Development of a consensus-based occupational therapy treatment template for veterans with combat-related posttraumatic stress disorder: A Delphi study
Posttraumatic stress disorder (PTSD) affects many combat veterans and is known to adversely impact everyday life activities. Occupational therapists treat veterans with PTSD but there is little evidence in the literature to support occupational therapy (OT) intervention with this population. Specifically, occupational therapists have not created and validated an OT treatment approach developed expressly for veterans with combat-related PTSD. The purpose of this research was to develop a consensus-based OT treatment template for veterans with combat-related PTSD. The study utilized a modified Delphi method of consensus attainment. The study employed iterative surveys with Canadian occupational therapists with an interest in mental health practice to develop a consensus of opinion on what should be included in an OT treatment template. The information derived from the study is presented as a model OT treatment template for veterans with combat-related PTSD that is both occupation-focused and occupation-based. The consensus-based treatment template is present-focused, addressing occupational performance in the present, rather than focusing on the past traumatic event. The templated treatment employs five program goals and is based upon theoretical foundations from one OT practice model, the Canadian Model of Occupational Performance and Engagement, and two cognitive-behavioral therapy treatment models, Behavioral Activation, and Acceptance and Commitment Therapy. The template utilizes six occupational therapy assessment tools: (a) the Canadian Occupational Performance Measure, (b) the Role Checklist, (c) the Occupational Questionnaire, (d) the Modified Interest checklist, (e) the Self-efficacy Scale, and (f) the functional assessment of the impact of stress triggers and avoidance behaviors on occupational functioning. The template also employs six specific interventions: (a) education on the cause of PTSD, stress reactions, and how it affects function; (b) life skills training; (c) mindfulness techniques; (d) cognitive and sensory grounding techniques; (e) cognitive restructuring of cognitive distortions; and (f) engagement in scheduled, graded, meaningful occupations and activities to support occupational roles, habits and routines. The author presents a discussion on future directions to convert the treatment template into a manualized intervention.