Essay: PTSD across veterans

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  • Subject area(s): Psychology essays
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  • Published on: March 23, 2018
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  • PTSD across veterans
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This article is extremely relevant today as we have an increasing knowledge of PTSD across veterans that is affecting their daily lives. We have men and women who are returning from war and unable to reintegrate into society, often resulting in problems such as alcoholism and losing their families which in extreme cases can end in the incarceration or homelessness of the veteran. The people who give up their lives to defend the freedom of the American people are coming back alive and losing their own lives here. We should care about these people, as they are sacrificing their own lives, and them ending up in prisons or on the streets shouldn’t be acceptable to this country.
 
Public policy changes could come out of this study as taxpayers fund the hospitals and programs that are supposed to take care of these people. If they are using therapies and treatments that are not working or are prolonging problems, then why should we continue funding them? Policies should be made that use effective therapies to take care of the people. If the experiment can prove that there is a cost effective way to come in and change the situation, and start making forward progress, then we should implement them to improve the overall condition we are presently faces with.

The experiment here is testing whether the use of accelerated resolutions therapy (ART) can reduce the effects of post traumatic stress disorder (PTSD) in a less intense way than they have before, and additionally a more cost and time effective way, in order to produce less damaging and more rapid results.

Instead of having veterans solely talk about the scenarios that haunted them in their PTSD flashbacks, they instead had them visualize the scenes and feelings while performing ART. They randomly divided participants into two groups, and randomly assigned them either the ART treatment, of the alternative attention control (AC) treatment. The patients who received the AC treatment were offered a crossover option to the ART after 3 months.

They administered the ART treatment 2-5 times with 60-75 minute sessions. Each session had two components, imagination exposure (IE) and imagery rescripting (IR). In IE participants were asked to recall, both verbally or nonverbally (the imagination) the traumatic event that the PTSD stemmed from while focusing on physiological sensations, thoughts, and emotions, on top of the imagining. During this component, the participant, with assistance from the clinician, was brought into a simultaneously relaxed and alert state, and then asked to reactivate the traumatic memory for a 30 to 45 second period of time. The exposure to the memory was followed by the participant’s identification and eradication of the negative emotional or somatic symptoms to themselves, with again the assistance of the professional. They executed this by directing the participant to hold their awareness of the negative associated symptoms while simultaneously carrying out the directed eye movements.

The IR portion of the testing involves the use of techniques in which the participant is instructed to again visualize their traumatic scene, but this time imagine replacing the imagery and sensory components of the scene to anything they choose, much like rewriting the script of what happened, giving it the name rescripiting. As they start to use the positive scene as a substitute, the participant was then instructed to try and again access the original, previously distressing, images. The treatment of the traumatic scene was considered effective when only the replacement scene could be accessed, however noting that knowledge of the original scene was still part of the participants memory. A consistent way that the ART session was ended was to ask the participant to picture a bridge and then imagine leaving the distressing images behind and then crossing the bridge, which represented the people then moving on from the problems.

Veteran participants were recruited for the experiment from centers and organizations around the Tampa Bay area, including local VA hospitals, military bases, and through USF itself. The participants were tested at the school’s College of Nursing. Additionally, there was a one time outreach to Nellis Air Force Base in Las Vegas, Nevada. The selected people who on a self evaluation test, the PCL-M Checklist that self reports DSM-IV symptoms of PTSD in response to stressful military experiences. It not only shows indications of PTSD but also accompanying disorders such as major depressive disorder, generalized anxiety disorder, panic disorder, drug or alcohol abuse/dependence, psychosis, eating disorder, somatization disorder, obsessive compulsive disorder, social phobia, hypochondriasis, and agoraphobia, which all can accompany or even intensify PTSD. The tests and questionnaires are meant to figure out the statistics of the people involved, specifically the number of traumatic events, the duration of symptoms, their personal feelings that could continue to affect the PTSD, and what other treatments they have undergone in attempt to help with their problems.

The AC option consisted of two hour long sessions of the participants choice of either the fitness assessment and planning option or career assessment and planning option. The fitness assessment and planning regimen was conducted by a certified health fitness trainer. This option included determination of body fat percentage, determining their body mass index, a review of the participants previous exercise history, and defining of physical fitness goals specific to the individual. The alternative career assessment and planning regimen was conducted by a professional career counselor. It included completion and review of the Career Planning Scale, which encompasses 6 scales covering knowledge of the world of work, knowledge of occupations, self-knowledge, career decision making, career planning, and career implementation. For both the fitness and career regimens, the first session was devoted to current assessment and the second session was devoted to developing an individualized plan to achieve goals. As a bonus, it kept the participants in the eyes of professionals, and could control for the idea that professional involvement alone could be an impacting factor in the ART trials. Although they did not specifically have PTSD training, the goal setting environments they were in could be loosely compared to the goal of the ART group to be able to move past their problems. Additionally, they were able to set and work toward goals, which could allow for personal development.

