(Press-News.org) Our nation's veterans continue to suffer emotional and psychological effects of war--some for decades. And while there has been greater attention directed recently toward post-traumatic stress disorder (PTSD), and more veterans are seeking help, current psychotherapy treatments are less than optimal, according to a new narrative review published in the August 4, 2015 issue of JAMA.
In a review of medical literature over a 35-year period, researchers from the Steven and Alexandra Cohen Center for Post-Traumatic Stress and Traumatic Brain Injury -- a program in the Department of Psychiatry at NYU Langone Medical Center -- and other institutions found that non-medical approaches to treat PTSD were effective in some patients but not in others, suggesting a need for broader, more personalized approaches to care.
The researchers looked at randomized clinical trials of psychotherapy for military-related PTSD to examine which psychotherapies improve symptoms. This included, in particular, a review of trials of two commonly-used, evidence-based treatment models: cognitive processing therapy (CPT) and prolonged exposure (PE) therapy.
Searches were conducted via PubMED, PsycINFO, and PILOTS for randomized clinical trials of individual and group psychotherapies for PTSD in military personnel and veterans published from January 1980 to March 2015. Of 891 publications initially identified, 36 were included in the JAMA Narrative review, representing 2,083 participants.
"Our findings showed that PE and CPT are not as broadly effective as we might have once thought or hoped," says Maria M. Steenkamp, PhD, assistant professor of psychiatry at NYU Langone and lead author of the study. "As many as two-thirds of veterans receiving CPT or PE keep their PTSD diagnosis after treatment, even if their symptoms improve. So there is room for improvement."
"The emotional effects of war are gaining attention," says Charles R. Marmar, MD, the Lucius Littauer Professor and chair of psychiatry at NYU Langone, director of its Cohen Veterans Center, and the senior author of the JAMA study. "And there are veterans from all wars who are struggling, not just those who most recently served in the wars in Iraq and Afghanistan."
In fact, recently released findings from another study led by Dr. Marmar and published July 22, 2015 in JAMA Psychiatry --the National Vietnam Veterans Longitudinal Study--found that over 270,000 Vietnam veterans -- 40 years since the end of that war -- are still suffering from clinically important levels of PTSD symptoms, and one-third of those have a current, major depressive disorder.
"There is a pressing need for innovation in treatments for PTSD and TBI to protect a new generation of veterans," adds Dr. Marmar.
Dr. Steenkamp suggests that the JAMA study indicates there is still much to learn about how to optimize PTSD treatments of veterans. "It is clear that there is no one-size-fits-all approach," she says. "Ideally, we have to move toward clinical options that match patients to treatments, based on their preferences and their comfort with talking about their trauma. One thing we do know is that veterans are unlikely to benefit unless they complete a full course of treatment. Finding ways to develop treatments that align with patient needs and preferences is important."
The U.S. Veterans Administration and the U.S. Department of Defense have been funding such approaches to treatment, Dr. Marmar says. "There are encouraging findings that while therapies that focus on processing trauma are generally effective for veterans who complete that course of treatment, there are alternatives for veterans who are emotionally unprepared to confront their war-zone experiences," he adds.
Understanding the underlying mechanisms that occur in specific patients is key. A novel five-year multicenter study led by NYU Langone's Cohen Veterans Center is looking into objective biological markers of PTSD and TBI in returning soldiers of the wars in Iraq and Afghanistan. The goal is to transform the way mental health disorders are diagnosed by identifying specific brain imaging and blood and other biological markers that can tell clinicians definitively that a person is suffering from PTSD or TBI or a combination. Presently, there is no single valid diagnostic test that can independently confirm either diagnosis. Stanford University, Emory University and the U.S. Department of Defense Systems Biology Program at Fort Detrick, Maryland are partners in this research.
"Collectively, these studies may bring us one-step further in tailoring treatment to the individual, monitoring progress, and measuring long-term effectiveness," Dr. Marmar says.
INFORMATION:
In addition to Drs. Steenkamp and Marmar, co-authors of this study include: Brett T. Litz, PhD, VA Boston Healthcare System, and Charles W. Hoge, MD, Walter Reed Army Institute of Research.
AURORA, Colo. (Aug. 4, 2015) - Physicians should improve the way they discuss firearm safety with patients by showing more respect for the viewpoints of gun owners, according to an article by a University of Colorado School of Medicine faculty member published in the Aug. 4 issue of JAMA.
