War Veterans Treatment by Cognitive Behavior Therapy - Research Paper Example

?Running head: PTSD AMONG WAR VETERANS PTSD among War Veterans Treated with Cognitive-behavioral Therapy (school) One of the most common mental health issues which war veterans are afflicted with is post-traumatic stress disorder (PTSD). This affliction is most often founded on their combat and war experiences, experiences which often significantly affect their emotional and behavioral coping in their post-war activities. Due to their inability to mentally process their war experiences, many of them often experience PTSD, with its symptoms which include reoccurring thoughts, avoidance, numbing, and hyperarousal (Brown, 2007). Their symptoms often make it difficult for them to function in normal society, as they sometimes are very jumpy, are highly suspicious, and the imagined reoccurrence of their war experience puts themselves and other people in danger. There are different types of therapies available for these patients and most of them feature different approaches for recovery and treatment. This paper shall discuss the specific applications of the cognitive-behavioral therapy for these PTSD war veterans. This study is being carried out in order to establish a clear and comprehensive understanding of PTSD as it is seen among war veterans. Cognitive behavioral therapy is one of the different types of therapies for PTSD among war veterans. The Veterans’ Association recommends two types of cognitive behavioral therapy for veterans diagnosed with PTSD, and these therapies include the cognitive processing therapy and the prolonged exposure therapy (US Department of Veteran Affairs, 2007). Cognitive behavioral therapy is meant to help the patient understand and change how he thinks about the trauma and its results. The overall goal of the patient during this therapy is to understand how some thoughts on the trauma often lead to stress and how they can make the stress worse (Tarrier, Pilgrim, Sommerfield, Faragher, & Reynolds, 1999). This type of therapy is meant to assist the patient in identifying his thoughts about the outside world and the patient himself – thoughts that are making him feel afraid or stressed. With the therapist, the patient would learn to substitute his thoughts with less anxious and less stressful ones. In other words, the patient would learn how to cope with his feelings of anger and fear, and in many veterans, his feelings of guilt (Tarrier, et.al., 1999). For many veterans, that feeling of guilt often stems from the deaths of their comrades in the face of their survival. They often feel guilty about their decisions or actions which they associate with the death of their comrades. The CBT therapist often helps the patient come to terms with the fact that the traumatic event was not the patient’s fault. The prevalence of PTSD is often considered higher among women serving in the military, however, limited studies have been carried out within this population. Some studies however point out that cognitive behavioral therapy is effective in this population. A study by Shnurr, Friedman, Engel, Foa, and Shea (2007) sought to compare prolonged exposure which is a type of cognitive behavioral therapy with the present-centered therapy which is a supportive therapy in the management of PTSD. This was carried out as a randomized controlled trial on female veterans and active duty personnel with PTSD. The study revealed that women who were subjected to the cognitive behavioral therapy (prolonged exposure) manifested with an improved reduction of their PTSD symptoms as compared to women who were subjected to the present-centered therapy (Shnurr, et.al., 2007). There is also a higher possibility for those who underwent prolonged exposure therapy to totally be relieved of their PTSD; they were also less likely to go through a relapse in their symptoms. In effect, this study establishes strong support for cognitive behavioral therapy among PTSD war veteran patients. Prolonged exposure includes therapies like systematic desensitization, flooding, implosive therapy, self-control desensitization, participant modeling, and similar techniques (Keane and Kaloupek, 1996). Any of these therapies can sometimes be used in order to access emotions which are associated with traumatic events; and they can later help in the processing of emotions. This element of emotional processing is often considered by experts as important elements in the management of PTSD (Keane and Kaloupek, 1996). The in vivo and imaginal exposure therapies for PTSD usually involve an element of graduated exposure to traumatizing cues. In the end, these therapies help the patients become less antagonistic and be more relaxed. These therapies also includes returning to the event which has traumatized them, or it may also include coming into contact with nuances and other qualities of their experience which may be associated with the incident (Monson, Schnurr, Resick, Friedman, Young-Xu, Stevens, 2006). This therapy would maximally expose them to the traumatic experience in order to establish their triggers and their thought processes in the midst of the experience. Once such elements are established, the patients are taught how to deal with the experience on a more productive and less antagonistic manner. Stress inoculation therapy is another form of cognitive behavioral therapy for PTSD among war veterans (Keane and Kaloupek, 1996). This type of therapy adopts a skills training model where the patient would first accustom himself to particular behavioral techniques which are known to change the usual response to anxiety or stress. The patient is then taught how to apply these new techniques in the management of their PTSD symptoms. The patients often go through relaxation training, skills training, and anger management (Donta, Clauw, Engel and Guarino, 2003). These therapies usually address specific triggers, shifting responses to these triggers into more productive directions. There are different studies which support the efficacy of cognitive behavioral therapy. Most of these studies highlight the importance of a systematic exposure to some form of depiction of these traumatizing incidents (Tarrier, Sommerfield, Pilgrim, and Faragher, 2000). Studies have also manifested benefits for combat veterans in terms