It is most frequently associated with combat veterans, victims of violent crimes or those caught up in natural disasters, but post-traumatic stress disorder (PTSD) is most prevalent among survivors of serious car accidents.
"PTSD occurs in about 28% of those who have experienced or witnessed a life-threatening event," said Gayle Beck, PhD, professor of psychology at the University at Buffalo and director of the university's Motor Vehicle Accident Clinic.
"Serious car accidents are perhaps the most commonly experienced traumatic events in the United States," she said, "They injure 3 million Americans a year and kill 42,000."
PTSD is marked by clear and significant psychological and physical changes. Its symptoms in accident victims, added Beck, can be just as serious and debilitating as they are in combat veterans.
"They have nightmares, flashbacks, sleep difficulties, feel jumpy and jittery, experience anxiety, fear of driving and social isolation," she said. "If untreated, about 30% of those affected will develop a chronic form of the disorder that will persist throughout their lives."
Beck said the therapeutic community after many years finally has recognized the frequency and seriousness of postaccident PTSD.
"More people are being diagnosed and treated," she said, "but as the incidence rates go up, more and more insurance companies balk at paying for conventional treatment. To date, the most common and successful treatment used for all kinds of PTSD is individual cognitive behavioral therapy conducted by a highly trained professional," Beck said.
"Insurance companies have been 'skinnying up' reimbursements to psychologists and psychiatrists for years," she noted, "and want to limit their enrollees with PTSD to group therapy conducted by other kinds of therapists because it's cheaper for the companies.
After years of clinical research, she and her team believe they have developed an effective therapeutic model for applying cognitive therapies to PTSD patients in a group setting.
This model can be adapted for the group treatment of people traumatized by other events as well, but Beck said it will work best when a therapy group comprises individuals traumatized by similar experiences; all members of the group are sexual assault victims, were in bad accidents, or lived through another life-threatening event.
To assist therapists who may not be familiar with the treatment of such patients, the team also is completing a treatment manual that will train them to apply these methods successfully.
"That's important," said Beck, "because we cannot simply pick up a successful model for individual therapy and impose it on a group. Nor can we expect untrained, inexperienced therapists to treat PTSD in group sessions without running into risks, such as aggravating the symptoms of some members of the group."
The group training-and-treatment program is being evaluated under a 3-year, $500,000 grant from the National Institute of Mental Health.
Based on her previous experience, Beck said she expects the evaluation to show that patients whose therapists carefully apply the recommended cognitive behavioral therapies in a group setting will benefit greatly.
"I expect that at the end of group therapy, patients will show reductions in PTSD-related symptoms like anxiety and depression," she said. "They also will use health care resources less often, and will report less distress and impairment from pain at the end of treatment.
"What we've learned from applying this treatment is that group therapy not only can work as well as individual therapy," she added, "but it can go even further in helping patients deal with their frightening and misunderstood symptoms. This article was prepared by ManagedHealthcare.Info editors from staff and other reports.
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