Trauma research and treatment of combat veterans: An evidence-based integrative literature review

The mainstream treatments for Post Traumatic Stress Disorder (PTSD) are Cognitive Behavioral and Prolonged Exposure Therapies (CBT & PE). These closely studied evidence based treatments also show high relapse, dropout, and failure rates of up to half of those treated (Bryant, R., et al., 2008, p. 555). While not as well researched and harder to measure in terms of the gold standard in Evidence Based Practice of Psychology (EBPP), studies of “alternative” treatments and their methods, yield different and interesting evidence. Using the standards espoused by EBPP alongside alternative movements, this study examined modalities used in veterans’ treatment. A guiding question was “What can the field of trauma studies learn from a systematic and comparative review of the research and treatment of combat veterans suffering the sequelae of trauma?” Included in this integrative literature review—which generates a critique and theoretical synthesis of a body of literature (Torraco, R., 2005, p. 356)—were peer-reviewed studies from 2006-2010. The participating studies consisted largely of Veterans Administration (VA)-funded, CBT/PE treatments, with an average of over 32 patients per participating study, of approximately 13 weeks duration, and where 20% of patients avoided treatment, 25% dropped out, and 30% failed treatment altogether. Concept matrix analysis of data included distillation of essential statements further reflecting poor tolerability, dropout, failure, and an inability to maintain symptom reductions (75% of studies). Authors tended to overstate positive effects while omitting adequate examination of study design and construct validity, leading to dearth bias, defined as scarcity of evidence hiding behind citations. From this integrative review of the literature a reconceptualization and agenda for future research emerged. The reconceptualization stems from the usefulness of hybridized efficacy and effectiveness research, self-reflection and bracketing, and more accounting for dearth bias. The future agenda recommends practitioners use concept matrices as iv research and practice tools, conduct more common factors research, and develop more clinical practice-based evidence. Especially as related to knowledge evaluation, increased accountability, and system-wide change, these recommendations can assist the spread of more diverse and useful EBPP, to help relieve some of the pain of the traumatized combat veteran.

Dissertation/Thesis

English

Peter Allen Brown

Brown, P. A. (2012). Trauma research and treatment of combat veterans: An evidence-based integrative literature review. California Institute of Integral Studies, San Francisco, CA