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Excerpts from PTSD IN MILITARY AND VETERAN POPULATIONS:
Exposure to any potentially traumatic event—such as physical or sexual abuse, natural disaster, being threatened with death, observing death, or taking someone else’s life—may trigger the symptoms that characterize PTSD. Those symptoms occur in four clusters:
• intrusive re-experiencing of the traumatic event, such as recurrent nightmares or flashbacks;
• avoidance of reminders of the traumatic event;
• distortions of thinking and memory or emotional numbing; and
• persistently high physiologic arousal and reactivity.
medical conditions that frequently co-occur with PTSD—such as TBI (traumatic brain injury), substance use disorders, depression, and chronic pain.
DoD and VA issued an updated joint clinical practice guideline for management of PTSD in 2010 and have also issued joint guidelines for medical conditions that frequently co-occur with PTSD—such as TBI, substance use disorders, depression, and chronic pain. However, there is no guideline on how to integrate treatment for PTSD with treatment for these co-occurring conditions. Further, there are no data on whether mental health care providers in either department use the PTSD guideline or whether they offer evidence-based treatments5—such as prolonged exposure therapy or cognitive processing therapy, or selected serotonin reuptake inhibitors—to their patients. Complementary and alternative treatments for PTSD—such as yoga, acupuncture, and animal-assisted therapy—received particular consideration as required by the legislation, but the lack of evidence on their effectiveness made them difficult to assess. The same was true of new techniques to deliver established, evidence-based treatments, such as telehealth and virtual reality, although studies of these are under way and some promising preliminary results have been reported. DoD has spent millions of dollars on programs to build psychological resilience and prevent the adverse effects of military operational stress. These programs include the Army’s Comprehensive Soldier and Family Fitness, the Navy and the Marine Corps Combat and Operational Stress Control programs, and the Marine Corps Operational Stress Control and Readiness program.
Many service members and veterans do not seek a diagnosis of their symptoms or seek treatment should they receive a PTSD diagnosis. The reasons for the treatment gaps are many and include patients’ concerns about their careers, not getting a security clearance in the future, loss of coworker confidence, side effects from medications, and the belief that family and friends would be more helpful than a mental health professional. Additional barriers to care include the difficulty of getting appointments with mental health care providers and restrictions on medications that can be used to treat for PTSD when a service member is in a combat zone. For veterans, barriers to care include lack of available providers, logistic challenges, and lack of knowledge of available services.
This report focuses on service members and veterans who have PTSD as a result of their time in service. Although PTSD in military and veteran populations may also affect family members and caregivers, these populations do not fall within the purview of this report.
it was obvious that a comprehensive survey and assessment of all PTSD treatment programs and services throughout the departments was not feasible because a survey would duplicate efforts already in progress; very few programs in DoD or VA collect data on outcomes, and many DoD and VA specialized PTSD programs were conceptualized and implemented individually or are new. Finally, the lack of data meant that it would be impossible to determine the success rates or effectiveness of DoD and VA PTSD programs and services.
Several literature searches were conducted in October 2013 to identify new programs, services, policies, or outcomes related to PTSD in DoD and VA. The search was limited to papers in English published since 2011 (policies published since 2005), and studies had to be conducted in military or veteran populations. Search categories for PTSD included physiological biomarkers, alternative therapies, prevention and resilience, treatment and diagnosis, rehabilitation and related topics, and policy reports
Entire report: ptsd-treatment
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