Franklian treatment with Vietnam veteran couples

In this article, the Franklian treatment method of existential reflection is described as it can be used in marital therapy with Vietnam veterans. The author also provides information about treatment results with twenty-three Vietnam veteran couples from 1974 to 1987.     

P. A. News & Notes

A case study of a Vietnam combat veteran with episodic rage attacks is discussed with emphasis on Rorschach formal scoring and content analysis. Rorschach data suggest a near neurotic level of ego organization with massive repression in the form of dissociated violent outbursts. Vietnam combat trauma appears to be a precipitant. Developmental differences between preoedipal splitting and higher level dissociation are discussed. Dissociative states are posited to represent a developmental level of ego organization midway between borderline and neurotic levels and are not easily encompassed by either borderline or neurotic classifications.     

The Vietnam veteran on wal: The relation of post-traumatic stress disorder to criminal behavior

The purpose of this paper is to conceptualize the relationship of Post-Traumatic Stress Disorder (PTSD) in Vietnam veterans to criminal behavior. A conceptual framework is discussed which proposes that the disposition to criminal behavior is determined by whether or not the veteran enters into the survivor mode of functioning as a behavioral defense mechanism against the disorder. It is hypothesized that there exists a relationship between the severity of PTSD and the tendency to commit illegal acts. The Vietnam Era Stress Inventory (Wilson and Krauss, 1980) was used to assess PTSD among a volunteer national sample of Vietnam combat veterans (N = 114) participating in the Veterans Administration's counseling program known as Operation Outreach. The results strongly supported the hypothesis and indicated that combat role variables, exposure to stressors in Vietnam and the severity of PTSD were significantly correlated with criminal acts.     

Cumulative trauma and midlife well-being in American women who served in Vietnam: effects of combat exposure and postdeployment social support

Background and Objectives: Research increasingly demonstrates that trauma exposure can have cumulative effects, yet much remains to be learned about effects of cumulative trauma, particularly regarding longer term adjustment. One such trauma, combat exposure, is insufficiently understood, especially for women, who are increasingly engaged in professional combat activities. Design: The study comprised a cross-sectional survey assessing multiple aspects of current well-being in women approximately 25 years after their service in Vietnam during the Vietnam War. Methods: Participants were 1374 women (78% military and 22% nonmilitary; mean age = 59.7). This study investigated the relations between three separate categories of trauma exposure (childhood, adulthood, and combat) and well-being and examined whether perceived social support at return from Vietnam moderated the association between combat exposure and well-being. Results: While both childhood and adulthood trauma exposure related to midlife well-being, combat exposure still uniquely predicted outcomes. Further, postdeployment perceived social support moderated the association of combat and well-being: recollected higher perceived social support at homecoming buffered participants from the links between combat exposure and well-being. Conclusions: These results may have important implications for interventions to reduce the impact of traumatic experiences, particularly in light of the increasing exposure of women to direct combat events.     

The Political Consequences of Combat: Post‐Traumatic Stress and Political Alienation Among Vietnam Veterans

On average, veterans are more civically and politically engaged than civilians. Previous research on the effects of military service, however, did not account for differences in veterans’ combat experiences. Using survey data from a representative sample of Vietnam veterans, this study presents evidence that veterans who were exposed to severe combat trauma and veterans who exhibited attitudes and fears associated with post‐traumatic stress had significantly lower levels of political efficacy and trust. The negative consequences of combat exposure and post‐traumatic stress are not mitigated when veterans have quality social support or when they seek professional counseling. These findings inform political psychology and hold implications for claims regarding the empowering influence of service in the U.S. military, increased political engagement, in particular. Among Vietnam veterans, exposure to severe combat trauma and post‐traumatic stress were both associated with reduced political efficacy and trust.     

