Whether in the military or as a civilian, at some point in life people tend to experience traumatic conditions that challenge their view of the world and its environments. Based on the experiences, some people's reactions last longer than expected hence leading to Post-Traumatic Stress Disorder (PTSD). The most affected people are the war-service veterans because they often witness other people being killed, dead bodies and other horrific events when on duty. The condition might also occur during training due to the hardships associated with the career. Research shows that approximately 8 percent of the Americans who experience traumatic events develop PTSD at some time during their lives. Trauma is a very personal thing. The reason is that what traumatizes some people can be less meaningful to others. The differences occur due to variations in people's beliefs, level of experience, and personal values. The following is a review of the PTSD disorder among the veterans and the use of prolonged exposure therapy as the most effective treatment method.
Systematic Review
Development of PTSD and prevalence rate - according to Ehlers & Clark (2017), the existence of PTSD health concerns can be traced back as a far as warfare itself where it was first mentioned in Greek by a historian named Herodotus who was writing about a battle marathon. The historian described the life of a soldier who went blind after a fellow workmate was killed. Such accounts have been reviewed in literary works related to the diagnosis and treatment of PTSD. Traditionally, those who served in the military were more prone to being affected than the modern day soldiers due to the prevalence in the number of wars (Foa, 2014). The civil war also marked the start of medical researches to determine the most effective method for treatment. The diagnosis process became official in 1980 with researchers being permitted to interview the affected veterans.
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The prevalence rates among returning service members vary based on the period of war and the era. The most affected countries include Afghanistan and Iraq due to their war ton nature. Statistics show that approximately five thousand U.S army members who served in wars against these two nations have suffered from a traumatic disorder. The current wars present a unique set of circumstances which contribute to the high rate of PTSD (Ehlers & Clark, 2017). Examples include the urban-styles used in wars, extensive use of explosive devices, and guerrilla attacks. These factors trigger more post-traumatic stress conditions as compared to conventional fighting technique.
Symptoms- according to Ehlers & Clark (2017), the first signs may be evident within the first month after the event. The symptoms cause significant problems in work and relationship situations. Most people can longer go about their regular daily tasks. The most observed symptoms include recurrent memories of the event, upsetting nightmares, and dreams, challenges in avoiding thinking about the issue, negative thoughts about oneself and hardships in maintaining relationships (Stein at al. 2016). The signs can vary in intensity over time depending on whether one was treated or not. Other associated problems include depression, anxiety, and drug abuse. Failure to seek medical care can lead to disrupted lifestyle regarding job, health, and relationships.
Prolonged exposure therapy -Despite the large-scale efforts to support veterans since the world wars, recent statistics show that there has been no effective method in the treatment of PTSD. Examples of primary techniques include evidence-based talk therapy and psychology-related interventions (Stein at al. 2016). In an attempt to find better ways, the American health department has discovered the use of prolonged exposure therapy over these wait-list control group methods. There are a few concerns in the treatment method, among them being costs, barriers to receiving treatment and medication issues. The improvement in protective gear and provision of the battlefield medication facilities has led to an increase in the number of survivors, but there are high costs involved.
The prolonged exposure therapy (PET)is one of the methods that can be used to treat traumatic disorders. The plan is a gradual process that helps the affected individuals to re-engage with life activities as usual. The method also aims at strengthening one's ability to distinguish between danger and safety (Powers et al. 2013). PET requires that the individual should speak about the encounter and the encounter-related thoughts that have been reoccurring in one mind. The sessions typically take one hour and occur once per week for approximately three months. The therapist might also ask the affected individual to list down the traumatic experience and read it aloud. The patient would then be taught how to interact with safe things.
Errors analysis - when researching about the method, one of the primary challenge is the number of probable errors. An example is the lack of attention to follow up data where some researchers ignore the treatment time points (Powers et al. 2013). Additionally, when focusing on data obtained from past researches, there is the issue of exclusion and inclusion of some studies in the analysis. Not all details are relevant when conducting research hence careful examination is required.
Evidence-Based Quantitative Article
Since the early years of the 21st century, there have been numerous studies evaluating the interventions of post-traumatic stress in veterans. According to Yoder et al. (2012), there is significant support for the exposure method in the treatment of traumatic conditions across different populations. However, there is little evidence about how different individuals react to the continued use of this method. The article Prolonged Exposure Therapy, (Yoder et al. 2012) compares the effects of this method on different individuals. All the subjects involved in the study were already diagnosed with traumatic symptoms and were enrolled in the treatment process.
