Multicomponent behavioral treatment for chronic combat-related posttraumatic stress disorder: Trauma management therapy

Posttraumatic stress disorder (PTSD) is a severe and chronic mental disorder that is highly prevalent within Veterans Affairs (VA) Medical Centers. A severe psychiatric disorder, combat-related PTSD is typically accompanied by multiple comorbid psychiatric disorders, symptom chronicity, and extreme social maladjustment. Thus, PTSD is a complex psychiatric disorder resulting in considerable emotional distress and impaired social functioning and often constitutes a significant treatment challenge. Although a range of psychotherapeutic strategies for chronic PTSD have been advanced, behavioral treatments emphasizing various methods of exposure therapy have been the most carefully studied and show the most promise. However, chronic PTSD exposure alone does not appear to have a significant effect on the negative symptoms of PTSD (e.g., avoidance, interpersonal difficulties) or anger control. This may be because exposure is more focused on anxiety and fear reduction and does not address basic skill deficits, help reestablish impaired relationships, or teach anger control. Therefore, we developed a multicomponent treatment program to complement exposure by targeting those areas of the clinical syndrome (e.g., social skills) not found to be helped by exposure alone. This treatment program, trauma management therapy (TMT), has showed good preliminary results in an open trial. In this article, we describe the treatment program, including elements of education, individually administered exposure therapy, programmed practice (i.e., homework), and group-administered social and emotional skills training. The appendix includes a detailed description of how to implement the social and emotional skills training components on a session-by-session basis; the full TMT treatment manual is available on request.