Mental health and functional impairment outcomes following a 6-week intensive treatment programme for UK military veterans with post-traumatic stress disorder (PTSD): a naturalistic study to explore dropout and health outcomes at follow-up

Abstract

ObjectiveCombat Stress, a UK national charity for veterans with mental health problems, has been funded by the National Health Service (NHS) to provide a national specialist service to deliver treatment for post-traumatic stress disorder (PTSD). This paper reports the efficacy of a PTSD treatment programme for UK veterans at 6 months follow-up.DesignA within subject design.SettingUK veterans with a diagnosis of PTSD who accessed Combat Stress.Participants246 veterans who received treatment between late 2012 and early 2014.InterventionAn intensive 6-week residential treatment programme, consisting of a mixture of individual and group sessions. Participants were offered a minimum of 15 individual trauma-focused cognitive behavioural therapy sessions. In addition, participants were offered 55 group sessions focusing on psychoeducational material and emotional regulation.Main outcome measuresClinicians completed measures of PTSD and functional impairment and participants completed measures of PTSD, depression, anger and functional impairment.ResultsWe observed significant reductions in PTSD scores following treatment on both clinician completed measures (PSS-I: −13.0, 95% CI −14.5 to −11.5) and self-reported measures (Revised Impact of Events Scale (IES-R): −16.5, 95% CI −19.0 to −14.0). Significant improvements in functional impairment were also observed (eg, Health of the Nation Outcome Scales (HONOS): −6.85, 95% CI −7.98 to −5.72). There were no differences in baseline outcomes between those who completed and those who did not complete the programme, or post-treatment outcomes between those we were able to follow-up at 6 months and those lost to follow-up.ConclusionsIn a naturalistic study we observed a significant reduction in PTSD scores and functional impairment following treatment. These improvements were maintained at 6 month follow-up. Our findings suggest it may be helpful to take a closer look at combining individual trauma-focused cognitive behaviour therapy and group sessions when treating veterans with PTSD. This is the first UK study of its kind, but requires further evaluation.

A five-day inpatient EMDR treatment programme for PTSD: pilot study

“…A comparison between intensive cognitive therapy for PTSD and regular weekly treatment in a clinical setting suggested that the intensive format may lead to increased efficacy (Murray, El-Leithy, & Billings, 2017). Specifically for veterans, Murphy et al (2015) tested a somewhat longer intensive treatment programme of six weeks with individual TF-CBT and found promising results. One pilot study is available in which the effects of an intensive eight-day EMDR programme were investigated in seven patients (Bongaerts, Van Minnen, & de Jongh, 2017), with large effects.…”

Exploring Outcome Predictors in UK Veterans Treated for PTSD

“…244/292 (84%) were successfully followed up six months after treatment and are the sample used for the current study. In a previous publication, we demonstrated that there were no significant differences on a range of health outcomes between individuals who did not complete the treatment and those who did and also between individuals that were followed up successfully at six months and those lost to follow up (Murphy et al, 2015). Based on these findings, we were confident that there was no evidence for the presence of a health bias between individuals we were able to follow up or not.…”

“…We have previously reported significant improvements on a range on mental health outcomes following treatment for PTSD in UK veterans (Murphy et al, 2015). In this paper, we focused on analysing the subscales that make up the PSS-I.…”

“…Group sessions included psycho-educational groups (for example, learning a EXPLORING OUTCOME PREDICTORS IN UK VETERANS TREATED FOR PTSD 443 psychological understanding of PTSD or the impact of PTSD on communication styles and relationships) or symptoms management groups (for example, managing low mood or grounding strategies for intrusive PSTD symptoms). Further details about the treatment programme have been published elsewhere (Murphy et al, 2015).…”

“…Given this, it is encouraging that treatment programmes for PTSD in UK, US, Canadian, and Australian veterans that incorporate elements of individual trauma-focused therapy, and in many cases are supplemented by group therapy, have reported significant improvements that have been maintained at follow up (Richardson, Contractor, Armour, St Cyr, Elhai, & Sareen, 2014;Forbes, Lewis, Parslow, Hawthorne, & Creamer, 2008a;Creamer, Morris, Biddle, & Elliot, 1999;Murphy et al, 2015;Morland et al, 2014;Chard, Schumm, Owens, & Cottingham, 2010;Resick, Monson, & Chard, 2007;Monson, Schnurr, Resick, Friedman, Young-Xu, & Stevens, 2006).…”