Initiating cognitive processing therapy or prolonged exposure (CPT/PE) sessions for post-traumatic stress disorder (PTSD) victims reduces the PTSD suicide rate by over 20%, according to a new study.
“Although receipt of eight or more CPT/PE encounters was associated with lower suicide risk in unadjusted analyses, this finding was not significant in adjusted analyses,” study author Rebecca Sripada, PhD, of the Department of Veterans Affairs (VA) in Ann Arbor, Michigan, and colleagues wrote.
“However, the parameter estimates for adequate therapy (HR 0.80) and initiation (HR 0.77) were similar, and it is notable that CPT/PE initiators who received fewer than eight sessions were included as controls in the analysis of adequate treatment analyses,” they pointed out. “Thus, differences in significance between the two analyses should be interpreted with caution.”
While the study could not directly test whether starting CPT/PE reduced suicide risk, “the findings nevertheless point to some important clinical implications,” noted Shannon Wiltsey Stirman, PhD, of the VA Palo Alto Healthcare System in Menlo Park, California.
“Contrary to expectations, an adequate course (≥eight sessions) of trauma-focused therapy, as opposed to simply initiating CPT/PE, was no longer associated with suicide risk after controlling for covariates,” Wiltsey Stirman wrote in an accompanying editorial.
“However, given the rates of dropout from trauma-focused therapy and therapy in general, it is reassuring that the potential for reduced suicide risk exists even among veterans who do not complete a full course of CPT/PE,” she added.
CPT and PE are evidence-based treatments included in VA guidelines for managing PTSD. The therapies target avoidance and isolation and have reduced negative cognition opens in a new tab or window associated with traumatic memories. Prior studies have also reported that CPT can improve emotion regulation and reduce perceived burdens.
The researchers studied 847,217 veterans diagnosed with PTSD from 2016 to 2019, using Veterans Health Administration (VHA) Corporate Data Warehouse records to obtain demographic, clinical, and treatment records.
PTSD Causes and Symptoms
About half of Iraq and Afghanistan combat veterans, not half the injured combat veterans, sustained traumatic brain injuries. The combat conditions in these Southwest Asia countries included all three major causes of brain injuries, which are:
- Unintentional Falls: These injuries may be the most common non-combat-related injuries among deployed soldiers. When victims fall and land hard, their brains slam against the insides of their skulls. The repeated, violent motion could cause one or more kinds of permanent head injuries.
- Intentional Violence: Combat operations against insurgents place contractors at risk for violence-related head injuries. That injury could be a trauma impact, as discussed above. Furthermore, bullets and shrapnel essentially drill holes in the head. These injuries cause significant brain bleeding and swelling.
- Loud Noises: A sudden loud noise, like an exploding IED, triggers shock waves that disrupt brain functions. So, an overseas private military contractor could sustain a brain injury even though s/he sustained no other visible trauma injuries.
TBIs come in several forms, including Post Traumatic Stress Disorder. So, PTSD is a specific kind of physical brain injury. Therefore, it’s a compensable injury under the Defense Base Act. More on that below.
The extreme stress of any of the aforementioned events, especially the latter two, alters the brain’s chemical composition. Stress enlarges the part of the brain that controls emotional responses (amygdala). As a result, the part of the brain that controls logical responses (hippocampus) shrinks. That imbalance causes symptoms like:
- Depression,
- Anger,
- Flashbacks,
- Hypervigilance, and
- Nightmares.
The cumulative effects of seemingly minor incidents, like falls, could cause complicated PTSD. If a deployment-related fall or other such injury was the straw that broke the camel’s back, in terms of PTSD, maximum benefits are usually available. Insurance companies are typically responsible for the actual consequences of any deployment-related injury.
PTSD Treatment
Currently, available medications and therapies ease the symptoms of PTSD but do not “cure” this brain injury or even adequately address its chemical cause.
Most PTSD medications are anti-anxiety drugs. These drugs often help PTSD victims sleep through the night so they can function the next day. Furthermore, these drugs often ease panic attacks and other issues.
Frequently, however, these medications do more harm than good. Many anti-anxiety drugs are highly addictive. An addiction to prescription medication makes PTSD treatment much more difficult. Such drug use transforms complicated or uncomplicated PTSD (uncomplicated means a single incident caused the injury) into comorbid PTSD.
In other cases, anti-anxiety medications work too well. Many PTSD victims assume that if one pill works well, two or three will work even better. This overuse, however well-intentioned, begins a downward spiral.
Only one kind of medication is currently available. Researchers are hopeful that hallucinogens could correct PTSD chemical imbalances, but approved drugs are still in the development phase. In contrast, several kinds of individual and group therapy are available.
Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE), the two kinds of therapy in the above study, are effective treatments for PTSD. PE focuses on directly confronting trauma memories through repeated exposure. CPT primarily aims to change negative thoughts and beliefs about the trauma by challenging them through cognitive techniques. So, PE is more suitable for individuals who benefit from direct exposure to their trauma, while CPT benefits those who struggle with negative thought patterns related to the trauma.
Group therapy helps PTSD victims remember that they do not suffer in isolation. It also helps these individuals avoid PTSD triggers, like violent movies. More innovative group therapy programs include art therapy, group therapy, and animal interaction therapy.
Therapy is hit-and-miss. Not all forms of individual or group therapy resonate with all PTSD victims. The nature of therapy often drives up the cost of treatment.
Injury Compensation Available
When private military contractors are injured overseas, a Defense Base Act lawyer forces insurance companies to replace their lost wages and pay all reasonably necessary medical bills.
Generally, the Defense Base Act, a 1941 law that’s similar to workers’ compensation in many ways, applies to private military contractors who are injured in an overseas war zone. Let’s break these components down.
Usually, the private military contractor must be under contract with a U.S. government agency, such as the DoD or State Department. Coverage applies to both military and non-military contractors, such as cooks and mechanics. DBA benefits may also be available for Peace Corps volunteers and anyone else in the service of the U.S. government overseas.
An overseas area is usually a foreign country. Many U.S. territories, such as Guma, also qualify as overseas deployment. Similarly, the law also defines a “war zone” very broadly. Any nation with an official U.S. military presence, even something as small as a guard at an embassy, is an overseas war zone.
Finally, a Defense Base Act lawyer must establish a nexus (indirect connection) between the deployment and the victim’s illness or injury.
For more information about DBA injury benefits, contact Barnett, Lerner, Karsen, Frankel & Castro, P.A.