A three-week intensive outpatient therapy program (IOP) has been found to significantly reduce post-traumatic stress disorder and depression symptoms among military veterans. The intervention adds to the growing evidence that suggests providing several hours of therapy over several consecutive days is an effective method to address the unmet mental health needs of military veterans.
Over a 14-month period, Rush University Medical Center researchers closely monitored 191 veterans who had been referred to the program’s intensive outpatient program (IOP) because their PTSD was not responding to traditional therapeutic approaches. A traditional approach typically includes daily treatment over the course of 6 to 12 weeks.
At the beginning of treatment with an intensive 3-week approach, 96 percent of patients reported moderate to severe PTSD. The reports of moderate to severe PTSD fell to only 42 percent by the end of the three-week treatment period.
“The numbers that we’re seeing show that we can make a profound impact in veterans’ lives in just three weeks” said Alyson Kay Zalta, Ph.D., lead author of the study, conducted while she was research director of the Road Home Program.
The Road Home Program at Rush helps military veterans and their families make healthier transitions to civilian life by offering specialized mental health care, peer-to-peer outreach, counseling and community resource navigation.
The new findings appear in the journal BMC Psychiatry. The authors believe the intensive therapy was more successful than therapy that stretches out for many weeks because a longer-term approach presents multiple many barriers to completion. For example, a 6-12 week program means that individuals are away from family and work for a significant period of time.
Zalta noted that “by concentrating therapy over consecutive days in three weeks, we see that over 90 percent of veterans stick with the program. By comparison, an estimated 40 percent of veterans drop out of traditional programs before they receive an adequate treatment dose. ”
The veterans in the study at Rush were put into groups of eight to 12 individuals and received more than 100 hours of specialized mental health services that combined evidence-based therapy such as cognitive processing therapy (CPT) with wellness interventions including mindfulness, yoga, art therapy and acupuncture.
The participants typically received 15 individual session and 13 group sessions of CPT, considered one of the most effective treatments for PTSD. CPT helps people better understand how trauma has changed the way they think, teaches them how to evaluate their thoughts, and equips them with the skills to better manage PTSD symptoms.
Complementing this treatment, the meditation-based techniques teach people to be focused on what they are sensing and feeling at every moment, without interpretation or judgment.
During the study, researchers sought to better understand how veterans improved over the course of the program. They showed that changes in thoughts predicted subsequent improvements in symptoms.
“We hope that being able to answer whether changes in thoughts proceed changes in symptoms will allow therapists to better determine who is most likely to benefit and how they will benefit from specific techniques,” Zalta said.
The Department of Veterans Affairs (VA) estimates that 23 percent of veterans returning from Iraq or Afghanistan have or will develop symptoms. Accordingly, the department has invested tens of millions of dollars to make proven effective, evidence-based PTSD treatment programs more widely available.
The study authors hope the findings will lead to more mental health treatment options and opportunities for veterans by accelerating acceptance of the IOP model. Such intensive treatment typically is not administered within the VA system but increasingly is available through philanthropically-funded, private sector efforts like the Road Home Program.
The VA, which operates the nation’s largest integrated health care system, is the central component of the health care delivery system for veterans. “But the VA cannot and should not be expected to do so alone,” said paper co-author Michael Brennan, Psy.D., Road Home’s assistant medical director and US Army Reserve Captain ABPP.
“It takes a nation, not one government agency, to build a military and go to war. Our nation shouldn’t rely on just the VA to make sure our military veterans make a healthy transition to civilian life.”