PTSD (Post-Traumatic Stress Disorder) is nothing but a normal reaction of the human organism to abnormal situations or experiences. It usually follows an event that makes a person feel unsafe or helpless; the most common of such events are war, assault, kidnapping, sexual abuse, rape, car accident, plane crash, and even certain forms of medical treatment (especially in the case with children). Experiences in military combats, however, remain the most frequently met causes of PTSD; the symptoms of PTSD based on combat experience include flashbacks, nightmares, tries to suppress the memories, irritability, hyperarousal, sleep disorders, numbing, and, sometimes, amnesia for specific aspects of the traumatic event (Corsini, Weddings, & Dumont, 2007). Treatment for PTSD should be timely because symptoms may get worse and achieving the expected outcomes will be complicated. Besides, PTSD may lead to family and interpersonal problems, let alone its effect on physical health. As found by Taft, Kaloupek, & Shumm (2007), several combat veterans develop aggression and problems with alcohol as a result of the PTSD that was not treated in time. This is why applying for help is vital not only for the veterans’ health but for the welfare of the people who surround them. There are several therapies that are used for treating combat veterans with PTSD and individual psychotherapy, group therapy, eye movement desensitization and reprocessing, and Cognitive Behavioral Therapy is the most commonly used; of these, the latter has shown to be the most effective, irrespective of whether cognitive restructuring, exposure therapy, or the combination of these approaches is used.
Some of the therapies that are used for treating PTSD in combat veterans are individual psychotherapy, eye movement desensitization and reprocessing (EMDR), and group therapy, each of which has shown to be quite effective in dealing with this disorder. Individual psychotherapy as a method of treatment involves regular
meetings and talks with a healthcare professional (most often, a psychiatrist or a psychiatric social worker) in the course of which the veterans may share their experiences with this professional. Its main benefit is that it may help the patient sort out the real facts from the distorted memories which are the most problematic for the veterans with PTSD (Corsini et al, 2007). At this, however, such treatment can only provide the patient with supportive environment and help him/her understand more about the roots of the disorder, while no coping with the problem and symptoms of the disease as such might take place.
This being the reason, individual group therapy is combined with or simply replaced by group therapy, which has shown to be more beneficial for the veterans with PTSD in particular. Group work is an integral part of group therapy which “focuses on therapeutic issues through discussions, dream analysis, active imagination, psychodrama, gestalt, and bioenergetic modalities” (Corsini et al, 2007, p. 129). During such meetings, the patients interact with each other and often share experiences, which is quite effective namely for the combat veterans who thus learn to focus on their present, rather than live through their past again and again. Group therapy is effective in coping with stressful memories, fear, and anger, but it might not be completely efficient in case with veterans because not all of them agree to talk about their trauma; besides, traumatic experiences of the others may sometimes result in aggravation of the PTSD because the patient may get too overwhelmed with the memories of other group members.
Furthermore, EMDR can also be used to treat the veterans with PTSD, and it is more effective than interpersonal or group therapies. EMDR is effective for the veterans in particular because it addresses disturbing aspects of the patient’s memories and these may be past aspects, as well as present and future ones (Corsini et al, 2007). According to the theory upon which this therapy is based, traumatic experiences overwhelm the ways of a person’s coping, which results in inadequate processing of the event and, therefore, improper storing of the memory within the memory network. EMDR is used to release a particular memory and make the patient process it correctly. At this, EMDR integrates the elements of a number of other therapies, including cognitive, interpersonal, physiological, and imaginal exposure therapies which are combined with bilateral stimulation, a procedure during which two parts of the brain work in turn, instead of working simultaneously as it usually takes place. This allows accessing traumatic memories more effectively, which significantly decreases stress pertinent to a specific memory, but no changes in general diagnostic status of the patient might take place.
This being the reason, Cognitive Behavioral Therapy (CBT) is regarded as the most effective in treating the PTSD in combat veterans. In general, CBT is a psychotherapeutic approach that “consists of practice based primarily on social-cognitive theory and encompassing a range of cognitive principles and procedures” (Corsini et al, 2007, p. 225). It has developed through the merging of cognitive and behavioral therapies and shown to be far more effective in treating symptom-based diagnoses than psychodynamic treatments used before this therapy has emerged. Its use is equally effective in individual and group settings and the variety of techniques that it encompasses can even be used for self-help. Since it has formed from two different approaches to therapy (cognitive and behavioral ones), there still exists certain subdivision within it with some clinicians being more oriented towards cognitive treatment (such clinicians use cognitive restructuring to treat the patient), those who are behaviorally oriented (such clinicians resort more often to exposure therapy), and those who combine there two approaches, which results in imaginal exposure therapy (Taylor, 2004). On the basis of these approaches, there may be trauma-focused therapy that, at first place, is aimed at reducing the symptoms of the PTDS with the help of making them go through their traumatic experience over and over, and present-centered treatment that focuses on the patients’ present experiences rather than their past. Any of the approaches applied within the CBT is effective and, as a number of studies have confirmed, results in positive outcomes for the combat veterans who suffer from PTSD.
