Running head: POST-TRAUMATIC STRESS DISORDER AMONG COMBAT VETERANS 1

Post-Traumatic Stress Disorder among Combat Veterans

Abigail Constant
Wayne State University

POST-TRAUMATIC STRESS DISORDER AMONG COMBAT VETERANS

Problem Formulation
In the research conducted by Price, Gros, Strachan, Ruggiero, and Acierno, the problem
of post-traumatic stress disorder (PTSD) among veterans is being addressed. The researchers
argue that multiple potentially traumatic events increase the risk of PTSD for all members of
society. Due to the nature of military service and exposure to combat situations when deployed,
military personnel are more prone to suffering from PTSD. Veterans from Operation Enduring
Freedom (OEF) and Operation Iraqi Freedom (OIF) are the population being researched in this
study. In this study, researchers argue that pre-deployment preparedness and other military
specific protective factors can reduce the prevalence of PTSD among veterans. The study also
addresses the effectiveness of exposure therapy, a common treatment of PTSD, when used on
these veterans. It is pointed out in the study that by determining the amount of pre-deployment
preparation that an individual has received, treatment can be tailored to their specific needs.
Researchers argue that the recognition that not all veterans respond to the same treatment is
extremely beneficial when professionals are treating them. The researchers hypothesize that the
amount of combat exposure results in a poor response to exposure therapy, however, increased
pre-deployment preparedness can decrease the prevalence of PTSD in veterans altogether.
Research Design
This study uses both qualitative and quantitative research designs, although quantitative
data is used much more in this particular study. One part of the study includes exposure therapy
and interviews to determine the progress made throughout the exposure therapy. This is the
qualitative part of the research design. Several different types of quantitative data are used to
measure different aspects of mental health. These clinician-rated measures include Beck
Depression Inventory2nd Edition, Clinician-Administered PTSD Scale, PTSD Checklist

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Military, Combat Experiences Scale, and Deployment Risk and Resiliency Inventory. All of these
provide numerical data that measures different mental health issues including symptoms of
depression, diagnosis of PTSD, severity of PTSD, and frequency of combat exposure.
By focusing strictly on the potentially traumatic events that may have taken place while
participants were deployed, threats to internal validity can be controlled. The use of quantitative
data in this particular study decreases the threat to internal validity due to the nature of the tests
that are used. The researchers in this study focused on pre-deployment preparation as well as
events that occurred during deployment that contributed to their PTSD. Also, any participants
using medication to help with existing symptoms are required to remain on the same medications
throughout the entire study. External validity in this study is not as easily controlled. Most of the
participants are males and it is a relatively small sample, using only one hundred and eleven
participants.
Sampling
The sample used in this study made use of one hundred and eleven veterans from
Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). These individuals had
all been diagnosed with PTSD or subthreshold PTSD, measured using the ClinicianAdministered PTSD Scale and were recruited through referrals at a Southeastern Veteran Affairs
Medical Center (Price, Gros, Strachan, Ruggiero, & Acierno, 2013). According to the study,
persons who are actively psychotic or demented, individuals with both suicidal ideation and
clear intent, or persons with substance dependence were excluded (Price, Gros, Strachan,
Ruggiero, & Acierno, 2013) which helps to control internal validity. This sample is
representative of recent military personnel. According to the study, OEF and OIF veterans have
been exposed to more combat situations than any other war in the history of the United States.

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Although OEF and OIF are the most recent wars affecting the country, there are many veterans
who have experienced different things due to the nature of the different wars of our history. This
study is effective because it deals with modern war veterans however, it does not deal with all of
the veterans that live within the United States. Dealing with modern war veterans can be an
advantage because wars have changed. Modern war is very different from historical wars.
Modern war is more combative and soldiers are exposed to an increased amount of potentially
traumatic events. A disadvantage to focusing on modern war veterans is that the aging veterans
from past wars may be experiencing PTSD as a result of different exposure. Again, due to the
different natures of wars in the past and the present, interventions that are effective with modern
war veterans could potentially be very different from historical war veterans. Using a different
sample of veterans from other wars could potentially lead to different results in this study
Measurement
Key variables in this study include the existence of PTSD or subthreshold PTSD
symptoms in participants and the effectiveness of treatment measured at the end of the study. The
existence of symptoms in participants was diagnosed by trained research staff supervised by
licensed clinical psychologists using the Clinician-Administered PTSD Scale. This scale is also
used to define PTSD and subthreshold PTSD. Other variables include potentially traumatic
events experienced during combat and perceived pre-deployment training which are both
variables that depend on each individual participant. By using all of the clinician-rated tests
listed in the Research Design section, researchers are able to compare levels before exposure
therapy and after therapy. This provides numerical data for every participant that can be
compared at the beginning and end of the study in order to determine the effectiveness of the
treatment. If the existence of PTSD or subthreshold PTSD was not defined by the Clinician-

