Academic journal article Best Practices in Mental Health

Efficacy of Group Cognitive Processing Therapy in an Intensive Outpatient Trauma Program for Active Duty Service Members with Posttraumatic Stress Disorder

Academic journal article Best Practices in Mental Health

Efficacy of Group Cognitive Processing Therapy in an Intensive Outpatient Trauma Program for Active Duty Service Members with Posttraumatic Stress Disorder

Article excerpt

Background

Traumatic brain injury (TBI) is considered the signature wound among veterans of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). There are many mechanisms of injury that can result in a mild traumatic brain injury (mTBI) or concussion such as combative injuries, falls, airborne accidents, and blast injuries resulting in concussive blast wave exposure, as well as secondary and tertiary effects such as flying debris or loss of balance/falling due to disorientation during the blast event. Although the vast majority of these TBIs (89%) are in the mild or moderate range (Betthauser, Bahraini, Krenel, & Brenner, 2012), the circumstances of the event may present additional psychological sequelae leading to an acute stress response and possible progression to a chronic posttraumatic stress disorder (PTSD) diagnosis (Bolzenius, Roskos, Salminen, Paul, & Bucholz, 2015; Capehart & Bass, 2012; Combs et al., 2015). This comorbid constellation of mTBI and PTSD presents unique challenges to military therapists and clinicians assisting patients in rehabilitation (Neipert et al., 2014; Otis, McGlinchey, Vasterling, & Kerns, 2011; Pietrzak, Johnson, Goldstein, Malley, & Southwick, 2009).

A significant body of research exists on the comorbid symptom sequelae of mTBI and PTSD. Much of the literature speaks to the confounding effect that both conditions have on each other and to the challenges of remitting overall symptom expression based on what providers are treating: the cognitive and affective expression of symptoms in response to the traumatic event that caused the mTBI or the psychological manifestation of emotional dysregulation and behavioral manifestations of the posttraumatic stress reaction to the event (Betthauser et al., 2012; Capehart & Bass, 2012; Combs et al., 2015; Hill, Mobo, & Cullen, 2009; Otis et al., 2011; Pietrzak et al., 2009). Treatment that is multimodal and can not only address negative affective states and behavioral regulation but also support cognitive rehabilitation would be highly desirable for both conditions; however, best practice for supporting patients in benefitting from this type of approach remains an important consideration.

One of the challenges of maximizing benefit from treatment is to determine what treatment modality is most effective. Again, there is a wealth of research on treatment approaches, strategies, and interventions targeting the symptoms of both PTSD and mTBI. The Department of Defense recognizes three established evidence-based therapies for the treatment of PTSD: eye movement desensitization and reprocessing (EMDR), prolonged exposure, and cognitive processing therapy (CPT). Although there is a strong literature base to support these therapies for PTSD, there is limited evidence for a targeted application to patients with comorbid diagnoses of mTBI and posttraumatic stress. Applying a best practice model for PTSD allows for generalization of this knowledge to other conditions such as mTBI.

This article will examine retrospective outcome data from an intensive outpatient treatment program as part of a performance improvement project for PTSD at Landstuhl Regional Medical Center (LRMC). Although patients were referred to the program specifically for treatment of their posttraumatic stress, many reported other conditions such as mTBI, post-concussion syndrome, or cognitive disorders not otherwise specified. Therefore, we wanted to evaluate efficacy and openness to engage in this treatment for patients with PTSD and present preliminary process improvement results that indicate applicability to other diagnoses. The results presented in this article evidence cohort data that appear to indicate benefit from CPT for patients with mTBI as well as PTSD. These preliminary results will be explored with suggestions for future research and clinical application for providers working with service members who are transitioning from the military. …

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