The Role of Social Support in Exposure Therapy for Operation Iraqi Freedom/Operation Enduring Freedom Veterans: A Preliminary Investigation.

The lack of social support has consistently been identified as a relevant factor in the development, maintenance, and treatment of posttraumatic stress disorder (PTSD). Prospective studies with combat veterans have supported the erosion model of social support in the development of PTSD. This model posits that increased PTSD symptoms lead to diminished social support over time. Additional epidemiological work that has investigated mental health and functional impairment in recently returning Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF) veterans has suggested that interpersonal problems coincide with the onset of PTSD. Despite research that suggests OIF/OEF veterans experience high rates of PTSD and associated interpersonal problems, no studies have examined social support in relation to treatment response in this group. The current study examined the role of four theorized functional aspects of social support- emotional/informational support, positive social interactions, affectionate support, and tangible support- on pretreatment PTSD symptom severity and treatment response in a sample of OIF/OEF veterans receiving exposure-based psychotherapy. Findings showed that positive social interactions were negatively correlated with pretreatment symptom severity, and emotional/informational support was positively related to increased treatment response. Together, these findings suggest that specific types of social support may have an important influence on the course of exposure treatment.

[1]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[2]  Peter W. Tuerk,et al.  Exposure therapy for PTSD delivered to veterans via telehealth: predictors of treatment completion and outcome and comparison to treatment delivered in person. , 2011, Behavior therapy.

[3]  B. Felker,et al.  Hopelessness and Suicidal Ideation in Iraq and Afghanistan War Veterans Reporting Subthreshold and Threshold Posttraumatic Stress Disorder , 2011, The Journal of nervous and mental disease.

[4]  Peter W. Tuerk,et al.  Prolonged exposure therapy for combat-related posttraumatic stress disorder: an examination of treatment effectiveness for veterans of the wars in Afghanistan and Iraq. , 2011, Journal of anxiety disorders.

[5]  Sherry L Pagoto,et al.  Ten Year Revision of the Brief Behavioral Activation Treatment for Depression: Revised Treatment Manual , 2011, Behavior modification.

[6]  L. Zoellner,et al.  Understanding factors associated with early therapeutic alliance in PTSD treatment: adherence, childhood sexual abuse history, and social support. , 2010, Journal of consulting and clinical psychology.

[7]  R. Rosenheck,et al.  War Zone Veterans Returning to Treatment: Effects of Social Functioning and Psychopathology , 2010, The Journal of nervous and mental disease.

[8]  S. Wilcox Social Relationships and PTSD Symptomatology in Combat Veterans , 2010 .

[9]  S. Southwick,et al.  Structure of posttraumatic stress disorder symptoms and psychosocial functioning in Veterans of Operations Enduring Freedom and Iraqi Freedom , 2010, Psychiatry Research.

[10]  T. Dalgleish,et al.  Social Support Moderates Outcome in a Randomized Controlled Trial of Exposure Therapy and (or) Cognitive Restructuring for Chronic Posttraumatic Stress Disorder , 2010, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[11]  Peter W. Tuerk,et al.  A pilot study of prolonged exposure therapy for posttraumatic stress disorder delivered via telehealth technology. , 2010, Journal of traumatic stress.

[12]  Y. Neria,et al.  Adult attachment, perceived stress, and PTSD among civilians exposed to ongoing terrorist attacks in Southern Israel , 2009 .

[13]  Shira Maguen,et al.  Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002-2008. , 2009, American journal of public health.

[14]  Joshua D. Clapp,et al.  Understanding the relationship between PTSD and social support: the role of negative network orientation. , 2009, Behaviour research and therapy.

[15]  Stéphane Bouchard,et al.  Effectiveness of Cognitive Behavioural Therapy Administered by Videoconference for Posttraumatic Stress Disorder , 2009, Cognitive behaviour therapy.

[16]  C. Rosen,et al.  Relationships among PTSD symptoms, social support, and support source in veterans with chronic PTSD. , 2008, Journal of traumatic stress.

[17]  F. Norris,et al.  Longitudinal linkages between perceived social support and posttraumatic stress symptoms: sequential roles of social causation and social selection. , 2008, Journal of traumatic stress.

[18]  C. Greeno,et al.  A Confirmatory Factor Analysis of an Abbreviated Social Support Instrument: The MOS-SSS , 2008 .

[19]  D. Forbes,et al.  Mechanisms of anger and treatment outcome in combat veterans with posttraumatic stress disorder. , 2008, Journal of traumatic stress.

[20]  Steven Southwick,et al.  Cognitive–Behavioral Theory and Preparation for Professionals at Risk for Trauma Exposure , 2008, Trauma, violence & abuse.

[21]  M. Cloitre,et al.  Social bonds and posttraumatic stress disorder. , 2008, Annual review of psychology.

[22]  Charles W Hoge,et al.  Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. , 2007, JAMA.

[23]  S. Galea,et al.  The serotonin transporter genotype and social support and moderation of posttraumatic stress disorder and depression in hurricane-exposed adults. , 2007, The American journal of psychiatry.

