Cognitive Behavioral Therapy For Posttraumatic Stress Disorder In Military Women

Background

Discuss about the Cognitive Behavioral Therapy for Posttraumatic Stress Disorders.

The article for critique gives a detail discussion on how military women are prone to posttraumatic stress disorder.The authors suggest that the cognitive behavioral therapy will treat the disorder. The therapy involves changing a person’s behavior and thought that is brought by certain traumatic event (Frost, Laska and Wampold, 2014).  The title of the article is informative. However, the authors have generalized the title to women. In the research, they categorically dealt with military women.  According to Schnurr et al (2007), posttraumatic stress is prevalent in women who serve in the military. The title does not distinguish whether the research is on the active-duty women or women of any occupation. Perhaps the title could be cognitive behavioral therapy for posttraumatic stress disorder in active-duty women. However, the title clearlyindicates the population of study which is women, posttraumatic stress disorder as the independent variable and the cognitive behavioral therapy as the dependent variable.

According to the researchers, their focus was on women. studies had been previously done on men. They indicated there is high lifetime prevalence of posttraumatic stress disorder in women in  theUS than in menserving in the military (Harvey, Bryant and Tarrer, 2003).This indicate it is necessary for this research to be conducted. Since the study was on active-duty women, it is expected that the ability to perform their duties is reduced. As according to Foa and Rothbaum (2001), when the posttraumatic symptoms goes untreated they lead to depression and changes a person’s way of life. The major causes of this disorder being events that cause anxiety behavior such as attack, war, assault, rape and accident, the authors focused on military women as the population under consideration. However, these traumatic events seem to be highly experienced by refugees, orphans and slaves (Hoge and Chard, 2018). Therefore, more research studies should be done in women who have been exposed to these traumatic events to avoid biasness in the results. The aim of the study was to test treatments for posttraumatic stress disorder. According to the researchers’ cognitive behavioral therapy and medications were used in treatment of this disorder, therefore, it was not necessary to point that the study was to test treatment. The aim of the study is not relevant since already there is treatment for the disorder. Perhaps the aim could be to determine the effective treatment of the posttraumatic stress disorder. The study hypothesized that prolonged exposure therapy would be more effective than present-centered therapy. This hypothesisis drawn from the fact that re-experiencing the trauma through memories helps the anxiety and emotions related to the traumatic event to die off (Power et al, 2010). the justification for the study is that, present-centered therapy, a supportive intervention was seen to reduce the posttraumatic stress disorder but do not remove depression as compared to cognitive process therapy (Resick et al, 2015). Normally in the cognitive therapy, the therapist and the client are usually the main participants. As stated by Roth, Eng and Heimberg (2002), the therapist normally does not have the answers to the client problems, but they work together to overcome the disorder. The level of cooperation from the client highly determine the effectiveness of the treatment (kar, 2011).

Research Objectives

The theoretical framework of the research was not clearly identified. The authors do not explain why military women act as the focus of the study while the title generalizes on women. The concept on prolonged exposure as treatment for posttraumatic stress disorder was clearly identified by reference to other single researches where the treatment was successful. However, the researchers do not identify why the suggested treatments were chosen over other cognitive behavioral therapy techniques. The literature review did not cover on the effectiveness of other cognitive behavioral therapy techniques on the treatment of PSTD. The basis of development of the hypothesis was clearly defined by the use of the present centered theory, present centered therapy was seen as not effective on treatment on PSTD.

In this research, the experimental design was used. Two hundred and eighty-four participants were enrolled.The sampling of the veterans’ location was not well elaborated. Theresearchersdetermined the criterion of inclusion. A participant should have symptoms severity of forty-five or higher. This severity was determined by qualified clinicians. The participants should have been exposed to the traumatic event three months or more before the study. The criteria of setting the duration that one should have been exposed to the traumatic event before the study was conducted, was not indicated in the study. The criteria of inclusion coincide with the objective for the study, to test treatments for posttraumatic stress disorders. one hundred and forty-one were randomly exposed to the prolonged exposure therapy and one hundred and forty-three to the present-centered therapy.Here the experimenters do not have the right to allocate participants into groups.This provide no room of experimenter manipulation.  In the prolonged exposure therapy, the patients were educated or taught on common reactions to trauma and they were made to remember the events they had passed through more frequently. In the present -centered therapy the patients were told to focus on the current life problems or difficulties and think of the problem that brings more of the trauma symptom (McDonagh, Friedman, McHugo, Ford, Sengupta, Mueser, Descamps, 2005). the participants were later followed up biweekly through telephone calls. The assessment was also done on three and six months interval. The follow up of participant during the study was an efficient method of identifying effects of the treatment and the adverse events. However, the client may give false information especially in phone calls (Tuerk, Yoder, Grubaugh, Myrick, Hamner&Acierno, 2011). This may compromise on the results. The design allows tighter control of the participants and therefore making it easier to identify the causes of the anxiety behavior and the effects of the same on the participants. Comorbid symptoms and direct exposure data were collected through questionnaires and life checklists respectively. This ensures standardization of the questions and help to avoid biasness. However, this method of data collection lack details and perhaps video recording could be used to collect data during the treatment sessions. They used a seven-point scale to rate the treatment satisfaction.

Study Design

The researchers observed the research ethics. The participants were well informed about the study and their consent to participate in the study was put into consideration. They also had a right to leave the study at their own will. The participant treatment conditions were handled with confidentiality and the research focused on not harming the participants but rather helping them to overcome the anxiety behaviors.

