Group Therapy Interventions for Combat Veterans Suffering from PTSD

The process of group therapy can be extremely beneficial for individuals suffering from post-traumatic stress disorder (PTSD). However, the interventions used in the group counseling setting must be appropriate to each individual within the group, adding a level of complexity to the job of the therapist choosing the interventions. By using a number of different therapeutic theories and interventions, the therapist can hope for the best possible results for the group as a whole and for the individual clients. Some of the most flexible therapeutic frameworks that work well in group therapy settings are cognitive-behavioral therapy, solution-focused therapy, and psychoeducation.

Cognitive-behavioral therapy, a popular therapeutic framework, has been successfully used to treat patients suffering from post-traumatic stress disorder. One intervention suitable for the group therapy setting is thought-stopping. Thought-stopping involves analyzing the thought patterns our brains have created and interrupting the process at the point where thoughts begin to turn irrational. For example, in the group therapy setting a member of the group may report that while walking on the sidewalk one day, a man began to approach from the opposite direction and the group member, a combat veteran, had a flashback to terrifying war events. The therapist leading the group would then facilitate a discussion of deconstructing the client’s thought processes. The group may then determine that the combat veteran saw the man coming towards him and the man’s physical appearance, manner of movement, or other visual cues reminded the client of the way an enemy soldier approached him during the war. The client’s thoughts then turned to his memories of the terrifying experience he had with the enemy soldier. Finally, the client then made the assumption that the man on the street had the same intentions as the enemy soldier and experienced a flashback, feelings of being back in the dangerous war environment. Using the cognitive-behavioral technique of thought-stopping, the therapist asks the group to identify the point at which the client’s thoughts turned illogical or irrational. The group finds that when the client made the assumption that the man on the street had foul intentions, he began to think illogically. The therapist agrees and asks the client to run through the situation in his mind again, but stopping his thoughts from jumping to the conclusion that he was in danger. When the client is out in the world again, he will practice this technique and stop himself from experiencing another flashback.

In an Australian research study, researchers found that combat veterans suffering from post-traumatic stress disorder who used cognitive-behavioral techniques such as thought-stopping reported “statistically significant and sustained improvements” in measures of “PTSD, depression, anxiety, alcohol use, anger, and quality of life” (Khoo, Dent, & Oei, 2011, p. 663). The subjects in the Australian research study participated in a six-week treatment program and reported that “PTSD symptom reduction occurred consistently each year for 9 years” after the initial six-week program (Khoo et al., 2011, p. 663). These findings show the power and longevity of cognitive-behavioral therapy interventions such as thought-stopping. Further research has shown that cognitive-behavioral therapy interventions can have a significant effect on decreasing post-traumatic stress disorder symptoms of insomnia and frequent and vivid nightmares (Margolies et al., 2013, p. 1026). The research study by Margolies and colleagues (2013) shows that not only does cognitive-behavioral therapy work for symptoms that occur during waking hours, but the interventions’ influences expand into subconscious brain activity as well.

In a study by Ready and colleagues (2012), researchers studied thirty combat veterans suffering from post-traumatic stress disorder who participated in a group therapy practice of exposure therapy. Exposure therapy, a solution-focused therapeutic technique, involves deliberately exposing a client to the stimulus of which he or she is afraid, but in a safe, controlled environment. The goal of exposure therapy is to give the client an experience of safety and positive outcomes that will essentially override the client’s fear, proving to the client that there is no longer anything to fear. For example, in working with combat veterans with post-traumatic stress disorder, a therapist may ask the client to review news stories, view images, or talk through memories of the traumatic event of war. As the client re-experiences the scenario he or she fears, the therapist helps the client to remain calm through deep breathing exercises, self-awareness, and reminders that the client is safe and in control. Researcher David Ready and his colleagues found that, when conducted in a group-therapy setting, exposure therapy greatly reduced the severity of participants’ symptoms and improved their quality of life. In fact, researchers checked in with the participants every month for a year after completion of the therapy program and found that “36% of participants no longer met criteria for PTSD at the 7-11 month posttreatment assessment” (Ready et al., 2012, p. 90). These findings speak volumes to the efficacy and longevity of exposure therapy when used in a group therapy setting.

A third intervention found to be successful with combat veterans suffering from post-traumatic stress disorder is the psychoeducation of mindfulness. Psychoeducation is a therapeutic framework that aims to arm clients with the knowledge to help them better understand their specific diagnoses, symptomology, and the mind-body connection. Mindfulness is only one intervention within the psychoeducation framework, but it has proven a powerful tool in therapy. In a research study conducted at Boston University in 2012, thirty-three male combat veterans were randomly assigned to two psychoeducation intervention programs (Niles et al., 2012, p. 538). One of these programs taught participants the art of mindfulness (Niles et al., 2012, p. 538). The mindfulness program taught to participants in this research study is described as one that “introduces a meditative practice and cultivates present awareness of mental processes and physical states” (Niles et al., 2012, p. 539). The researchers found that “participation in the mindfulness intervention is associated with a temporary reduction in PTSD symptoms” (Niles et al., 2012, p. 538). While further research is needed to determine whether the mindfulness intervention program has long-term positive effects, the preliminary research shows that clients did experience relief from post-traumatic stress disorder symptoms through mindfulness.

Post-traumatic stress disorder is a complex and difficult diagnosis to treat. Sadly, the vast numbers of combat veterans returning home from war with post-traumatic stress disorder only compound the difficulty of treating this persistent disorder. Post-traumatic stress disorder causes great difficulties in all areas of life for the individual with the diagnosis as well as friends and families of the combat veteran. Fortunately, therapists can employ several evidence-based practices and interventions to help these brave men and women including thought-stopping, exposure therapy, and mindfulness. By using these interventions in a group therapy setting, therapists can reach more clients and provide a sense of support and community, which adds to the impact of the interventions.

References

Khoo, A., Dent, M. T., & Oei, T. P. S. (2011). Group cognitive behavior therapy for military service-related post-traumatic stress disorder: effectiveness, sustainability, and repeatability. Australian and New Zealand Journal of Psychiatry, 45, 663-672.

Margolies, S. O., Rybarczyk, B., Vrana, S. R., Leszczyszyn, D. J., & Lynch, J. (2013). Efficacy of a cognitive-behavioral treatment for insomnia and nightmares in Afghanistan and Iraq veterans with PTSD. Journal of Clinical Psychology, 69(10), 1026-1042.

Niles, B. L., Klunk-Gillis, J., Ryngala, D. J., Silberbogen, A. K., Paysnick, A., & Wolf, E. J. (2012). Comparing mindfulness and psychoeducation treatments for combat-related PTSD using a telehealth approach. Psychological Trauma: Theory, Research, Practice, and Policy, 4(5), 538-547.

Ready, D. J., Sylvers, P., Worley, V., Butt, J., Mascaro, N., & Bradley, B. (2012). The impact of group-based exposure therapy on the PTSD and depression of 30 combat veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 4(1), 84-93.