The article also evaluates some of the past studies conducted regarding the specific use of the treatment technique. Most of these studies indicate that the veterans do not fare well in treatments as compared to a range of other traumatized patient populations. More specifically, meta-analysis research conducted in 2005 shows that PTSD is a predictor of the post-treatment effects where the combat veterans record least changes even after treatment. The other most affected individuals are the sex assault survivors. Between 2002 and 2008, more than ten thousand veterans received PTSD treatments after returning from operations.
The study focused on participants who were receiving treatment for the disorder in a veteran's medical center, and it was conducted for two years. All participants were diagnosed with the disorder through a previously performed clinical test. The intake process involved meeting a therapist and completing a self-assessment form. The clinicians would then evaluate the detail obtained from the interview and present the case to other team members during a PTSD meeting (Yoder et al. 2012). If a patient was rated to have met all the treatment requirements, and accepted to participate in the study, he would then be assigned to a specific therapist who would follow up on the treatment procedure. The article is written using the archival data from the study which was obtained from a program database kept in the hospital.
One hundred and twelve participants were involved. Sixty-one of them had recently returned from combat theatres while the others had primarily participated in Gulf and Vietnam wars. The mean age of the participant was forty-one years with the majority of them being whites. Approximately 60 percent of these individuals had service-related disabilities. The therapists participated in weekly discussions where they presented their observations. Other forms of treatment include psycho-education and self-assessment of anxiety. Some of these sessions were recorded to be used in future treatment plans.
Evaluation and Application of the Results
There are several notable outcomes from the study. First, the exposure intervention process is robust. Secondly, there is a difference in the treatment response across the three groups of participants. The Gulf war veterans were more responsive to the treatment procedures used hence a decline in the symptoms of the disorder after a short period. Thirdly, there was variation in results based on the therapists' level of specialization (Yoder et al. 2012). Although all the therapists had received specialized training on how to handle PTSD patients, there were those who had primarily mastered in training and consultancy. Majority of the non-completers were those who had returned from combat theatres.
A surprising finding is that despite their responsiveness, the Gulf war veterans at the final session as showed little improvements compared to the others. Similarly, the slope of their curve regarding treatment throughout the treatment period was not as steep as that of other participants. The main reason for this finding is the difference in experiences among the members. The chronic fear of death is the most distressing experience for these veterans. The soldiers reported having been continually involved in war affairs which bring about traumatic memories of the sound of sirens, wearing protective devices and waiting in the dark for hours. It is therefore right to conclude that the treatment outcomes are influenced by the nature of the traumatic event experienced. Patients of traumatic context such as accidents and general combat are more likely to recover in the shortest time possible.
Limitations and biases
The study employed a nonrandomized evaluation procedure which involved the retrieval of records. The process is not valid when it comes to making conclusions about the causes of the difference among the participants. Multiple factors could have led to these variations including the number of sessions required to complete the study and nature of patient distribution across the clinicians (Yoder et al. 2012). There were few women participants hence it is difficult to make conclusions based on gender. The supervisions standards were also not met because the therapists discussed their findings and made inferences as a group. As a result, there was no difference in treatment techniques among the therapists. The most effective method involves an observer who would review the decisions made from time to time. The data obtained can be used to further medical research on the treatment of PTSD. The idea that the symptom outcomes were not influenced by service connection means that the exposure technique is useful even when dealing with other types of patients. The intervention can also be used even in cases of service-connected disability.
Conclusion
In conclusion, PET is among the most effective treatment methods for a traumatic stress disorder. It is likely that the current increasing demand for mental health services in the defense departments will require the implementation of adequately investigated procedures. Future research programs should, therefore, be directed towards determining the other factors that bring about variation in treatment response. Untreated PTSD is often associated with a host of other problems such as poor physical health and low life expectancy rates. Therapists should also ensure that patients are aware of the benefits of treatment-seeking behavior and personalization of health programs.
References
Ehlers, A., & Clark, D. M. (2017). A cognitive model of posttraumatic stress disorder. Behavior research and therapy , 38 (4), 319-345.
Foa, E. B. (2014). Prolonged exposure therapy: past, present, and future. Depression and anxiety , 28 (12), 1043-1047.
Powers, M. B., Halpern, J. M., Ferenschak, M. P., Gillihan, S. J., & Foa, E. B. (2013). A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clinical psychology review , 30 (6), 635-641.
Stein, D. J., Ipser, J. C., Seedat, S., Sager, C., & Amos, T. (2016). Pharmacotherapy for post-traumatic stress disorder (PTSD). Cochrane database of systematic reviews , (1).
Yoder, M., Tuerk, P. W., Price, M., Grubaugh, A. L., Strachan, M., Myrick, H., & Acierno, R. (2012). Prolonged exposure therapy for combat-related posttraumatic stress disorder: Comparing outcomes for veterans of different wars. Psychological Services , 9 (1), 16.
