Multiple studies have found that Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans are at high risk for developing a number of physical and mental health problems, including chronic pain, smoking, difficulties managing anger, suicide, PTSD and depression.
The presence of depression, in addition to PTSD, among OEF/OIF veterans is a serious issue. Although there are a number of effective treatments available for PTSD, depression may interfere with people seeking out or sticking with these treatments. Depression is often associated with low motivation, feelings of hopelessness, difficulties concentrating, and low energy. All of these symptoms may prevent someone from fully benefiting from what an effective PTSD treatment, such as exposure therapy, has to offer.
For this reason, mental health professionals are beginning to develop specialized treatments for OEF/OIF veterans that combine elements of effective treatments for PTSD with elements of effective treatments for depression. One group of researchers at the Ralph H. Johnson Veterans Administration Medical Center and the Medical University of South Carolina developed such an intervention that combines exposure therapy with behavioral activation. Before we discuss this intervention, let's provide a little background on exposure therapy and behavioral activation.
Exposure therapy is considered a behavioral treatment for PTSD. This is because exposure therapy targets learned behaviors that people engage in (most often the avoidance) in response to situations or thoughts and memories that are viewed as frightening or anxiety-provoking.
The goal of exposure therapy is to help reduce a person's fear and anxiety, with the ultimate goal of eliminating avoidance behavior and increasing quality of life. This is done by actively confronting the things that a person fears. By confronting feared situations, thoughts, and emotions, a person can learn that anxiety and fear will lessen on its own. This can be done by having a person confront objects or images that remind them of their traumatic event. A therapist may also have a person imagine the traumatic event.
Behavioral activation is also a behavioral treatment, and it has been found to be very effective in addressing depression. However, there is some evidence that it may also be useful for people with PTSD. It is based in the idea that people with depression do not come into contact with positive or rewarding aspects of their environment. In behavioral activation, the main goals are to increase activity levels (and prevent avoidance behaviors) and help the patient take part in positive and rewarding activities which can improve mood.
The patient and therapist come up with a list of activities that the patient values and finds rewarding, such as reconnecting with friends or exercising. The therapist and patient also look at any obstacles that might get in the way of completing these goals. Each week the patient is asked to set goals for how many activities he or she wants to complete outside of session. Throughout the week, the patient then tracks his progress in achieving these goals.
A Combined Treatment
In the combined treatment, OEF/OIF veterans went through eight, 90-minute sessions that involved exposure to feared situations or thoughts, as well as scheduling meaningful activities and monitoring progress in doing these activities throughout the week. The researchers provided the treatment in-person, as well as in veterans' homes through video-conferencing technology.
The researchers found that the combined treatment was successful in reducing symptoms of PTSD, depression, and anxiety. Now, it is important to point out that the researchers did not compare this treatment to another treatment, so we can't be completely sure that the veterans wouldn't have responded just as well to another treatment. However, in the end, these findings are promising and show that a combined treatment for PTSD and depression does work.
If you are a returning OEF/OIF veteran and you suffer from symptoms of PTSD and depression. Help is available and mental health professionals are working hard to develop the best treatments for PTSD and depression in veterans. Your local U.S. Department of Veterans Affairs office can provide you with services, especially treatments that have been found to be effective in reducing symptoms of PTSD and depression. In addition, there are several websites that can help you find mental-health providers in your area who treat PTSD and other disorders.
Strachan, M., Gros, D.F., Ruggiero, K.J., Lejuez, C.W., & Acierno, R. (2012). An integrated approach to delivering exposure-based treatment for symptoms of PTSD and depression in OIF/OEF veterans: Preliminary findings. Behavior Therapy, 43, 560-569.