Telephone-Delivered CBT for Pain Management among Older Military Veterans

This study investigated the effectiveness of telephone-delivered cognitive-behavioral therapy (T-CBT) in the management of chronic pain with older military veterans enrolled in VA primary-care clinics. We conducted a randomized clinical trial comparing T-CBT with telephone-delivered pain education (T-EDU). A total of 98 military veterans with chronic pain were enrolled in the study and randomized into one of two treatment conditions. Study participants were recruited from primary-care clinics at an urban VA medical center and affiliated VA community-based outpatient clinics (CBOCs). Pain management outcomes were measured at mid-treatment (10 weeks), post-treatment (20 weeks), 3-month follow-up (32 weeks), and 6-month follow-up (46 weeks). No significant differences were found between the two treatment groups on any of the outcome measures. Both treatment groups reported small but significant increases in level of physical and mental health, and reductions in pain and depressive symptoms. Improvements in all primary outcome measures were mediated by reductions in catastrophizing. Telephone-delivered CBT and EDU warrant further study as easily accessible interventions for rural-living older individuals with chronic pain.

Carmody, T. P., Duncan, C. L., Huggins, J., Solkowitz, S. N., Lee, S. K., Reyes, N., Mozgai, S., … Simon, J. A. (January 01, 2013). Telephone-delivered cognitive-behavioral therapy for pain management among older military veterans: A randomized trial. Psychological Services, 10(3), 265-275.


Evidence-Based Treatment Approaches for Troops with PTSD

Nearly 20% of the 2.6 million troops deployed to Afghanistan and Iraq report symptoms of posttraumatic stress disorder (PTSD). PTSD is associated with hyperarousal, avoidance, and disturbing or reoccurring flashbacks, all of which affect mental and physical health.

The Department of Defense (DoD) and Veterans Affairs (VA) have recommend four treatment approaches for PTSD: Prolonged Exposure (PE) Therapy, Cognitive Processing Therapy (CPT), Stress Inoculation Therapy (SIT), and Eye-Movement Desensitization and Reprocessing (EMDR) Therapy. While there has been little empirical research indicating that EMDR and SIT are effective for PTSD, there is considerable research supporting the effectiveness of both PE and CPT. As a result, the VA has mandated that PE and CPT be available to all patients with PTSD. PE uses imagined and in vivo exposure to help patients confront trauma-related stimuli and extinguish fear responses. CPT targets trauma-related maladaptive cognitions by exposing patients to their own thoughts as they write about their traumas. According to the current review, four randomized control trials (RCTs) support the efficacy of PE for military-related PTSD and one RCT and one uncontrolled effectiveness study provide initial support for the efficacy of CPT in treating military-related PTSD.

Even though the VA has mandated PE and CPT for veterans and military service men and women with PTSD, it is important for clinicians who work with this population (both within and outside the VA) to educate their clients about evidenced based treatment to promote retention and recovery.

Steenkamp, M. M., & Litz, B. T. (February 01, 2013). Psychotherapy for military-related posttraumatic stress disorder: Review of the evidence. Clinical Psychology Review, 33, 1, 45-53.

CPT is Effective for Military-Related PTSD

According to a recent study published in the Journal of Anxiety Disorders, cognitive processing therapy (CPT) may have a greater effect on military-related PTSD than other usual treatments. CPT is a form of trauma-focused cognitive behavior therapy (CBT) that focuses on key themes such as safety, control, power, self-esteem, and intimacy. The present study examines the efficacy of CPT for PTSD among treatment seeking veterans (n=59) within a naturalistic setting compared to other treatments typically used for PTSD (a variety of non-trauma focused symptom management intervention, psycho-education, supportive counseling, and CBT with elements of exposure.) At post-treatment and 3 month follow up, participants in the CPT condition (n=30) showed significantly lower levels of PTSD symptoms than those who received other treatments (n=29) according to self -reporting and clinical ratings.  Additionally, there were larger reductions in comorbid depression and anxiety for participants receiving CPT than treatment as usual. These results suggest that CPT is an effective, evidence based treatment for military-related PTSD in real world environments and situations.

Forbes, D., Llyod, D., Nixon, R. D. V., Elliot, P., Varker, T., Perry, D., Bryant, R. A., & Creamer, M. (2012). A multisite randomized controlled effectiveness trial of cognitive processing therapy for military-related posttraumatic stress disorder. Journal of Anxiety Disorders, 26(3), 442-452.

Cognitive Therapy is Helping Veterans

Guest Blogger: John Milwee, Psy.D., Veterans Administration therapist and Beck Institute alumnus

Veterans returning from the conflicts in Afghanistan and Iraq may face many challenges as they begin to reintegrate into their roles as parents, employees, friends, and neighbors. In recent months a great deal of media attention has been focused on those returning Veterans who suffer with symptoms of Post-Traumatic Stress Disorder (PTSD) associated with their combat experience. Alarming statistics are frequently reported that describe the number of these Veterans who, when untreated, commit suicide. Read more

Older Veterans with Post-traumatic Stress Disorder Helped by CBT

NewStudy-Graphic-72x72_edited-3Medscape: According to a pilot study presented at the Anxiety Disorders Association of America 2009 Annual Conference, older veterans suffering from post-traumatic stress disorder (PTSD) and related symptoms of depression and anxiety – which can persist for decades – may benefit from prolonged exposure therapy (a form of cognitive behavioral therapy). Twelve sessions included “in vivo experience, in which patients are exposed to fears out in the world, and imaginary exposure.”

Measures of efficacy included a Clinician-Administered PTSD Scale (CAPS); after treatment, patients showed a significant reduction in mean CAPS score and 75% no longer met PTSD criteria. Patients showed clinical improvement in most PTSD symptoms along with individual symptoms of avoidance and hyperarousal. Additionally, Beck Depression Inventory (BDI) and other measures showed “clinically significant improvement in both depression and anxiety.” The study author noted that after the treatment, the men were able to “do things they hadn’t done in years.”

These findings are particularly promising because they call into question the “dogma” that older adults cannot tolerate or could be harmed by exposure therapy.

According to the study author, “There are lots of people with PTSD who fought in prior wars or who have the condition for other reasons, who have pushed it aside and coped pretty well throughout their lives. Then a spouse dies, they retire or become medically ill, and their PTSD is something they no longer can put aside, and they need help. We need to know how to treat these people.”

The author is planning a randomized clinical trial in 100 older adults with PTSD.

Study author: S. R. Thorp