Is there a role for peer support delivered interventions in the treatment of veterans with post-traumatic stress disorder?

Up to 13% of veterans from the recent conflicts in Iraq and Afghanistan have combat-related post-traumatic stress disorder (PTSD). Despite the availability of evidence-based treatments, which improve core PTSD symptoms and prevent further negative consequences, only a minority of help seeking veterans follow-up with the recommended course of mental health treatment. This highlights the need for innovative strategies that make treatment for veterans with PTSD more acceptable, easier to engage in, and adhere to. Recovery-orientated approaches to PTSD treatment, which allow the affected individual to experience improved health, wellness, and overall quality of life by emphasizing patient centered care, empowerment, and the instillation of hope may represent a solution to this problem. Peer support is a specific example of a recovery orientated approach and is typically defined as a peer with a history of mental illness who, having experienced significant improvement in their condition, offers services and support to a peer considered to be not as far along in their own recovery process. For individuals living with serious mental illness (SMI), supplementing traditional mental health treatment with peer support to has been shown to reduce many of the problems associated with engaging patients in mental health treatment. Furthermore, in 2004, the Veterans Administration (VA) Mental Health Strategic Plan specifically called for the formalization of peer support within VA with the “hiring of veterans as Peer/Mental Health Para Professionals.” Peer support, within VA ideally, consists of four pillars: (1) affiliation on as many qualities as possible; (2) a lived experience with the same illness, or as close to the same illness as possible; (3) the peer provider being successfully engaged in recovery, and; (4) having certification in peer support competencies. Promising outcomes have been found using peer support for veterans with SMI. The feasibility of obtaining system “buy in” and formally recruiting, training, and supervising such “peer support technicians” to supplement traditional mental health treatment for veterans with SMI has been demonstrated. These developments raise a key question: can formal peer support interventions provide a unique and valuable supplement to VA PTSD treatment too? There appears to be a significant body of experimental evidence to support this assertion. First, the social ecology of PTSD framework proposes that social bonds exert a powerful influence on the development and maintenance of PTSD and, more crucially, it is within such social bonds that individuals develop the sense of safety necessary for improvement of PTSD symptoms. Second, research specifically examining the role of veteran-to-veteran mutual support in improvement in PTSD outcome has identified veterans as an important and highly valued component of veteran PTSD patients’ social networks. Since military experiences are often intertwined with the traumatic events that contribute to the etiology of PTSD in combat veterans, it is reasonable to assume that an intervention offered by a veteran peer in recovery from PTSD may hold considerable potential. Although a number of programs elegantly describe peer paraprofessional outreach in the treatment of military personnel coping with PTSD, there remains a gap in our knowledge as to the effectiveness and durability of approaches which integrate formal peer support into PTSD treatment. As a first step to examine the mechanisms by which peer support may be helpful to veterans with PTSD, we conducted focus groups at the VA Palo Alto Health Care System, Trauma Recovery Programs, a PTSD Residential Rehabilitation Program, and a Women’s Trauma Recovery Program. The focus group data was collected as the first phase of a larger ongoing study and was approved by the Stanford University Institutional Review Board. The Trauma Recovery Programs have both a 40-bed men’s and a 10-bed woman’s program, *National Center for Posttraumatic Stress Disorder, VA Palo Alto Health Care System, 795 Willow Road, NC-PTSD-324, Menlo Park, CA 94025. †Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305. ‡VA Sierra-Pacific Mental Illness Research, Education and Clinical Center, VA Palo Alto Health Care System, 795 Willow Road, NC-PTSD-324, Menlo Park, CA 94025. The views expressed are those of the authors and do not necessarily reflect the official policy or position of the Department of Veterans Affairs or the United States Government.