[24]  A. Kilbourne,et al.  Social support among veterans with serious mental illness , 2007, Social Psychiatry and Psychiatric Epidemiology.

[25]  B. Rothbaum,et al.  Prolonged Exposure Therapy for PTSD : Emotional Processing of Traumatic Experiences Therapist Guide , 2007 .

[26]  Lynda A. King,et al.  Directionality of the Association Between Social Support and Posttraumatic Stress Disorder: A Longitudinal Investigation , 2006 .

[27]  Carol L Hart Posttraumatic Stress Symptomatology in Aging Combat Veterans: The Direct and Buffering Effects of Stress and Social Support , 2006 .

[28]  J. Elhai,et al.  Subthreshold PTSD in Primary Care: Prevalence, Psychiatric Disorders, Healthcare Use, and Functional Status , 2005, The Journal of nervous and mental disease.

[29]  C. Hoge,et al.  Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. , 2004, The New England journal of medicine.

[30]  B. Doebbeling,et al.  Confirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the Gulf War. , 2002, Journal of abnormal psychology.

[31]  D. Clark,et al.  A prospective investigation of the role of cognitive factors in persistent posttraumatic stress disorder (PTSD) after physical or sexual assault. , 2001, Behaviour research and therapy.

[32]  C. Brewin,et al.  Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. , 2000, Journal of consulting and clinical psychology.

[33]  D. Clark,et al.  A cognitive model of posttraumatic stress disorder. , 2000, Behaviour research and therapy.

[34]  S. Cotten,et al.  Social Support Among Women Veterans , 2000, Journal of women & aging.

[35]  E. Foa,et al.  Interpersonal Friction and PTSD in Female Victims of Sexual and Nonsexual Assault , 1999, Journal of traumatic stress.

[36]  A. M. Ruscio,et al.  Psychometric Properties of Nine Scoring Rules for the Clinician- Administered Posttraumatic Stress Disorder Scale , 1999 .

[37]  D. King,et al.  Posttraumatic stress disorder in a national sample of female and male Vietnam veterans: risk factors, war-zone stressors, and resilience-recovery variables. , 1999, Journal of abnormal psychology.

[38]  Lynda A. King,et al.  Confirmatory Factor Analysis of the Clinician-Administered PTSD Scale: Evidence for the Dimensionality of Posttraumatic Stress Disorder. , 1998 .

[39]  A. Taylor,et al.  Psychological morbidity associated with motor vehicle accidents. , 1994, Behaviour research and therapy.

[40]  F H Norris,et al.  A test of the social support deterioration model in the context of natural disaster. , 1993, Journal of personality and social psychology.

[41]  P. Resick,et al.  Cognitive processing therapy for sexual assault victims. , 1992, Journal of consulting and clinical psychology.

[42]  Judith Lewis Herman,et al.  Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. , 1992 .

[43]  J. S. Mizes,et al.  Combat Level and Social Support in the Development of Posttraumatic Stress Disorder in Vietnam Veterans , 1988, Behavior modification.

[44]  M J Horowitz,et al.  Stress-response syndromes: a review of posttraumatic and adjustment disorders. , 1986, Hospital & community psychiatry.

[45]  T. Wills,et al.  Stress, social support, and the buffering hypothesis. , 1985, Psychological bulletin.

[46]  J. Fairbank,et al.  Social support in Vietnam veterans with posttraumatic stress disorder: a comparative analysis. , 1985, Journal of consulting and clinical psychology.

[47]  Peter W. Tuerk,et al.  Innovative service delivery for secondary prevention of PTSD in at-risk OIF-OEF service men and women. , 2011, Contemporary clinical trials.

[48]  C. A. Morgan,et al.  Psychosocial buffers of traumatic stress, depressive symptoms, and psychosocial difficulties in veterans of Operations Enduring Freedom and Iraqi Freedom: the role of resilience, unit support, and postdeployment social support. , 2010, Journal of affective disorders.

[49]  J. Singer,et al.  Applied Longitudinal Data Analysis , 2003 .

[50]  S. Batten,et al.  Acute Stress Disorder and Posttraumatic Stress Disorder: A Brief Overview and Guide to Assessment , 2002 .

[51]  M. First,et al.  Structured clinical interview for DSM-IV axis I disorders : SCID-I : clinical version : scoresheet , 1997 .

[52]  D. Charney,et al.  The development of a Clinician-Administered PTSD Scale , 1995, Journal of traumatic stress.

[53]  S. West,et al.  Multiple Regression: Testing and Interpreting Interactions. , 1994 .

[54]  C. Sherbourne,et al.  The MOS social support survey. , 1991, Social science & medicine.

[55]  Alan Vaux Social Support: Theory, Research, and Intervention , 1988 .

[56]  R. Kessler,et al.  Social factors in psychopathology: stress, social support, and coping processes. , 1985, Annual review of psychology.

[57]  J. House,et al.  Measures and concepts of social support , 1985 .