For patients with PTSD to derive the greatest benefit
from available evidence-based psychotherapies and
psychiatric medications they must be able to fully
engage in their treatment. However, a wealth of
published data demonstrates that a majority of service
members and Veterans with PTSD are not successful
in doing so (e.g., Hoge et al., 2014; Spoont, Murdoch,
Hodges, & Nugent, 2010). Patient engagement in
mental health services has received relatively little
attention as compared to the substantial consideration
given to patient engagement in the design and
delivery of patient-centered physical health care
(Carman et al., 2013). Below, we provide a selective
review of the available literature in an attempt to
describe factors that make patients more likely to
engage in PTSD treatment and identify interventions
that may improve patient engagement in PTSD
treatment, with a focus on evidence-based treatments.
Following Gruman et al.’s (2010) conceptualization,
we define patient engagement as the behaviors
required to achieve optimal benefit from health care.
The review focuses on the three aspects of
engagement most often examined in the PTSD
literature: treatment initiation (utilizing care; starting
treatment), retention (completing the intended
course of treatment), and adherence (performing
behaviors in the treatment plan). The scope of the
review is adult patients’ engagement in PTSD
treatment; however, due to limited data regarding
civilians’ engagement, a majority of the studies
reviewed focus on active duty and Veteran populations.
Following the review, we evaluate this literature
within a patient engagement conceptual framework
and suggest future research directions.
Factors Associated with Engagement
Demographic factors such as age, gender, race, and
ethnicity have been the most frequently studied and
are among the few variables that have consistently
demonstrated significant associations with treatment
initiation and retention across studies. Patient
age has r
epeatedly been found to predict initiation
and retention in general mental health treatment,
psychotherapy, and evidence-based psychotherapy
(EBP) in that younger patients are less likely to
initiate and be retained in treatment (Goetter et al.,
2015; Kehle-Forbes, Meis, Spoont, & Polusny, 2016;
Spoont et al., 2014). Patient race has also been
shown to be associated with treatment initiation and
retention, although not as consistently as age
(Goetter et al., 2015; Spoont, Hodges, Murdoch, &
Nugent, 2009; Spoont et al., 2015). For example,
African American and Latino Veterans were found
to be less likely than white Veterans to receive
a minimally adequate trial of treatment (both
psychotherapy and pharmacotherapy for African
American Veterans; pharmacotherapy only for Latino
Veterans) within six months of PTSD diagnosis
(Spoont et al., 2015). Negative attitudes towards
psychotherapy and pharmacotherapy (e.g., believing
that treatment wouldn’t be helpful) accounted for
the disparity in Latino Veterans’ retention, but the
disparities in African American Veterans’ retention
remained after accounting for treatment-related
beliefs (Spoont et al., 2015). Findings regarding
the associations between engagement and other
demographic variables such as Veterans’ service
connection status, marital status, and employment
have been equivocal (Goetter et al., 2015; Mott,
Mondragon, et al., 2014; Grubbs et al., 2015).
Potentially modifiable factors underlying differences
in engagement between demographic groups should
be the focus of future research.
Pretreatment symptomology and patients’ social
environments are two nondemographic factors that
have been subject to considerable study. Research
regarding the impact of PTSD severity on initiation
and retention has yielded inconsistent results, with
some studies showing that higher total levels of
If you want to read the entire article click on the fallowing link; Patient Engagement in PTSD Treatment
While it’s something that many people don’t want to talk about, sex matters to people. Sexual function and sexual desire can be important parts of a person’s life, particularly if he or she is in a relationship. And, unfortunately, what we know is that combat posttraumatic stress disorder (PTSD) affects a veteran’s sexual desire and sexual function in negative ways. In fact, some studies have showed such a correlation between sexual dysfunction and PTSD that some have proposed making it an official, diagnostic criteria.