In this study, the quantitative data from the questionnaires and checklist were analyzed by the biostatisticians. However, the analysis methods were not clearly explained it was a mere description of the tools used. the researcher could provide a statement describing how reliable and valid the results are. his may make the results unreliable. In the analysis the primary analysis was done using all randomized participants and the secondary analysis using data from all those who completed the study. The quantitative result indicated that averagely the participants had been exposed to ten types of trauma. Sexual trauma being the worst trauma ever experience, physical assault and war zone exposure following respectively. as asserted by Suris and Lind (2008), the risk factors that exposed military women to sexual harassments included age, enlisted rank and negative home life. Tables were well and accurately used to indicate the type of trauma they were exposed to. In the table presentation, data appeared vague. Perhaps bar chats could be used instead to clearly depict the differences in severity. From the result the researchers found that there is an increased number in treatment drop out in the prolonged exposure therapy. Also, in the prolonged exposure the participants had a tendency of losing their diagnosis than those in the present centered therapy. However, the researcher also identifies some adverse events that occurred to the participant. The research results however cannot be extrapolated to the other women who don’t serve in the military. This is because of variation in environments and frequency of exposure to these traumatic events.

The studies indicated factors that led to the high drop out from treatment in the prolonged exposure. However, this was not covered extensively. Lack of reference from other researchers in their discussion makes the work to lack credibility. The drop out could have been attributed to other factors other than fear of the participants to contain their traumatic memories (Bennett and Nelson, 2006),which was not well covered by the researchers. The loss of diagnosis in the prolonged exposure that was attributed to the adaptation to the anxiety behaviors through re-experiencing the events was not well elaborated. The inclusion of qualified clinicians in the study could affect the results of the study. the participants lacked a supportive environment that could be achieved by having people who they could interact with well. The researchers achieved their hypothesis by finding that the prolonged exposure therapy was an effective method of treating posttraumatic stress disorder. However, further research should be done to determine whether the results applies in other women exposed to the traumatic events frequently for instance the refugees.

Results

Conclusion

In conclusion, the articles procedures and methodology were well elaborated and chronologically arranged. It was easy to follow and understand. The research found that there were significant improvements in the prolonged exposure therapy. Therefore, recommended the adoption of the results in the military department to prevents detrimental effects of the posttraumatic stress disorder on the active-duty women. However, the article based their arguments more on the prolonged- exposure therapy. The study focused on its own agenda of proving that cognitive behavioral therapy was the right treatment of posttraumatic stress disorder. It did not give the reader room to determine which of the treatment was effective. The study therefore may not be considered credible. Further research should be done to find whether the prolonged exposure therapy could be effective for other disorder other than those caused by trauma events. For instance, bulimia, management of chronic pain, coping with grief and loss, managing anger, drug addiction and overcoming sleep disorders.

References

Bennett, R., & Nelson, D. (2006). Cognitive behavioral therapy for fibromyalgia. Nature   Reviews Rheumatology, 2(8), 416

Foa, E. B., &Rothbaum, B. O. (2001). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. Guilford Press.

Frost, N. D., Laska, K. M., &Wampold, B. E. (2014). The evidence for present?centered therapy as a treatment for posttraumatic stress disorder. Journal of Traumatic Stress, 27(1), 1-8.

Harvey, A. G., Bryant, R. A., & Tarrier, N. (2003). Cognitive behaviour therapy for posttraumatic stress disorder. Clinical psychology review, 23(3), 501-522.

Hoge, C. W., & Chard, K. M. (2018). A Window Into the Evolution of Trauma-Focused Psychotherapies for Posttraumatic Stress Disorder. Jama, 319(4), 343-345

Kar, N. (2011). Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a  review. Neuropsychiatric Disease and Treatment, 7, 167.

McDonagh, A., Friedman, M., McHugo, G., Ford, J., Sengupta, A., Mueser, K., … & Descamps, M. (2005). Randomized trial of cognitive-behavioral therapy for chronic posttraumatic            stress disorder in adult female survivors of childhood sexual abuse. Journal of consulting   and clinical psychology, 73(3), 515.

Powers, M. B., Halpern, J. M., Ferenschak, M. P., Gillihan, S. J., &Foa, E. B. (2010). A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clinical psychology review, 30(6), 635-641.

Resick, P. A., Wachen, J. S., Mintz, J., Young-McCaughan, S., Roache, J. D., Borah, A. M., … & Peterson, A. L. (2015). A randomized clinical trial of group cognitive processing therapy    compared with group present-centered therapy for PTSD among active duty military  personnel. Journal of Consulting and Clinical Psychology, 83(6), 1058.

Roth, D. A., Eng, W., &Heimberg, R. G. (2002). Cognitive behavior therapy. Encyclopedia of      psychotherapy, 1, 451-458.

Surís, A., & Lind, L. (2008). Military sexual trauma: A review of prevalence and associated health  c onsequences in veterans. Trauma, Violence, & Abuse, 9(4), 250-269.

Tuerk, P. W., Yoder, M., Grubaugh, A., Myrick, H., Hamner, M., &Acierno, R. (2011). Prolonged exposure therapy for combat-related posttraumatic stress disorder: An examination of    treatment effectiveness for veterans of the wars in Afghanistan and Iraq. Journal of anxiety   disorders, 25(3), 397-403.