Veterans with PTSD Require Tailored Approach: Some Military Organizations Have Implemented Programs Aimed at Spotting Problems in Early Stages

By Finn, Robert | Clinical Psychiatry News, February 2007 | Go to article overview

Veterans with PTSD Require Tailored Approach: Some Military Organizations Have Implemented Programs Aimed at Spotting Problems in Early Stages


Finn, Robert, Clinical Psychiatry News


HOLLYWOOD, CALIF. -- Military veterans with posttraumatic stress disorder can be especially difficult to treat, Mark Creamer, Ph.D., said at the annual meeting of the International Society for Traumatic Stress Studies.

"The very first controlled trials of treatment for PTSD [posttraumatic stress disorder] of any kind were done with veterans, and we've been trying hard ever since then to treat veterans effectively," said Dr. Creamer of the University of Melbourne.

"The sad fact is that generally, the improvements following treatment have not been great, and the effect sizes that we're getting with veteran populations are routinely smaller than those that we're getting with civilian populations."

It is possible that this difference in response may be an artifact of the study designs, but it's also possible that it has something to do with the veterans themselves. During the meeting, which was also sponsored by Boston University, Dr. Creamer advanced several hypotheses that might explain this difference.

He also noted, however, that there are some reasons for optimism and offered several suggestions on how PTSD treatment can be tailored for veterans.

Military veterans differ from the general population in several ways. First, the overwhelming majority of veterans are men, and as a group men are notoriously resistant to psychological treatment. Second, studies have shown that among military recruits, there tends to be a high proportion of people with adverse childhood experiences. Both of these factors may constitute preexisting vulnerabilities that make recovery after trauma exposure more difficult.

Third, military training might explain some of these differences in treatment response. "The fact is that the kinds of skills we need to teach people to be good soldiers are not necessarily the kinds of skills that they need to be good patients or very psychologically minded," Dr. Creamer said. "As people are being trained as soldiers, they're taught to respond to feelings of fear and vulnerability with anger and aggression.

"That makes a lot of good sense when they're in combat, but when they carry that through to peacetime and treatment with the feelings of fear and vulnerability [that] may be invoked, anger becomes a major issue."

Fourth, soldiers are exposed to a unique type of stress. They're away from home for 6-12 months under conditions of perpetual hypervigilance, and their stress exposures are complex. Not only are they themselves under significant threat, but they're continually exposed to the suffering and death of others in situations in which it's often difficult to tell the good guys from the bad guys. …

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