Intensive outpatient therapy shows rapid reduction of veterans' PTSD symptoms

August 1, 2018, Rush University Medical Center
PTSD
Regions of the brain associated with stress and posttraumatic stress disorder. Credit: National Institutes of Health

Military veterans who participated in a three week, intensive outpatient treatment program for post-traumatic stress disorder (PTSD) saw rapid and clinically meaningful changes in PTSD and depression symptoms, according to results of a study by researchers at Rush University Medical Center published July 30 in BMC Psychiatry. This paper adds to the growing body evidence that shows that providing several hours of therapy over several consecutive days could be an important step in addressing the unmet mental health needs of tens of thousands of military veterans.

Research conducted at the Road Home Program at Rush University Medical Center from July 2016 through September 2017 closely monitored 191 veterans who had been referred to the program's intensive outpatient program (IOP) because their PTSD was not responding to traditional therapeutic approaches, which typically includes daily treatment over the course of 6 to 12 weeks. At the beginning of treatment, 96 percent of patients reported moderate to severe PTSD, which fell to only 42 percent by the end of the three week treatment period.

"The numbers that we're seeing show that we can make a profound impact in veterans' lives in just three weeks" said Alyson Kay Zalta, Ph.D., lead author of the study ""Evaluating Patterns and Predictors of Symptom Change during a Three-Week Intensive Outpatient Treatment for Veterans with PTSD" conducted while she was research director of the Road Home Program.

The Road Home Program at Rush is a part of the Warrior Care Network, a groundbreaking collaboration between Wounded Warrior Project and its academic medical center partners, Emory Healthcare, Massachusetts General Hospital, UCLA Health and Rush University Medical Center to create a nationwide, comprehensive care network that will enhance access and provide clinical and family-centered treatment to veterans living with military service-related mental health issues. Wounded Warrior Project provided the majority of the funding for this study.

Intensive program removes barriers to completing treatment

The authors noted that therapy that stretches out for many weeks presents multiple many barriers to completion, such as patients being away from family and work for a significant period of time. However, Zalta noted that "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. "

The veterans in the study at Rush were put into groups of eight to 12 individuals and received more than 100 hours of specialized mental health services that combined evidence-based therapy such as Cognitive Processing Therapy (CPT) with wellness interventions including mindfulness, yoga, art therapy and acupuncture. The participants typically received 15 individual session and 13 group sessions of CPT, considered one of the most effective treatments for PTSD.

CPT helps people better understand how trauma has changed the way they think, teaches them how to evaluate their thoughts, and equips them with the skills to better manage PTSD symptoms. Complementing this treatment, the meditation-based techniques teach people to be focused on what they are sensing and feeling at every moment—without interpretation or judgment.

Researchers also sought to better understand how veterans improved over the course of the program. They showed that changes in thoughts predicted subsequent improvements in symptoms.

"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.

It takes a nation to make sure veterans make a healthy transition to civilian life

The Department of Veteran's Affairs (VA) estimates that 23 percent of veterans returning from Iraq or Afghanistan have or will develop PTSD and has invested tens of millions of dollars to make proven-effective, evidence-based PTSD treatment programs more widely available

The study authors hope the findings will lead to more treatment options and opportunities for veterans by accelerating acceptance of the IOP model. Such intensive typically is not administered within the VA system but increasingly is available through philanthropically-funded, private sector efforts like the Road Home Program.

The VA, which operates the nation's largest integrated health care system, is the central component of the health care delivery system for veterans. "But the VA cannot and should not be expected to do so alone," said paper co-author Michael Brennan, PsyD, Road Home's assistant medical director and US Army Reserve Captain ABPP.

"It takes a nation—not one government agency—to build a military and go to war. Our nation shouldn't rely on just the VA to make sure our make a healthy transition to civilian life."

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