of improved outcomes in relation to exposure based interventions among chronic sufferers (Boudewyns and Hyer, 1990). Variations in the management of PTSD have sometimes been implemented in order to address certain targets or symptoms, including guilt, cognitive distortions, and dysfunctional values (Keane and Kaloupek, 1996). The benefit of cognitive behavioral therapy was seen in the study by Rauch, Defever, Favorite, and Duroe, (2009) where the authors presented data on the treatment of veterans with chronic PTSD. In general, the authors were able to establish significant decrease in the total PTSD symptoms from the pre and the post-treatment period. The subjects of this study – veterans from the Afghanistan and Iraq wars were able to manifest decreased symptoms and issues associated with PTSD (Rauch, et.al., 2009). Moreover, many of them also exhibited reduced symptoms in depression after undergoing cognitive behavioral therapy. The authors expressed much support for the use of this type of therapy for returning war veterans suffering from PTSD because of its ability to achieve improved patient outcomes. War veterans with PTSD often require treatment which is fashioned to the particular qualities of combat, military culture, and the patient’s personal circumstances (Macready, 2008). Cognitive behavioral therapy has often been managed with the application of exposure therapy or cognitive processing theory. The idea in the application of CBT is based on the fact that recovery is seen when there is a repeated and gradual exposure to the situation which has caused the trauma – this, in an effort to decrease the symptoms of PTSD and the avoidant behavior which often follows (Macready, 2008). The circumstances may be more difficult to recreate among war veterans, however, simulations can be substituted in place of the combat experience, including the incorporation of noises and smells associated with the trauma. In the end, prolonged exposure can help achieve improved coping patterns, as well as reduced incidents in the manifestation of symptoms. Although cognitive behavioral therapy already appears to be an effective treatment for war veterans with PTSD, there are various considerations which must be made by mental health professionals in the management of these patients. One consideration is the fact the behavioral disturbances among these veterans may actually be caused by other factors (Rothbaum, Hodges, Ready, Graap, & Alarcon, 2001). A thorough evaluation of the patient must therefore be carried out in order to establish a clear and accurate diagnosis (Macready, 2008). Moreover, in the treatment of war veterans, each veteran must undergo comprehensive psychosocial, vocational, and medical issues, including psychiatric illnesses (Macready, 2008). These veterans must also be educated in order to orient them of the fact that immediate treatment is important in their recovery. The discussion above establishes the benefits and the applications of cognitive behavioral therapy for war veterans suffering from PTSD. PTSD is one of the most common mental health issues among war and combat veterans and in some instances it is often debilitating to their normal functioning. Cognitive behavioral therapy serves to shift their thought processes towards less aggressive and less stressful ways of managing the emotional and behavioral triggers of their disorders. Various applications of this therapy include prolonged exposure and cognitive processing therapy. These two therapies seek to achieve what CBT basically seeks to achieve and this includes teaching the patient to handle stress and anxiety better, and to teach him to not follow the usual patterns of behavior or thought processes which he associates with the stress or trauma. For the most part, CBT has been successful in reducing patient’s PTSD and in assisting the patient in eventually living a life without the disorder. Reference Boudewyns, P. & Hyer, L. (1990). Physiological response to combat memories and preliminary treatment outcome in Vietnam veteran PTSD patients treated with direct therapeutic exposure. Behavior Therapy, 21, 63-87. Brown, S. (2007). Counseling Victims of Violence: A Handbook for Helping Professionals. New York: Hunter House. Donta, S., Clauw, D., Engel, C., Guarino, P., Peduzzi, P., Williams, D., & Skinner, J. (2003). Cognitive behavioral therapy and aerobic exercise for Gulf War veterans' illnesses: a randomized controlled trial. JAMA, 19; 289(11):1396-404. Rothman, B., Riggs, D., & Murdock, R. (1991). Treatment of posttraumatic stress disorder in rape victims: A comparison between cognitive-behavioral procedures and counseling. Journal of Consulting and Clinical Psychology, 59, 715-723. Keane, T. & Kaloupek, D. (1996). Cognitive behavior therapy in the treatment of posttraumatic stress disorder. The Clinical Psychologist, 49(1), 7-8. Macready, N. (2008). Challenges of Treating PTSD in Veterans. Medscape. Retrieved 31 October 2011 from http://www.medscape.com/viewarticle/584096 Monson, C., Schnurr, P., Resick, P., Friedman, M., Young-Xu, Y., & Stevens, S. (2006). Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 74(5), 898-907. Rauch, S., Defever, E., Favorite, T., Duroe, A., & Garrity, C. (2009). Prolonged Exposure for PTSD in a Veterans Health Administration PTSD Clinic. Journal of Traumatic Stress, 22(1), 60–64 Rothbaum B., Hodges, L., Ready, D., Graap, K., Alarcon, R. (2001). Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder. J Clin Psychiatry, 62: 617-622. Schnurr, P., Friedman, M., Engel, C., Foa, E., Shea, M., & Chow, B. (2007). Cognitive Behavioral Therapy for Posttraumatic Stress Disorder in Women: A Randomized Controlled Trial. JAMA, 297(8): 820-830. Tarrier, N., Pilgrim, H., Sommerfield, C., Faragher, B., Reynolds, M. & Graham, E. (1999). A randomized trial of cognitive therapy and imaginal exposure in the treatment of chronic posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 67(1), 13-18 Tarrier, N., Sommerfield, C., Pilgrim, H., & Faragher, B. (2000). Factors associated with outcome of cognitive-behavioral treatment of chronic post-traumatic stress disorder. Behavior Research and Therapy, 38(2), 191-202. US Department of Veterans’ Affairs (2007). Treatment of PTSD. Retrieved 30 October 2011 from http://www.ptsd.va.gov/public/pages/treatment-ptsd.asp Read More