Process and content in a long-term PTSD therapy group for Vietnam veterans

Process and content were studied in four 16-session segments of a psychodynamically oriented therapy group for Vietnam veterans suffering from posttraumatic stress disorder (PTSD). On the Group Climate Questionnaire (GCQ-S), the group scored significantly higher in the Engaged dimension and significantly lower in the Avoiding and Conflict dimensions than contrasting samples of neurotic and psychotic groups. There was no evidence of group stages. Topics related to symptoms of PTSD were discussed most frequently (43.1%), followed by issues concerning relations with others (32.4%),general group therapy issues (13.7%), and other topics (10.8%). Clinical implications of these findings are discussed.The authors thank Tom Metzler, M.A., and Heidi Ronfeldt, B.S., for their assistance with the data analysis.Parts of this paper were presented at the American Group Psychotherapy Association Annual Meeting, February 15–20, 1993, San Diego, CA.     

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.     

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.     

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.     

Cognitive-behavior therapy vs exposure therapy in the treatment of PTSD in refugees

The present study investigated the efficacy of cognitive-behavior therapy (CBT) and exposure therapy (E) in the treatment of post-traumatic stress disorder (PTSD) in refugees. Sixteen outpatients fulfilling the DSM-IV criteria for PTSD were randomized to one of the two treatments. Assessor and self-report measures of PTSD-symptoms, generalized anxiety, depression, quality of life and cognitive schemas were administered before and after treatment, and at a 6-month follow-up. The patients were treated individually for 16-20 weekly sessions. The results showed that both treatments resulted in large improvements on all the measures, which were maintained at the follow-up. There was no difference between E and CBT on any measure. E and CBT led to a 48 and 53% reduction on PTSD-symptoms, respectively, a 49 and 50% reduction on generalized anxiety, and a 54 and 57% reduction on depression. The results were maintained at the 6-month follow-up. The conclusion that can be drawn is that both E and CBT can be effective treatments for PTSD in refugees.     

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.     

Exposure therapy for PTSD delivered to veterans via telehealth: predictors of treatment completion and outcome and comparison to treatment delivered in person

Recent research has focused on the effectiveness of evidence-based psychotherapy delivered via telehealth services. Unfortunately to date, the majority of studies employ very small samples and limited predictor and moderator variables. To address these concerns and further replicate and extend the literature on telehealth, the present study investigated the effectiveness of 12-session exposure therapy delivered either via telehealth (n = 62) or in person (n = 27) in veterans with posttraumatic stress disorder (PTSD). Findings demonstrated that although older veterans and Vietnam veterans were more likely to complete the telehealth treatment, telehealth findings were not influenced by patient age, sex, race, combat theater, or disability status. Exposure therapy delivered via telehealth was effective in reducing the symptoms of PTSD, anxiety, depression, stress, and general impairment with large effect sizes. Interestingly, exposure therapy via telehealth was less effective than exposure therapy delivered in person; however, lack of random assignment to condition limits conclusions of differential effectiveness. Overall, these findings support the utility of telehealth services to provide effective, evidence-based psychotherapies.     

Long-term improvement in coping skills following multimodal treatment in war veterans with chronic PTSD

Due to the long-lasting and resistant symptoms characteristic of chronic combat posttraumatic stress disorder (PTSD), its treatment is complex and often requires a tailored therapeutic approach incorporating both psychotherapy and pharmacotherapy. A multimodal approach of psychoeducative, sociotherapeutic, and dynamically oriented trauma-focused groups is described. We assessed the short- and long-term effectiveness of this therapeutic program by monitoring its impact on PTSD symptoms, depression, neurotic symptoms, coping skills, and quality of life for three years. The findings revealed short-term reduction in the symptoms of PTSD and depression, while the long-term results were manifested as the increased use of all coping mechanisms and a greater level of obsession.     

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.     

The utility of the Anxiety Disorders Interview Schedule (ADIS) in the diagnosis of post-traumatic stress disorder (PTSD) in Vietnam veterans

The ability of a novice interviewer utilizing the ADIS to make diagnoses of PTSD in Vietnam veterans with combat experience was tested in a sample of 43 cases. Agreement between ADIS diagnosis and a criterion diagnosis was found in 93.0% of cases (κ = 0.857), suggesting that the diagnostic category can be reliably identified and demonstrating the utility of the ADIS for ascertaining this diagnosis.     

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.     

Interpersonal styles of Vietnam Era veterans.

The study aims were to identify the interpersonal style characteristics of Vietnam Era veterans by comparison with World War II veterans. The sample included 3,075 veterans in treatment in 47 VA health care facilities. Patients were categorized as medical-surgical, psychiatric, and drug addicted, and divided by age into the 24 or less, and the 45 to 55 age groups. The measuring device was the Interpersonal Style Inventory. Group differences on the 17 scores were tested by discriminant function analyses. The Vietnam Era veterans were found to be more rebellious, mistrustful, adventure-seeking and expedient than the older veterans.     

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 reparation of the self: Clinical and theoretical dimensions in the treatment of Vietnam combat veterans

This paper discusses a broad range of theoretical and clinical issues pertaining to a proposed approach to individual psychotherapy with Vietnam combat veterans. Called theself-reparative process, this approach features four phases, ranging in the first from anactive behavioral-cognitive approach to the fourth phase that utilizes a less active, psychoanalytic approach. This range of approaches is essential in order to adapt to the ongoing progressivespectrum-of-needs of the veterans, with the objective of increasing psychological control to resolving narcissistic rage and building a cohesive self.The views contained in this paper represent those of the author, who is solely responsible for its contents. As such, the views herein are not necessarily those of the Veterans Administration. Paper presented at a Queens Hospital Center (affiliation of Long Island Jewish-Hillside Medical Center) Department of Psychiatry, Grand Rounds in Jamaica, New York on April 10, 1981. The author acknowledges the gracious assistance of Doctors Scott Mykel and Robert Mednick of Queens Hospital Center during the first 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.     

Trance and confusion in Gestalt therapy

This article introduces hypnotic principles of confusion and trance as fundamental operations in Gestalt therapy. A process is identified which utilizes perceptual shifts of reference as a method of organizing Gestalt techniques. The sequence of operations constituting the confusion process is outlined and developed in a psychotherapy session through the use of implication, dissociation, and embodiment. The development of this organization of Gestalt therapy is intended to enhance the strategic capacities of therapists.