PTSD as a social wound, do social wounds require social healing?

Abstract

Post-traumatic Stress Disorder (PTSD) occurs in a minority of traumatized individuals but its effects can be pervasive and disabling. For instance, PTSD has a high comorbidity rate with other psychiatric conditions, most particularly depression, eating disorders, suicidality, and addictions. The consensus of previous research is that no single treatment modality is effective in ameliorating the complex array of symptoms demonstrated by some trauma survivors (Blake & Sonnenberg, 1998). In other words, some treatments have been attributed to reductions in one cluster of symptoms but not another and vice versa. Trauma researchers are now looking to multimodal treatment programs as the treatment of choice. This research examines both the microtheory and macrotheory of a treatment program for chronic PTSD. An outcome and process evaluation of a 6-week inpatient program were conducted.

Data were collected at a minimum of one point in time on 157 individuals who were attending the Program for Traumatic Stress Recovery. These participants (128 women, 29 men) were all self-identified survivors of trauma, who had experienced one or more of the following traumatic experiences: severe abuse as a child or adult, natural or man-made disasters, serious accidents, work-related trauma, and combat exposure. Questionnaire data was collected at waitlist, pre-treatment, post-treatment and at four-month follow-up. Generally the symptoms picture was stable prior to treatment. According to the self-report data, clients made many gains with treatment. Specifically, clients had greater body esteem and awareness, were functioning better in activities of daily living (self-care) and in relationships, experienced fewer symptoms of PTSD, reported less distress, depression, and anxiety, and held more positive views of themselves after treatment. The notable exceptions were with respect to the severity of PTSD symptoms (which did not improve relative to waitlist) and hopelessness. While clients initially gained some hope from attending the program, these gains were not maintained at follow-up. Overall it was demonstrated that this program is quite successful in ameliorating a variety of difficulties relevant to trauma survivors in that the gains made were both statistically and clinically significant.

The program is unique in that it is offered in the context of a therapeutic community. It was hypothesized that individuals who reported predominantly positive experiences in community milieu would experience greater gains relative to their peers who reported negative experiences. Interviews provided rich qualitative data, but it was not possible to provide quantitative evidence of a moderating effect of the community. However, it was noted that clients who were viewed by treatment staff as more invested in the program did experience greater treatment gains (independent of pre-treatment status). Finally, the purpose of the process evaluation was to determine whether the treatment model was correct as specified. Specially, relationships between program outcomes and participation in particular activities were examined in a series of regression analyses. The treatment rationale was not strongly supported, indicating that the program acts as a gestalt which is inseparable from the community milieu in which it embedded. This research offers tentative support for the notion that social wounds do require social healing.