Veterans and Substance Abuse

The type of group that our members have come up with is a treatment group which focuses on returning veterans, specifically from the Operation Enduring Freedom and Operation Iraqi freedom, who have PTSD. According to the book An Introduction to Group Work Practice written by Toseland and Rivas, they describe treatment groups as a group whose purpose is to address clients’ emotional needs . This differs from a task group, whose purpose would be to complete a task or reach a goal. The goal of our group is to work towards improving the mental health and emotional needs of the clients. The purpose for this group will be to help these veterans reintegrate themselves into the community and into their families by using group recreation therapy.

The setting of the group would begin in a typical group room most likely at the Portland VA Medical Center, and eventually transition to recreational activities out in the community. We have determined that this group will be funded by the veterans VA benefits. This would insure that the group is accessible to all veterans who choose to participate. If the group is successful, it can be implemented in at other VA clinics in Washington, Oregon, and other locations where there is a need. For this purpose of this literature review, I chose to focus on the effectiveness of group therapy on people who suffer from PTSD with or without co-occurring disorders such as substance abuse or depression.

The question formulated to guide this literature review is: How effective is group therapy for people suffering with PTSD with or without co-occurring disorders? Databases used to locate articles for this group were Academic Search Complete (EBSCOhost) and Psychology Database (ProQuest). Search terms that worked were “Group Therapy”, “PTSD”, “co-occurring disorders”, “substance use”, “depression”, “effectiveness”. Search terms that did not work were searching the keywords “Veterans” with “Recreational therapy” and “Group therapy for PTSD”. There was not much on this topic when narrowed down and my group members had already used the articles that did show up, so I decided to broaden my search so that I could find more research that has been done on how effective groups are for people with PTSD in general, including veterans but not limited to veterans.

This research will help us in forming our final group.The possible group intervention that has been described by authors Varkovitsky, Sherrill, and Reger in the article Effectiveness of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders among Veterans is called Unified Protocol (UP) which is described as a way to focus on, control, and change the regulation of emotions for people suffering with emotional disorders. These authors took well-known cognitive-behavioral strategies that have been empirically supported and tested and combined these techniques together to form a treatment group. There were four randomized controlled trials and two open trials conducted for individuals who have been diagnosed with mood or anxiety disorders. The researchers chose to do a 16-week group session on men and women (43 men, 9 women) examining self-reported symptoms.

The methods used by these authors was inclusion criteria of the diagnosis of PTSD, and receiving services through the VA. They were given a health questionnaire and out of 170 veterans asked to be in the study, 150 of them participated but only 52 completed the whole process. They were given survey packets to complete after the 16-week group treatment session. Information on diagnosis was collected from each participants’ medical records. Unified Protocol uses a variety of treatments and therefore is flexible in its delivery and use (Varkovitsky, Sherrill, & Reger, 2018). For this study, there were eight modules given to each participant. The modules consisted of topics such as how to increase motivation to change, identifying emotional awareness, and modifying emotional reactions and behaviors.

These are all skills that would assist in working to change dysfunctional cognitive patterns. Limitations to this study are the small participant number and that they all need to be veterans. Another limitation is that there was a small number of women tested and non-white veterans, so it is difficult to get an accurate conclusion on if this works well across genders and on diverse populations. After these trials were concluded, the evidence showed that there were improvements for the 18 months they were followed after the Unified Protocol was completed in the symptoms of anxiety, depression, improved quality of life, and functioning on a daily basis.

Assessed in another article written by authors Maio and Jorgensen-Wagers called Efficacy of Group Cognitive Processing Therapy in an Intensive Outpatient Trauma Program for Active Duty Service Members with Posttraumatic Stress Disorder is another method of group treatment for individuals suffering from PTSD. These authors have done research on the effects of certain types of treatment on service members who have been diagnosed with PTSD and also have mild or moderate traumatic brain injury, which is common to see both in these individuals. The research concluded that this type of intensive treatment had positive long-term effects with using Cognitive Processing Therapy (CPT) in a group setting.According to the authors CPT is offered in a group format, lasting eight weeks long with members attending three times a week.

This is considered intensive due to the amount of time spent each week. The members write down an account of their trauma report, which might be used during the group, but it may not be used. Within the group, members are asked to discuss their beliefs around six major topics, some of which were topics such as how they feel about safety, trust, intimacy etc. They are to complete this before treatment and after treatment using the Stuck Point Inventory. The authors used the PTSD check list as the way to measure symptoms and improvements.

The authors concluded that there was long-term improvement in the members who returned to active duty after the treatment. They reported that one of the limitations was small sample size as well as trying to identify which particular mode of treatment would be most effective. They also pointed out that there is limited research to support use of this treatment for the targeted population of veterans with the combination of PTSD and traumatic brain injury. After a careful assessment of strengths of available literature, the best available evidence supports a Unified Protocol and CPT treatment group for the purpose of symptom reduction in individuals with PTSD in a group setting.

The evidence that seems to be a best fit for this setting and potential group member is that there were long-term improvements in these veterans with PTSD, symptom reduction, and improved emotional regulation. This shows that either of these type groups implemented into the development of our group would be beneficial. A method used in the literature to evaluate group outcomes that could be used for this group is the survey conducted by the members at the end of the group. Although we are then relying on self-reporting, it has proven to be an accurate assessment and method of getting results.

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