Assessment of Cognitive Behavioral Therapy on Quality of Life of Patients with Chronic War-Related Post-Traumatic Stress Disorder

Article excerpt

Byline: Mohammadjavad. Ahmadizadeh, Khodabakhsh. Ahmadi, Jafar. Anisi, Amir. Ahmadi

Background: Post-traumatic stress disorder (PTSD) is the one of the most commonly observed psychiatric disorder in veterans. The condition can lead to considerable social, occupational, and interpersonal dysfunction. PTSD occurring after combat injury appears to be strongly correlated with the extent of injury, and develops over several months. Present study was designed for assessing the cognitive behavioral therapy in the quality of life (QOL) of war-related PTSD in veterans compared to control group and compare applied treatments with each other. Materials and Methods: In the present study, we assessment effects of cognitive behavioral therapy such as problem solving, exposure therapy and their combination on QOL in 120 Iranian PTSD patients veterans after Iran-Iraq war. They were randomly allocated to one of four equal interventional groups: (a) Problem solving therapy (b) exposure therapy (c) combined therapy (exposure therapy plus problem solving) (d) control group. Before and after study intervention, patients were evaluated by short form-36 (SF-36) questionnaire. Results: Post-test and follow-up SF-36 scores were 55.6[+ or -]4 and 55.1[+ or -]3.6 in exposure therapy, 50[+ or -]4.4 and 56.1[+ or -]3.8 in problem solving, and 48.73[+ or -]3.8 and 50.9[+ or -]4.2 in combined therapy. In comparing to control group, all intervention showed significant improvement in QOL in PTSD patients. Conclusion: According to the results of the present study, behavioral therapy can improve QOL in PTSD patients.

Introduction

War veterans were exposed frequently to a variety of traumatic events and stressors due to their special condition. Post-traumatic stress disorder (PTSD) is the most commonly observed psychiatric disorder in communities affected by disasters and mass violence. [sup][1] PTSD has been described as "the complex somatic, cognitive, affective, and behavioral effects of psychological trauma." [sup][2] PTSD is characterized by intrusive thoughts, nightmares and flashbacks of past traumatic events, avoidance of reminders of trauma, hypervigilance and sleep disturbance, all of which lead to considerable social, occupational, and interpersonal dysfunction. About 27% of people, who experienced an awful trauma and have been injured physically, would suffer from the PTSD in future. [sup][3] The pathophysiology of PTSD reflects long-lasting changes in the biological stress response systems that underlie many of the symptoms of PTSD and other trauma related disorders. [sup][4]

In the overall, PTSD imparts substantial functional impairment in the exposed and is often comorbid with conditions such as depression, generalized anxiety disorder, and substance abuse. [sup][5] PTSD occurring after combat NZ injury appears to be strongly correlated with the extent of injury and develops over several months. [sup][6] Evidence suggests that the severity of PTSD is related to the degree of combat exposure and war duration. [sup][7],[8],[9] Since, Iran-Iraq war lasted for 8 years (1982-1989) it has been presumed to burden a variety of uncompensated psychological damages such as PTSD, on both sides.

Cognitive-behavioral treatment (CBT) comprising interactive psycho education, cognitive restructuring and anxiety management training, offers the best outcome supported by Randomized Clinical Trial (RCT) studies for PTSD patients. [sup][10],[11],[12] Generally, controlled research studies have indicated that behavioral and CBTs are effective in reducing symptoms of PTSD and depression. [sup][13] Problem solving therapy, a short-term cognitive behavioral intervention teaches a systematic method for solving current, and future problems. Exposure-based behavioral treatments utilize gradual, systematic, repeated exposure to the feared object or situation to allow patients with anxiety disorders to become desensitized to the feared stimulus. …