Implementing and Evaluating a Patient-Centered PTSD Treatment Program for Military Personnel


Sep 25, 2024

The past 20 years of research, including by STRONG STAR, has yielded sufficient evidence for the efficacy of several therapies for posttraumatic stress disorder in military personnel. Similarly, success with different delivery formats – spread out over several weeks, condensed into one or two weeks, in-office, in-home, or via telehealth – has made evidence-based treatments more appealing and accessible to the military community.

Yet PTSD recovery rates are still not as high in military as compared to civilian populations, and there seems to be a reluctance among military personnel first to initiate and then to complete PTSD treatment. Some report that’s due to feeling like a particular treatment is not well-suited to them or their situation, while others have expressed frustration over a seeming lack of control over their treatment.

Empower patients, improve care?

If service members seeking PTSD treatment could be presented with more options and allowed to engage in informed, shared decision making about the treatment they receive, might that increase their likelihood of initiating, more fully engaging in, and completing treatment – and in the process lead to improved recovery rates and increased patient satisfaction?

Answering that question is the aim of a STRONG STAR study led by Initiating Principal Investigator (PI) Alan Peterson, PhD (Lt Col, USAF, Ret.), and Early Career Partnering PI Vanessa Jacoby, PhD, of The University of Texas Health Science Center at San Antonio.

How the study works

The study will involve active duty military personnel at Fort Cavazos and evaluate a shared-decision-making model of patient-centered healthcare that has been shown to maximize patient engagement and satisfaction. Military participants will be offered and receive thorough descriptions of a menu of evidence-based, cognitive-behavioral therapies to include Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and Written Exposure Therapy (WET). Options also will be provided on treatment frequency (condensed or spread out over several weeks), treatment modality (in the clinic or via telehealth), and length (number of sessions may vary by treatment type and/or patient response).

This two-step, partially randomized preference trial will then follow a process that allows patients with a strong preference to select their particular treatment and others to identify treatment arms to which they are willing to be randomized. Investigators will examine which patient characteristics and preferences lead to selection of and improved outcomes with different treatment options, with the goal of guiding future efforts in personalized medicine.

Expected benefit

Investigators also will compare these outcomes to prior randomized clinical trials with military personnel that did not involve shared decision making. They hypothesize that those who engage in shared decision making will (1) show higher rates of treatment completion and (2) have larger reductions in PTSD symptoms posttreatment.

If their hypotheses are correct, this model could be recommended to help improve PTSD care across the Military Health System for service members with a PTSD diagnosis who avoid treatment or who drop out prematurely.

Assessment and Treatment of Chronic Anger and Aggression Following Military-Related Interpersonal and Institutional Betrayal: A Pilot Investigation


Mar 20, 2023

Difficulty controlling anger is the most commonly reported problem that military service members and veterans report upon reintegration after deployment. Research shows that more than half of veterans using VA services report problems controlling anger. This results in legal, employment, social interaction, or relationship problems for many veterans. Chronic, unmanaged anger can lead to aggression, interpersonal violence, and suicidal thoughts.

Chronic hostility, anger, and aggression are common after a person experiences betrayal betrayal. More than one fourth of service members and combat veterans report experiencing events involving military-related betrayal, either by the military or individuals during military service, including loved ones.

Seeing a need for an intervention to address anger and aggression in active duty military personnel, STRONG STAR investigators have designed a pilot study to test a treatment that directly targets reducing chronic anger and aggression and improving interpersonal relationships. The treatment, Countering Chronic Anger and Aggression Related to Trauma and Transgressions (CCAARTT), will focus on helping service members heal after transgressions they have suffered.

How the program works

CCAARTT will combine evidence-based anger regulation and interpersonal effectiveness skills with betrayal-focused processing. This might include such things as making meaning of betrayal, letting go of ineffective resentment, and finding purpose after betrayal. The study will prominently include promotion of forgiveness and compassion for self and others as a way to reduce anger and improve interpersonal functioning. Forgiveness and compassion-focused interventions have been found to be effective in prior research, but this has not yet been tested in a military population.

The research team has worked to fine-tune the intervention by consulting with service members, military leaders, and key military-serving providers to ensure that the treatment approach aligns with military culture.

Led by Initiating Principal Investigator (PI) Vanessa Jacoby, PhD, and Partnering PI Alan Peterson, PhD (Lt Col, USAF, Ret.), of The University of Texas Health Science Center at San Antonio, the team will recruit participants from the Fort Cavazos (formerly Fort Hood) area in Killeen, TX, including mental health clinics where STRONG STAR has ongoing and well-established relationships.

A four-phased approach

The CCAARTT intervention is heavily based on an approach called the Process Model of Forgiveness. Using this model, the intervention is divided into four phases to guide patients through the process of forgiveness:

  • Developing motivation for change by exploring the benefits of forgiveness and negative impact of holding onto anger or resentment
  • Making the decision to work toward forgiveness
  • Building skills of empathy and compassion to reduce anger and find peace, and
  • Exploring the emotional freedom one has gained by putting down the burden of chronic anger.

Expected benefits

The research team believes that participants will experience significant reductions in the frequency and intensity of distressing anger, psychological aggression, and physical aggression, as well as improvements in their interpersonal functioning.