Psychoeducation Effectiveness on Military with PTSD ABSTRACT This research paper explores medical professional’s use of psychoeducation in the treatment of Post traumatic Stress Disorder (PTSD) with military personnel. Through my research I wanted to find in depth narratives outlining the following questions: Is psycho-education a suitable intervention technique in the treatment of PTSD? If so, when is it correct to use or integrate psychoeducation in the treatment process with military personnel? Also, what have been the results in using psychoeducation as a type of treatment for PTSD with individual military personnel? How do you assess the success of this intervention? Results from exploring the meaning and understanding of psychoeducation, and the effectiveness in the treatment of PTSD revealed subjective results due to timeframe and situation of use with the treatment technique. The data collected from the research suggested the need for more research to be performed on the effectiveness and best practices of the use of psychoeducation in the treatment of PTSD. Post-traumatic Stress Disorder (PTSD) has captured the minds and imagination of the American public especially during this time of war. With the increased violence due to the war in Iraq and Afghanistan, many Soldiers are affected by the violence and the trauma associated with conflict. Post-traumatic stress disorder is defined in the dictionary as a mental disorder, as battle fatigue, occurring after a traumatic event outside the range of usual human experience, and characterized by symptoms such as reliving the event, reduced involvement with others, and manifestations of autonomic arousal such as hyper-alertness and exaggerated startle response (“Posttraumatic stress disorder. ” Random House Unabridged Dictionary. Soldiers throughout history have had to deal with the mental, physical and emotional stress associated with combat. Many of the returning Soldiers from the Iraq War have indicators of combat related stress or are diagnosed with PTSD. In a speech to the U. S. House Committee on Veterans Affairs’ Health Subcommittee Col. Charles Hoge, M. D. , Chief of Psychiatry and Behavior Services at the Walter Reed Army Institute of Research stated that 19% to 21% of troops who have returned from combat deployments meet criteria for PTSD, depression or anxiety. Of these, 15% to 17% of troops who served in Iraq and 6% of those who served in Afghanistan had PTSD symptoms when surveyed three to 12 months after their deployments. In general, PTSD rates were highest among units that served deployments of 12 months or more and had more exposure to combat (Kaplan, 2006, p. 1). The Department of Defense has initiated numerous resources such as Military OneSource, pre/post health assessments, and has increased the behavioral health services that military personnel, veterans can use for mental health resources (Kaplan, 2006). There are several therapeutic approaches used in the treatment of PTSD, which include Psychotherapy, Cognitive Behavioral Treatment, Family Systems theory, group therapy and psychoeducation. However for the current research, I have chosen to focus on the effectiveness of psychoeducation in the treatment of combat related trauma, also known as PTSD, with military families and veterans, because of the limited body of literature and its flexibility of use with individuals, groups and in a variety of treatment. Psychoeducation has proven to be an effective method in the treatment of many mental illnesses including PTSD. The research strongly suggests that psychoeducation can be effective in reducing symptoms, hospitalization and stigma in a person’s diagnoses with PTSD while providing support and cost efficient treatment. Since the inception of PTSD, several theories of treatment have been introduced focusing on varied aspects of the biological, social and psychological reasons for the development of PTSD. According to the Handbook of Post-Traumatic Therapy, while theories vary, they all had 6 similar assumptions on how trauma affects the individual. Trauma impacts the person’s “psychobiological state, changes in learned behavior, changes in cognitive processing, changes in self-structure, changes in interpersonal relationships, and the nature of the stressors experienced within the time-space framework of a culture at a historical moment” (Williams, 1987, p. 15). It is important to recognize that each individual has a unique and diverse symptom pattern of PTSD (Wilson, Friedman & Lindy, 2001). Therefore, it is necessary to have different treatment theories and interventions available for the clinician’s use. Posttraumatic Stress Disorder is considered an anxiety disorder and defined as a “delayed psychological reaction to experiencing an event that is outside the range of usual human experience… events of this type include accidents, natural disasters, military combat, rape and assault” (Baker, 2003, p. 331). The symptoms of PTSD includes but is not limited to anxiety, and impairment of social and occupational functioning (APA, 2000). PTSD can be a chronic and devastating disorder if treatment is not sought (Creamer & Forbes, 2004). Education is designed to “develop long-term, organized bodies of knowledge and generic problem-solving skills that will help the learner solve personal problems, both in the present and in the future” (Allen 2001). Psychoeducation is the “process of teaching clients with mental illness and their family members about the nature of the illness, including its etiology, progression, consequences, prognosis, treatment and alternatives (Barker, 2003, p. 347). Psychoeducation’s goal is to offer education and therapeutic strategies to improve the quality of life for the family while decreasing the possibility