Veterans' Voices Provide Key to Measuring PTSD Treatment Success

A research team recently found that perceived improvement – whether someone reports feeling better – can be a valuable tool in PTSD treatment. Rhea Mundle, a University of Mississippi doctoral student in clinical psychology from Chicago; Philip Held, associate professor of psychiatry and behavioral sciences at Rush University; and Emily Patton, a clinical psychology doctoral student from Georgia State University, published their work in Cognitive Therapy and Research.

"Perceived improvement stood out to us because it's just not something that's commonly looked at – whether someone actually is feeling better," Patton said. "There are people who are meeting improvement thresholds but not actually feeling that much better."

"What does feeling better feel like? That's what we wanted to capture, beyond the clinical checklist."

Post-traumatic stress disorder rates are particularly high in the veteran community. Research shows the vast majority of veterans – around 87% – report experiencing at least one traumatic event, though not all develop PTSD.

Even so, up to 50% of veterans leave standard trauma-focused therapy without completing treatment.

"This is a massive challenge, and improving engagement is a critical goal," Held said. "Evidence-based trauma-focused therapy is incredibly hard work. If a veteran is putting in all that effort, it's vital that they feel seen and that their progress is acknowledged."

Including the veterans' perceived improvement as they undergo treatment could help them feel more engaged with their recovery, Mundle said.

"These markers of meaningful improvement are common across different treatment settings to measure progress of outcomes, and that's helpful for the clinician side," Mundle said. "But this study is really taking into account how the patient feels as well as how they are scoring."

The researchers worked with 259 veterans receiving treatment at the Road Home Program Rush University Medical Center in Chicago, where Held is research director. They found nearly 88% reported feeling at least a little better after treatment.

Patients who reported feeling better often showed significant improvement in clinical measures like self-efficacy and emotion regulation along with reductions in PTSD severity.

"These findings highlight that recovery is a deeply personal, multifaceted process that is not captured by symptom measures alone," Held said. "What this study suggests is that a veteran's subjective sense of 'feeling better' is linked to regaining a sense of control over their lives and their symptoms."

Other clinical measures, however, did not always align with whether the veteran was feeling better. The study found that scores regarding depression symptoms, negative post-traumatic cognitions – or negative thoughts about traumatic events – and resilience did not correlate with perceived improvement.

Understanding that a veteran may not be feeling better just because they score better is important, the researchers said.

"From the veteran's side of it, maybe they are noticing specific symptoms reducing, and that's why they feel better, but maybe not," Mundle said. "My question now is really, 'Are they aware of what symptoms they're experiencing and changes in those that are contributing to them feeling better, and is that something they themselves can recognize throughout the treatment process?'"

Perceived improvement has not been widely measured in PTSD treatment. This study suggested adding that metric could better inform treatment plans, Held said.

"By adding a simple measure of the veteran's own perception, we get a more complete picture than we can with symptom measures alone," he said. "For instance, a veteran's symptom scores might not yet meet a clinical threshold for improvement, but they may report 'feeling much better.'"

These instances could prompt therapists to probe deeper, asking exactly what seems to be working for the patient and what feels different, Held said.

"Conversely, and perhaps more importantly, the study found a group of veterans – about 12% – who met the clinical criteria for improvement but reported that they did not feel better," he said. "If we only looked at the symptom checklist, we would miss this crucial information."

Regardless of the success of any program, veterans with PTSD will likely always have some lingering effects of trauma, the researchers said.

For veterans who experience PTSD, the goal of treatment is not to erase their experiences, but to help them manage lingering symptoms and improve daily functioning, Patton said.

"PTSD severity is measured on a scale of zero to 80," she said. "Complete symptom resolution is rare, but meaningful improvement is very possible. Our goal is to ensure that individuals have the tools to manage any remaining distress effectively."

This material is based on work supported by the National Institutes of Health fellowship no. T32AA031818.

Top: Assessing how veterans say they feel during treatment for post-traumatic stress disorder can help them feel more engaged with their recovery, according to research conducted by an Ole Miss doctoral student in psychology and colleagues in Georgia and Illinois. Adobe Stock photo