Intensive,Multi-Couple Group Therapy for PTSD: A Nonrandomized Pilot Study With Military and Veteran Dyads

Cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD; Monson & Fredman, 2012) is efficacious in improving PTSD symptoms and relationship adjustment among couples with PTSD. However, there is a need for more efficient delivery formats to maximize engagement and retention and to achieve faster outcomes in multiple domains. This nonrandomized trial was designed to pilot an abbreviated, intensive, multi-couple group version of CBCT for PTSD (AIM-CBCT for PTSD) delivered over a single weekend for 24 couples that included an active-duty service member or veteran with PTSD who had deployed in support of combat operations following September 11, 2001. All couples completed treatment. Assessments conducted by clinical evaluators 1 and 3 months after the intervention revealed significant reductions in clinician-rated PTSD symptoms (ds = -0.77 and -0.98, respectively) and in patients’ self-reported symptoms of PTSD (ds = -0.73 and -1.17, respectively), depression (ds = -0.60 and -0.75, respectively), anxiety (ds = -0.63 and -0.73, respectively), and anger (ds = -0.45 and -0.60, respectively), relative to baseline. By 3-month follow-up, partners reported significant reductions in patients’ PTSD symptoms (d = -0.56), as well as significant improvements in their own depressive symptoms (d = -0.47), anxiety (d = -0.60), and relationship satisfaction (d = 0.53), relative to baseline. Delivering CBCT for PTSD through an abbreviated, intensive multi-couple group format may be an efficient strategy for improving patient, partner, and relational well-being in military and veteran couples with PTSD.     

Dimensionality of the Beck Anxiety Inventory in a Polytrauma Sample of OEF/OIF/OND Veterans: Findings From Exploratory and Confirmatory Factor Analysis

The Beck Anxiety Inventory (BAI) is commonly used as a screening instrument for symptoms of anxiety in clinical settings. The factor structure has been researched in a variety of different clinical settings with results ranging from a 2- to 5-factor structure. The purpose of this study was to explore the factor structure of this instrument in a polytrauma veteran sample. A sample of 304 veterans was used for this study. All subjects were administered the BAI screening measure as part of an evaluation in an outpatient polytrauma clinic. Exploratory factor analysis was conducted for half of the sample, followed by confirmatory factor analysis for the remaining sample to determine the best model. Factor analyses revealed that a 5-factor model provided a best fit. It is interesting to note that previously identified models of the BAI with other types of samples did not provide the best fit for this polytrauma sample. The BAI may provide additional information for clinicians when examining the 5-factor model with veterans in polytrauma settings. The factor structure of the BAI includes 1 factor (i.e., personal safety) that may be unique for veterans who have served in combat zones.     

Validation of a brief measure of posttraumatic stress disorder: the Distressing Event Questionnaire (DEQ)

The Distressing Event Questionnaire (DEQ) is a brief instrument for assessing posttraumatic stress disorder (PTSD) according to criteria provided in Diagnostic and Statistical Manual of Mental Disorders (4th ed.). The DEQ possesses high internal consistency and exhibited satisfactory short-term temporal stability in studies with Vietnam War combat veterans and battered women. In a sample of Vietnam War veterans and 4 separate samples of abused women (with histories of incest, rape, intimate partner abuse, or prostitution and abuse), the DEQ exhibited very good discriminative validity when judged against structured interview assessment of PTSD. The DEQ exhibited strong convergent validity with other PTSD measures and other indexes of adjustment and also exhibited strong convergent validity as a measure of PTSD across ethnic groups in both the veteran sample and the combined women's sample.     

"Detoxification" of Vietnam War Trauma: A Combined Family-Individual Approach

Treatment with families of veterans suffering from the aftereffects of combat trauma in the Vietnam War often requires a preliminary phase of disjoint treatment, in which family members are seen separately, before conjoint treatment can proceed. In this disjoint phase of treatment, wives and children are introduced to the brutal realities of Vietnam combat experience and to an understanding of its sequelae. This disjoint phase of family therapy detoxifies combat experience so that it can be approached in subsequent conjoint sessions along with more traditional family therapy issues.     

Post-traumatic stress disorder in Vietnam veterans: Assessment in a forensic setting

The recognition and proper evaluation of Vietnam veterans' demonstrating Post-Traumatic Stress Disorder syndromes is reviewed. The special problems of accurate diagnosis and assessment of former Vietnam combatants is emphasized. The forensic evaluation of Vietnam veterans' raising the Post Traumatic Stress Disorder syndrome in either civil or criminal proceedings is comprehensively discussed. The question “What are the clinical techniques necessary to accomplish a competent forensic evaluation of the Vietnam veterans?” is specifically addressed with special emphasis on legal dispositions and treatment implications. The relationship between the criminal acts of combat veterans and their exposure to the psychological trauma of war is explored.     

