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Posttraumatic mental health in veteran and military populations
Cognitive processing therapy trial (CPT trial)
In July 2007, ACPMH began a trial of cognitive processing therapy provided for veterans in the community by counsellors by VVCS - Veterans and Veterans Families Counselling Service.
Since its development in the USA 14 years ago, CPT’s effectiveness has been demonstrated through a number of randomised controlled trials (RCTS) but it has never been tested in a naturalistic setting. This is a real world trial, with practitioners from an existing community clinical service (VVCS), treating clients with PTSD who, of their own volition, seek help at the service. The trial involves 18 participating therapists, with nine delivering CPT and nine delivering treatment as usual. A two-day CPT training workshop and weekly expert CPT consultation are provided for the nine therapists providing the CPT treatment. Sixty veterans will be involved, with half receiving 12 weekly CPT sessions and half receiving treatment as usual. DVA is funding the trial and it is expected to be complete at the end of 2009.
For more information about this trial, see our newsletter article Alternative to exposure therapy: a real world trial (PDF)
Monitoring outcomes of DVA-funded PTSD programs to support quality assurance initiatives
Over the past 11 years, ACPMH has built up one of the largest PTSD treatment outcome databases in the world, with data for approximately 4670 veterans.
Since 1995 ACPMH has monitored clinical outcomes of participants from ACPMH-accredited Department of Veterans’ Affairs (DVA)-funded PTSD programs. ACPMH monitors clinical outcomes for veterans participating in the programs by collecting data from veterans and clinicians at key points during program delivery.
These data are used to provide feedback to DVA, as well as to the service providers, as part of our on-going PTSD program accreditation process and help to ensure that the programs evolve to meet the changing needs of veterans and their families.
Over the past 11 years, ACPMH has built up one of the largest PTSD treatment outcome databases in the world, with data for approximately 4670 veterans. Analysis of the PTSD data generally shows significant improvements in core PTSD symptoms, as well as in most other areas of psychological and social functioning, following participation in an accredited PTSD program. While this has been an important component of ACPMH’s work since 1996, the number of PTSD programs and participants has been decreasing since 2001.
This treatment outcome monitoring data contributes significantly to our quality assurance and program accreditation which we have conducted for DVA since the PTSD programs began. This accreditation process has recently been revised, meaning that quality assurance can be progressively introduced to a much broader range of mental health treatment settings for veterans.
Posttraumatic mental health in veteran and military populations: other research projects
ACPMH undertakes a range of research exploring posttraumatic mental health with veteran and military populations, including studies on conceptual and methodological issues. The results of this research may have broader applicability to posttraumatic mental health in other populations. For example, knowing more about how people experience nightmares following traumatic exposure may help to better understand the mechanisms underlying the condition and to develop more effective interventions.
The phenomenology of nightmares following traumatic exposure.
Repetitive and distressing trauma-related dreams are a core symptom of PTSD, but their phenomenology has been the subject of surprisingly little research. At the most basic level, there is no apparent consensus on the parameters of the symptom: that is, how distressing and how trauma-related do the dreams need to be to meet DSM-IV criterion for a PTSD nightmare? There is also poor understanding about the question of the relationship between the recurrent distressing dreams of PTSD and the common experience of trauma-related dreams following exposure in people who do not develop PTSD. Are they a categorically distinct phenomenon or do they differ only qualitatively? To date PTSD and non-PTSD trauma-related dreams have been studied independently within the fields of PTSD and dreaming respectively. With different foci of enquiry and research methodologies, little is known about the relationship between them. This research seeks to further an understanding of the phenomenology of nightmares in PTSD and the relationship between these and non-PTSD trauma-related dreams. Explanatory models for the range of observed posttraumatic nightmare phenomenology will be pursued as the study progresses. This study is being conducted by Andrea Phelps (PhD Candidate, ACPMH, University of Melbourne). A review of the existing research and clinical literature from the PTSD and dreaming fields has been published (Phelps et al., 2008).
Phelps, A.J., Forbes, D. & Creamer, M. (2008) Understanding posttraumatic nightmares: An empirical and conceptual review. Clinical Psychology Review 28(2): 338-355.
The augmentation of dementia symptomatology following a diagnosis of PTSD in World War II veterans: implications for treatment.
This study, being conducted by Jonathan Osborne (PhD Candidate, University of Sydney), aims to assess whether a past history of PTSD leads to a different clinical presentation or course in dementia. If so, the study aims to determine the implications for treatment and the epidemiological implications – notably the prevalence of comorbid PTSD and dementia. The role of ACPMH in this study is as an external advisor on methodology, data analysis and interpretation.
Randomised controlled trial of integrated treatment for alcohol use disorder and co-existing posttraumatic stress disorder
This study aims to determine whether cognitive behavioural therapy (CBT) for alcohol use disorder and PTSD is most efficacious when delivered: i) in a staged mode or ii) simultaneously. The second aim is, using daily diaries, to develop a better understanding of the association between alcohol use and PTSD symptoms and the manner in which each problem acts to maintain the other. It is hypothesised that participants whose problems are addressed simultaneously will show greater improvements on primary alcohol and PTSD outcomes than participants who receive alcohol treatment first followed by PTSD treatment. This study is being conducted by the National Drug and Alcohol Research Centre in Sydney. The role of ACPMH in this study is to provide specialist advice to the primary research team on methodology, data analysis and interpretation.