Setting the stage for recovery: Improving veteran PTSD treatment effectiveness using statistical prediction

Abstract

Over half a million Dutch veterans participated in almost a hundred war and peace keeping missions since 1940. During past deployments, veterans promoted peace and stability in conflict situations, endeavoured to win the hearts and minds of local communities and improved the lives of those affected in warzone circumstances. These men and women operated under harsh conditions that placed them at the vanguard of human violence and tragedy. Despite exposure to shocking and life-threatening events, combat veterans are resilient and the majority reflects positively on their deployment experiences. Some, notwithstanding, develop enduring psychological distress as a result of psychotraumatic experiences. Posttraumatic stress disorder (PTSD) is the most prevalent deployment-related psychological disorder. Veterans with PTSD are a difficult-to-treat population and psychotherapy interventions are limited in their effectiveness. Much is unknown about the workings of PTSD psychotherapy and why some veterans recover, whilst others do not respond to therapy. This dissertation identifies factors that impact and predict PTSD treatment outcome, to enable more tailored and effective interventions for veterans. The work also reflects on the workings of psychotherapy, arguing that the present dominant treatment paradigm, the medical model of psychotherapy, by itself is incomplete to understand and effectively improve therapeutic recovery. The dissertation demonstrated how predictive research can bridge the gap between science and practice to help increase the odds of recovery for veterans with PTSD. Therapeutic recovery can be predicted at three separate levels: patient, therapy, and setting. The predictors related to each level help set the stage for therapeutic recovery. Incorporating elements that predict treatment effectiveness outcome into our treatment strategies allows us to tailor our care strategies and improve the effectiveness of PTSD treatment interventions. Besides the identification of PTSD treatment effectiveness predictors, several alternative frameworks were forwarded that challenges the exclusivity of the medical model of psychotherapy in our research, practice and policies. These alternative frameworks, based on placebo effects and common factors, allow us to explore novel pathways to improve PTSD treatment effectiveness.