Prospectus: The Effectiveness of CPT in Treating Young Iraq War Veterans Diagnosed with PTSD
Order Description
Prospectus

Prospectus: The Effectiveness of CPT in Treating Young Iraq War Veterans Diagnosed with PTSD
Anthony Ukaha
Doctor of Human Services
Walden University
A00158659 – Quarter Based

Prospectus: The Effectiveness of CPT in Treating Young Iraq War Veterans Diagnosed with PTSD
Problem Statement
The number of veterans in the USA suffering from post-traumatic stress disorder (PTSD) persists in being a serious problem in the national health statistics.
Particular health measures exist for PTSD intervention, but as veterans continue returning from the wars in Afghanistan and Iraq, the incidences of veteran suicide persist (Zarembo, 2014). Statistical reports have indicated a jump in the number of young veterans, aged between 18 to 29 years, committing suicide, with the number having gone from 88 in 2009 to 152 in 2011 (Zarembo, 2014). This increase represents about 44% change in suicide rate based on data from the Veterans Health Administration. This trend is despite the fact that the overall rates of suicide among veterans have remained unchanged, remaining at about 22 veterans a day, implying
that the rates of suicide for older veterans have diminished significantly (Hudenko, Homaifar, & Wortzel, 2016). With such trends, it becomes plausible that the existing interventions for PTSD are ineffective among younger veterans, and compels the need for more fitting treatment for this population. The prominence of veteran suicide becomes clearer with comparative statistics for the general population. Veterans only comprise 7% of the population of the USA, and yet 18% of all the suicides
in the country are committed by this minor group. The number translates to about 7400 veterans annually, according to figures from the US Department of Veteran Affairs (Hudenko, Homaifar, & Wortzel, 2016). It is possible that these numbers may be higher according to public debates on the reporting of suicides.
The rate of veteran suicide has especially increased post 9/11, suggesting the intersection of the experiences of war and the conditions at home in deteriorating the quality of mental health among the veterans (U.S. Department of Veterans Affairs, 2016). The younger veterans are especially vulnerable to PTSD, owing to their having to seek employment and make homes after they leave the service and barely seeking health care (Zarembo, 2014). In an attempt to combat the rate of veteran suicide, the
US Department of Veteran Affairs applies two primary interventions: prolonged exposure and cognitive processing therapy (CPT) (U.S. Department of Veterans Affairs, 2016). While these statistics persist, one must note that there already exist interventions for PTSD among veterans. However, the viability of current approaches to
treating PTSD and traumatic brain injury remains a matter of contention. Arguments indicate that the use of CPT is only effective for the reduction of symptoms and not
necessarily to treat PTSD (Bares, 2015). Several studies have undertaken to assess the viability of CPT as an intervention for PTSD among war veterans, with most of
them revealing positive findings (Chard, Schumm, McIlvain, Bailey, & Parkinson, 2011; Eftekhari, et al., 2013; Monson, et al., 2012). Nevertheless, the persistence of
PTSD occurrence and adverse effects such as veteran suicide suggests the need for specificity in the assessment. There have been minimal studies that focus on the
interventions for PTSD among young veterans from the war in Iraq and Afghanistan (Kehle-Forbes & Polusny, 2014). The specific focus is required with regards to the nature of their experiences of war, as well as their age group and the factors that could possibly diminish or compound the value of an intervention. This study, therefore, proposes to fill the research gap from a dual perspective. Primarily, it focuses on the effectiveness of CPT as an intervention for PTSD in a specific population, the veterans of the Iraq and Afghanistan wars. It also focuses on the younger veteran population, owing to the fact that their suicide rates have been on the increase despite the existence of evidence-based interventions in practice.

Purpose
This research purposes to explore the effectiveness of CPT programs as interventions for PTSD among veterans of the wars in Iraq and Afghanistan. The programs are expected to address the traumatic experiences and outcomes of the soldiers from the war, and significantly reduce, if not eliminate, the symptoms of PTSD. While the rates of overall suicide among veterans have remained consistent, internal trends have indicated a decrease in suicides for older veterans while the younger ones have
experienced an increase. This trend is especially visible in the wars post 9/11, especially the wars in Afghanistan and Iraq. The study approach will primarily be qualitative and will utilize the case study method for its exploration on the treatment of Iraq War soldiers diagnosed with PTSD and participating in a CPT program.
Interviews will be conducted among the participants of the program every session in order to gauge what impacts the program has on reducing trauma. Moreover, interview questionnaires will help in collecting first-hand information from clinicians involved in treatment of patients with PTSD. Following the implementation of this
research, it is expected that clear trends in the alleviation of symptoms will be visible as indicators of effectiveness. In situations where such signs are not perceived, there will be additional attempts to understand the possible shortcomings of this approach especially among the younger veterans.
Significance Previous research and practice has elaborated the occurrence of PTSD among war veterans, as well as the application of CPT as an intervention. The development of PTSD
is induced by a terrifying experience or ordeal, whereby one either undergoes physical harm or the threat of physical harm (U.S. Department of Veterans Affairs, 2016).
