Running head: Effective Treatment for PTSD

Assignment #1: Article Review on Effective Strategies in the Treatment of Post Traumatic
Stress Disorder
Daniel R. Gaita, MA
September 15th, 2016
University of Southern California
School of Social Work
SOWK 545
Instructor: Maria Duggan MSW, LICSW

Effective Treatment For PTSD

Effective Treatment For PTSD

Identification of Article Importance

Recently released, July 2016, data provided by the Department of Veterans Affairs
continues to underscore the urgency in implementing effective strategies to reduce the myriad of
symptoms, which often lead our nations veterans to committing suicide at rates far greater than
the general population (Thompson, 2016). This paper covers a critical review (Dworkin, 2011), of
seventeen published studies specific to psychosocial interventions between 2000-2010 for
veterans with Post Traumatic Stress Disorder (PTSD)
Specialty Population Served
The Department of Veterans Affairs claims to have taken the most comprehensive analyses
of Veteran suicide rates in the U.S. by examining over 50 million Veteran records from 1979 to
2014 from every state in the nation. The collected data states that in 2014, an average of 20
Veterans died from suicide each day. Of those, 30% were utilizing VA services, accounting for
18% of all deaths from suicide among U.S. adults, while constituting only 8.5% of the US
population (Thompson, 2016).
Overall, Since 2001, the age-adjusted rate of suicide among U.S. Veterans has increased
by 32.2%, U.S. Veteran males have increased by 30.5%, while females U.S. Veterans increased by
85.2% compared to the age-adjusted increase in the rate of suicides among U.S. civilian adults of
only 0.3% and 39.7% respectively (Thompson, 2016).
Approximately two-thirds of all Veteran deaths from suicide were the result of firearm
injuries with continued evidence of higher rates among middle-aged and older adult Veterans with
approximately 65% of all 2014 suicides being committed by those aged 50 years or older
(Thompson, 2016).

Effective Treatment For PTSD

While the data is shocking, it has shown improvement and expands upon a previous 2010
Department of Defense Study which used data from over 3 million veterans records from 20 states
that had showed 22 veterans suicides each day. The results of that prior study sparked a national
awareness campaign to end veterans suicides and the Department of Veterans Affairs has
responded with multiple programs (Thompson, 2016).
The article we have selected for this work is a focused critical review of the psychosocial
interventions currently being administered for veterans with PTSD.
Explanation of Chosen Treatment
We have chosen Cognitive Processing Therapy due to repeated efficacy in findings using
data collected from the Clinician Administered PTSD Scale (CAPS) across multiple studies
referred to in the Dworkin, 2011 article and in addition to supportive data in its use in group and
video teleconferencing group settings. (Morland, Hynes, Mackintosh, Resick, & Chard, 2011).
Measuring PTSD symptoms with CAPS.
Clinician Administered PTSD Scale (CAPS). The CAPS is a 30-item scale that measures
the existence and intensity of the 17 symptoms of PTSD as stated in the DSM- IV (Blake et al.,
1995). The CAPS is completed by way of a mental health professional interviewing a subject with
the use of the scale (Blake et al., 1995). Severity scores of 0-19 = asymptomatic/few symptoms,
20-39 = mild PTSD/sub threshold, 40-59 = moderate PTSD/threshold, 60-79 = severe PTSD
symptomatology, and > 80 = extreme PTSD symptomatology," (Weathers, Keane, & Davidson,
2001, p. 135). Change in scores representing a decrease or increase in CAPS scores ranging from
10 to 15 have been recommended or used as interpretations of clinical significance (Weathers et
al, 2001; Ready, Thomas, Worley, Backscheider, Harvey, Baltzell, & Rothbaum, 2008).
Evaluation of findings.

Effective Treatment For PTSD

Following an evaluation of clinician administered PTSD Scale (CAPS) scores, pre and
post treatment, specific to their utilization in data collection for Cognitive Processing Theory

(CPT), Exposure Therapy, Present Centered Therapy, Skill Building focused CBT and Multimodal
Therapy, the extensive review of psychosocial interventions provided in the Dworkin, 2011
analysis demonstrate greater short and long term efficacy in treating PTSD with the use of
Cognitive Processing Therapy (CPT) and exposure-like therapies.

