Non-Trauma Intervention to Treat Posttraumatic Stress Disorder (PTSD) for Veterans and Service Members Suffering from a Traumatic Brain Injury (TBI)

Gold-standard treatments for posttraumatic stress disorder typically focus on the patient’s trauma through recall, retelling, and discussion of the trauma in order to promote psychological processing and recovery. These treatments can be highly effective but also difficult to complete, and so not the best option for everyone.

Particularly among service members and veterans with PTSD and traumatic brain injury (TBI), for whom added cognitive impairment can increase treatment difficulty, numerous studies show that few will initiate trauma-focused treatment in the first place. Of those who do, half drop out before completion. For those with co-occurring PTSD, TBI, and pain, such as posttraumatic headaches, rates are even worse.

Unfortunately, the consequences of failed PTSD treatment are dire for this population. When PTSD goes untreated, disability significantly increases, quality of life suffers, and suicide risk rises.

Hope for a good alternative

Fortunately, a growing body of research indicates that some non-trauma-focused cognitive-behavioral therapies, which do not directly address PTSD, can be effective options, with more patients completing treatment and experiencing improvements comparable to gold-standard therapies.

In fact, our own group developed and tested Cognitive Behavioral Therapy for Headache (CBTH) with veterans who had mild TBI, posttraumatic headache, and symptoms of posttraumatic stress. This brief, 8-session intervention combines symptom tracking, relaxation, stress management, problem-solving, biofeedback and cognitive therapy strategies to improve self-management of symptoms.  For the study, a leading PTSD therapy called Cognitive Processing Therapy (CPT) was used with a comparison group.

Results with CBTH were even greater than expected. Not only did it help participants with their headaches; it also reduced PTSD symptoms at rates comparable to CPT while being better tolerated by patients, with fewer dropouts. Further analyses revealed that headache improvement was not primarily associated with reductions in PTSD symptoms, but rather, posttreatment changes in depression, anxiety, and insomnia severity.

Current study adapts and tailors treatment

Based on these findings, the researchers will now adapt the headache therapy to focus more on PTSD symptoms as they work to develop, refine and then pilot test a non-trauma intervention for PTSD tailored to military service members and veterans with TBI. They’re naming it Non-Trauma Treatment for TBI and Comorbid PTSD, or T3 PTSD.

This effort is led by Cindy McGeary, PhD, of The University of Texas at San Antonio Long School of Medicine, and involves a multi-step, participatory research approach. Taking the empirically supported treatment manual for CBTH, the team will consult with a community advisory board, lived experience consultant, and subject matter experts to assess the treatment and how best to adapt CBTH to T3 PTSD, then revise the manual to incorporate those recommendations.

Next, focus group sessions will be conducted incorporating two patient-based groups: military and veterans who have experienced trauma-focused interventions for PTSD and/or the manualized CBTH intervention upon which the revision is based. Focus groups will answer questions related to treatment acceptance, adoption and use of the manual, tolerability of the T3 PTSD treatment, and treatment completion and satisfaction. Their feedback will be used to further refine the treatment manual before it is adopted by the group.

The final phase of the study is to pilot test the intervention with active duty military and veteran participants from the Intrepid Spirit Center at Fort Hood’s Carl R. Darnall Army Medical Center.  Participants may have headaches of any severity or no headaches at all to ensure that the sample is representative of the population of interest: service members and veterans with comorbid TBI and PTSD.

Besides treatment outcomes, the study team will monitor treatment completion and dropout rates and conduct exit focus groups to obtain feedback on patient satisfaction.

Expected outcomes

Findings will be used to further refine the treatment manual and to develop a full-scale randomized clinical trial to evaluate treatment efficacy.

Ultimately, researchers hope to offer the field a non-trauma-focused intervention that can significantly impact the psychological health of individuals with co-occurring PTSD and TBI while reducing barriers to care, with applicability to service members, veterans, and civilians.