Symptom Overreporting in Combat Veterans Evaluated for PTSD: Differentiation on the Basis of Compensation Seeking Status

We examined the role of compensation-seeking status on response patterns to self-report inventories of acute psychopathology and psychological distress in a group of 165 combat veterans evaluated for posttraumatic stress disorder (PTSD) at a Department of Veteran Affairs (VA) Medical Center. Veterans completed the Minnesota Multiphasic Personality Inventory-Revised, Beck Depression Inventory, Mississippi Scale for Combat-Related PTSD, a fixed-response format version of the Dissociative Experiences Scale, and Impact of Events Scale as pan of a standard assessment battery. Results showed that compensation-seeking veterans endorsed dramatically higher levels of psychopathology across measures and produced sharply elevated fake-bad validity indices as compared to non-compensation-seeking veterans. Differences between the two groups on most scales and indices exceeded effect sizes of 1.0, even when effects of income, global assessment of functioning, and clinician-rated severity of PTSD were controlled for. It is suggested that the availability of VA disability compensation for combat-related PTSD impedes accurate initial assessment of veterans presenting for treatment and may impair estimation of long-term therapeutic outcome in this population.     

An Innovative Approach to Treating Combat Veterans with PTSD at Risk for Suicide

Suicide rates among military personnel had a significant drop in 2013, but there is no evidence of a drop among veterans. The problem of suicide among combat veterans with posttraumatic stress disorder (PTSD) remains a source of concern. The Department of Defense and the Department of Veterans Affairs are now calling for innovative treatment approaches to the problem. A short‐term psychodynamic therapy presented here may be able to fill that need by dissipating the guilt from veterans' combat‐related actions that leads to suicidal behavior. The treatment showed promise of success with veterans of the war in Vietnam. Preliminary work with combat veterans of the wars in Iraq and Afghanistan indicates that it may be equally successful in treating them. Basic aspects of the psychodynamic approach could be incorporated into current therapies and should improve their ability to treat veterans with PTSD at risk for suicide.     

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.     

A Clinician's Guide to PTSD Treatments for Returning Veterans

What options are available to mental health providers helping clients with posttraumatic stress disorder (PTSD)? In this paper we review many of the current pharmacological and psychological interventions available to help prevent and treat PTSD with an emphasis on combat-related traumas and Veteran populations. There is strong evidence supporting the use of several therapies including prolonged exposure (PE), eye movement desensitization and reprocessing (EMDR), and cognitive processing therapies (CPT), with PE possessing the most empirical evidence in favor of its efficacy. There have been relatively fewer studies of non-exposure based modalities (e.g., psychodynamic, interpersonal, and dialectical behavior therapy perspectives), but there is no evidence that these treatments are less effective. Pharmacotherapy is promising (especially paroxetine, sertraline, and venlafaxine), but more research comparing the relative merits of medication vs. psychotherapy and the efficacy of combined treatments is needed. Given the recent influx of combat-related traumas due to ongoing conflicts in Iraq and Afghanistan, there is clearly an urgent need to conduct more randomized clinical trials research and effectiveness studies in military and Department of Veterans Affairs PTSD samples. Finally, we provide references to a number of PTSD treatment manuals and propose several recommendations to help guide clinicians' treatment selections.     

Psychological Functioning of Partners of Australian Combat Veterans: Contribution of Veterans' PTSD Symptoms and Partners' Caregiving Distress

Previous research has found posttraumatic stress disorder (PTSD) symptoms in combat veterans to be associated with impaired psychological functioning in their partners. However, little is known about possible mediators of this association. The present study investigated the mediational properties of six dimensions of the revised Partners of Veterans' Distress Scale (MacDonell, Marsh, Hine, & Bhullar, 2010). Participants were 181 female partners of Australian combat veterans, age ranging from 43 and 83 years (M = 60.47, SD = 4.96), who completed measures assessing their caregiving distress levels, dyadic adjustment, mental health, and satisfaction with life. The combat veterans also completed a scale measuring their PTSD symptoms. Our results indicated that higher scores of veterans' PTSD were associated with lower levels of dyadic adjustment, mental health, and satisfaction with life in their partners. Partners reported that distress related to exhaustion and intimacy problems significantly mediated the relationship between veterans' PTSD symptoms and their partners' satisfaction with life, whereas partners' distress associated with intimacy problems was the sole significant mediator for their dyadic adjustment, and exhaustion was the only significant mediator for partners' mental health. Implications for programmes designed to address the significant needs of the partners of combat veterans are discussed.     

