Managing Posttraumatic Stress Disorder Symptoms in Active-Duty Military Personnel in Primary Care Settings

Abstract

Active-duty military personnel face deterrents to seeking outpatient mental health treatment despite the high prevalence of posttraumatic stress disorder (PTSD) in this population. The Behavioral Health Consultation (BHC) model may be the answer for those presenting subthreshold PTSD symptoms, at high risk for PTSD due to their occupation, not interested in outpatient mental health treatment, or unable to seek such treatment due to occupational limitations. Three empirically based interventions that have been effective in managing symptoms of PTSD are summarized and then integrated into the established BHC model as suggested treatments for managing PTSD symptoms in an integrated primary care setting. Pilot data and recommendations for future research and practice are provided.

Treatment of Department of Veterans Affairs primary care patients with posttraumatic stress disorder.

“…This is in part attributable to the fact that brief CBT interventions for PTSD that are suitable for the primary care setting have yet to be fully developed or tested (Sullivan et al, 2007). However, recent research describes how many CBT consistent interventions, for example written trauma narratives (Corso et al, 2009), psychoeducation about PTSD symptoms, and motivational interviewing to increase willingness for treatment (Maguen et al, 2010) can be incorporated into PC-MHI sessions. Our findings may also reflect a larger problem regarding the of lack training in evidence-based psychotherapies.…”

“…PTSD treatment provided solely by a PCP is not consistent with practice guidelines. PTSD treatment provided within the context of PC-MHI, while not considered the gold standard, is starting to accumulate research support (Bower, Richards & Lovell, 2001;Corso et al, 2009). CBT approaches suitable for primary care are currently being developed and tested (e.g., Sullivan et al, 2007).…”

Psychotherapy for military-related posttraumatic stress disorder: Review of the evidence

“…Patients showed improvements in PTSD (g = 1.1) and depressive symptoms (g = 0.8), with half no longer meeting criteria for PTSD at onemonth follow up. In a similar study in primary care, active duty service members (N= 19) received three brief PTSD treatments, each intervention consisting of two to four 30-minute sessions: treatment as usual (consisting of problem-focused, behavioral approaches), writing about a stressful deployment event, and writing an impact statement about the meaning and impact of the event on their lives (Corso et al, 2009). Of these, only the impact statement resulted in statistically significant decreases in PTSD symptoms.…”

Treatment of active-duty military with PTSD in primary care: Early findings.

“…Over the last several years, evaluations of brief behavioral treatment protocols for specific conditions including insomnia (Goodie et al, 2009) and panic disorder (Roy-Byrne et al, 2005) have been successful, but there has been very limited attention to PTSD. In the one report published to date, Corso et al (2009) described the treatment of 19 active-duty military with PTSD in an integrated family medicine clinic within five 30-min appointments. This clinical case series reported on a treatment protocol that evolved over time across patients.…”