Gestalt therapy in the treatment of Vietnam veterans experiencing PTSD symptomatology

In the author's clinical work with Vietnam veterans experiencing symptoms of PTSD, Gestalt theory and concepts have proven to be very helpful in (a) conceptualizing what sustains Vietnam as a deleterious problem in the lives of these veterans and (b) providing techniques which are effective in helping them overcome their Vietnam-related troubles. Although of great potential, the author feels that the effective application of Gestalt therapy techniques necessitates the kind of prudent clinical discretion which ordinarily requires a solid background in general psychotherapy and specialized training in Gestalt theory, concepts, and techniques.     

The relationship between spiritual distress, PTSD and depression in Vietnam combat veterans

Presents empirical data showing the relationship between combat-related posttraumatic stress disorder (PTSD), depression and spiritual distress. Uses spiritual injury scale to measure distress; scale measures guilt, anger or resentment, sadness/grief, lack of meaning, feeling God/life has treated one unfairly, religious doubt, and fear of death. Shows high association between spiritual injuries and both PTSD and depression. Also finds inverse relationship between intrinsic religious faith and these two diagnostic categories. An inverse relationship also exists between religious faith as measured by regular worship with a faith community and both depression and PTSD.     

Prolonged exposure therapy for chronic combat-related PTSD: a case report of five veterans

Prolonged exposure (PE) therapy has been found efficient in reducing posttraumatic stress disorder (PTSD) symptoms mostly among rape victims, but has not been explored in combat-related PTSD. Five patients with severe chronic PTSD, unresponsive to previous treatment (medication and supportive therapy) are described. Patients were evaluated with the PTSD Symptom Scale-Interview, and Beck Depression Inventory, before and after 10-15 sessions of PE therapy. All five patients showed marked improvement with PE, with a mean decrease of 48% in PTSD Symptom Scale-Interview score and 69% in Beck Depression Inventory score. Moreover, four patients maintained treatment gains or kept improving 6-18 months after the treatment. The results suggest that PE was effective in reducing combat-related chronic PTSD symptoms.     

Heart rate during group flooding therapy for PTSD

The objective of this study was to assess, via heart rate, the arousal levels of participants in group trauma reexposure therapy for posttraumatic stress disorder, and so to better understand this common mode of treatment, particularly in regards to its presumed curative factor, extinction. Six Vietnam combat-related PTSD inpatients participated twice weekly in group trauma reexposure therapy during which their electrocardiograms were recorded. Heart rate was quantified continuously off-line. Heart rates of participantsnot directly engaged in imaginal reexposure to their personal combat traumas consistently exhibited mild linear declines from the beginnings to the ends of the approximately 2.5 hour sessions. Participants actively engaged in personal combat trauma reexposure exhibited higher whole-session heart rates. Most also exhibited more specific elevation extending over the later portions of therapy sessions during which intensive reexposure usually occurred. Surprisingly, no patients exhibitedfocal increases in heart rate concurrent with periods of most intensive traumatic incident review as judged from videotape. Administering imaginal reexposure in a group context does not preclude substantial physiological (sympathetic) arousal, as is preconditional for extinction. Under conditions in which the actively engaged reexposure patient is reliably identified, group trauma reexposure therapy may not provide an opportunity for “vicarious” flooding in nonengaged participants.     

Psychodynamic group treatment of posttraumatic stress disorder in Vietnam veterans.

Exposure to combat frequently imparts a sense of aloneness, guilt, and helplessness. These and other intrapsychic and interpersonal issues need to be addressed in treating Vietnam veterans suffering from posttraumatic stress disorder (PTSD). Group therapy is proposed as a core treatment modality for dealing with these problems. A model is proposed in which patients are treated for 1 year or more in weekly groups that meet for 16-week sequential segments. Clinical guidelines are made explicit to new members by the co-therapists. Discussion topics deal not only with traumatic experiences related to combat, but also with important pre- and postwar issues that are relevant to the symptoms of PTSD. Timely integration and working through of these issues in the group is critical.     

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.     

Post-traumatic accelerated cohesion: Its recognition and management in group treatment of Vietnam veterans

Post-traumatic accelerated cohesion (p-TAC) is the name given to a frequently observed group phenomenon in the treatment of Vietnam veterans who suffer traumatic war neuroses. It is critical that this group dynamic be discussed, especially since group is widely regarded as the modality of choice in treating these veterans. Post-traumatic accelerated cohesion is the rapid, premature development of cohesion in a group of virtual strangers, and is here presented in terms of its harmful impact on the group and the impasses it creates. Suggestions are given to resolve p-TAC and move the group toward fulfilling its goals. Placed within the self psychology and object relations theoretical frameworks, the discussion addresses issues pertaining to developmental arrests and post-traumatic self disorders and their relationship to p-TAC dynamics.The views in this paper are the author's sole responsibility and do not necessarily reflect those of the Veterans Administration.     

The evolution of a therapy group for vietnam veterans on a general psychiatry unit

The evolution of a therapy group for hospitalized Vietnam veterans with post-traumatic stress disorder (PTSD) and related symptomatology is described. The literature on group treatment for this population is briefly reviewed and discussed in relation to an inpatient psychiatry setting. The prevailing conditions at the time of group inception are recalled along with the initial goals of the therapeutic intervention. Problems encountered are also discussed, along with the changes made in response to these identified difficulties. The results of three and one-half years of experience with this group are described in detail.The authors would like to thank Cynthia Sturm, Ph.D. for her helpful editorial assistance.     

