Building a Family Systems Model to Promote Adherence to PTSD Treatment

Posted April 15, 2016
Laura A. Meis, Ph.D., LP, Minneapolis VA Health Care System, University of Minnesota, Minneapolis, MN

Laura A. Meis, Ph.D. Post-traumatic stress disorder (PTSD) occurs in as many as one in five Service members returning from Iraq and Afghanistan and is associated with a host of negative, long-term consequences. Despite the effectiveness of evidence-based psychotherapies for PTSD, many Service members struggle to successfully finish these trauma-focused treatments. Improving family support for treatment may prove a promising strategy for keeping Service members in care. Dr. Meis is an Assistant Professor at the University of Minnesota Medical School and the Center for Chronic Disease Outcomes Research at the Minneapolis Department of Veterans Affairs (VA). Her team is studying Veterans in treatment for PTSD across four VA medical centers in Minneapolis, Phoenix, Palo Alto, and Charleston, to understand how families influence Veterans' use of trauma-focused treatment for PTSD. Preliminary findings indicate that Veterans who simply told a family member about their PTSD treatment were nearly eight times more likely to complete at least a minimum of eight therapy sessions. Additionally, if families encouraged Veterans to face issues they had avoided, Veterans were nearly three times more likely to complete at least eight sessions. Finally, when families encouraged Veterans to quit, Veterans were more than 10 times more likely to quit treatment before session 8.

Early findings suggest families likely affect Veterans' attendance by (1) influencing Veterans' opinions about treatment and (2) influencing Veterans' willingness to attend, perhaps in spite of Veterans' opinions about treatment. Veterans whose families encouraged them to face things they found difficult were more likely to find trauma-focused PTSD treatment credible, and subsequently to attend more treatment sessions (Figure). Additionally, when families were strongly invested in the credibility of the treatment, Veterans' own opinions about the treatment had less influence on whether or not Veterans stayed in treatment. This suggests that when families feel strongly about treatment's credibility, Veterans may consider their own beliefs about the treatment less in deciding whether or not to complete treatment, perhaps to please their family members.

A highly publicized 2014 Institute of Medicine report highlighted a deficit in family-oriented programming within the Department of Defense and VA. For more than a decade, national mandates have persisted unanswered in their demands for routine family inclusion in care for PTSD. Dr. Meis' study is an important step toward a response and prompts calls for further research to develop and test strategies of improving family support for existing treatments that work. If strategies for engaging families in care improve retention and outcomes for PTSD, these strategies can be applied and tested with other conditions, including suicide prevention, traumatic brain injury rehabilitation, resilience, and substance abuse, and may have broad implications for the delivery of mental health care. While these results are preliminary, the team looks forward to completing the project and discovering the final impact of families on Veterans' choices.

Figure. Social Influences on Adherence


Public and Technical Abstracts: Building a Family Systems Model to Promote Adherence to PTSD Treatment

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