(PS10-64) Exploring Comprehensive and Interdisciplinary Diagnostic Evaluation and PTSD Treatment in Military Special Operations Forces

Military special operations forces (SOF) face a heightened risk of developing cognitive, physical, and emotional health conditions, including post-traumatic stress disorder (PTSD) and traumatic brain injury. Research indicates trauma-related symptoms are often correlated and nonspecific, complicating diagnosis and treatment. Although prolonged exposure (PE) and cognitive processing therapy (CPT) are standard PTSD treatments, the complex symptomatology in SOF populations may suggest a need for further comprehensive diagnostic evaluation alongside trauma-focused therapies.

The present study compares PTSD and related symptoms in SOF personnel who attended a comprehensive evaluation program after completing an intensive clinical program (ICP) for PTSD treatment (ICP-E) with those who only participated in the ICP (ICP-O). This exploratory study aims to provide preliminary insights into broader research questions regarding the effects of comprehensive evaluations on PTSD and related symptoms, as well as identifying patients who may benefit from such an evaluation following PTSD treatment.

A total of 256 participants completed a 2-week ICP for PTSD between 2018 and 2023, consisting of daily individual PE or CPT and group therapies. Afterwards, 69 of the participants attended a 5-day interdisciplinary evaluation program focused on health and functional concerns. The time between treatment completion and evaluation ranged from 1 day - 1.6 years (M=6.22, SD=3.2 months). Most participants were white (93%) and male (97.7%), with a mean age of 44.03 years (SD=7.8). The PTSD Checklist for DSM-5 (PCL5) assessed PTSD severity, while the Patient Health Questionnaire (PHQ9) and the Neurobehavioral Symptom Index (NSI) measured depressive and neurobehavioral symptoms, respectively. NSI subscales measured somatic, vestibular, cognitive, and affective symptoms.

Groups did not differ on baseline, pre-ICP PCL5 scores. Significant symptom reductions were seen in both groups following treatment (ICP-E and ICP-O p< .001). However, at the end of treatment, the ICP-E group reported significantly higher symptom severity (M=37.42, SD=16.18) than the ICP-O group (M=31.83, SD=17.45), t(201)= 2.116, p=.036. This difference between the groups diminished after adding somatic (F(1, 199)=3.664, p=.06), affective (F(1, 198)=2.193, p=.14), and depressive symptom (F(1, 193)=3.487, p=.06) covariates to the model.

The ICP-E group completed the PCL5 prior to their subsequent 5-day evaluation and 1-month later. Their post-evaluation PCL5 scores (at 1-month) were significantly lower (M=29.33, SD=14.21) than their pre-evaluation scores (M=36.80, SD=15.59), t(14)=2.568, p=.022. Moreover, the ICP-E group’s PCL5 scores at 1-month following their comprehensive evaluation did not significantly differ from the ICP-O group’s scores at the end of treatment.

Findings suggest that comprehensive evaluation may promote further therapeutic effects in addressing symptoms beyond PTSD. Due to the study's observational nature, conclusions should be drawn cautiously. Future research, particularly randomized controlled trials, is needed to confirm these preliminary insights and elucidate factors influencing treatment outcomes comprehensively.