Treating PTSD With Talk

21 Aug

Couples Therapy and PTSD Danish psychologists now think post-traumatic stress disorder (PTSD) is more than just a battlefield phenomenon.

A large-scale survey of the mental condition of military personnel before, during and after their posting to Afghanistan has proved thought-provoking. In total, 746 Danish soldiers took part in the survey. The soldiers completed a questionnaire five times in all — before their posting, during their time in Afghanistan and three times after their return to Denmark.

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“Typically, it is not the experience of war that triggers the symptoms of post-traumatic stress disorder (PSTD),” explains Dorthe Berntsen.

“In the case of soldiers in Afghanistan, we might well expect that it was their experiences of war there that triggered PSTD. However, the situation is not so simple. We need to look at the soldiers’ experiences in a lifetime perspective. The study has provided new information, because the survey includes data on the soldiers’ state of health before their departure, during their tour of duty and several times after their return. It shows that many of the soldiers had already experienced trauma before they went to Afghanistan, and that this has affected the way they reacted during their posting.

“It has long been generally thought that PTSD occurs after violent experiences. Our survey thus provides new knowledge,” says Dorthe Berntsen.

“War in itself is not the crucial factor in making soldiers ill. It can be a contributing factor, but it is not the decisive factor.”

PTSD sufferers, according to Berntsen, are prone to “involuntary intrusive recollections”, and are more or less resilient depending upon many factors, including military training and childhood trauma. Perhps that explains the value of a new approach to treating PTSD, couples therapy.

In the trial, 40 heterosexual and homosexual couples – with one partner having PTSD – were given weekly therapy sessions at the VA Boston Healthcare System or in a Toronto research center, or assigned to be in a control group. Those with PTSD who had the couple therapy experienced a greater improvement after 15 weekly sessions compared with those who didn’t have therapy.

“About 80 percent of the participants in the treatment group had a loss of their PTSD diagnosis by the end of the study, compared with 20 percent of those in the control group,” said study author Candice Monson, a psychologist at Ryerson University in Toronto. A far greater percentage of patients and their partners who underwent therapy reported they were satisfied in their relationship at the end of the study compared with those who didn’t get help.

Previous research has shown that social support is crucial for successful treatment of the mental disorder.In that earlier researcher, patients were encouraged to repeatedly recall the traumatic event in as much detail as possible to help their brain become desensitized to the painful memories and move on from them.

The couple therapy practiced in the new study took a different approach, said Monson. It helped PTSD patients and their partners find meaning in the event rather than rehashing the “nitty-gritty details.” Couples were also instructed to take part in activities that they’d been avoiding because of the PTSD, such as going out for dinner or spending time with friends.

Monson said her research team plans to expand the study to include other close social connections in couple therapy, including parents, siblings, or war buddies to see if including non-romantic partners can be just as effective.

And, for those PTSD patients not in a committed relationships, help is coming to them through their smartphones.

Ten years ago, the resources available to veterans with PTSD who were unwilling or unable, because of geography or other factors, to be treated by a therapist were limited. Researchers are developing technologies to reach people like Sullivan wherever they are, putting tools directly into their hands through programs online and on their smartphones.

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In April 2011, the two agencies launched PTSD Coach, an app that allows people to use their phones to take well-studied tests for assessing the severity of symptoms, track those results over time, and create quick-reference pages to contact the people who provide support in moments of need.

The program, available free on iPhone and Android devices, includes a series of exercises, such as guided meditation to help with anxiety and a page of resources for people in crisis. As of the end of July, the app had been downloaded about 66,000 times, Batten said.

Researchers at T2 now have a series of apps and more in development. The one that prompted Sullivan to return to treatment, called PE Coach, was launched in March and is designed for use in conjunction with “prolonged exposure” therapy that takes place in person.

Patients typically are asked, between visits, to listen to recordings of their therapy session, which can be recorded in the app. The program also includes self-assessment questionnaires and space for notes.

People with PTSD avoid things that trigger memories of trauma. So taking the first steps to get help and sticking with it can be difficult, said Greg Reger, a clinical psychologist at T2. The app is designed to make that process easier.

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