The integrative management of PTSD: A review of conventional and CAM approaches used to prevent and treat PTSD with emphasis on military personnel
Introduction
Post-traumatic stress disorder may be the most urgent problem the U.S. military is facing today. The personal, social and economic burden of human suffering, treatment costs, disability compensation, and productivity losses related to PTSD are major issues facing American society and, to a lesser extent, other countries that have supported the U.S.-led conflicts in Iraq and Afghanistan.
After decades of research there is still no consensus on the causes, nature or treatment of the psychological and psycho-somatic consequences of trauma [1], [2]. Different understandings of human trauma have led to different conceptual models and disparate treatment approaches. Conventional pharmacological and psychological approaches widely used to treat PTSD are based on the assumption that traumatic exposure results in chronic dysregulation in neurophysiology and maladaptive coping with stressful situations. Many therapies endorsed by mainstream psychiatry reduce the severity of some PTSD symptoms however most conventional approaches have limited efficacy. In a review of 55 studies on empirically supported treatments of PTSD high drop-out rates or non-response rates (up to 50%) were common [3]. The limitations of current mainstream approaches invite open-minded consideration of the range of promising alternative and integrative approaches aimed at preventing PTSD following exposure to trauma and treating chronic PTSD.
Section snippets
Challenges and barriers to adequate assessment, prevention and treatment of PTSD
Adequately assessing and treating the complex symptoms of PTSD calls for comprehensive screening and multi-modal collaborative treatment. In general, mental health problems among the military are probably under-reported because of concerns over confidentiality and feelings of shame, anger and guilt [4]. Conversely, some veterans may falsify or exaggerate claims of mental illness—including PTSD—when seeking disability compensation. These challenges become even greater with respect to programmes
Prevention of PTSD following trauma
Gartlehner et al. [8] compared the effectiveness and adverse effects of psychological and pharmacological interventions aimed at preventing PTSD in adults. Thirteen studies on efficacy included diverse populations including victims of sexual assault, accidents, terrorist attacks and others. Significant findings included no evidence for debriefing in preventing PTSD, some evidence for a collaborative care (CC) model combining pharmacological management and CBT, no evidence for comparative
CAM perceptions and use trends in civilian and military personnel diagnosed with PTSD
Rates of CAM use among veterans and the civilian population are comparable and range between 23% and 50% depending on the type of CAM and the population surveyed [13]. A cohort analysis of 599 individuals who had been diagnosed with PTSD and reported active symptoms of PTSD within the past year found that 39% reported using a CAM treatment to address emotional and mental problems within the same one-year period however only 13% saw a CAM practitioner for treatment [14]. Types of CAM most widely
Meditation
Research studies have evaluated mindfulness training, mantra reciting and compassionate meditation (Vipassana) for their potential beneficial effects in PTSD. A review of meditation practices addressed at preventing PTSD found more evidence supporting mindfulness meditation than mantra reciting or compassionate meditation [17]. The majority of studies on mindfulness have been done on individuals diagnosed with generalised anxiety—not PTSD—therefore outcomes may not generalise to PTSD.
Towards an integrative model for preventing and treating PTSD
Numerous conventional and CAM therapies addressing PTSD are currently used or are at various stages of investigation. Exh 1 summarises evidence for conventional and CAM therapies aimed at preventing or treating PTSD including comments on limitations of findings and safety.
Exhibit 2 is provided as a concise guide to interventions addressing the three target populations of interest:
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Groups who are at high risk of exposure to trauma because of the nature of their work including active duty
Recommendations on policy and research
Challenges interfering with access to care and quality of care within the VA and DOD healthcare systems include inadequate funding, delays in funding allocation to new programme development efforts, difficulties recruiting qualified mental health professionals, and slow progress around implementation of specialised PTSD programme and clinics. Such system-level problems directly impact on the timely implementation of adequate, appropriate, cost-effective evidence-based services and resources
Conflicts of interest
The author has no financial conflicts of interest to declare.
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