Posttraumatic Growth in Combat Veterans

Combat veterans and their families face significant challenges not only to their abilities to cope, but often to their fundamental belief systems. Traumatic events represent assaults on core beliefs, yet at times, produce cognitive processing that can ultimately result in personal transformations called posttraumatic growth (PTG). Clinicians can utilize a systematic therapeutic approach to facilitate PTG as they carry out a relationship of expert companionship. PTG in service members is described in this article, as well as the approach to facilitation of PTG.     

Juror Preference for Curative Alternative Verdicts for Veterans With PTSD

Two studies examined mock juror verdicts for veterans with PTSD in the criminal justice system. Mock jurors demonstrated a leniency toward treatment bias for veterans with PTSD who committed a violent crime, compared to a nonviolent crime. This leniency toward treatment bias occurred only when alternative verdict options, beyond guilty or not guilty, were available. In fact, a guilt bias was demonstrated by mock jurors when the only verdict options were guilty or not guilty, and a bias toward treatment was demonstrated when curative alternative verdicts were available. Implications for efforts to address the growing national problem of veterans with PTSD in the criminal justice system are discussed.     

A Review of Research on Moral Injury in Combat Veterans

The moral injury construct has been proposed to describe the suffering some veterans experience when they engage in acts during combat that violate their beliefs about their own goodness or the goodness of the world. These experiences are labeled transgressive acts to identify them as potentially traumatic experiences distinct from the fear-based traumas associated with posttraumatic stress disorder. The goal of this article was to review empirical and clinical data relevant to transgressive acts and moral injury, to identify gaps in the literature, and to encourage future research and interventions. We reviewed literature on 3 broad arms of the moral injury model proposed by Litz and colleagues (2009) Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., &; Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29, 695–706. 10.1016/j.cpr.2009.07.003[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]: (a) the definition, prevalence, and potential correlates of transgressive acts (e.g., military training and leadership, combat exposure, and personality), (b) the relations between transgressive acts and the moral injury syndrome (e.g., self-handicapping, self-injury, demoralization), and (c) some of the proposed mechanisms of moral injury genesis (e.g., shame, guilt, social withdrawal, and self-condemnation). We conclude with recommendations for future research for veterans suffering with moral injury.     

Spiritual Interventions in Veterans with PTSD: A Systematic Review

Journal of Religion and Health - This article reports the results of a systematic review on the effectiveness of religious/spiritually (R/S)-based interventions in veterans with post-traumatic...     

Comparison Of Narratives Of Loss Experiences Of World War Ii and Vietnam Combat Veterans

Abstract

While their continuing grief now is receiving periodic media attention, for years and even decades, American soldiers who fought in World War II (WWII) and who fought in Vietnam have suffered their life-altering experiences of loss in silence. Many of the WWII generation now have died and cannot share their grief with us. We as scholars of loss and trauma have a special obligation to reach out to the living survivors of WWII for information about their experiences. As has been often noted (e.g., Kuenning, 1990), for years after the conclusion of the Vietnam War, the stories of loss and grief of Vietnam veterans were not welcomed. The purpose of this chapter is to report some comparative narrative evidence from veterans of these two wars. Our major question was whether strong differences between groups in perceived long-term impact of combat experience would be reported.     

Trauma Informed Guilt Reduction Therapy With Combat Veterans

Guilt related to combat trauma is highly prevalent among veterans returning from Iraq and Afghanistan. Trauma-related guilt has been associated with increased risk for posttraumatic psychopathology and poorer response to treatment. Trauma Informed Guilt Reduction (TrIGR) therapy is a 4-module cognitive-behavioral psychotherapy designed to reduce guilt related to combat trauma. The goals of this study were to describe the key elements of TrIGR and report results of a pilot study with 10 recently deployed combat veterans.Ten combat veterans referred from a VA Posttraumatic Stress Disorder (PTSD) or mental health clinic completed TrIGR over 4 to 7 sessions. Nine veterans completed the posttreatment assessment.This initial pilot suggests that TrIGR may help to reduce trauma-related guilt severity and associated distress. Changes in trauma-related guilt were highly correlated with reductions in PTSD and depression symptoms over the course of treatment, suggesting a possible mechanistic link with severity of posttraumatic psychopathology.TrIGR warrants further evaluation as an intervention for reducing guilt related to traumatic experiences in combat.     

Comprehensive System Rorschach Data on Vietnam Combat Veterans

To better understand and, therefore, treat Vietnam combat veterans with a diagnosis of posttraumatic stress disorder (PTSD), the Rorschach was administered to 50 patients so diagnosed. The most important findings were that, on average: (a) These patients have a low level of stress tolerance and are, therefore, likely to respond impulsively to stressful situations; (b) this tow stress tolerance appears to be a long-term adjustment problem; and (c) their perception of reality is unconventional and often distorted. A primary therapeutic indication from these data is that the use of structure would be important for successful therapy. Other findings and therapeutic recommendations are also discussed.     