Dissociative disorders in Vietnam combat veterans

A group of Vietnam combat veterans were surveyed to determine the quantity and quality of their dissociative symptoms. The results suggest that the symptoms of post-traumatic stress disorder (PTSD) and dissociative disorders in this group of patients may be much more closely intertwined than we have heretofore considered. Those who suffer from PTSD have a continuum of severity of dissociative symptoms ranging from the frequent experience of a partially forgotten traumatic experience to the rare occurrence of a full blown case of multiple personality disorder (MPD). Most cases of MPD are related to trauma during childhood in environments fraught with extreme ambivalence and victimization, in association with abandonment and betrayal. However, the high frequency of dissociative symptoms and even occasional occurrences of MPD in Vietnam veterans suggests a similarity in the environmental factors associated with the Vietnam war.     

Prolonged Exposure Therapy for a Vietnam Veteran With PTSD and Early-Stage Dementia

Although prolonged exposure therapy (PE) is considered an evidence-based treatment for PTSD, there has been little published about the use of this treatment for older adults with comorbid early-stage dementia. As the number of older adults in the United States continues to grow, so will their unique mental health needs. The present article describes the successful coordination of care and application of PE in the assessment and treatment of a Vietnam veteran with comorbid PTSD and early-stage dementia. Measures related to the patient's cognitive and psychological functioning were obtained before, during, and after treatment. PE was associated with significant declines in PTSD and depression symptoms. Moreover, the patient's cognitive functioning was made clearer in the absence of severe psychiatric symptoms. Factors contributing to the patient's positive response are discussed.     

Anhedonia and emotional numbing in combat veterans with PTSD

We explored relationships between anhedonia and posttraumatic stress disorder (PTSD) symptom clusters, including their role in predicting psychiatric comorbidity. Our measure of anhedonia was derived from an examination of the latent structure of the Beck Depression Inventory. We found evidence for a two-factor solution, leading to anhedonia and undifferentiated, global depressive symptoms scales. In primary analyses, anhedonia had a unique positive relationship with PTSD's emotional numbing symptoms and minimal relationships with other PTSD symptoms. Upon examining the incremental validity of appetitive functioning (i.e., anhedonia, emotional numbing) over and above aversive functioning (i.e., re-experiencing, avoidance, and hyper-arousal PTSD symptoms) variables, greater emotional numbing increased the likelihood of being diagnosed with a major depressive disorder, and greater anhedonia increased the likelihood of being diagnosed with additional anxiety disorders and to a lesser extent, psychotic disorders. Results were consistent with research on the distinction of appetitive and aversive functioning, providing insight into the nature of PTSD.     

Process and content in an outpatient schizophrenic group

Process and content issues were evaluated during the first six months of an outpatient schizophrenic group. Compared with groups composed of neurotic and characterological patients, the schizophrenic group scored higher in the Avoiding dimension of the Group Climate Questionnaire (GCQ-S). There was more cohesion and less interpersonal conflict as time went on. Although topics related to engagement and differentiation were discussed, there was no obvious GCQ-S evidence of these first two stages of group development. However, the data supported the presence of stage 3 (individuation) during sessions 20–26. Interpersonal topics dominated the group discussions, followed by issues involving reality-testing, expression of emotions, and advice-giving.The authors wish to thank Dr. K. Roy MacKenzie for his helpful comments on a draft of this paper.     

Therapeutic and lifestyle reduction of aggressiveness in Vietnam veterans

Sixty-six Vietnam in-country veterans were surveyed to determine how three variables (rap group participation, self-management effectiveness, and support unit help) were related to aggressiveness measures on the Interpersonal Behavior Survey (IBS). The subjects were divided into three groups: veterans who were currently attending rap groups at local Vietnam Era Veterans Outreach Centers; veterans who had attended rap groups during the preceding year; and veterans who had never attended rap groups. Prerap group and postrap group levels of aggressiveness and self-management were assessed. The study produced three major findings: 1) Expression of Anger scores on the IBS were significantly lower for veterans who had participated in rap groups than for those who had not; 2) as aggressiveness decreased across subjects, self-management effectiveness increased; 3) level of support for the returning Vietnam veteran and self-reported aggressiveness were negatively correlated.     

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.     

Gratitude and hedonic and eudaimonic well-being in Vietnam war veterans

Little information exists on the contribution of psychological strengths to well-being in persons with post-traumatic stress disorder (PTSD). Data from other populations suggest that gratitude, defined as the positive experience of thankfulness for being the recipient of personal benefits, may have salutary effects on everyday functioning. We investigated whether dispositional gratitude predicted daily hedonic and eudaimonic well-being in combat veterans with and without PTSD. We also examined associations between daily gratitude and daily well-being across time. Veterans with PTSD, compared to those without PTSD, exhibited significantly lower dispositional gratitude; no differences were found on daily gratitude. Dispositional gratitude predicted greater daily positive affect, percentage of pleasant days over the assessment period, daily intrinsically motivating activity, and daily self-esteem over and above effects attributable to PTSD severity and dispositional negative and positive affect in the PTSD group but not the non-PTSD group. Daily gratitude was uniquely associated with each dimension of daily well-being in both groups. Although preliminary, these results provide support for the further investigation of gratitude in trauma survivors.