Within post-traumatic psychiatric and MDD are the most prevalent disorders. In addition it appears that PTSD, although related to post-traumatic MDD beyond a mere sharing of common symptoms, is at the same time differentiated from it as an independent diagnostic category.

(Solomon, 1989a) along with high levels of depression, anxiety and obsessive preoccupations (Solomon, 1989b), as well as impaired social functioning, disturbed family relationships, and decline in job performance (Solomon, 1989~). Many of these veterans also presented with multiple somatic complaints (Solomon, 1988a).Throughout the years following the Lebanon war, veterans with combat-related PTSD were followed up clinically by the Combat Reaction Unit of the Department of Mental Health, which provided them counselling, support and treatment. Combat casualties in Israel are at the focus of a great deal of public attention, and all possible efforts are made in order to provide them with adequate treatment and rehabilitation. Every CSR casualty had, therefore, access to a free treatment program implemented by the IDF. A network of trained and experienced clinicians situated throughout the country provided a large variety of treatment resources encompassing every mode of treatment that was conceived as helpful (e.g., pharmacotherapy, individual psychotherapy, family consultation, etc.).Yet in spite of the effort not to leave a single PTSD casualty without access to treatment, the general feeling was that conventional treatment modes were not working. These impressions were reinforced by research findings which failed to show significant treatment-related improvement in the cohort of CSR veterans with PTSD from the Lebanon war. The accumulating disappointment with the outcome of 3 years of organized effort to treat PTSD casualties with conventional approaches led to the initiation of the Koach project, aimed at treating PTSD veterans by less conventional modes of treatment (see Solomon ef al., 1991a). However, the need to accompany this new project by rigorous scientific evaluation was also clear: any claim for success in the treatment of PTSD could raise hopes in hundreds of casualties. In order to be accepted, the project had to be empina l l y evaluated and compared with the natural course of PTSD in patients who did not participate in the program. An evaluation team, independent from the team that implemented the project, was therefore established. The aim of this team was to assess the project's effectiveness.From its outset, the Koach project was accompanied by empirical evaluations supervised by the same team that carried out the follow-up studies. In order to assess the effectiveness of the project we examined the degree to which its stated aims were achieved. More specifically, we evaluated the extent to which treatment in Koach contributed towards eliminating PTSD, reducing general psychiatric symptomatology, improving social Negative Psychometric Outcomes 227 functioning in various areas, and increasing self-confidence in their ability to function in combat. METHOD SubjectsTwo groups of subjects participated in this study. The first group consists of 40 reserve CSR soldiers who were treated in the Koach project.These soldiers were selected from among several hundred CSR veterans who participated in the fo...

To assess the effectiveness of the Koach project, two groups of subjects, comprising the 40 Koach participants and 40 PTSD veterans who served as controls, were examined 1 year before Koach and 9 months afterwards. In addition, the Koach participants were also assessed immediately before and immediately following the project. The self‐report measures focused on PTSD symptomatology, post‐traumatic intrusion and avoidance, general psychiatric symptomatology, social functioning and perceived self‐efficacy in combat. Participation in Koach led to improvement in one area only: perceived self‐efficacy in combat. The measures of emotional distress and psychiatric symptomatology indicated that patients treated in Koach fared worse than untreated PTSD controls. In addition, in order to assess the long‐term impact of the program, 36 Koach participants were surveyed by phone approximately 2 years after the residential stage of the project. Military functioning, family life, work, and psychiatric symptomatology were assessed. Findings indicate that most of the participants had not returned to their prewar level of functioning.