Assessment and Treatment of Combat-Related PTSD in Returning War Veterans

Over the past 9 years approximately 2 million U.S. military personnel have deployed in support of Operation Iraqi Freedom in Iraq and Operation Enduring Freedom in and around Afghanistan. It has been estimated that 5–17% of service members returning from these deployments are at significant risk for combat-related posttraumatic stress disorder (PTSD). Many of these returning war veterans will seek medical and mental health care in academic health centers. This paper reviews the unique stressors that are related to the development of combat-related PTSD. It also reviews evidence-based approaches to the assessment and treatment of PTSD, research needed to evaluate treatments for combat-related PTSD, and opportunities and challenges for clinical psychologists working in academic health centers.     

Healing from Moral Injury: A Qualitative Evaluation of the Impact of Killing Treatment for Combat Veterans

This paper evaluates the Impact of Killing (IOK) treatment—a psychological intervention designed to address moral injury and trauma associated with killing in war. Using qualitative data from interviews with 28 combat veterans, we examine IOK’s impact, how it differs from other trauma-focused treatments, and how it can be improved to better meet veterans’ needs. We found that many veterans processed their killing experiences for the first time in IOK, even though all had previously completed evidence-based treatments for posttraumatic stress disorder. Several described killing in war as the most distressing and transformative trauma of their lives, and all affirmed the value of an intervention focused directly and explicitly on moral injury and killing. IOK helped veterans to acknowledge their grief, shame, and distress; gently but critically examine their thoughts and beliefs about killing in war; and make strides toward acceptance, reconciliation, and forgiveness.     

PTSD Symptom Severity and Family Adjustment Among Female Vietnam Veterans

This study examined relations between posttraumatic stress disorder (PTSD) symptom severity and several family adjustment variables among a sample of 89 female Vietnam veterans and their male relationship partners. Findings revealed associations between PTSD symptom severity and measures of marital adjustment, family adaptability, family cohesion, parenting satisfaction, and psychological abuse. Results suggest that the presence of PTSD symptomatology may have important implications with regard to the family life of female Vietnam veterans.     

Transparent Assessment: Discovering Authentic Meanings Made by Combat Veterans

To inform treatment innovation and assessment toward relevance to combat veterans, this mixed-methods intuitive inquiry applied art-based methods to thematic analysis with an emphasis on making the civilian researcher's interpretation transparent. The study explored changes in moral injury and complicated grief that corresponded with statistically significant improvement in posttraumatic stress disorder (PTSD). Eight male combat veterans voluntarily participated in a continuous five-day residential arts-based intervention (The Warrior's Journey). Each participant created 11 pieces of art and told a culminating story. Pre/post Posttraumatic Stress Checklist (PCL-M) Likert scales corresponded closely with narrative themes indicative of the identity domain of meaning reconstruction and posttraumatic growth. It was shown that meaning making and researcher bias can be assessed using art-based research methods. The results offer direction for increasing the relevance of treatment and assessment to address the issues of combat veterans.     

The Effectiveness of Emotionally Focused Couples Therapy With Veterans With PTSD: A Pilot Study

The current study is a pilot project conducted at Baltimore VA Medical Center investigating the use of emotionally focused couples therapy (EFT) for couples in which one partner is a veteran who has been diagnosed with posttraumatic stress disorder (PTSD). Fifteen couples enrolled in the study and seven of these couples completed treatment (26 to 36 weekly sessions of EFT). Both partners were assessed on measures of relationship satisfaction, psychological distress, depression, and quality of life, and veterans were assessed on measures of PTSD symptoms at baseline and 2 weeks after the intervention. Paired t-tests were used to compare scores before and after EFT. In terms of results, the veterans' partners reported significant improvements in relationship and life satisfaction and in decreased depression and a decrease in psychological distress. Veterans demonstrated a significant decrease in self-reported symptoms of PTSD. These results provide preliminary evidence for the usefulness of EFT to help foster improved relationship satisfaction, and psychological well-being for veterans with PTSD and their partners who completed treatment.     

Killing Versus Witnessing Trauma: Implications for the Development of PTSD in Combat Medics

Killing in combat uniquely predicts elevated PTSD symptomatology among military veterans. This study investigated the effects of combat killing in a sample of 345 U.S. Army combat medics who had recently returned from operational deployments to Iraq or Afghanistan. Combat medics provide frontline medical care before, during, and after battles but also fight alongside other soldiers when under attack. Attempting to kill in combat was a significant predictor of PTSD symptomatology even after accounting for passively witnessing trauma in fellow soldiers. Medics may be well prepared to cope with the passive experiencing and witnessing of war-zone trauma, but may benefit from training to cope with the negative consequences of taking actions to kill.