Evaluation of an Integrative Post-Traumatic Stress Disorder Treatment Program

Abstract

Objectives: Post-traumatic stress disorder (PTSD) and combat-related stress can be refractory, pervasive, and have a devastating impact on those affected, their families, and society at large. Challenges dealing with symptoms may in turn make a servicemember more susceptible to problems, including alcohol abuse, interpersonal conflict, and occupational problems. An effective treatment strategy will address multifactorial issues by using a holistic multimodal approach. Back on Track is an intensive outpatient program utilizing a holistic philosophy and multimodal treatments to provide a whole systems approach for the treatment of combat-related stress reactions and PTSD in active duty servicemembers. Design/Setting/Subjects: An explanatory, sequential, mixed-methods program evaluation was conducted to assess the effectiveness of a PTSD and combat stress treatment program. Quantitative outcomes were collected and analyzed on 595 participants at pre-and postinterventions and 6-week follow-up and qualitative data were gathered through participant interviews. Intervention: The manualized program uses a multimodal, psychoeducational group therapy format with a holistic approach for treating combat stress, increasing resiliency, and assisting with reintegration. Rotating providers visit from other programs and services to deliver content in bio-psycho-social-spiritual domains, including didactic lectures on mindfulness and the relaxation response and daily sessions of yoga nidra and meditation. Outcome measures: The primary outcome measure was PTSD symptom severity assessed with the PTSD Checklist-Military Version (PCL-M). Secondary outcomes included self-efficacy, knowledge, use, and satisfaction. Quantitative data were contextualized with interview data. Results: Results demonstrated a highly statistically significant effect of the program when comparing within-subject PCL-M scores before and after program participation, signed rank S (N = 595) =-47,367, p < 0.001. This translates to a moderate effect size, Cohen's d (N = 595) =-0.55, 95% confidence interval =-0.62 to-0.47, and a mean decrease of 7 points on the PCL-M at postintervention, demonstrating response to treatment. There were significant increases in knowledge and self-efficacy and high levels of satisfaction with the program overall, content, materials, and delivery. Conclusions: The treatment program has served *800 servicemembers since inception and has since expanded to five installations. The provision of whole systems care where the approach is holistic, multimodal, and multidisciplinary may be a way forward for the successful treatment of PTSD and other debilitating behavioral health conditions in military contexts and beyond.

Mental skills in the armed forces: A scoping review.

“…Mental skills programs may take time away from other forms of training or employment obligations, may create additional financial obligations on the part of the participant, or the implementation of these skills may feel more like a burden on the performer than a helpful addition (Mattie et al, 2020). However, from the results found in the present review, most programs and applications of mental skills were considered beneficial for those involved, outweighing the costs of the program, and providing important improvements for active duty, Veteran, and family members alike (Adler, Bliese et al, 2015; Adler et al, 2009; Bui et al, 2018; Fischer et al, 2013; Hilton et al, 2019; Kees et al, 2015; Precious & Lindsay, 2019).…”

“…Regarding the descriptiveness of information, each study was presented in such a way to identify the most pertinent program aspects and resultant outcome information. However, this led to discrepancy surrounding the information, where some studies presented copious program detail (e.g., Adler et al, 2009; Fischer et al, 2013; Jha et al, 2015; Kees & Rosenblum, 2015; Precious & Lindsay, 2019; Rosenblum et al, 2015), others only reported on certain elements of the program, such as the skills applied, session breakdown, or type of program approach (e.g., Blevins et al, 2011; Harper et al, 2014; Jensen et al, 2020; Reivich et al, 2011; Sylvia et al, 2020; Tenhula et al, 2014), and some only gave a vague description of the program in an overview before moving into their study (e.g., Casey, 2011; Hilton et al, 2019; Lester et al, 2011; Meyer, 2018; Smith, 2013; Tedeschi & McNally, 2011).…”

“…Regarding improvements, some outcomes included higher levels of reported self-confidence (Adler, Bliese, et al, 2015; Adler, Williams et al, 2015; Hammermeister et al, 2009), improved interpersonal communication (Bui et al, 2018; Fischer et al, 2013; Lester et al, 2011; Perlman et al, 2010), greater psychological health (Cohn & Pakenham, 2008; Lester, Liang, et al, 2016; Saltzman et al, 2016), improved performance on physical tasks (Adler, Bliese, et al, 2015; Jensen et al, 2020; Jha et al, 2017), greater resilience and coping skills (Kees & Rosenblum, 2015; Pickering et al, 2010; Sylvia et al, 2020), and enhanced connection with family or transition out of the armed forces environment (DeFraia et al, 2014; Harper et al, 2014). Outcomes involving a decrease in negative psychosocial experiences included decreases in post traumatic stress disorder (PTSD) symptoms (Adler et al, 2009; Blevins et al, 2011; Hilton et al, 2019), lowered depression scores or reduction of depression symptoms (Blevins et al, 2011; Dodge et al, 2018; Kees et al, 2015; Sylvia et al, 2015), and a reduction in anxiety or overall stress (Adler, Williams et al, 2015; Bui et al, 2018; Cohn & Pakenham, 2008; Judkins & Bradley, 2017; Kees & Rosenblum, 2015; Lester et al, 2013; Sylvia et al, 2020; Tenhula et al, 2014).…”

“…When exploring program effectiveness, a cost–benefit evaluation was warranted to understand whether participation was beneficial with respect to potential negatives. Though some programs were identified as potentially time-consuming, external resources detracting from time spent in training or in other life areas, programs were considered low risk, low cost, and acceptable solutions (Hilton et al, 2019). Programs presented significant benefits to participants, even for those who did not receive the full intervention or program implementation (Adler et al, 2009).…”

Military chaplains and mental health clinicians: Overlapping roles and collaborative opportunities.

“…For example, chaplains conducted weekly sessions to address spiritual concern during the 4-week skills-building IOP for patients recently discharged from the inpatient psychiatry ward at Madigan Army Medical Center (Hoyt et al, 2018). In the 2-week IOP "Back on Track" for marines undergoing treatment for posttraumatic stress disorder (PTSD) at Naval Hospital Camp Lejeune, chaplains facilitated group modules on meaning making, forgiveness, and grieving MILITARY CHAPLAIN COLLABORATION for fallen comrades (Hilton et al, 2019). Similar modules on finding meaning in military service and trauma were conducted by chaplains in the military PTSD IOP at Rush University Medical Center (Zalta et al, 2018).…”