Psychotherapeutic treatment program for posttraumatic stress disorder: prospective study of 70 war veterans



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Psychotherapeutic treatment program for posttraumatic stress disorder: prospective study of 70 war veterans
Dolores Britvić, M.D.

Vesna Antičević, psychologist

Ivan Urlić, M.D., Ph.D.

Goran Dodig, M.D., Ph.D.

Branka Lapenda, M.D.

Vesna Kekez, psychologist


Department of psychiatry, Clinical hospital Split, Split University School of Medicine, Split, Croatia

Correspondence:

Britvić Dolores

Klinička bolnica Split

Šoltanska 1

21 000 Split

Tel. 00 385 21 557 411

00 385 21 220-586

Fax 00385 21 557 507

dbritvic@globalnet.hr
Short title:

Outpatient psychotherapeutic program for PTSD


Key words (not in title).

Combat, outcome, group psychotherapy, depression, quality of life.



Abstract:

Aim. To assess the effectiveness of psychotherapeutic model of treatment of war veterans with posttraumatic stress disorder (PTSD), by evaluating the symptoms of PTSD, associated neurotic symptoms, ways of coping with stress, and indicators of quality of life and depressiveness.

Methods. Prospective cohort study included 77 war veterans who took part in a psychotherapeutic model of treatment lasting 40 weeks. On each visit, there were three types of group sessions: socio-therapeutic, psycho-educative, and trauma-focused groups. Groups consisted of 10-12 veterans, and each session lasted 60 minutes. Mississippi scale for PTSD was used for assessing the intensity of PTSD, Crown-Crisp Index for neurotic symptoms, Inventory of dispositional and situational coping with stress for ways of coping with stress, Quality of Life Scale for indicators of quality of life, and Beck Depression Inventory for depression at the beginning and the end of psychotherapeutic program.

Results. Seventy veterans finished the whole course of treatment. After the completed psychotherapeutic treatment program, there was an increase in problem-oriented coping with stress (t=-2.073, p=0.042), and coping by avoidance (t=-2.803, p=0.007). BDI scores at the end of treatment were significantly lower than at the beginning (t=4.563, p=0.000). There were no significant changes in symptoms of PTSD (t=1.730, p=0.088), neurotic symptoms and scores on the QLS (t=-1.825, p=0.072).

Conclusion. Revealing and working through the traumatic events facilitated gradual ending of the process of pathologic grief, which resulted in reduction of depression. Other therapeutic factors (altruism, giving hope, developing social skills) contributed to the achieved therapeutic effects.

Introduction

Ten years after the end of war in Croatia, there are still many patients showing a complex posttraumatic response to traumatic experiences (1, 2). Brutality and repetitive nature of traumatic battlefield experience profoundly changes motives, spiritual and existential views on life, as well as the individual feeling of meaning and purpose (3). An inner world of deeply repressed emotions reflects itself on the totality of intrapsychic and interpersonal layers of personality, causing changes in biological functions, strong anxiety, and often depression and changes in quality of life (4-7). Group psychotherapy, which goes deep into intrapsychic and interpersonal spheres, is a necessary part of integral approach to treatment of psychotrauma (8,9).

Literature on group therapy of posttraumatic stress disorder (PTSD) gives descriptions of different therapeutic techniques, each of them mostly focusing on a particular psychological disturbance such as anxiety, fear or avoidance behavior (10, 11). The majority of recent studies suggests multidimensional approach using psychoeducation, support, anxiety relief, and life-style modification, all of which have a goal of normalizing the stress reactions and reducing the maladaptive psychobiological processes (8-10). Various models are recommended for this purpose, but there is still no common stand on how these integral techniques should be applied. The fact that only a few studies evaluated the effect of such treatment (12-15) contributes to the problem.

Aiming towards the above mentioned in treatment of PTSP, we implemented a psychotherapeutic program consisting of socio-therapeutic, psycho-educative and dynamic-oriented group approach. The purpose of this study was to assess the effectiveness of such psychotherapeutic program by evaluating the symptoms of PTSD, neurotic symptoms, ways of coping with stress, depressiveness and indicators of quality of life.


Patients and methods




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