The experiences induce the need to develop strategies for which to cope with the persistent feelings of imminent threat, which potentially diminishes the mental health
of the individual. Veteran health has been especially instrumental in highlighting the occurrence of PTSD and the need for interventions against it. Exposure to
environments of death, threats to their lives, and the constant sound of war are all factors contributing to PTSD among veterans. Their coping habits will often tend
to the negative, including indulgence in drug abuse or engagement in violent behavior (Hudenko, Homaifar, & Wortzel, 2016). There remains a strong possibility that the
CPT intervention is no longer viable due to differences in the nature of current wars as well as the surrounding socio-economic conditions in the USA (Zarembo, 2014).
Regardless, the research is significant in the attempt to create an understanding among practitioners in the medical and psychiatric fields for the most appropriate
interventions and the possible requirement for change in current treatments. This study will help in the analysis of the effectiveness of CPT – the most widely used
method of treatment – in treating patients with PTSD. This research will help to bridge the gap involving various cases of extreme effects of PTSD and the
effectiveness of CPT in treating PTSD patients. Unlike previous research, it objectively focuses on the provision of quality mental health care among young veterans
and responds to the change in trends surrounding veteran mental health issues.
This research is unique since it addresses the under-researched area involving why most young veteran soldiers commit suicide and others engage in extreme violent
behaviors, even as the trend reduces in older veterans. The US Department of Veteran Affairs reports high occurrences of alcohol and tobacco abuse among veterans,
while other reports indicate about 9% of prison inmates being veterans of war (U.S. Department of Veterans Affairs, 2016). The results of this research will play a
major role in providing insight on proper processes of treating PTSD patients. The current processes will be put to test to establish their overall effectiveness with
impact statements from the participants themselves as primary bases. The research could also lead into a different approach to treatment of PTSD in a more effective
manner. Since CPT is the most widely used method of treatment of patients suffering from PSTD, an analysis on the outcomes and mechanisms of the program viewed from
the perspective of the participants will help to enhance its value in mental health care. Ultimately, any improvements that can be identified surrounding the program
will facilitate the achievement of better mental health outcomes, as well as overall improvement in the quality of life for young veterans of war.
Background
The study bases on selected articles that have explored the application of CPT and prolonged exposure therapy as intervention for PTSD in war veterans. The nature of
these articles is outlined below:
1. Morland, Hynes, Mackintosh, Resick, and Chard (2011), Morland, et al. (2014), and Fortney, et al. (2015) provided randomized control trials on group cognitive
processing therapy delivery through video teleconferencing for PTSD veteran patients, assessing for effectiveness against the delivery of the same in person. Both
approaches deemed equally effective
2. Wanner, Long, & Teng (2010) addressed the multi-component treatment of posttraumatic nightmares (PTNMs), which may lead to increased levels of PTSD symptoms in war
veterans
3. Steenkamp, Litz, Hoge, & Marmar (2015) conducted a review of randomized control clinical trials on the efficacy of psychotherapies for PTSD in military and veteran
population.
4. Walter, Dickstein, Barnes, & Chard (2014) and Chard, Schumm, McIlvain, Bailey, & Parkinson (2011) compared the effectiveness of CPT to CPT-C in treating patients
with PTSD or Traumatic Brain Injury (TBI); but the study yielded no significant differences in the application of both models
5. Monson, et al. (2012) sought to define whether social adjustments affects PTSD symptoms as well as improve right after receiving CPT intervention treatment.
6. Dickstein, Walter, Schumm, & Chard (2013) compared the outcomes of treating military patients suffering from sub threshold and threshold PTSD using CPT intervention
measures.
7. Mullen, Holliday, Morris, Raja, & Suris (2014) compared the effectiveness of CPT with Present centered therapy (PCT) in addressing the issues of military sexual
trauma and PTSD while working towards a model to developing comprehensive interventions for specific issues in military trauma.
8. Alvarez, et al. (2011) and Forbes, et al. (2012) surveyed the effectiveness of group CPT relative to group treatment as usual (TAU) in treatment of PTSD among male
veterans, yielding better results for CPT than the TAU approach in the context of residential rehabilitation programs.
9. Tuerk, et al. (2011) examined the effectiveness of using prolonged exposure (PE) therapy intervention in treating military patients suffering from PTSD through the
use of telehealth technology, indicating positive outcomes in the form of reduction of self-reported pathologies.
