Evidence-based assessment and treatment of military/Veteran PTSD: Reflections on 15 years of practice

Abstract

LAY SUMMARY This reflection following 15 years of military/Veteran clinical practice reviews special assessment and treatment considerations, with a focus on prolonged exposure therapy for posttraumatic stress disorder. It discusses common assumptions about evidence-based psychotherapy that can negatively impact treatment outcome and patient motivation and participation in treatment. The widely varying clinical presentations of the Canadian military population and unique nature of military service, as well as its impact on mental health, are reviewed. Key practice suggestions include the importance of identifying the index trauma, using outcome monitoring, and understanding the theory of each of the gold-standard trauma-focused psychotherapies, as well as the rationale for each included intervention, so that clinicians can tailor treatments to patients as clinically required. Common misunderstanding and complexities related to trauma-focused psychotherapies are discussed, including the goal of treatment and clinician hesitation to implement evidence-based psychotherapies. The intention of this reflection is to increase discussion, contribute to a greater understanding and deeper appreciation for the uniqueness of military/Veteran patients, and promote advancement and innovation in research and clinical practice.