Critical Interaction Therapy: Couples Therapy in Combat-Related Posttraumatic Stress Disorder

There is a need for family therapy interventions that are specific to the conditions found in families of traumatized people such as combat veterans. In these families, the historically "real" event of the trauma often continues to exert influence on the family system despite collusive arrangements that serve to keep it hidden. In families of combat veterans, a situation develops whereby the veteran becomes triangulated with a dead buddy without the spouse's knowledge. The discrepancy between past and present emerges in what we call the critical interaction between the spouses. This article outlines a method of couples therapy that attempts to demystify this critical interaction, and begins to integrate the discrepant narratives of each spouse. The establishment of a nascent mutuality of perspective within the couple releases energies that can be directed toward support rather than symptom-formation in the family system.     

Normative mid-life concerns among Vietnam veterans with post-traumatic stress disorders: Some preliminary empirical findings

Most Vietnam veterans are now in the mid-life years. Veterans suffering from post-traumatic stress disorder (PTSD) may find that mid-life concerns both precipitate and exacerbate their PTSD symptomatology. Preliminary research with four groups of adult males supports this notion. A cross-sectional study with nonveteans, Vietnam era noncombatants, Vietnam combat veterans not in treatment, and Vietnam veterans in treatment for PTSD suggests that the mid-life issues of affiliation, identity, demonic guilt, and work may be the most problematic. Implications for treatment are discussed.     

The Influence of Service Era: Comparing Personality Assessment Inventory (PAI) Scale Scores Within a Posttraumatic Stress Disorder Treatment Clinic (PCT)

Research is mixed on the role of service era in symptom endorsement among Veterans, with differences emerging depending on the instrument evaluated. This study compares Personality Assessment Inventory (PAI) scale scores of VA test-takers who served during the Vietnam, Desert Storm, or Post-9/11 service eras. The sample was collected at a VA Posttraumatic Stress Disorder Clinical Team. Associations between gender and combat exposure were also examined as covariates. Results suggest that Veterans’ self-report on the PAI is influenced by service era, even after accounting for gender and combat exposure during deployment. The largest differences were between Vietnam or Post-9/11 Veterans and those from the Gulf War era. Symptom differences typically varied across scales commonly associated with symptoms of trauma exposure/posttraumatic stress disorder. Implications for the clinical use of, and research with, the PAI and other broadband personality assessments within the VA healthcare system and trauma treatment settings are discussed.

     

The Relationship Between Postdeployment Factors and PTSD Severity in Recent Combat Veterans

Combat traumas precipitate posttraumatic stress disorder (PTSD); however, nontraumatic deployment and postdeployment factors may also contribute to PTSD severity. The Deployment Risk and Resilience Inventory (DRRI) was used to investigate pre-, peri-, and postdeployment factors associated with current PTSD severity in 150 recent combat veterans with PTSD and hazardous alcohol use. Hierarchal linear regression analyzed what factors independently predicted PTSD severity when controlling for sociodemographic characteristics and combat specific variables. Four postdeployment factors independently predicted PTSD severity: unemployment, alcohol use, social support, and stressful (nontraumatic) life events. The centrality of trauma in the maintenance of PTSD and clinical implications for treatment providers are discussed.     

Group therapy with Vietnam veterans: A brief review

This paper reviews the benefits and general considerations regarding group therapy with Vietnam veterans. A review of veteran rap groups and traditional therapy groups highlights the similarities and differences between types of groups used to treat this population. The importance of countertransference reactions and the need to consider a variety of treatment approaches is emphasized.     

Interplay Between Service Era,PTSD Symptom Expression,and Treatment Completion Among Veterans

The current veteran population has grown significantly as a result of 3 recent major conflicts: Vietnam, Persian Gulf War, and Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF). Despite a strong presence in VA PTSD specialty clinics nationwide, little is known about how these veteran cohort groups differ in PTSD symptom presentation. Additionally, it is unclear how variations in PTSD symptom presentation may in turn affect treatment adherence and completion. Understanding factors associated with treatment dropout from exposure-based therapy for PTSD is an important area of study, as individuals who drop out of treatment are likely to remain symptomatic and experience significant impairment across a number of psychosocial domains. The present study examined the relationship between service theater affiliation and pretreatment symptom expression as predictors of treatment completion in a sample of 164 veterans. Although treatment completion did not differ by service era, study data revealed statistically significant differences in initial PTSD symptom expression. Implications of the results and future directions are discussed.     

