Publication year
2017
Citation Title
Moving effective treatment for posttraumatic stress disorder to primary care: A randomized controlled trial with active-duty military.
Journal Name
Families, Systems, & Health
Journal Volume
35
Issue Number
4
Page Numbers
450-462
DOI
10.1037/fsh0000315
Summary
Due to perceived stigma, many Service members with posttraumatic stress disorder (PTSD) do not receive mental health treatment. This randomized clinical trial examined the efficacy of brief cognitive-behavior therapy in reducing PTSD symptoms when delivered in a primary care setting with Active Duty Service members. Results showed a marked reduction in PTSD severity and general distress.
Key Findings
The brief cognitive-behavior therapy significantly reduced PTSD and co-occurring symptoms.
Participants in the delayed treatment control group also showed marked reduction in PTSD and co-occurring symptoms after treatment was provided.
At the six month posttreatment follow-up, results suggest that both the treatment and control groups maintained the reduction in symptoms.
Implications for Program Leaders
Enhance education, activities, and curriculum for Service members and their intimate partner on coping behaviors to manage PTSD symptoms
Offer workshops during reintegration to help families and Service members adjust to the Service member's return, especially if the deployment included combat exposure
Disseminate information regarding the symptoms of PTSD and and where individuals and families can find help for those symptoms
Implications for Policy Makers
Continue to support programs that address the unique challenges faced by Service members and their families when the Service member is experiencing PTSD symptoms
Continue to recommend training of professionals to better identify Service members who experience PTSD symptoms and on how to encourage Service members to seek help for these symptoms
Continue to provide support for programs that work to implement prevention and intervention strategies for PTSD
Methods
Participants were recruited from a population of primary care patients at two military treatment facilities in San Antonio, Texas.
Participants were randomly assigned to either a treatment group or a delayed, minimal contact treatment control group. The control group was asked to not engage in trauma-related treatment for six weeks. The treatment group received brief, trauma-focused cognitive behavioral therapy using the primary care behavioral health model.
Assessments were completed at baseline, posttreatment or postminimal contact control, and at eight-week and six-month posttreatment follow-up points.
Researchers analyzed data to determine how effective the brief treatment was at reducing PTSD and co-occurring symptoms.
Participants
Participants were 67 Active Duty Service members who had previously been deployed in OEF, OIF, and OND.
The sample included 50 men and 17 women and 85% of the participants were serving in the Air Force.
The racial breakdown of the sample was 24% Black, 16.5% Latino, 55.5% White, and 4.5% other or unknown.
The approximate ages of the treatment and control groups were 38.9 years and 41 years, respectively. Further, there was a higher representation of senior commissioned officers than lower ranking Service members.
Limitations
Most of the participants were serving in the Air Force, limiting generalizability of findings to other branches.
Since there was a higher representation of senior-commissioned officers, generalizability to lower ranking Service members is limited.
Participants may perceive a risk to their career if symptoms do not improve, and this may bias their self-reports of symptoms and the treatment efficacy results based on participants' reports.
Avenues for Future Research
Replicate the current study with Service members from all branches of the military
Include more Service members from lower ranks of the military in order to determine if rank effects treatment efficacy
Conduct a study comparing Active Duty Service members to civilian and Veteran populations to determine the effectiveness of the treatment with other groups
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
INTRODUCTION: Many military service members with PTSD do not receive evidence-based specialty behavioral health treatment because of perceived barriers and stigma. Behavioral health providers in primary care can deliver brief, effective treatments expanding access and reducing barriers and stigma. The purpose of this randomized clinical trial was to determine if a brief cognitive-behavior therapy delivered in primary care using the Primary Care Behavioral Health model would be effective at reducing PTSD and co-occurring symptoms. METHOD:A total of 67 service members (50 men, 17 women) were randomized to receive a brief, trauma-focused intervention developed for the primary care setting called Prolonged Exposure for Primary Care (PE-PC) or a delayed treatment minimal contact control condition. Inclusion criteria were significant PTSD symptoms following military deployment, medication stability, and interest in receiving treatment for PTSD symptoms in primary care. Exclusion criteria were moderate or greater risk of suicide, severe brain injury, or alcohol/substance use at a level that required immediate treatment. Assessments were completed at baseline, posttreatment/postminimal contact control, and at 8-week and 6-month posttreatment follow-up points. Primary measures were the PTSD Symptom Scale-Interview and the PTSD Checklist-Stressor-Specific. RESULTS: PE-PC resulted in larger reduction in PTSD severity and general distress than the minimal contact control. Delayed treatment evidenced medium to large effects comparable to the immediate intervention group. Treatment benefits persisted through the 6-month follow-up of the study. DISCUSSION: PE-PC delivered in integrated primary care is effective for the treatment of PTSD and co-occurring symptoms and may help reduce barriers and stigma found in specialty care settings.
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