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Administered PTSD Scale, a baseline diagnosis for each participant could be less consistent
which would cause problems with the entire study.
Data Collection
Data was collected two different ways. Participants were randomly selected to participate
in exposure therapy using either telecommunication or in-person. The individual treatment
involved eight weekly 1.5 hour sessions of exposure therapy (Price, Gros, Strachan, Ruggiero, &
Acierno, 2013). Assessments were administered in the first, second, fourth, sixth, and final
sessions. All of the clinician-related tests are administered in the first and final sessions. Selfreported measures of PTSD and depression were also reported during these sessions (Price, Gros,
Strachan, Ruggiero, & Acierno, 2013). Telecommunication sessions are conducted in the same
manner, but instead of in-person sessions, the use of Skype and other telecommunication
technology is used to administer treatment and assessments. In addition to treatment sessions,
each participant used a daily planner to keep track of participation and homework completion.
According to the study, exposure therapy administered via telecommunication is an
effective way to treat individuals with PTSD (Price, Gros, Strachan, Ruggiero, & Acierno, 2013).
An advantage to using telecommunication is that, although participants were randomly selected
to receive treatment via telecommunication, it might be more convenient for some participants.
Alternately, participants who were selected to receive in-person treatment might not have access
to transportation and might have a difficult time attending sessions.
By collecting data in sessions with the researchers, the study was not dependent entirely
on the participants, which is an advantage. This gives researchers more control over the
information they receive from participants. Administering assessments and test was the
responsibility of researchers which reduces some of the responsibility placed on participants. If,

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perhaps, information needed to be supplied by participants without attending sessions, there

could be an issue with participants dropping out of the study. Attending the exposure therapy
sessions holds participants accountable for taking part in the study.
Ethics and Cultural Considerations
This study was focused on finding OEF and OIF veterans that fit their criteria. According
to the study, 91% of participants were male, 60% were employed, and 52% were married. The
average age of participants was roughly 32 years old. Researchers claim that the study was
representative of the surrounding area with most participants self-identifying as Caucasian
(51%) or African American (44%). The research does not address physical disabilities, sexual
orientation, or economic class and primarily represents only two races. The research could have
included a wider variety of races as well as providing information regarding economic class and
other information. Additionally, the study does not specifically address many ethical issues. The
research states that participants were referred to the study from a Veteran Affairs Medical Center.
Although the article does not mention consent or confidentiality, it can be assumed that
participants gave consent and therapy sessions were confidential.
Results and Implications
This research found that more combat exposure resulted in a lower rate of change in
PTSD symptoms. This means that the more combat situations that participants were exposed to,
the lower the rate of change in symptoms after undergoing treatment and assessment. The
research also found that pre-deployment preparedness reduced the strength of the association
between combat exposure and treatment response for PTSD symptoms (Price, Gros, Strachan,
Ruggiero, & Acierno, 2013). This research greatly expands upon prior research, which mainly

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focuses on PTSD among civilians and sexual assault victims. The research found that generally,
exposure therapy decreased symptoms of PTSD in combat veterans.
I believe that this intervention would prove to be extremely effective when used on
modern war veterans. Treating PTSD in veterans is not the same as treating PTSD in civilians
due to the nature of traumatic exposure. Veterans are exposed to combat situations that civilians
would never be faced with in the United States. This particular intervention worked with
participants on an individual level by assessing participants self-identified pre-deployment
preparedness and using this as a way to measure their improvement throughout the study. Since
every veteran has a different background, different ethnicity and race, different religion, it is
important to take all of these factors into account when treating individuals.
A very important thing to take into consideration when treating veterans is that PTSD is
frequently undiagnosed. When PTSD remains undiagnosed, symptoms can worsen and increase.
Veterans would also not have access to any interventions if they are not diagnosed with PTSD.
The stigma of mental illnesses is another important factor that can limit the effectiveness of any
intervention. Having a mental illness in the military is looked down upon, which increases the
instances of undiagnosed mental illnesses, including PTSD.
This interventions main focus is PTSD symptoms in veterans. It specifically treats my
target population. The research identifies multiple factors that contribute to PTSD symptoms,
including the amount of pre-deployment training individuals receive and different levels of
combat exposure. This study is formulated very well as a way to handle the problem of PTSD in
veterans.
This research proves that increased pre-deployment preparedness decreases the risk of
PTSD among veterans. The research also proves that increase combat exposure increases the risk

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of PTSD. Finally, the research proves that exposure therapy decreases the symptoms of PTSD. I
believe that these are very valid findings that can be used to help veterans in the future.

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References
Price, M., Gros, D., Strachan, M., Ruggiero, K., & Acierno, R. (2013). Combat experiences, predeployment training, and outcome of exposure therapy for post-traumatic stress disorder
in Operation Enduring Freedom/Operation Iraqi Freedom veterans. Clinical Psychology
and Psychotherapy. 20. Pages 277-285.