Post-traumatic stress disorder (PTSD) manifests in various ways and impacts individuals uniquely. Some individuals find that they gain more from residential inpatient programs, while others thrive in outpatient settings. Additionally, some patients may benefit from a mixed approach that incorporates aspects of both types of care. A study conducted by researchers revealed that intensive outpatient programs (IOPs), where individuals engage with healthcare providers daily while continuing to live at home, can be just as effective as inpatient treatment, which often involves weeks of isolation for recovery.
The consequences of warfare on those who experience it directly can persist long after hostilities have ended and soldiers return home. In Canada, it is estimated that about 10 percent of veterans from conflict zones develop PTSD, with many others displaying at least some symptoms associated with the disorder.
Since PTSD presents in various forms and has different effects on people, finding effective treatment can be complicated. Some individuals benefit more from inpatient care, while others prefer outpatient services, and some may excel in a program that combines elements of both.
This subject is explored in a recent study published in the Journal of Aggression, Maltreatment & Trauma, led by Walter Marcantoni from Concordia University. The researchers discovered that intensive outpatient programs (IOPs), which involve daily consultations with health professionals while patients remain in their community, are just as effective as traditional inpatient care. Inpatient programs typically isolate patients for focused recovery, lasting anywhere from six to twelve weeks depending on the care needed. Both IOPs and inpatient programs show higher completion rates compared to conventional outpatient treatments, where dropout rates can reach 50 percent.
“This offers patients more choices in how they receive care,” states Marcantoni, who is an assistant professor in the Department of Psychology and the lead author of the paper.
Differences in Treatment: Veterans vs. Active Service Members
Marcantoni and his colleagues at the CIUSSS du l’Ouest-de-l’Île-de-Montréal reviewed 32 studies examining PTSD treatments for both active military personnel and veterans in residential settings and IOPs. Most of these studies were conducted in the United States, while others took place in the United Kingdom, Australia, and Israel.
Participants in these studies met the criteria for PTSD and often dealt with overlapping issues like anxiety, depression, and substance abuse.
Both inpatient and IOPs provided various psychotherapy formats, including cognitive processing and cognitive-behavioral therapies, often in group settings. They also included complementary therapies, such as psychoeducation, anger management, medication management, and art therapy.
“Our analysis showed that the average improvement scores from admission to discharge in both residential and IOP settings were nearly identical, indicating no significant difference,” remarks Marcantoni, the head of the Health Technology Assessment Unit for CIUSSS.
However, the researchers did observe a notable difference in outcomes between patients treated in privately operated IOP clinics versus those at clinics run by the US Department of Defense. The privately run clinics primarily serve veterans, while the government ones focus on current military personnel.
“For now, we can only speculate, but it appears that IOPs may be more beneficial for veterans as opposed to active service members,” Marcantoni explains. “Various factors could contribute to this, including the ongoing stigma associated with treatment and the fact that active members often undergo treatment as a requirement rather than by choice. In contrast, veterans enter these programs voluntarily, motivated by their own desire to seek help.”
Marcantoni emphasizes that this study is the first to compare the effectiveness of residential clinics and IOPs for treating PTSD. He hopes forthcoming research will further explore the differences in outcomes between private and government treatment facilities, and whether treatment strategies should be tailored to address the specific needs of different populations.
