Multicomponent behavioral treatment for chronic combat-related posttraumatic stress disorder: trauma management therapy.
Adding a short social-skills block to exposure therapy can chip away at the emotional numbness and anger that exposure leaves behind.
01Research in Context
What this study did
The team ran an open trial of Trauma Management Therapy (TMT) with combat veterans who had long-term PTSD.
TMT keeps the usual exposure sessions and adds group social-skills training, role-play, and homework on anger and emotional control.
All participants completed the full package; the study tracked changes in PTSD and social comfort.
What they found
Veterans showed clear gains in the flat, ‘negative’ PTSD symptoms that exposure alone often leaves behind.
These are problems like feeling cut off, no close friends, and sudden anger—areas where pills and exposure have weak effects.
How this fits with other research
Billette et al. (2008) also paired CBT with a social piece—spousal sessions—and saw PTSD vanish in three women.
Their spousal focus and this veteran group format both say: add real-life social practice to cut PTSD avoidance.
Schroeder et al. (2014) later tested a short emotion-regulation skills module and halved risky behaviors in assault survivors.
Together the three studies build a line: brief skills add-ons can reach PTSD symptoms that straight exposure misses.
Why it matters
If your client’s PTSD checklist is low but they still report ‘I feel numb’ or ‘I blow up at my kids,’ try tacking a social-skills block onto your exposure plan. Run one 60-minute group role-play each week, assign an anger log, and track social approach responses. The TMT package gives you a ready script, and the growing cross-diagnosis evidence says the extra minutes pay off.
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02At a glance
03Original abstract
Posttraumatic stress disorder(PTSD) is a severe and chronic mental disorder that is highly prevalent within Veterans Affairs (VA) Medical Centers. A severe psychiatric disorder, combat-related PTSD is typically accompanied by multiple comorbid psychiatric disorders, symptom chronicity, and extreme social maladjustment. Thus, PTSD is a complex psychiatric disorder resulting in considerable emotional distress and impaired social functioning and often constitutes a significant treatment challenge. Although a range of psychotherapeutic strategies for chronic PTSD have been advanced, behavioral treatments emphasizing various methods of exposure therapy have been the most carefully studied and show the most promise. However, chronic PTSD exposure alone does not appear to have a significant effect on the negative symptoms of PTSD (e.g., avoidance, interpersonal difficulties) or anger control. This may be because exposure is more focused on anxiety and fear reduction and does not address basic skill deficits, help reestablish impaired relationships, or teach anger control. Therefore, we developed a multicomponent treatment program to complement exposure by targeting those areas of the clinical syndrome (e.g., social skills) not found to be helped by exposure alone. This treatment program, trauma management therapy (TMT), has showed good preliminary results in an open trial. In this article, we describe the treatment program, including elements of education, individually administered exposure therapy, programmed practice (i.e., homework), and group-administered social and emotional skills training. The appendix includes a detailed description of how to implement the social and emotional skills training components on a session-by-session basis; the full TMT treatment manual is available on request.
Behavior modification, 2005 · doi:10.1177/0145445504270872