10. Eftekhari, et al. (2013) analyzed the effectiveness of using PE therapy on veterans suffering from PTSD.
Framework
The theoretical base for this study is Richard Lazarus’ cognitive appraisal theory. The primary premise of the theory is that the manner in which individuals appraise
a situation results in specific emotional responses that differ among individuals. In the context of traumatic experiences or situations, the theory postulates that
trauma follows a series of events – stimulus, thought, response, and emotion in that respective order – that affects a person’s behavior (Cherry, 2015). Being a
cognitive theory, it aligns with the assumption that trauma is induced by disruptions to world views or belief systems on the part of the individual. Because Lazarus’
theory connects thoughts, stimulus, and emotions, it will help in explaining why soldiers who return from warzones experience PTSD and most end up committing suicide
or other abnormal behaviors. Their negative appraisals of the warzones can be directly related to their adverse reactions that are portrayed at symptoms of PTSD once
they leave the war. The theory explains the sequence in which activities take place before a person experiences emotions that affects their cognitive thinking (Cherry,
2015). It, therefore, follows that any interventions with the ability to reverse such adverse reactions should effectively address the emotions, resulting in the
recognition of the appraisal and thoughts to enable better coping on the part of the effected.
Research Questions
1. How do young Iraq War veterans diagnosed with PTSD describe their trauma experiences?
2. How do the participants perceive the expression of their self-reported trauma symptoms after undergoing the CPT?
3. How do they relate the application and effectiveness of the CPT with their social lives following their return from service?
4. How do practitioners perceive the response of young veterans to the provisions of CPT?
Nature of the Study
The nature of this study will be qualitative, implementing a case study design- within a single hospital context. The purpose of this research project is to evaluate
the effectiveness of a PTSD program on young veterans diagnosed with PTSD after returning from the Iraq or Afghanistan war by examining the experiences of participants
in a CPT program at a hospital. The qualitative approach is consistent with the need to acquire the subjective opinion of the patient regarding the effectiveness of
the CPT program, rather than relying on statistical descriptions of the same. It will also be useful due to the need for specific sampling approaches that are
immensely purposeful and based on convenience. Qualitative research is perceived as being more capable of producing a comprehensive picture of the phenomena under
study (Neuman, 2013). In the proposed analysis, qualitative methods will be used to determine the participant’s assessment of their trauma experiences in order to
build a more comprehensive understanding of the impacts and mechanisms of CPT. Consequently, it will produce an understanding of not only the outcomes, but also the
patterns based on patient opinions regarding the use of CPT and its suitability to their lifestyles after the war. Qualitative studies have also been identified as
valuable methods for health science researchers to evaluate programs and interventions in order to come up with robust recommendations for the improvement of
interventions. In this particular context, it creates an opportunity to identify possible shortcomings to the CPT intervention and improve the quality of evidence-
based practice in mental health care. The qualitative case study method is useful in the field of mental health research because its correct application will enable
the development of new theory, assessment of existing programs, and development of interventions (Baxter & Jack, 2008). Yin (2003) further elaborates the nature of the
case study design, whereby it is useful to address “why” and “how” questions; it is impossible to manipulate behavior, and the context and the phenomena lack clear
boundaries. Impact statements from participants will be obtained through interviews following every CPT session they undergo, accompanied by interviews from
practitioners. It is expected that the dual approach will yield sufficient information on the applicability of CPT.
Data Types and Sources of Information
1. Abstracts from nursing journal articles and publications that relate to the research questions.
2. Complete articles on the areas of PTSD and the common interventions used or approved by the US Department of Veteran Affairs (mostly the CPT and prolonged exposure
therapy) and earlier studies on the effectiveness of these approaches for the alleviation or elimination of symptoms
3. Professional websites, Institutional websites, and blogs rich with information relevant to the study topic.
4. Books from both physical and online libraries that address interventions for PTSD among veterans and specifically the use of CPT.
5. Primary data specific to the study from interviews with practitioners and sessions with PTSD veteran patients currently undergoing treatment using the CPT as the
primary intervention
6. Observation of the processes of CPT therapy administration within one hospital context for veteran patients diagnosed with PTSD as a possible perspective to
achieving triangulation for validity
Possible Analytical Strategies (Optional)
The process of analysis will most possibly apply the combination of qualitative content analysis and thematic analysis. The organization of qualitative data will make
use of qualitative content analysis. The strategy focuses on the search for patterns in both qualitative and quantitative data (Neuman, 2013). This process involves
“examining, categorizing, tabulating, testing, or otherwise recombining both quantitative and qualitative evidence to address the initial propositions of a study”
(Yin, 2003, p.109). Following the initial organization, actual analysis applies the emergent thematic patterns from the data that is acquired. The expectation is that
the use of open interviews will allow for the creation of participant narratives, which will then be used for the identification of common themes. Thematic analysis
requires the researcher to pinpoint, examine, and record such themes as they surface from the data. The process, however, requires the development of repeated ideas
from chunks of text, before the repeated ideas are classified into themes (Shaughnessy, 2014). Themes comprise patterns in the data which are relevant in describing
the phenomenon under investigation. The development of themes will allow the relationship of the findings with existing theory on the subject, and consequently enable
identification of either consistency or differences from the data (Neuman, 2013). It is expected that the participant narratives will, therefore, be used to develop an
elaborate understanding of the experiences of participants and the implications these outcomes have on practice.

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