Psychodynamic group treatment of posttraumatic stress disorder in Vietnam veterans

Department of Veterans Affairs Medical Center, San Francisco, CA.
International Journal of Group Psychotherapy (Impact Factor: 0.44). 05/1992; 42(2):225-46.
Source: PubMed


Exposure to combat frequently imparts a sense of aloneness, guilt, and helplessness. These and other intrapsychic and interpersonal issues need to be addressed in treating Vietnam veterans suffering from posttraumatic stress disorder (PTSD). Group therapy is proposed as a core treatment modality for dealing with these problems. A model is proposed in which patients are treated for 1 year or more in weekly groups that meet for 16-week sequential segments. Clinical guidelines are made explicit to new members by the co-therapists. Discussion topics deal not only with traumatic experiences related to combat, but also with important pre- and postwar issues that are relevant to the symptoms of PTSD. Timely integration and working through of these issues in the group is critical.

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    • "Cognitive therapy Resick et al., 1988(98) Foa etal., 1991 (84) Resick and Schnicke, 1992 (97) Psychodynamic therapy Foreman and Marmar, 1985 (108) Hendin etal., 1986 (112) Lindy et al., 1988 (111) Lansky 1991 (113) Marmar, 1991 (114) Lindy et al., 1992 (115) Group therapy Walker, 1983 (117) McWhirter and Liebman, 1988 (118) Brockway, 1987 (119) Fischman and Ross, 1990 (120) Koller et al., 1992 (121) Helicopter ride OT War veterans 45 Increase in in-flight reactions, post- therapy Attitude survey and flight intrusive and painful memclinical observations ories. "
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    ABSTRACT: This article analyzes the literature on the treatment of posttraumatic stress disorder (PTSD). It briefly exposes the theoretical basis for each treatment modality and extensively examines pharmacological, behavioral, cognitive, and psychodynamic therapies, as well as group and family therapies, hypnosis, inpatient treatment, and rehabilitation. Articles were identified by scanning Medline and PsychLit for all papers in English reporting treatment of PTSD. Anecdotal case reports were, then, excluded. Eighty one articles were identified and categorized as either biological or psychological, with the latter category further divided into behavioral, cognitive, psychodynamic, and other treatment modalities. Information regarding the type of trauma, the sample studied, the treatment method, and the results of the treatment has been extracted from each article and is presented briefly. A synthesis of findings in each area is provided. Most studies explored a single treatment modality (e.g., pharmacological, behavioral). The cumulated evidence from these studies suggests that several treatment protocols reduce PTSD symptoms and improve the patient's quality of life. The magnitude of the results, however, is often limited, and remission is rarely achieved. Given the shortcoming of unidimensional treatment of PTSD, it is suggested that combining biological, psychological, and psychosocial treatment may yield better results. It is further argued that rehabilitative goals should replace curative techniques in those patients with chronic PTSD. A framework for identifying targets for each treatment modality is presented.
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    • "The lTauma literature supports Ule notion of having a co-therapy team for a group of survivors (Cole & Barney, 1987; Walker & Nash; Courtois, 1988; Sgroi, 1989; Fischman & Ross, 1990; Koller, Marmor & Kanas, 1992). There are many benefits to having team leadership especially willi a population that has suffered trauma: mutual support, shared observation and processi ng ofmaterial, and the po tential for a lessening of llie intensity of anxiety in the transference (Courtois. "

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