Archive for March, 2009

Older Veterans with Post-traumatic Stress Disorder Helped by CBT

Friday, March 27th, 2009

NewStudy-Graphic-72x72_edited-3Medscape: According to a pilot study presented at the Anxiety Disorders Association of America 2009 Annual Conference, older veterans suffering from post-traumatic stress disorder (PTSD) and related symptoms of depression and anxiety – which can persist for decades – may benefit from prolonged exposure therapy (a form of cognitive behavioral therapy). Twelve sessions included “in vivo experience, in which patients are exposed to fears out in the world, and imaginary exposure.”

Measures of efficacy included a Clinician-Administered PTSD Scale (CAPS); after treatment, patients showed a significant reduction in mean CAPS score and 75% no longer met PTSD criteria. Patients showed clinical improvement in most PTSD symptoms along with individual symptoms of avoidance and hyperarousal. Additionally, Beck Depression Inventory (BDI) and other measures showed “clinically significant improvement in both depression and anxiety.” The study author noted that after the treatment, the men were able to “do things they hadn’t done in years.”

These findings are particularly promising because they call into question the “dogma” that older adults cannot tolerate or could be harmed by exposure therapy.

According to the study author, “There are lots of people with PTSD who fought in prior wars or who have the condition for other reasons, who have pushed it aside and coped pretty well throughout their lives. Then a spouse dies, they retire or become medically ill, and their PTSD is something they no longer can put aside, and they need help. We need to know how to treat these people.”

The author is planning a randomized clinical trial in 100 older adults with PTSD.

Study author: S. R. Thorp

Military recruits benefit from brief CBT intervention

Wednesday, March 4th, 2009

newstudy-graphic-66x60.jpgAccording to a study in Military Medicine, the stressors experienced during military recruit training often contribute to training failure and discharge because of psychological difficulties. A study of Australian Army soldiers evaluated a brief cognitive-behavioral therapy (CBT) intervention designed to modify causal attributions, coping strategies, and other factors.

The intervention included psychoeducation on cognitive restructuring wherein recruits were instructed to consider that their difficulties were caused by “controllable factors” such as lack of effort or poor strategy and not by “uncontrollable factors” such as lack of aptitude. Recruits were then encouraged to modify coping strategies to match a realistic interpretation of their training difficulties. Measures of attributional style, coping strategies, psychological adjustment, and satisfaction were used in this study.

The results were promising. One important finding was that compared with a control group, participants who received the CBT intervention reported a significant reduction in the use of self-blame, for example, which suggested that the intervention reduced attribution of difficulties to stable and global causes. Additionally, most of the recruits rated the program as useful or very useful (82%), personally relevant (86%), and relevant to recruit training (92%).

The authors concluded that overall reduction of stress is likely to enhance retention and that a CBT intervention could be routinely incorporated into recruit training.

Study authors: A. Cohn, K. Pakenham