Assessment and treatment of PTSD in ex-serving members of the ADF

Clinical tools

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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 treatment sequencing for comorbid presentations.

Treatment

Trauma-focussed cognitive behavioural therapy (TF-CBT) and eye movement desensitisation and reprocessing (EMDR) are the most effective treatments for veterans with PTSD.

Cognitive behavioural therapy for PTSD

The key components of CBT for the treatment of PTSD include:

  • imaginal exposure - confronting traumatic memories in a safe environment, until the memories no longer create high levels of distress
  • in vivo exposure - graded exposure to places, activities and situations currently avoided or endured with significant distress
  • arousal/anxiety management - manages the physical hyperarousal consequences of PTSD with strategies such as breathing retraining and progressive muscle relaxation
  • cognitive therapy - identifies and challenges unhelpful beliefs and assumptions associated with the trauma

Eye movement desensitisation and reprocessing for PTSD

The key components of eye movement desensitisation and reprocessing (EMDR) for the treatment of PTSD include:

  • imagery and stress reduction - helps the veteran to manage emotional distress
  • bilateral stimulation (such as eye movements, taps or tones) - 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. Conducting Imaginal exposure in PTSD Clinical Manual and DVD: a step-by-step training package available to purchase from Phoenix Australia: Centre for Posttraumatic Mental Health.

Newer antidepressants (such as 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.

PTSD group programs (trauma recovery)

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.

Details of current programs can be found if you contact a hospital provider.

Clinical treatment guidelines

Assessment and measures

Recommended readings and online resources

Publications

Podcast

Apps for mobile devices

  • DVA PTSD Coach Australia - includes CBT strategies to assist self-management of PTSD symptoms, and available for Apple and Android products
  • CPT Coach - a US app designed for veterans to use with their therapist during face-to-face Cognitive Processing Therapy for PTSD
  • PE Coach - a US app designed for veterans to use with their therapist during face-to-face Prolonged Exposure Therapy for PTSD
  • PTSD Family Coach - a US designed app that provides support and information for concerned family members of those with PTSD

Training