans than longer-term therapy. (Photo from Road Home Program Facebook page)

CHICAGO—Short-term intensive outpatient treatment is more effective for post-traumatic stress disorder in military veterans than longer-term therapy, a new study suggested.

In fact, the research pointed out that former servicemembers taking part in a three-week, intensive outpatient treatment program benefited from clinically meaningful improvements in PTSD and depression symptoms. Results were published in the journal BMC Psychiatry.1

The trial was conducted through the Road Home Program at Rush University Medical Center from July 2016 through September 2017. Participating were 191 veterans who had been referred to the program’s intensive outpatient program (IOP) because their PTSD was not responding to traditional treatment, which usually includes daily therapy from six to 12 weeks.

While 96% of patients reported moderate to severe PTSD, that percentage plummeted to 42% by the end of the three-week treatment period, the report said.

“The numbers that we’re seeing show that we can make a profound impact in veterans’ lives in just three weeks,” pointed out lead author Alyson Kay Zalta, PhD, who helped conduct the study when she was research director of the Road Home Program.

The Road Home Program, part of the Warrior Care Network, is a collaboration between the Wounded Warrior Project and academic medical center partners—Emory Healthcare in Atlanta, Massachusetts General Hospital in Boston, UCLA Health in Los Angeles and Rush. Its goal is to create a nationwide, comprehensive care network toenhance access and provide clinical and family-centered treatment to veterans with service-related mental health issues.

Treatment that extends for a month or more came be difficult for patients to complete, the study noted, because they have to be away from work and family for an extended period of time. Background information in the study stated, “Although evidence-based psychotherapies for PTSD such as Cognitive Processing Therapy (CPT) and Prolonged Exposure exist, many veterans do not receive these treatments or fail to receive a sufficient dose of treatment.”

On the other hand, Zalta emphasized, “by concentrating therapy over consecutive days in three weeks, we see that over 90 percent of veterans stick with the program. By comparison, an estimated 40 percent of veterans drop out of traditional programs before they receive an adequate treatment dose.”

During therapy, veterans were placed into groups of eight to 12 members who received more than 100 hours of specialized mental health services. Evidence-based therapy such as Cognitive Processing Therapy (CPT) was combined with complementary wellness modalities, including mindfulness, yoga, art therapy and acupuncture.

Trauma-Induced Changes

Overall, participants received about 15 individual sessions and 13 group sessions of CPT, which seeks to help patients better understand how trauma has changed the way they think, instructs them how to evaluate their thoughts and trains them in skills to better manage PTSD symptoms.

Researchers listed the goals of the current study as:

  • Evaluating patterns of PTSD and depression symptom change over the course of a three-week cohort-based IOP for veterans with PTSD,
  • Examining changes in posttraumatic cognitions as a predictor of treatment response, and
  • Determining whether patterns of treatment outcome or predictors of treatment outcome differed by sex and cohort type—i.e., combat vs. military sexual trauma (MST).

The patients were divided in 19 cohorts—12 involving combat-related PTSD and seven involving MST-related PTSD—with PTSD symptoms, depression symptoms and posttraumatic cognitions documented before the intervention, after the intervention and approximately every other day during the intervention.

Pre-post analyses for the 176 veterans who completed the program revealed large reductions in PTSD (d = 1.12 for past month symptoms and d = 1.40 for past week symptoms), as well as depression symptoms (d = 1.04 for past two weeks), the study team pointed out.

In general, they noted, combat cohorts saw a greater reduction in PTSD symptoms over time compared to MST cohorts, adding, “Reduction in posttraumatic cognitions over time significantly predicted decreases in PTSD and depression symptom scores, which remained robust to adjustment for autocorrelation.”

“We hope that being able to answer whether changes in thoughts proceed changes in symptoms will allow therapists to better determine who is most likely to benefit and how they will benefit from specific techniques,” Zalta said in a Rush press release.

VA estimates that 23% of veterans returning from the wars in Iraq or Afghanistan have or will develop PTSD, according to the article, which notes that the healthcare system “has invested tens of millions of dollars to make proven-effective, evidence-based PTSD treatment programs more widely available.”

Study authors assert that intensive treatment programs show promise for “delivering evidence-based interventions to produce rapid treatment response and high rates of retention. Reductions in posttraumatic cognitions appear to be an important predictor of response to intensive treatment.”

They suggested, however, that more research is needed to better understand the . differences in intensive treatment response for veterans with combat exposure vs. MST.

The researchers also pointed out that the intensive treatment models usually are not administered within the VA system but tend to be available through philanthropically-funded, private sector efforts like the Road Home Program.

Co-author Michael Brennan, PsyD, Road Home’s assistant medical director and an Army Reserve Captain ABPP, explained that “the VA cannot and should not be expected to do so alone.”

“It takes a nation—not one government agency—to build a military and go to war,” Brennan said. “Our nation shouldn’t rely on just the VA to make sure our military veterans make a healthy transition to civilian life.”

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