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Objective: We evaluated patterns and predictors of change from three efficacy trials of trauma-focused cognitive–behavioral treatments (TF-CBT) among service members (N = 702; mean age = 32.88; 89.4% male; 79.8% non-Hispanic/Latino). Rates of clinically significant change were also compared with other trials. Method: The trials were conducted in the same setting with identical measures. The primary outcome was symptom severity scores on the PTSD Symptom Scale—Interview Version (PSS-I; Foa, Riggs, Dancu, & Rothbaum, 1993). Results: Symptom change was best explained by baseline scores and individual slopes. TF-CBT was not associated with better slope change relative to Present-Centered Therapy, a comparison arm in 2 trials. Lower baseline scores (β =.33, p <.01) and higher ratings of treatment credibility (β = −.22, p <.01) and expectancy for change (β = −.16, p <.01) were associated with greater symptom change. Older service members also responded less well to treatment (β =.09, p <.05). Based on the Jacobson and Truax (1991) metric for clinically significant change, 31% of trial participants either recovered or improved. Conclusions: Clinicians should individually tailor treatment for service members with high baseline symptoms, older patients, and those with low levels of credibility and expectancy for change. Three randomized trials demonstrated that trauma-focused cognitive–behavioral therapies for war-related posttraumatic stress disorder in active duty military personnel had rates of clinically significant change that were substantially smaller than in studies of civilians and not different from Present-Centered Therapy. This study highlights the importance of tailoring treatment for service members with high baseline symptoms, older patients, and those with lower levels of credibility and expectancy for change. [ABSTRACT FROM AUTHOR]

Objective: To determine whether group therapy improves symptoms of posttraumatic stress disorder (PTSD), this randomized clinical trial compared efficacy of group cognitive processing therapy (cognitive only version; CPT-C) with group present-centered therapy (PCT) for active duty military personnel. Method: Patients attended 90-min groups twice weekly for 6 weeks at Fort Hood, Texas. Independent assessments were administered at baseline, weekly before sessions, and 2 weeks, 6 months, and 12 months posttreatment. A total of 108 service members (100 men, 8 women) were randomized. Inclusion criteria included PTSD following military deployment and medication stability. Exclusion criteria included suicidal/homicidal intent or other severe mental disorders requiring immediate treatment. Follow-up assessments were administered regardless of treatment completion. Primary outcome measures were the PTSD Checklist (Stressor Specific Version; PCL-S) and Beck Depression Inventory-II. The Posttraumatic Stress Symptom Interview (PSS-1) was a secondary measure. Results: Both treatments resulted in large reductions in PTSD severity, but improvement was greater in CPT-C. CPT-C also reduced depression, with gains remaining during follow-up. In PCT, depression only improved between baseline and before Session 1. There were few adverse events associated with either treatment. Conclusions: Both CPT-C and PCT were tolerated well and reduced PTSD symptoms in group format, but only CPT-C improved depression. This study has public policy implications because of the number of active military needing PTSD treatment, and demonstrates that group format of treatment of PTSD results in significant improvement and is well tolerated. Group therapy may an important format in settings in which therapists are limited. [ABSTRACT FROM AUTHOR]

Irritability, angry outbursts, and aggression are common among individuals with posttraumatic stress disorder (PTSD). Although aggression can be a problem among many individuals with PTSD, research suggests that the relationship between PTSD and aggression might be particularly relevant among military/veteran populations as compared to civilians. The current study examined psychological and physical aggression in a large sample of treatment-seeking military service members and veterans (N = 1434) enrolled in nine PTSD clinical trials. A baseline assessment using a modified version of the Revised Conflict Tactics Scales evaluated aggression toward others in the past month. The results indicated that psychological aggression was more prevalent than physical aggression among military personnel with PTSD. Overall, 84.7% reported engaging in weekly psychological aggression, and 11.4% reported weekly physical aggression. Shouting at someone, insulting someone, and stomping off during a disagreement were the most frequent forms of psychological aggression endorsed. The findings provide a detailed account of the point prevalence and nature of various self-reported aggressive behaviors in military personnel with PTSD. • Psychological aggression (85%) was more prevalent than physical aggression (11%). • Shouting/yelling, insulting/swearing, and stomping off were commonly endorsed. • Most participants reported engaging in psychological aggression on a weekly basis or more. • About 1/10 participants reported engaging in physical aggression on a weekly basis or more. [ABSTRACT FROM AUTHOR]