Thus, for instance, imaginal exposure therapy has proven to be quite effective in treating the patients with sleeping disorders of which the nightmares were the most frequent. One of the therapeutic techniques within the CBT is keeping a diary in which the patient records significant events and feelings associated with them; this can be regarded as a variation of imaginal exposure (as a rule, during this therapy a negative memory is revisited in the course of a therapy session). This technique has shown to be especially useful for the veterans with PTSD who had sleep disturbances. Disturbed sleep is one of the most severe PTSD symptoms which can be observed among the combat veterans. Treating the patients with such disturbances using the CBT is the most effective; within the imaginal exposure, this can be done through recording the nightmares, listening to the recordings afterwards, and analyzing the heard, which is then followed by relaxation exercises (Kelly, 2008). Though the experiment carried out using this technique has shown no changes in frequency of the nightmares, the therapy has brought positive changes into the content of the nightmares, which significantly reduced distress levels for the participants (Kelly 2008). This shows that one of the most serious symptoms of PTSD may be effectively treated with the help of the imaginal exposure therapy.
Finally, though the combination of behavioral and cognitive methods of treatment (imaginal exposure) is quite effective for treating some PTSD symptoms in veterans, they are no less effective if used separately. This has been discovered by Hales, Yudofsky, & Gabbard (2008) who compared the use of these therapies and found out that the use of exposure therapy and cognitive restructuring results in marked improvement in the patients (with these improvements maintained for no less than 6 months), whereas the combination of these therapies shows no additional benefit for the patients. The main difference between these two approaches is that cognitive restructuring is aimed at correcting the thinking errors that the veterans have; it helps them to identify negative thoughts, tie them with the distorted beliefs and the traumatic event, and then modify these beliefs (Corales, 2005). This significantly helps to reduce anxiety and manage stress, as well as get rid of dysfunctional thoughts that lead to aggression, sleep disorders, flashbacks, numbing, and the like symptoms. Exposure therapy, in its turn, makes veterans not only talk about their traumatic experiences; it exposes them to different “vivo” stimuli, such as sounds of the battle or the pictures of war. As found by Britt and Adler (2003), 75% of the veterans who undergo exposure therapy show reduced levels of anxiety and depression, as well as have fewer nightmares and less frequently experience hyperarousal. Therefore, cognitive restructuring and exposure therapy are extremely effective in treating the PTSD in combat veterans; they can be used either separately or in combination with each other and, possibly, other therapies, which will not affect significantly the results of treatment.
Taking into consideration everything mentioned above, it can be concluded that combat veterans are among the most exposed to the development of the PTSD and working out an effective treatment for them is more than important. Most of the therapies used to deal with this problem, however, remain ineffective. Thus, individual psychotherapy, group therapy, and EMDR are partially helpful but they all have significant disadvantages. Cognitive and Behavioral Therapy, in its turn, is the most beneficial in treating PTSD in veterans; all its three therapies, cognitive restructuring, exposure therapy, and a combination of these, imaginal exposure therapy, have been tested in a variety of studies which have confirmed that each of them is able to significantly reduce PTSD symptoms in veterans and tangibly improve their psychological health. Therefore, so far, CBT remains the most effective among the number of therapies used for treating combat veterans’ PTSD.
Reference List
- Britt, T.W. & Adler, A.B. (2003). The psychology of the peacekeeper: Lessons from the field. New York: Greenwood Publishing Group.
- Corales, T.A. (2005). Trends in posttraumatic stress disorder research. Hauppauge: Nova Publishers.
- Corsini, R.J., Wedding, D., & Dumont, F. (2007). Current psychotherapies. Mason: Cengage Learning.
- Hales, R.E., Yudofsky, S.C., & Gabbard, G.O. (2008). The American Psychiatric Publishing textbook of psychiatry. Arlington, VA: American Psychiatric Publications.
- Kelly, J. (2008). Cognitive Behavioral Therapy improves sleep and reduces nightmares in veterans with PTSD. Neuropsychiatry Reviews, 9(8), 21.
- Taft, C., Kaloupek, D.G., & Schumm, J.A. (2007). Posttraumatic stress disorder symptoms, physiological reactivity, alcohol problems, and aggression among military veterans. Journal of Abnormal Psychology, 116(3), 498-507.
- Taylor, S. (2004). Advances in the treatment of posttraumatic stress disorder: Cognitive-behavioral perspectives. New York: Springer Publishing Company.