Sexual Desire and Combat PTSD
Sexual desire, is, of course, one’s desire for sexual relations and whether one has a partner or not, this can be important. In a 2014 study, Problems in Sexual Functioning among Male OEF/OIF Veterans Seeking Treatment for Posttraumatic Stress, 63% of male veterans in the study reported sexual desire problems. Of those with partners, 72% reported a lack of sexual desire. According to the study, white race, combat exposure, social support, and avoidance/numbing symptoms predicted a lack of sexual desire. The 2008 study Sexual Functioning in War Veterans with Posttraumatic Stress Disorder, found that veterans with PTSD had significantly reduced sexual activity including sexual fantasies, foreplay, oral sex, and intercourse, in the previous month. Veterans cited their own health problems as the reason for reduced sexual activity.
It’s not clear why veterans with combat PTSD experience a loss in sexual desire but I suspect the above study may have hit on one main reason: the PTSD symptoms of avoidance/numbing. These symptoms often produce a lack of emotional intimacy in relationships and it only stands to reason that sexual intimacy would also be reduced.
Sexual Function and Combat PTSD
Several studies have focused on physical, sexual dysfunction in combat PTSD veterans. In Problems in Sexual Functioning among Male OEF/OIF Veterans Seeking Treatment for Posttraumatic Stress, an official erectile dysfunction diagnosis was present in 12% of male combat veterans while sexual arousal problems were present in 62% of partnered veterans.
In the 2002 study Sexual Dysfunction in Combat Veterans with Post-traumatic Stress Disorder, “patients [combat veterans] with PTSD had poorer scores on overall satisfaction and orgasmic function and showed trends toward poorer scores on intercourse satisfaction and erectile function.” In this study, erectile dysfunction rate was 85% in veterans with PTSD while it was 22% in veterans without PTSD.
Medication, Sexual Function, Desire and Combat PTSD
It is not known why sexual desire and sexual function are so impeded in veterans with combat PTSD but part of the reason may be medication-related. Antidepressant therapy is common in combat PTSD treatment and this medication may impact desire, arousal, and sexual functioning.
How to Improve Sexual Desire and Functioning in Combat PTSD
Medication can address some sexual dysfunction issues and if the sexual function or arousal is being impacted due to a PTSD medication, a change in medication can often solve the problem. Many choices of medication exist so, in general, veterans should not have to live with this side effect.
Additionally, there is research that suggests that treating the underlying combat PTSD will correct the problems in sexual desire and function. This makes perfect sense. As other PTSD symptoms lessen, so do these ones.
Psychotherapy for combat PTSD is also often helpful in addressing these types of issues.
However, none of this help can be employed if the combat veteran is not open about what is happening for him or her so my biggest piece of advice for veterans experiencing reduced sexual desire or functioning is to be open with his or her healthcare provider so that you can look for a solution together. And remember: this, too, can be a symptom of combat PTSD and is not your fault.
This veteran is from the Vietnam conflict and is a former POW. He needed to move residences at short notice. The previous landlord didn’t want to fix the house where he was staying. Instead of fixing the house, the landlord gave the veteran 3 days to move out. Tri-state Veterans Community Alliance (TVCA) contacted me and Ken to see if we could help this veteran.
I got a vision from God to help the veteran community in some way. This was our first project from that vision and it went well. The veteran needed the next home painted and help with the move. On Saturday my son, Ken, and I painted the house as much as we could. The new landlord didn’t bring enough paint, so we did what we could with the time and supplies we had. On Monday, Jack, a friend from my church Crossroads, Elizabeth, a member of Team RWB, Ria, a member of Team Rubicon, and I packed and made 3 trips of furniture and other goods to move the veteran.
We are trying to start a group that would help veterans with things, like moving, if they don’t have the money for it. Also, with painting if they don’t have anyone to paint for them and other things like putting a window A/C in. The idea is to connect as many of the organizations that want to help veterans together to make an impact on the every day life of the disabled veterans in the community. This was an effort put together from TVCA, to Ken and I, then we contacted Team RWB, Team Rubicon, WWP, Good Will, and Easter Seals. There was only a small group of us that came together and it was a great success.I would like to know if there is an organization doing something like what we did and learn more of any ones experience.
The First link is a small video of the move and the second of the painting.