Article Summary and Analysis

How Techniques Apply
CPT focuses on creating a detailed account of one's trauma in order to alter maladaptive
accommodations and assimilations by reconstructing them in more adaptive ways for the
individual, which is theorized to allow a person to confront and reduce symptoms acquired from
trauma (Sobel et al., 2009).
Description of Therapeutic Application
CPT is a recovery-focused therapy, which works off both collaboration and informed
choice, uses a twelve-session protocol implemented either individually, in-group, or both and may
or may not include trauma focused cognitive therapy. However, it can be implemented without
traumatic accounts (Resick, Monson, & Chard, 2008).
Critical Analysis
The results of CPT for both Vietnam and Operation Iraqi Freedom and Enduring Freedom
(OIF/OEF) veterans showed no significant differences between groups but did demonstrate
treatment efficacy across both populations with CAPS score of 71.88 reduced to 31.50 for
OIF/OEF and 66.48 reduced to 42.50 for Vietnam Veterans. Similar findings of overall CAPS
score reductions were replicated across multiple studies (Dworkin, 2011).

Effective Treatment For PTSD

Key Finding for Future Research
Of importance to note is the rapid increase in suicide rates among female U.S.
Veterans by the Department of Veterans Affairs (Thompson, 2016), yet very little data is
presented across all 17 published studies cited in the Dworkin review of psychosocial
interventions on female study subjects. While CPT had been initially conducted with rape
victims and has since been used successfully with a range of other traumatic events
(Resick, Monson, & Chard, 2008) we will need more research as it applies to women in
the armed forces as they take up a growing number of newly opened positions in the
combat arms sectors. Effective treatment interventions for combat trauma will be
instrumental in ensuring the long-term mental health of female veterans equally to their
male counterparts.
Application to Selected Population

Today, CPT is widely used through the Department of Veterans Affairs (VA) mental health
sector and made widely available for use and implementation globally. They currently provide the
following link, http://alrest.org/pdf/CPT_Manual_-_Modified_for_PRRP(2).pdf to the actual
Veterans and Military CPT Manual (Resick, Monson, & Chard, 2008), being implemented in
providing CPT treatment for PTSD through the United States Veterans Affairs healthcare system
as well as other helpful instructional video series provided by the National Center for PTSD and
the U.S. Department of Veterans Affairs here,
http://www.ptsd.va.gov/professional/continuing_ed/flash-files/CPT/Player/launchPlayer.html?
courseID=1568&courseCode=PTSD101_cpt specific to CPT implementation guidelines currently
in effect.

Effective Treatment For PTSD

References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Washington, DC: Author.
Blake, D. D., Weathers, F. W., Nagy, L. M, & Kaloupek, D. G. (1995). The development
of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8(1), 75-90. doi:
10.1002/jts.2490080106.
Dworkin, D. (2011). A critical review of psychosocial interventions for veterans with
posttraumatic stress disorder (Order No. 1493116). Available from ProQuest
Dissertations & Theses Full Text; ProQuest Dissertations & Theses Global.
(866298062). Retrieved from http://libproxy.usc.edu/login?
url=http://search.proquest.com.libproxy2.usc.edu/docview/866298062?
accountid=14749
Morland, L. A., Hynes, A. K., Mackintosh, M.-A., Resick, P. A. and Chard, K. M. (2011),
Group cognitive processing therapy delivered to veterans via telehealth: A pilot
cohort. J. Traum. Stress, 24: 465469. doi:10.1002/jts.20661
Ready, D. J., Thomas, K. R, Worley, V., Backscheider, A. G., Harvey, L. A. C, Baltzell,
D., & Rothbaum, B. O. (2008). A field test of group based exposure therapy with 102
veterans with war-related posttraumatic stress disorder. Journal of Traumatic Stress,
21(2), 150-157. doi: 10.1002/jts.20326.

Effective Treatment For PTSD

Resick, P.A., Monson, C.M., & Chard, K. M. (2008). Cognitive Processing Therapy:
Veteran/Military Manual. Veterans Administration. Retrieved from:
http://alrest.org/pdf/CPT_Manual_-_Modified_for_PRRP(2).pdf
Sobel, A. A., Resick, P. A., & Rabalais, A. E. (2009). The effect of cognitive processing
therapy on cognitions: Impact statement coding. Journal of Traumatic Stress, 22(3),
205-211.
Thompson, C., (2016). VA Suicide Prevention Program, Facts about Veteran Suicide,
Suicide. Prevention and Community Engagement. Retrieved from:
http://www.va.gov/opa/publications/factsheets/Suicide_Prevention_FactSheet_New_V
A_Stats_070616_1400.pdf
Weathers, F. W., Keane, T. M., & Davidson, J. R T. (2001). Clinician-administered PTSD
scale: A review of the first ten years of research. Depression & Anxiety, 13(3), 132156.