A Case Report of Cognitive Processing Therapy Delivered Over a Single Week

Although evidence-based treatments for posttraumatic stress disorder (PTSD), such as Cognitive Processing Therapy (CPT), have been developed and widely disseminated, the rate of veterans engaging in and completing these therapies is low. Alternative methods of delivery may be needed to help overcome key barriers to treatment. Delivering evidence-based therapies intensively may address practical barriers to treatment attendance as well as problems with avoidance. This report details the case of a combat veteran who received 10 sessions of Cognitive Processing Therapy delivered twice per day over a single, 5-day workweek (CPT-5). Posttreatment, the veteran reported large and clinically meaningful decreases in PTSD and depression symptom severity as well as in guilt cognitions, which is a purported mechanism of successful treatment. These effects persisted 6 weeks after treatment ended. Despite the intensive nature of the treatment, the veteran found CPT-5 tolerable and could cite many benefits to completing therapy in 1 workweek. In conclusion, CPT-5 holds promise as a way to efficiently deliver an evidence-based therapy that is both clinically effective and acceptable to patients, although more rigorous clinical trials are needed to test this treatment delivery format.     

Differential Reactions of Patients Receiving Group Psychotherapy with Concomitant Somatic and Drug Therapies

The embeddedness of combat aggression, violence, survival, and antiauthority dynamics in the psychic organization of Vietnam veterans in groups shape the treatment enterprise. Inherent in treatment interactions and dynamic processes of the Vietnam therapy group are the reactivations of Vietnam-historical reenactments. These involve strong affective reactions toward superiors and toward fellow combatants (“grunts”), with an attendant sense of group danger, unconsciously reminiscent of Vietnam's guerrilla war terrain. This paper notes that because of the tendency of the group to repeat actual events (as opposed to fantasied events), these groups require divergent conceptualizations and technical management. An innovative model comprising a series of developmental phases is presented. This model, called “the curvilinear regressive-progressive model” of treatment with Vietnam veterans, focuses on both peer- and leader-centered dynamics in working through guilt-driven defenses in members. The leader plays a pivotal function in monitoring levels of affect tolerance in the group, and is expected to manage countertransference reactions, and to have sensitivity to the effects of combat stress on self structure. As the Vietnam therapy group members relive the history of the Vietnam conflict in the group, the leader utilizes a flexible, phase-sensitive system of interventions to reactivate arrested development by creating a healing climate where developmental tasks can be mastered and integrated by group members.     

Vietnam Veterans: Overreporting Versus Acceptable Reporting of Symptoms

Overreporting of symptoms among Vietnam combat veterans is a problem area with little research. Five hundred thirty Vietnam-era veterans were given the MMPI. They were divided according to two criteria, combat status and reporting status. For combat status, subjects were either in Vietnam (in-country) or in the military but not in Vietnam (Vietnam-era) between 1964 and 1975. For reporting status, the MMPI overreporting criteria of the subtle-obvious (S-O) items given by Green (1986) were used. Overreporters had an S-O total of > 160, and acceptable subjects were at or below this figure. Also, all subjects who responded randomly were excluded (MMPI Test-Retest scales > 4). Results indicated that a high number of subjects randomly responded to the MMPI, and that in-country veterans met the overreporting criteria in greater numbers than the Vietnam-era group. Also, multivariate analyses of variance (MANOVAs) showed significant differences among groups in four distinct areas—MMPI basic scales, Harris-Lingoes, Wiggins, and special subscales—for both reporting status and combat status, but not for the interaction. Post hoc analyses of variance (ANOVAs) showed that reporting status was especially robust. Two Vietnam in-country PTSD types, overreporters and "acceptable" patients, are discussed. Overreporters are more pathological and a distinct challenge in treatment relative to the other in-country veterans.