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Study: Group therapy helps with combat stress

Three new studies looking at combat stress have found group exposure therapy seems to work, that troops with traumatic brain injuries are more likely to have post-traumatic stress disorder, and that stress debriefings held after traumatic events don’t appear to prevent PTSD.

The research comes as the Department of Veterans Affairs works to find the best treatment methods for combat veterans. It follows a report by Rand Corp. that showed only one treatment method — exposure therapy — has been proven to help PTSD in studies by objective researchers.

The first study looked at a program that had been in place for four years at the Atlanta VA Medical Center. The center’s Posttraumatic Stress Disorder Clinical Team began researching group-based exposure treatment.

Past studies have shown group therapy to be ineffective on veterans with PTSD, but authors of this study, published in the April issue of the Journal of Traumatic Stress, said the amount of exposure therapy — 60 hours — in this group may be the key to why it works.

First, nine to 11 people get to know each other and talk about their experiences before they joined the military. Then, they spend several weeks talking about their wartime experiences.

Each person gives a 2½-hour presentation to the group about what they witnessed, and then they privately listen to recordings of their own presentation 10 times. Each then gives a second presentation about their traumatic wartime experiences, which they also listen to 10 times. Toward the end of 18 weeks, they work on feelings of grief and guilt.

A total of 93 Vietnam veterans, four Gulf War veterans, one Korean War veteran and two Iraq war veterans took part in the study, with 81 percent showing “clinically significant improvement,” which was still at 81 percent six months later.

And the study found something else: VA clinicians indicated to researchers that they do not use exposure therapy out of concern for possible increases in suicide ideation, hospitalizations and dropout rates, but “we found the opposite to be true,” the study’s authors said.

Many patients said hearing others’ traumatic experiences evoked painful recall of what had happened to them, but “none reported any negative lasting effects, and many indicated that this process helped them put their own experience into better perspective,” the study said.

For example, one-third of the group members said they had frozen under fire.

“Learning how common this was helped reduce the shame and guilt that many patients had felt for decades,” researchers said.

However, the therapy did not eliminate symptoms. Still, while group-based exposure treatment is “far from a cure,” it “may represent a step forward in the treatment of chronic war-related PTSD in the VA system,” the study said.

A second study, published in the June 15 issue of the American Journal of Epidemiology, looked at rates of PTSD in veterans with mild traumatic brain injuries or concussions. Lead author Aaron Schneiderman of the War-Related Illness and Injury Study Center at the Washington, D.C., VA Medical Center, found that people with multiple injuries and mild brain injuries had higher rates of PTSD.

This is the second study on this topic in recent months because both PTSD and TBI cause sleep problems and irritability. Post-concussive syndrome symptoms — or brain injury symptoms that continue after several months — include headaches, dizziness, short-term memory loss, balance problems and ringing in the ears.

Researchers sent a survey to people in all services, both active-duty and reserve, and found that of 275 people who suffered TBI in Iraq or Afghanistan, 35 percent had post-concussive syndrome symptoms as well as higher rates of PTSD, even when symptoms similar to both disorders were ruled out.

This is different from the first study of this issue, conducted by Charles Hoge, chief of psychiatry and behavior services at the Walter Reed Army Institute of Research in Washington, D.C. Hoge said there was no increased risk of post-concussive symptoms, except for headaches, in people who had lost consciousness in theater, but instead reported higher rates of PTSD without the TBI symptoms. This suggested that soldiers suffered from PTSD and not post-concussive symptoms.

The new study’s authors say their anonymous research of people who had left service, and thus did not fear repercussions on their careers if they talked about mental health symptoms, may have caused the difference in results. Also, only 44 percent of people who screened positive for PTSD in the study had previously been diagnosed with it, they said.

A third study, published in the June issue of the Journal of Traumatic Stress, looked at whether critical incident stress debriefings decreased symptoms of PTSD.

The debriefings, being used in Iraq and Afghanistan, let people who have just gone through a traumatic event talk about it in a group, with moderation by a trained mental health worker or chaplain.

The study looked at soldiers in Bosnia in 2002.

“Our results are consistent with prior [studies] of debriefing in that there were no clear positive effects associated with [debriefings] relative to no intervention,” the report states. “However, there were no strong negative effects, either.”

They recommended a study of service members in Iraq.