Mental Health Syndrome

In our agency “No Vets left behind,” the biggest issue many of our clients are struggling with is the readjustment back into civilian life. There are many issues affecting veterans returning home from combat. Many of these service members exhibit high levels of emotional distress while on deployments. The events experienced in combat that may elicit trauma include: firefights, improvised explosive devices, minesweeping, witnessing death and much more. These traumatic experiences can create mental health problems such as posttraumatic stress disorder. The American Psychiatric Association (2013) defines PTSD as an anxiety issue that develops in individuals after extremely traumatic events. According to the American Psychiatric Association's
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), there are four types of symptoms of PTSD, re-experiencing, avoidance, numbing and arousal. These symptoms may not be exactly the same for everyone (American Psychiatric Association 2013).
Symptoms usually start as soon as the traumatic event is experienced, but it is possible for the symptoms to appear until months or years later (American Psychiatric Association 2013). Veterans with PTSD have a greater risk of developing mental health disorders such as anxiety and depression (Back, Killeen, Teer, Hartwell, Federline, Beylotte, & Cox, 2014). Also, people with PTSD are more likely to develop eating disorders and substance abuse (Back et al., 2014). This mental health disorder impacts our client’s lives. According to Richardson, Frueh, and Acierno (2010), multiple studies purpose that United States veterans have reported a point prevalence of combat-related PTSD that ranges from 2-17% and lifetime prevalence of 6-31%. PTSD is a mental health disorder that seems to be affecting veterans for long periods of time. There are several psychotherapy interventions that can treat PTSD. One of the treatments that have received a lot of criticism is prolonged
exposure.
Evidence
Examining whether prolonged exposure therapy can reduce PTSD among veterans is essential in determining if the treatment is impactful and successful.
Exposure therapy requires patients to retell and talk about their trauma repeatedly until their recollection of the traumatic event is no longer distressing (Difede, Hoffman 2004). Some veterans may decline to engage in treatment that requires them to recount their experiences over and over again. A veteran may become overwhelmed with emotions when retelling their experience or they become emotionless, making themselves numb and inactive in the healing process (Difede, Hoffman 2004). Talking about the traumatic experience numerous times could result in setbacks that could me more detrimental than beneficial to a client (Difede, Hoffman 2004). Despite all the flaws with the prolonged exposure, there are far more benefits to this treatment than problems. There is a lot of research that supports this therapeutic approach. In a recent study done by Goodson, Lefkowitz, Helstrom and Gawrysiak (2013), one hundred fifteen veterans that were diagnosed with PTSD and depression participated in prolonged exposure therapy in the Veteran Affair clinics in Philadelphia. Patient’s levels of depression, PTSD, and overall health were measured before and after treatment using the PTSD Checklist-Military Version, a 17 item self-report measure (Goodson et al., 2013). In addition, baseline characteristics were examined as predictors of treatment
response (Goodson et al 2013). Of the one hundred fifteen participants, eighty-four completed the 9-12 week treatment (Goodson et al 2013). After treatment participants experienced a 42% reduction in PTSD symptoms, a 31% reduction in depression symptoms, and an increase in quality of life following prolonged exposure therapy (Goodson et al., 2013). These results imply that prolonged exposure therapy is helpful in lowering PTSD symptoms. Although, these results seem very promising there are critiques to this study. One of the critiques is the amount of participants that dropped out. These individuals tended to be younger than those who completed the therapy. There could be multiple factors that caused a participant to drop out including, work, school, and family. A threat to internal validly is attrition. Another critique is the veterans that were prescribed psychiatric medication experienced less of a reduction in PTSD symptoms than those not prescribed medications (Goodson et al., 2013). There are multiple treatments interfering. Summary I believe that prolonged exposure therapy is an effective treatment that our agency should adopt and implement in the therapeutic relationship with our clients. Research has indicated that prolonged exposure therapy has lowered PTSD symptoms, depression and increase the overall health of the veterans who have used the therapy. Although, this treatment does have some criticism the benefits outweigh the disadvantages. One of the primary benefits of exposure therapy is its direct approach in confronting a client’s fears. Many practitioners would agree that confronting a fear is a simple task that tends to take less time and resources than other evidence based practices; therefore it would be a great fit to our agency. The next steps are to begin training our clinician in this evidence-based practice and develop a scale to measure the effectiveness of the treatment. In addition, since many service members will be skeptical of this approach, we need to provide pyschoeducation to our client to instill a sense of hope and trust in the helping relationship.