It is important to note that in regard to the AC intervention, the alternate condition, it was not intended to be equal in contact time compared to its counterpart, ART. The idea behind having two 1-hour AC sessions was to measure the effects of “non-psychotherapeutic” type of therapies in, while simultaneously minimally withholding the amount of time to treatment (crossover) with ART. The goal of this was that the AC trails could then maximize recruitment and retention in the trial and minimize time of psychological distress.

At the end of the experiment, about 2/3 of the participants responded to the ART therapy. They took the same entry tests, and their symptoms were re-examined, and they showed significant improvement based on bot their initial entry, and in comparison to their AC counterparts. This rate did include treatment drop outs as well. After 3 months they re-examined participants, but from the sole ART group and from the crossover AC to ART group, and found that the treatment remained effective. The length of treatment in relation to the results is far more effective for the amount of reaction to the treatment in comparison to other Department of Defense or VA approved therapies, meaning it could save people time and money, and work on fixing the problem at hand more effectively at this point in time. This study only ended up with 63 participants, however, as successful as it is, it is being continued in other studies across the country to try and improve or dial in the techniques that can best serve this cause and these people.

The big picture coming out of these results is that there are alternative therapies available that may be more effective and cheaper than the ones in place. This knowledge could save tax payer money, and more rapidly increase the quality of life for people returning from war. Outside of just PTSD stricken war veterans, this information is a very large indication that long standing therapies might not be the only or the most effective for disorders like this one. If we are able to train people out of this long standing disease using techniques such as this, there is a chance that we can take similar or just overall new approaches to other diseases. It should serve as motivation for people in the field to continue to try new ideas and techniques because we are still learning so much about the brain and disorders that to not keep attempting to develop new ideas would actually be lazy. Even if something works, it doesn’t mean that something else couldn’t work better.

The overall quality of the work seems to be in good condition as they samples across different genders (19% female, 81% male), several races (84% caucasian, 16% minority), across more than 24 years of age (participants being 41 years old with a standard deviation of 12.2 years), all 4 military branches, education levels from high school to post-bachelors degree students, and 3 primary places of deployment. These statistics represent the biggest span of people in the military possible, despite being only 63 people. They also used completely random techniques for placement, but offered crossover to those who did not receive ART to still be able to help them and see the crossover results. The 3 month follow up was diligent and important to show that the retraining idea was more than just a temporary state of mind.

The general media article, like most, really just took the top layer of the actual research. It didn’t include any real results, just overgeneralized outcomes. They didn’t cite the actual article, although they talked to one of the researchers from it, but instead included a link to another study trying to replicate and continue the results. They also took the methods and simplified them a bit too far. A big point the media article tried to sell was that they didn’t use verbalization of the trauma, however that was half of the ART technique. The media made it seem like it was just an idea that Rosenzweig came up with, rather than an actually researched study. It doesn’t seem very realistic to assume that it would be a widely used, up and coming idea that one researcher decided to try. The title itself was even misleading, “ Therapist uses eye movements to retrain brain as treatment for PTSD.” ART therapies are already accepted for similar disorders, such as depression or other trauma related disorders, so the therapy itself is not necessarily ground breaking, but the fact that it is showing results on veterans with PTSD, at a more effective rate and a cheaper one is why it was brought to the forefront. It catches attention of the public because we can recognize the epidemic that the country is facing, not only in veterans but in an overall increase in PTSD diagnoses, and the fancy wording given by the title makes it sound, like many people in the media like to make science sound, like magic. Reading the media article first made me skeptical of the whole study initially. When they glossed over the scientific terms and methods (that were obviously more thoroughly explained in the journal article) they made the entire idea seem fairly bizarre. I was more hesitant personally going into the actual empirical article. The ambiguity initially was the only real confusing part about the media journal specifically. Without knowing the actual methods, or what came out of it besides that it had to have been decent enough for them to begin promoting it, it was hard to really understand even a general concept of what was really going on. When going over to the empirical article, it became confusing in the many acronyms and tests they were using initially to classify and gather data on the participants.

After reading both versions, my conclusions were sharpened. From reading the media article, if further studies were being carried out and the fact that the researcher was traveling to share the ideology across military installations in the US, it was easy to assume that they had found positive results, but drawing generalizations about the methods was near impossible. When the empirical article shed more light on the actual study, the conclusions from both came off relatively the same. The media article seemed to over exaggerate the methods used, and then under exaggerate the findings, by creating a sort of, for lack of better terms, “witch-craft” like methods, and then super vague results. In the end, with reading both articles and having background knowledge of the subject, I gathered that the use of ART therapy has shown positive results, and is being spread to other military installations, and is on its way to becoming an approved therapy in the DoD and VA world.

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