Marian "Emmy" Betz, MD, MPH, associate professor of emergency medicine, and Garen J. Wintemute, MD, MPH, professor of emergency medicine at the University of California Davis, write that physician counseling about gun safety is a key component of preventing firearm injury and death. ...
In a randomized trial that included veterans with posttraumatic stress disorder (PTSD), those who received mindfulness-based stress reduction therapy showed greater improvement in self-reported PTSD symptom severity, although the average improvement appears to have been modest, according to a study in the August 4 issue of JAMA, a violence/human rights theme issue.
Posttraumatic stress disorder affects 23 percent of veterans returning from Afghanistan and Iraq. Left untreated, PTSD is associated with high rates of other disorders, disability, and poor quality of life. ...
Even though homicide and assault rates have decreased in the U.S. in recent years, the number of these and other types of violent acts remains high, according to a report in the August 4 issue of JAMA, a violence/human rights theme issue. The authors write that multiple strategies exist to improve interpersonal violence prevention efforts, and health care providers are an important part of this solution.
Interpersonal violence is a pervasive public health, social, and developmental threat that affects millions of U.S. residents each year. It is a leading cause of death ...
A brief motivational intervention delivered during an emergency department visit did not improve outcomes for women with heavy drinking involved in abusive relationships, according to a study in the August 4 issue of JAMA, a violence/human rights theme issue.
There is a strong and reciprocal association between two highly prevalent public health problems: intimate partner violence (IPV) and heavy drinking. Each risk individually represents major costs to individuals, families, and society. The emergency department (ED) visit is conceptualized as a sensitive period or ...
Screening women for partner violence and providing a resource list did not influence the number of hospitalizations, emergency department, or outpatient care visits compared with women only receiving a resource list or receiving no intervention over 3 years, according to a study in the August 4 issue of JAMA, a violence/human rights theme issue.
The U.S. Preventive Services Task Force recommends women of reproductive age be screened for partner violence. However, others, such as the World Health Organization conclude there is insufficient evidence for this recommendation. ...
More than 1 in 4 female sex workers in the northern Mexico cities of Tijuana and Ciudad Juarez reported entering the sex trade as minors, and entering the sex trade as an adolescent vs as an adult was associated with a greater risk for HIV infection, according to a study in the August 4 issue of JAMA, a violence/human rights theme issue.
Adolescents migrating from Central America and Mexico to the United States are at risk for being trafficked into the sex industry in Mexico's northern border cities. Research from other regions indicates that those entering the sex trade ...
Researchers at University of California, San Diego School of Medicine report that more than one in four female sex workers in two Mexican cities on the U.S. border entered the sex trade younger than age 18; one in eight before their 16th birthday. These women were more than three times more likely to become infected with HIV than those who started sex work as adults. They were also three times more likely to be violently coerced to engage in sex with male clients and seven times less likely to use a condom during their first month in the sex trade.
The study is published ...
Scientists have discovered how earthworms can digest plant material, such as fallen leaves, that would defeat most other herbivores.
Earthworms are responsible for returning the carbon locked inside dead plant material back into the ground. They drag fallen leaves and other plant material down from the surface and eat them, enriching the soil, and they do this in spite of toxic chemicals produced by plants to deter herbivores.
The scientists, led by Dr Jake Bundy and Dr Manuel Liebeke from Imperial College London, have identified molecules in the earthworm gut that ...
WASHINGTON, D.C., August 4, 2015 -- Terahertz radiation, the no-man's land of the electromagnetic spectrum, has long stymied researchers. Optical technologies can finagle light in the shorter-wavelength visible and infrared range, while electromagnetic techniques can manipulate longer-wavelength radiation like microwaves and radio waves. Terahertz radiation, on the other hand, lies in the gap between microwaves and infrared, whether neither traditional way to manipulate waves works effectively. As a result, creating coherent artificial sources of terahertz radiation in ...
WASHINGTON, D.C., August 4, 2015 -- Studies of the impact a droplet makes on solid surfaces hark back more than a century. And until now, it was generally believed that a droplet's impact on a solid surface could always be separated into two phases: spreading and retracting.
But it's much more complex than that, as a team of researchers from City University of Hong Kong, Ariel University in Israel, and Dalian University of Technology in China report in the journal Applied Physics Letters, from AIP Publishing.
"During the spreading phase, the droplet undergoes an inertia-dominant ...
