A unique approach to the treatment of posttraumatic stress disorder (PTSD) is difficult to support, because of the complexity and heterogeneity of this pathology. Multiple evidence-based guidelines for PTSD treatment exist, elaborated by prestigious institutions around the world, but a certain level of the inconsistency of their recommendations appears when these sources are compared with each other. Therefore, a review of current guidelines and extraction of the most supported by evidence recommendations is considered important for clinical practice, due to the need to approach such complex cases as PTSD-diagnosed patients in a stepwise manner. Structured monitoring of the clinical status during the treatment is also an important and rather neglected aspect of the case management in PTSD, and the necessity of follow-up visits for efficacy and tolerability should be taken into consideration. Psychotherapy (especially cognitive- behavioral oriented therapies and eye movement desensitization and reprocessing therapy) is supported by evidence as a first-line approach, as well as certain antidepressants, like the selective serotonin reuptake inhibitors and venlafaxine. Many second-line pharmacological agents and psychotherapies are also available, but there is an obvious need for more pragmatic trials with PTSD patients.
This narrative review examines psychotherapeutic interventions for combat soldiers who deal with post-traumatic distress and face a complex therapeutic setting where the relationships between clients and therapy providers are often conflictual. Despite available emotional aid, gaps between traumatized soldiers’ emotional needs and institutional solutions are inevitable and are challenging for clients and therapists alike. These issues are discussed through Israeli soldiers’ experiences, a population at high risk for trauma-related distress, due to this country’s ongoing security threats. Following a narrative literature review, four key themes emerged: mutual difficulties in admitting mental injury, intergenerational trauma, preserving the soldier identity upon discharge, and choosing among therapeutic opportunities. The study highlights the need and rationale for diverse biopsychosocial interventions for veterans and proposes considerations for enhancing treatment success. Results emphasize the importance of tailored approaches that address both individual and systemic factors affecting veterans’ mental health. Guidance for psychosocial interventions is provided, considering the multifaceted nature of combat-related trauma.
