Diagnosis and prevalence
Although most people recover from experiencing a traumatic event, some will go on to develop a mental health problem such as depression or PTSD. Research suggests that between approximately 5 and 20 per cent of veterans will experience PTSD at some point in their lives. For more information on Australian veteran prevalence rates see Ikin et al. (2004) (PDF) and O’Toole et al. (1996) (PDF) . PTSD involves four main types of difficulties:
- Intrusive or re-experiencing symptoms e.g., unwanted, recurring memories, vivid nightmares, and intense emotional or physical reactions when reminded of the trauma.
- Alterations in arousal and reactivity, eg sleeping and concentration difficulties, irritability, reckless behaviour and a strong startle response.
- Persistent avoidance of reminders of the trauma, such as activities, feelings and places associated with the event.
- Negative alterations in mood or cognitions. e.g., feeling detached from friends and family, losing interest in activities or distorted blame of self.
It is not uncommon for PTSD to present with another disorder particularly substance use disorder, depressive disorders and anxiety disorders. Please refer to the following page on treatment sequencing for comorbid presentations.
Trauma-focussed cognitive behavioural therapy (TF-CBT) and eye movement desensitisation and reprocessing (EMDR) are the most effective treatments for veterans with PTSD.
- Imaginal exposure: this involves confronting traumatic memories in a safe environment, until the memories no longer create high levels of distress.
- In vivo exposure: this involves graded exposure to places, activities and situations currently avoided or endured with significant distress.
- Arousal/Anxiety management: This helps to manage the physical hyperarousal consequences of PTSD with strategies such as breathing retraining and progressive muscle relaxation.
- Cognitive therapy: this assists in identifying and challenging unhelpful beliefs and assumptions associated with the trauma.
The key components of EMDR for the treatment of PTSD include:
- Imagery and stress reduction: these techniques assist the veteran to manage emotional distress.
- Bilateral stimulation (e.g., eye movements, taps or tones): This stimulation occurs while the veteran focusses on a trauma-related image, a negative belief and related emotions and body sensations. This component of EMDR is repeated until the distress reduces.
Further information on recommended treatments is available in the Mental Health Advice Book that was developed for clinicians who work with veterans. Need to know more about trauma-focussed interventions? Conducting Imaginal exposure in PTSD Clinicial Manual and DVD: a step-by-step training package available to purchase from Phoenix Australia: Centre for Posttraumatic Mental Health.
Newer antidepressants (i.e., SSRIs, SNRIs) may be beneficial for veterans who are unwilling or unable to engage in trauma-focussed therapy or when psychological treatment is unavailable.
New treatment approaches – Cognitive Processing Therapy (CPT) is a 12-session manualised therapy for PTSD that addresses posttraumatic themes, including safety, trust, power and control, self-esteem and intimacy. It involves a smaller imaginal exposure component than trauma-focussed behavioural therapy (TF-CBT). Instead, veterans write down their narrative of the traumatic event and its impact, and read the narrative aloud during therapy. CPT has been less thoroughly researched than TF-CBT but evidence to date is promising, particularly in veteran populations. Cognitive processing therapy (CPT) training:a 9-hour web-based learning course for CPT with particular focus on the treatment of military and combat-related PTSD. Further information is provided in a CPT manual: veteran/military (PDF) and the CPT for PTSD website.
Trauma Recovery Programs
The Department of Veterans’ Affairs funds Trauma Recovery Programs – PTSD in hospitals across Australia. These programs are required to meet DVA’s National accreditation Standards for Trauma Recovery Programs – PTSD (2015). These standards provide a framework for ensuring that hospitals provide high quality evidenced based treatment for veterans and former serving members of the ADF who have PTSD.
2015 National Accreditation Standards
The standards address the key components of quality service provision:
- Clinical governance
- Access and targeting
- Veterans' rights and responsibilities
- Clinical pathways
- Clinical data collection.
The standards can be found here:
2015 National Accreditation Standards Workbook
The workbook will assist providers to prepare their TRP programs for accreditation, The workbook will assist in determining if there is sufficient evidence to demonstrate that systems and processes meet the accreditation requirements.
For details of current programs and/or further information, please contact one of the hospital providers listed here.
Clinical treatment guidelines
- The Australian Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder include guidance on PTSD and ASD treatment for adults, adolescents and children. Full and summary guidelines are available.
- A Practitioner Guide to Treatment: is a handy desktop guide for practitioners working with children and adolescents.
- WHO Management of Mental Health Disorders: trauma and acute stress reactions.
Assessment and measures
- The posttraumatic checklist (PCL) PDF) is a standardised assessment tool for PTSD that can help you develop a treatment plan, and assess symptom severity or treatment progress.
Other measures of psychosocial functioning include:
- DASS21 (PDF) .
- Audit for alcohol use (PDF) .
- DAST (PDF) .
- WHOQoL-Bref for measurement of overall quality of life.
Recommended readings and online resources
- Prevalence of PTSD in the Australian population (PDF) .
- Phoenix Australia yearly literature reviews: Annual overviews of research developed by Phoenix Australia: Centre for Posttraumatic Mental Health on topics related to military mental health and traumatic stress such as PTSD prevalence, risk factors, and treatment advances.
- PILOTS database: database of over 30,000 trauma-related article citations maintained by the US National Center for PTSD.
- Journal of traumatic stress abstracts: provides access to citations and abstracts for all articles published in this journal on trauma-related mental health issues
- DVA Evidence Compass: Summarises recent research on emerging interventions for adults with PTSD.
- Recent research on PTSD diagnosis & treatment: This University of Melbourne podcast provides a summary of recent research regarding the diagnosis and treatment of PTSD over two podcasts.
Mobile device apps
- DVA PTSD Coach Australia: includes CBT strategies to assist self-management of PTSD symptoms, and available for Apple and Android products.
- CPT Coach is a US app designed for veterans to use with their therapist during face-to-face Cognitive Processing Therapy for PTSD.
- PE Coach is a US app designed for veterans to use with their therapist during face-to-face Prolonged Exposure Therapy for PTSD.
- PTSD 101 online courses: web-based learning on topics such as assessment, prolonged exposure and cognitive processing therapy.
- Conducting Imaginal Exposure Clinician Manual and DVD: A step-by-step training package available to purchase from Phoenix Australia: Centre for Posttraumatic Mental Health.
- Cognitive Processing Therapy (CPT) training: a 9-hour web-based learning course for CPT with particular focus on the treatment of military and combat-related PTSD.
The following are recently published papers of interest. They have not been reviewed or validated by the Department of Veteran's Affairs.
Barrera, T.L., Graham, D.P., et al (2013). "Influence of trauma history on panic and posttraumatic stress disorder in returning veterans", Psychological Services 10(2): pp 168-176.
This study examines the role of predeployment sexual and physical abuse, combat exposure and postdeployment support in predictuing panic disorder and PTSD diagnoses. The findings indicate a high prevalence of panic disorder among returning veterans and highlight the importance for clinicians to assess returning veterans for panic disorder as well as PTSD.
- Home-based exposure monitoring sheet (PDF)
- Subjective units of distress scale (PDF)
- Progressive muscle relaxation (PDF)
- Breathing retraining instructions (PDF)
- CRUfAD PTSD patient treatment manual / PTSD manual (PDF)