Does War Zone Impact Treatment Response for Veterans with PTSD?

Back when I was a psychology intern at the Portland VA Medical Center, the majority of the veterans I worked with were Vietnam era. Veterans from the wars in Afghanistan and Iraq were trickling in, but were not a large presence yet. I’ve heard that’s changed in the last few years, and the Veteran’s hospitals are serving increasing numbers of younger vets.

 

A new study by Yoder and colleagues looks at whether there’s a difference among veterans in response to treatment for PTSD. The treatment is Prolonged Exposure (PE) therapy, an empirically-supported exposure-based therapy for PTSD. The study compares veterans of Vietnam, the Gulf War, and what are known as OEF (i.e., “Operation Enduring Freedom” aka the war in Afghanistan), OIF (i.e., “Operation Iraqi Freedom”), and OND (i.e., “Operation New Dawn” coined to indicate the shift from combat to stabilization in Iraq).

 

What Did They Look At?

Conducted at the VA Hospital in Charleston, SC, the researchers used archival data to test their hypotheses. What this means is that the study was not originally designed to answer the questions posed. This in itself is not a problem, but it means that the results should be taken with a bit more caution until replicated.

 

The study looked at veterans who completed PE for PTSD. There were 112 participants total: 61 OEF/OIF/OND; 34 Vietnam; and 17 Gulf War. Veterans were treated by one of three therapists using PE.

 

Gulf War Veterans May Respond More Slowly to Treatment

Overall, veterans improved with treatment regardless of war background. Interestingly, Gulf War veterans responded less well to PE than Vietnam and OEF/OIF/OND veterans even though all showed comparable scores of PTSD and depressive symptoms prior to treatment. Gulf War veterans were slower to respond to therapy.

 

Why did Gulf War veterans respond different? The researchers aren’t sure. What they suggest is that:

 

“It may be due to population differences related to variable stress-diathesis selection processes for chronic fear experiences versus acute types of trauma or to variable self-selection pressures and concurrent treatment seeking behaviors that may vary in some important, though unmeasured, ways among war-zone cohorts.” (p. 8)

 

This is just a long-winded, gobbledygook way of saying: We don’t know. Maybe Gulf War veterans are different.

 

My Thoughts

The good news is that veterans seem to respond well to PE for PTSD regardless of war. Why Gulf War veterans responded more slowly to treatment may be a fluke. I also wasn’t clear whether the researchers statistically accounted for this or not, but given that there were fewer of Gulf War veterans (n = 17) compared to Vietnam (n = 34), and OEF/OIF/OND (n = 61), it’s possible that the results may be skewed by a few Gulf War veterans who were poor responders to treatment (aka outliers).

 

For these reasons, I’d wait until the results are replicated with another sample before we can say with any confidence that Gulf War veterans may respond differently to treatment.

Brian is a licensed clinical psychologist with clinical and research interests in trauma and anxiety disorders, as well as a fascination with evidence-based practice and pseudoscience.
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