of relapse for the patient (Solomon, 1996). It also has been described as a “systematic didactic-psychotherapeutic intervention, designed to inform patients and their relatives about the disorder and to promote coping (Lincoln, Wilhelm, & Nestoriuc, 2007, p. 233). By strengthening the coping skills, communication and problem solving abilities of the family, the well-being and adaptability of the individual and family members are expected to improve. Even with limited empirical evidence suggesting the importance of psychoeducation, practical application and experience has proven its effectiveness (Creamer & Forbes, 2004; Lansverk & Kane, 1998). During my initial research of psychoeducation in the treatment procedure pertained to schizophrenia. Several of the studies conducted on schizophrenia found that patients benefited from psychoeducation, producing a reduction of relapses, better social performance, positive effects on well being, and a better perception and attitudes of family members regarding the illness (Merinder, 2002; Rotondi et al. 2005). A joint effort between the Department of Veterans Affairs (VA) and Department of Defense (DOD), referred to as the Joint Clinical Practice Guidelines for PTSD (JCPG-PTSD), publicized its support of the use of cognitive therapies in the treatment of trauma victims (Russell, Silver, Rogers, and Darnell, 2007). Existing data also states that psychological services are beneficial to military personnel and their family members. There is a wide array of information on CBT due to its popularity in empirical studies (Creamer and Forbes, 2004) and its proven effectiveness (Monson, Rodriguez & Warner, 2005). CBT is focused on cognition and the use of positive consequences (Cooper & Lesser, 2005). Incorporating CBT and psychoeducation in individual therapy involves questions and discussion, note taking and a summary of key points discussed in the session. Educating clients also is a common and essential practice in many therapeutic relations (Allen, 2001). Through conversation with fellow soldiers who had been to Iraq/Afghanistan and were diagnose with PTSD, it was stated that no one type of program or therapy was more effective than another, or that they used a variety of treatment options. For the soldiers that experience psychoeducaton the consensus was that integrating psychoeducation in their treatment was an effective intervention method and felt that psychoeducation or education after an incident or diagnosis was useful. In conclusion psychoeducation seems to be a worthwhile method of intervention to be used in the treatment of PTSD and that its treatment has positive outcomes on the patient understanding of the disorder. The data gathered from my small scale research could be built upon for a study or a even more larger scale research. It is important to do further research on which treatment modalities are more or less effective with psychoeducation. As more and more of our military members and Soldiers return from war diagnosed with or suffering from PTSD like symptoms, it would be beneficial, financial and educational, to train clinicians on the best practices for the treatment of PTSD. References Allen, Jon. (2001). Traumatic Relationships and Serious Mental Disorders. New Jersey: John Wiley & Sons, Ltd. Barker, Robert L. (2003). The Social Work Dictionary. Washington D. C. : NASW Press. Cooper, M. & Lesser J. (2005). Clinical Social Work Practice: An Integrated Approach, Boston: Pearson Education Creamer, M. , & Forbes, D. (2004). Treatment of posttraumatic stress disorder in military and veteran populations. Psychotherapy: Theory, Research, Practice, Training, 41(4), 388-398. Kaplan, Arline. (Jan 1, 2006). Hidden Combat Wounds: Extensive, Deadly, Costly. In Psychiatric Times, p1. Retrieved July 02, 2007, from Academic OneFile via Thomson Gale: https://find. galegroup. com/itx/infomark. do? &contentSet=IAC-Documents&type=retrieve&tabID=T002&prodId=AONE&docId=A141590763&source=gale&userGroupName=mlin_w_smithcol&version=1. 0 Lincoln, T. M. ; Wilhelm, K. ; Nestoriuc, Y. (2007). Effectiveness of Psychoeducation for Relapse, Symptoms, Knowledge, Adherence and Functioning in Psychotic Disorders: A Meta-Analysis. Schizophrenia Research, 96 (1-3), p 232-245. Merinder P. (2002) Psychoeducation for Schizophrenia (Review). Cochrane Database of Systematic Reviews 2002, Issue 2. Retrieved June 26, 2007 from: https://www. mrw. interscience. wiley. com/cochrane/clsysrev/articles/CD002831/frame. html Monson, C. , Rodriguez, B. , & Warner, R. (2005). Cognitive-Behavioral Therapy for PTSD in the Real World: Do Interpersonal Relationships Make a Real Difference? Journal Of Clinical Psychology 61(6), 751–761. “Posttraumatic stress disorder. Random House Unabridged Dictionary. © 1997 by Random House, Inc. , on Infoplease. © 2000–2007 Pearson Education, publishing as Infoplease. 24 Jul. 2010 <https://www. infoplease. com/ipd/A0515599. html>. Russell, M. , Silver S. & Rodgers, S. , & Darnell J. (2007). Responding to an Identified Need: A Joint Department of Defense/Department of Veterans Affairs Training Program in Eye Movement Desensitization and Reprocessing (EMDR) for Clinicians Providing Trauma Services. International Journal of Stress Management 14 (1), p 61-71. Solomon, Phyllis. (1996). Moving from psychoeducation for families of adults with serious mental illness. Psychiatric Services 47 (12), 1364-70. Williams, Tom. (1987). Post-Traumatic Stress Disorders: A Handbook for Clinicians. Cincinnati: Disabled American Veterans. Wilson, J, Friedman, M. & Lindy J. (2001). Treatment Goals for PTSD. In Wilson, J, Friedman, M. & Lindy J. (Eds) Treating Psychological Trauma and PTSD (pp. 3-27). New York: Guilford Press.
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