Examining military population and trauma type as moderators of treatment outcome for first-line psychotherapies for PTSD: A meta-analysis

Abstract

There is conflicting evidence as to whether military populations (i.e., veteran and active-duty military service members) demonstrate a poorer response to psychotherapy for posttraumatic stress disorder (PTSD) compared to civilians. Existing research may be complicated by the fact that treatment outcomes differences could be due to the type of trauma exposure (e.g., combat) or population differences (e.g., military culture). This meta-analysis evaluated PTSD treatment outcomes as a function of trauma type (combat v. assault v. mixed) and population (military v. civilian). Unlike previous meta-analyses, we focused exclusively on manualized, first-line psychotherapies for PTSD as defined by expert treatment guidelines. Treatment outcomes were large across trauma types and population; yet differences were observed between trauma and population subgroups. Military populations demonstrated poorer treatment outcomes compared to civilians. The combat and assault trauma subgroups had worse treatment outcomes compared to the mixed trauma subgroup, but differences were not observed between assault and combat subgroups. Higher attrition rates predicted poorer treatment outcomes, but did not vary between military populations and civilians. Overall, manualized, first-line psychotherapies for PTSD should continue to be used for civilians and military populations with various trauma types. However, greater emphasis should be placed on enhancing PTSD psychotherapies for military populations and on treatment retention across populations based on findings from this metaanalysis.

Self‐reported exercise frequency and PTSD: results from the National Health and Resilience in Veterans Study

“…Although there are several evidence-based approaches suggested for the treatment of PTSD, prior work suggests veterans diagnosed with PTSD often benefit less from psychotherapy than nonmilitary populations. For example, half of veterans who received treatment for PTSD continued to meet criteria for this disorder at posttreatment (5,47). This lack of responsiveness could be due to a variety of factors unique to veterans, such as trauma type and frequency of exposure to traumatic events (5,48).…”

“…For example, half of veterans who received treatment for PTSD continued to meet criteria for this disorder at posttreatment (5,47). This lack of responsiveness could be due to a variety of factors unique to veterans, such as trauma type and frequency of exposure to traumatic events (5,48). When considered in light of data from clinical trials that demonstrate the efficacy of exercise as a treatment for depression (46), the present findings justify further exploration of the potential for exercise as a stand-alone treatment or adjunct to psychotherapy and medications (49).…”

“…While efficacious pharmacological and psychosocial treatments exist for PTSD, they may be less efficacious among U.S. veterans (3)(4)(5). Modest treatment effects among veterans are due, in part, to high rates of "treatment-resistant PTSD," psychiatric comorbidities, and possible gender effects (6).…”

“…Modest treatment effects among veterans are due, in part, to high rates of "treatment-resistant PTSD," psychiatric comorbidities, and possible gender effects (6). Thus, there is a clear need to improve existing treatments and develop alternative treatments for PTSD, especially for veterans (5,6). Moreover, it is important to develop prevention and treatment approaches that may help mitigate risk for the development of PTSD through the promotion of factors that can help bolster resilience and recovery.…”

Evidence‐based psychotherapy trends among posttraumatic stress disorder patients in a national healthcare system, 2001–2014

“…Providers consistently report difficulty identifying which veterans are ready or appropriate for EBPs (Osei‐Bonsu et al, ; Zubkoff, Carpenter‐Song, Shiner, Ronconi, & Watts, ). While CPT and PE are among the most effective treatments for PTSD (Cusack et al, ; Watts et al, ), not all veterans benefit from these treatments (Steenkamp, Litz, Hoge, & Marmar, ; Straud, Siev, Messer, & Zalta, ) and little guidance is available to assist with differentiating which patients are most likely to benefit under which conditions (Steenkamp, ). Supporting clinicians by assisting with information about how to best engage reluctant patients can also help.…”