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A new study published in the Journal of Aggression, Maltreatment and Trauma looked at the effectiveness of residential and intensive outpatient programs for the treatment of post-traumatic stress disorder (PTSD) in active military.

“The care and services provided for the treatment of active military personnel and veterans suffering from PTSD encompass a variety of formats, including both residential and outpatient treatment programs,” study author Walter S. Marcantoni told us. “The structural differences between these program types present challenges in making direct comparisons.” 

However, intensive outpatient programs (IOPs) serve as an intermediate alternative, offering an organizational structure and range of care that more closely align with residential programs. The goal of the paper was to compare and assess the effectiveness of residential treatment programs versus IOPs in addressing PTSD among active military personnel and veterans.

“Our objective was to identify an alternative approach for treating PTSD symptoms in active military personnel and veterans that could deliver results comparable to those achieved through residential treatment programs,” Marcantoni told us.

The COVID-19 pandemic brought significant disruptions to healthcare services, including the temporary closure of many residential treatment programs for PTSD. These closures posed substantial challenges for individuals relying on such programs for intensive care. 

“Alternative approaches to PTSD treatment, such as IOPs were actively explored during this period to maintain access to care and achieve comparable outcomes,” Marcantoni told us. “However, even after the pandemic subsided, several residential treatment programs did not reopen due to logistical, financial, or operational constraints.” 

This permanent reduction in available residential services has highlighted a critical gap in the treatment landscape. Consequently, there is an increasing need to identify sustainable, scalable, and efficient alternative treatment methods that can effectively address the needs of active military personnel and veterans with PTSD, ensuring continuity and quality of care in the face of future challenges.

“A systematic review was conducted to compare and evaluate the effectiveness of residential programs versus IOPs in treating PTSD among active military personnel and veterans,” Marcantoni told us. “An extensive literature search was performed in the fall of 2022 to identify primary studies assessing PTSD treatment within these two program types. The search produced 1,099 titles, of which 32 studies (reported across 41 publications) were included in the review.” 

A meta-analysis was conducted to assess the effectiveness of treatment by examining changes in PTSD symptom scores between baseline (pre-treatment) and discharge (post-treatment). This analysis provided a quantitative evaluation of symptom reduction, offering insights into the overall effectiveness of interventions delivered through residential programs and intensive outpatient programs. By aggregating data from multiple studies, the meta-analysis aimed to identify patterns, measure the extent of symptom improvement, and determine the relative effectiveness of each treatment modality in alleviating PTSD symptoms among active military personnel and veterans.

“In summary, both residential programs and IOPs demonstrated a significant reduction in PTSD symptom scores by the end of treatment, with no substantial difference in overall effectiveness between the two,” Marcantoni told us. “However, a noteworthy distinction emerged when comparing the performance of Department of Defense (DoD) IOPs, which serve only active military members, and privately operated IOPs, which treat both active military personnel and veterans.” 

Both DoD and private IOPs shared several common features; they offered a range of complementary treatment modalities, operated within a similar treatment duration (14 to 21 days), and primarily served male patients. The key difference lay in the patient populations served. While DoD IOPs exclusively focused on active military members, private IOPs extended their services to veterans as well, which may have contributed to the observed variations in effectiveness. Specifically, privately run IOPs appeared to achieve better outcomes compared to those managed by the Department of Defense.  

“We were surprised to observe a notable difference in outcomes between the DoD IOPs and those operated privately,” Marcantoni told us. “This discrepancy raises the possibility that veterans may respond more favorably to IOP treatment than active military personnel, potentially contributing to the enhanced treatment effects observed in private settings.” 

However, Marcantoni told us. this remains speculative, as the studies that included mixed samples in private IOPs did not differentiate between the treatment responses of active military personnel and veterans. 

“It is important to note that these two populations—active military personnel and veterans—may differ in several factors that could influence their response to PTSD treatment,” Marcantoni told us. “These include variations in the frequency and duration of deployments, levels of exposure to combat, the availability of post-deployment support, and, specifically for active personnel, whether treatment was pursued voluntarily or mandated by superiors.” 

Such differences in motivation could introduce biases, potentially affecting both the treatment outcomes and the generalizability of study results. Further research is needed to explore how these factors contribute to the observed discrepancies and to optimize treatment approaches for each population.

“I believe future research should delve into understanding how active military personnel and veterans respond differently to similar treatment approaches for PTSD,” Marcantoni told us. “This exploration is crucial, as these two populations experience distinct challenges and circumstances that may influence their treatment outcomes. For instance, active military personnel often face ongoing operational demands, hierarchical pressures, and the possibility of redeployment, all of which may affect their engagement with and response to treatment. In contrast, veterans may grapple with post-service reintegration, a lack of structured support systems, and the long-term psychological impact of their service, which could shape their receptivity to therapeutic interventions.”