A recent study conducted by researchers at New York University and published in the Journal of the American Medical Association (JAMA) has led many to believe the leading evidence-based psychotherapies for PTSD do not work for up to two-thirds of patients.
Our findings at Wounded Warrior Project® (WWP) show very different results for veterans participating in our two- and three-week intensive outpatient programs (IOP) provided by our Warrior Care Network academic medical center (AMC) partners at Emory University, Massachusetts General Hospital, Rush University, and UCLA Health. They all use tailored combinations of evidence-based, complementary, and alternative therapies within the IOP.
Within the IOP, veterans receive upward of 70 hours of direct clinical care – more than a year’s worth of traditional therapy.
For the almost 2,000 veterans who have completed the IOP with Warrior Care Network, the results are extremely promising.
Veterans completing our IOP show a clinically significant reduction in PTSD symptoms (measured using the PCL-5), and these lower levels are relatively sustained 12 months following treatment.
This decreased symptomology tends to result in increased functioning – empowering veterans to more actively engage in life.
Remarkably, our IOP has a greater than 90% completion rate – double the national average. We believe this is due to a variety of factors including the condensed time period (2-3 weeks), our cohort model where small groups of veterans start the program together and graduate together, and the inclusion of evidence-based therapies with alternative and complementary therapies.
Our outcomes and results treating veterans seem to outpace other methods in clinical reduction of depression and PTSD, overall completion rates, and patient satisfaction scores.
While we appreciate the discussion generated by the JAMA article on the challenges of delivering mental health care and the need for future research and better treatment models, we are concerned about the researchers’ approach of collapsing veterans’ results within active-duty military and civilian results due to wide variations in cultural characteristics and treatment goals and methods.
While mental health care challenges are a global issue, it is important to remember that the military is a collectivist culture that places the group and mission over the needs of the individual. This dynamic, combined with the potential for increased and prolonged exposure to traumatic events, may increase service members’ risk for specific mental health challenges.
These cultural differences are compounded when military members leave active duty following inadequate transition assistance support programs and begin assimilating back into civilian culture. Many veterans may feel isolated during this period and struggle with their mental health as they attempt to find their new cultural identities and reengage in civilian life.
Even within the military community, treatment goals, results, and completion rates differ between the active-duty and veteran populations and the broader civilian population.
Differences between active-duty service members and veterans may be driven by desired outcomes. For instance, active-duty service members may be more interested in managing symptoms of PTSD so they can continue their careers effectively. Whereas veterans may tend to be more interested in symptom reduction, thereby increasing functionality and reducing the impact on their families.
Countless articles and studies in the multicultural psychology field have warned against comparing minority groups – veterans in this case – with majority groups, such as civilians, as results may serve to further normalize the majority group culture.
Comparing military and veteran results to civilian results may only further highlight the differences in the smaller military population when compared to the larger U.S. population.
There exists a large body of research that indicates that evidence-based treatment does work, however, the effect tends to vary at the individual level.
To better determine which therapies work best for which individuals, WWP invested in and is promoting research on biomarkers for PTSD.
With better understanding of these biomarkers, medical experts will be better able to tailor current therapies to individual patients and develop new models of care.
Until we gain a better understanding of individual differences in reacting to and recovering from trauma, we advocate for combining evidence-based therapies with complementary and alternative methods in an intensive outpatient format.
We welcome and support the need for further dialogue, discussion, research, and innovation in the field of PTSD treatment, but suggest caution in how findings are disseminated and interpreted.
It falls on researchers and community partners to ensure that the dissemination of results provides realistic expectations of treatment and refrains from creating additional barriers to care.
Most importantly, we strongly urge veterans who are struggling to do a brave thing: seek care because PTSD is treatable, and treatment works.
Retired Army Lt. Col. Mike Richardson is the vice president for mental and brain health programming at Wounded Warrior Project.
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