PTSD symptomatic population attitude to psychological therapy

According to the Israeli national health survey [1], the projected lifetime occurrence of Post-Traumatic Stress Disorder (PTSD) is 2.5%. In addition, 0.5% of the responder reporting experiencing PTSD symptoms in the last 12 months, with 70% of the of diagnosed respondents meeting the criteria for severe disorder. The circumstances imposed by Israel's ongoing state of national security threat are a unique risk factor in the developed world. The prolonged mandatory military service enforced in Israel puts young enlisted men and women in a particular risk. To relief the suffer of PTSD patients and to integrate them as contributing members to society is a core interest of Israeli society, as well as its moral obligation.

PTSD is a mental disorder which is particularly difficult to manage as it is often manifested a long period of time after the traumatic event and many time imposes withdrawal from social interactions and normative activities [2]. In spite of the dire consequences PTSD has on individuals' lives, several psychological interventions were shown to be effective in relieving its symptoms even in resistant chronic cases [3, 4]. However, paradoxically, PTSD population is characterized by therapy avoidance [5], in spite of their own best interest. Why do PTSD patients resist the help offer to them and how could help be offered in a way that will induce those in need more receptive to therapy?

A study on American PTSD soldiers returning from Iraq and Afghanistan found that one of the main causes for therapy avoidance is negative perceptions of therapy [6]. In addition, at the core of this therapy-avoidance lies patients' belief that they should manage, cope and solve their mental problems on their own [7]. Israel's society is unique in the sense that the obligatory military services mandates that a great percentage of the general population is closely familiar with the challenges imposed by the duty of service. How does this difference affect the attitude toward psychological therapy in young ex-soldiers men in general and specifically those who suffer from PTSD?

392 men aged 23-41 from the general population participated in a survey evaluating their PTSD symptoms [8] and attitude towards psychological therapy [9]. In the following analysis are included the 118 participants with combat experience that completed the full survey, of these 23 met the clinical criterion of PTSD. We find a weak, positive correlation between participants' age and their favoring attitude towards therapy (p=0.002, r=0.33). In addition we find a significant positive correlation between symptoms of PTSD and favoring attitudes towards psychological therapy (p=0.002, r = 0.32). This correlation becomes even stronger when calculated only on the subgroup of surveyed population which meet the clinical criteria of PTSD, such that more severe symptoms predict more favoring attitude towards psychological therapy (n=23, p=0.01, r = 0.625).

These results suggest that Israeli veterans with combat experience are in fact sensitive to their own mental state, specifically in the context of experiences from their service which may have triggered PTSD symptoms and accordingly acknowledge the need for getting psychological help. In contrast to their favoring attitude towards receiving psychological help, current literature has shown that PTSD population often avoids therapy, which suggest that there exist additional factors other then attitude towards therapy alone which inflict barriers for PTSD population from getting help. Taken together with our finding that younger population is less likely to have favoring attitudes towards psychological therapy, this study suggests that further investigation should be directed towards developing strategies which make psychological therapy more effectively accessible and that such strategies should be more focused on newly discharged individuals.

[1] Levinson, D., Zilber, N., Lerner, Y., Grinshpoon, A., & Levav, I. (2007). Prevalence of mood and anxiety disorders in the community: results from the Israel National Health Survey. Israel Journal of Psychiatry and Related Sciences, 44(2), 94.

[2] Sar, V., & Ozturk, E. (2006). What is trauma and dissociation?. Journal of Trauma Practice, 4(1- 2), 7-20.

[3] Taylor, S., Thordarson, D. S., Maxfield, L., Fedoroff, I. C., Lovell, K., & Ogrodniczuk, J. (2003). Comparative efficacy, speed, and adverse effects of three PTSD treatments: exposure therapy, EMDR, and relaxation training. Journal of consulting and clinical psychology, 71(2), 330.

[4] Oehen, P., Traber, R., Widmer, V., & Schnyder, U. (2013). A randomized, controlled pilot study of MDMA (±3, 4-Methylenedioxymethamphetamine)-assisted psychotherapy for treatment of resistant, chronic Post-Traumatic Stress Disorder (PTSD). Journal of Psychopharmacology, 27(1), 40-52

[5] Shalev, A. Y., Ankri, Y. L., Peleg, T., Israeli-Shalev, Y., & Freedman, S. (2011). Barriers to receiving early care for PTSD: results from the Jerusalem trauma outreach and prevention study. Psychiatric Services, 62(7), 765-773

[6] Kim, P. Y., Britt, T. W., Klocko, R. P., Riviere, L. A., & Adler, A. B. (2011). Stigma, negative attitudes about treatment, and utilization of mental health care among soldiers. Military psychology.

[7] Mojtabai, R., Olfson, M., Sampson, N. A., Jin, R., Druss, B., Wang, P. S., ... & Kessler, R. C. (2011). Barriers to mental health treatment: results from the National Comorbidity Survey Replication. Psychological medicine, 41(8), 1751-1761.

[8] Foa, Edna B., et al. "The validation of a self-report measure of posttraumatic stress disorder: the Posttraumatic Diagnostic Scale." Psychological assessment 9.4 (1997): 445.‏

[9] Mackenzie, Corey S., et al. "An adaptation and extension of the attitudes toward seeking professional psychological help scale 1." Journal of Applied Social Psychology 34.11 (2004): 2410-2433.‏