2041. Group Therapy for Veterans with PTSD and Depression: A Randomized Trial
Nancy Jo Dunn, PhD, Houston VAMC and MIRECC, Veterans Affairs South Central and Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, LP Rehm, A Puget Sound Healthcare System, J Schillaci,
VeriCare, J Souchek,
Houston Center for Quality of Care and Utilization Studies, Houston VAMC and Department of Medicine, Baylor College of Medicine, P Mehta,
University of Houston, C Aston,
Houston Center for Quality of Care and Utilization Studies, Houston VAMC and Department of Medicine, Baylor College of Medicine, JD Hamilton,
Houston VAMC and MIRECC, Veterans Affairs South Central and Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
Objectives: Comorbidities like depression complicate treatment of posttraumatic stress disorder (PTSD), a major mental health problem for veterans. We present final results of a five-year, VA HSR&D Service grant (Project #IIR 95-074)—a randomized controlled trial examining efficacy and cost-effectiveness of a manualized group therapy for male combat veterans with comorbid PTSD and depression. We hypothesized that this treatment, of demonstrated efficacy in depression, might improve depression and PTSD.
Methods: We randomly assigned 101 male combat veterans with both PTSD and depression to Self-Management Therapy (SMT; Rehm, 1984), a cognitive-behavioral treatment, or to Psychoeducational Group Therapy (PGT; Dunn et al., 2000), a comparison therapy developed specifically for the study. All participants also received standard care within the Houston VAMC Trauma Recovery Program. Clinician-administered and self-report assessments at pretest, posttest, and 3-, 6-, and 12-month follow-up periods measured psychiatric symptoms, psychosocial functioning, treatment-targeted constructs, treatment compliance, and satisfaction. We determined service utilization and costs from VA databases.
Results: Results were: (1) Lifetime psychiatric comorbidity rates were high. (2) Therapies produced high participant satisfaction but minimal clinical changes. SMT was associated with modest improvement in depression (but not PTSD) during therapy (lost during follow-up), and lower psychiatric service utilization and costs, but no other positive outcomes.
Conclusions: Veterans with chronic PTSD, as in other recent psychotherapy outcome studies, proved difficult to treat, with chronicity, depression severity, and additional comorbidities likely contributing to poor response.
Impact: Sustaining initial symptomatic gains and reconciling high satisfaction ratings with minimal therapeutic improvement remain challenges with this population.