Group treatment programme for elderly war veterans with PTSD

The case reports by Hilton (1997) contribute to the growing literature on post-traumatic stress disorder (PTSD) in elderly war veterans as reviewed recently by Bonwick and Morris (1996). The Veterans' Psychiatry Unit, Melbourne, is being referred an increasing number of veterans of both the Second World War and Korean War suering PTSD. Generally these veterans have suered ̄uctuating PTSD symptoms since their war experiences, but have often coped with these and not previously presented to psychiatric services. Many present with an exacerbation of symptoms triggered by stressors common to late life, such as physical illness, early cognitive impairment and social isolation. The veterans also often comment on the role of the media. This was particularly apparent during 1995, when the Australian media publicised extensive, government-supported celebrations of the ®ftieth anniversary of the end of WW2 (the `Australia Remembers' campaign). Also media coverage of current events, which were potent reminders of the initial traumatic experience, can be involved. One veteran had an exacerbation of PTSD symptoms following intensive media coverage of con ̄ict and turmoil in the Middle East, which re-evoked his service experience in Syria during WW2. Hilton has also commented on the diculties with treatment, and speci®cally the problem of non-compliance, possibly due to the avoidance symptoms which are part of the illness. Since early 1996 our unit has run a series of group treatment programmes for elderly veterans with PTSD (Bonwick, 1997). The programme runs once weekly for 16 weeks in a day hospital setting with each group containing eight veterans. We are currently running the ®fth such group programme. The programme includes psychoeducation, symptom management, relaxation training, group therapy and physical exercise. There is also a group for wives, providing education and support. During the programme veterans are also seen by the unit psychiatry registrar for optimization of pharmacotherapy. Only a small number of veterans assessed as having PTSD have declined participation in this programme. With the exception of one death, all of the 33 veterans who have commenced the programme have completed the 16 weeks. The vast majority have continued to regularly attend a monthly `maintenance' group after completion of the programme. There are a number of potential reasons for the good compliance with our treatment programme. The day hospital is dedicated to providing psychiatric treatment speci®cally to elderly veterans. The veterans' sense of it being `their' service is very important. Using a group focus takes full advantage of the strong camaraderie between war veterans. Each of the groups has established strong bonds and a sense of cohesion, which provide great support to individual group members. Another important aspect is the emphasis placed on the importance of family involvement in both assessment and treatment (Wilkie-Smith, 1997). Following the programme, both veterans and wives report an increased understanding of PTSD, improved coping strategies and enhanced quality of life. This is often despite only limited improvements in core PTSD symptoms. We are evaluating outcome using measures of speci®c PTSD symptoms, psychological well-being and psychosocial functioning. Early results are encouraging. RICHARD BONWICK Veterans Psychiatry Unit Austin and Repatriation Medical Centre Melbourne