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Evidence-Based Psychotherapy Interventions to Improve

Psychosocial Functioning in Veterans With PTSD
An Integrative Review
Kristina Reich, PMHNP-BC, RN; Lynne Nemeth, PhD, RN; and Ron Acierno, PhD

T
ABSTRACT he prevalence of posttraumatic
Posttraumatic stress disorder (PTSD) is a prevalent diagnosis among Veterans stress disorder (PTSD) in the
Veteran population across dif-
and is linked to psychosocial functioning impairment across various domains,
ferent war eras is 5% to 30% (Acierno
including marriage, employment, parenting, family, and education. Veterans are et al., 2017). Individuals with PTSD
more likely to be divorced, unemployed, and experience difficulties with parent- experience impairing symptoms, such
ing. Some research has suggested that improvement in PTSD–specific symptoms as intrusive thoughts, avoidance, nega-
tive alterations in mood, alteration
can also improve psychosocial functioning. An integrative review was conducted
in arousal, and reactivity (Fang et al.,
to explore the content and effectiveness of evidence-based psychotherapy (EBP) 2015). This symptomology negatively
interventions to improve psychosocial functions and investigate conditions for influences psychosocial functioning
symptom change. The Socio-Interpersonal Framework Model of PTSD was used (Fang et al., 2015) and interactions by
individuals within their environments,
to synthesize and organize findings. MEDLINE, CINAHL, and PsycINFO databases
as well as their ability to fulfill roles
were searched and seven articles met inclusion criteria. The main results indicate within environments, such as work, so-
that EBP interventions can improve psychosocial functioning in Veterans with cial activities, and relationships (Bosc,
PTSD. Treating Veterans until they no longer meet diagnostic criteria for PTSD 2000).
Rodriguez, Holowka, and Marx
may be beneficial to improve psychosocial functioning. The current integrative
(2012) note that PTSD is linked to
review revealed that this area is neglected in research. [Journal of Psychosocial problems in psychosocial functioning
Nursing and Mental Health Services, 57(10), 24-33.] in marital, parental, familial, and oc-

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cupational domains. For example, pa- ary or indirect variable, or these studies ological framework for integrative re-
tients with PTSD are more likely to fail to address psychosocial function- views developed by Whittemore and
miss work and report reduced work pro- ing (Frueh, Turner, Beidel, & Cahill, Knafl (2005) using the model’s five
ductivity. Furthermore, Veterans with 2001). Therefore, an integrative review stages of (a) problem identification,
PTSD are twice as likely as Veterans was conducted to investigate, through (b) literature search, (c) data evalua-
without PTSD to divorce and three the lens of the Socio-Interpersonal tion, (d) data analysis, and (e) presen-
times as likely to experience multi- Framework Model of PTSD (Maercker tation. Stage 1 involved formulating
ple divorces (Rodriguez et al., 2012). & Hecker, 2016; Maercker & Horn, and stating the question framing the
PTSD may also negatively impact par- 2013), current research about the con- review. Stage 2 was addressed using
enting ability, which can lead to im- tent and effectiveness of EBP PTSD a systematic literature search. Study
paired attachment with children, child interventions to improve psychosocial quality and level of evidence were
behavioral problems, and family vio- functioning in the Veteran population. then evaluated during Stage 3 using
lence (Rodriguez et al., 2012). Veterans In addition, the current integrative re- standardized tools. To finalize Stage 4
with PTSD typically avoid crowds and view explored whether specific factors of the methodological framework, the
may abruptly leave social events, creat- (e.g., age, race, sex) can facilitate such publications were presented in a table
ing discomfort for their partners and improvement. after data reduction. Stage 5 involved
others. Veterans often have limited synthesis of findings, implications, and
friendships because they cannot share THEORETICAL FRAMEWORK discussion of limitations (Whittemore
feelings, show emotional support, or The Socio-Interpersonal Framework & Knafl, 2015).
settle arguments in productive ways Model of PTSD (Maercker & Horn,
(Rodriguez et al., 2012). 2013) guided the current integrative re- Search Methods
Both the United States Department view. This model addresses complex re- To develop an effective literature
of Veterans Affairs (VA) and the De- lationships within the PTSD structure search strategy for the current integra-
partment of Defense (DOD) recognize and emphasizes the socio-interpersonal tive review, a medical reference librar-
the importance of addressing psycho- aspect of PTSD (Maercker & Horn, ian was consulted, and the PRISMA
social functioning in PTSD treatment. 2013). For example, family, peers, and statement was applied to guide the
The current VA/DOD practice guide- society are deemed important and conduction and reporting of the search
lines for management of PTSD accord- can influence PTSD symptomology process (Figure 1) (Moher, Liberati,
ingly advise clinicians to assess func- (Maercker & Hecker, 2016). For the Tetzlaff, & Altman, 2009). The
tioning in the aforementioned areas current review, results were synthesized search was conducted using CINAHL,
and monitor progress after treatment using the framework’s 3-level approach. MEDLINE, and PsycINFO electronic
(Rodriguez et al., 2012). In addition, The model’s 3-level approach in- databases and included Boolean opera-
the guidelines recommend using in- cludes individual, close relationship, tors. In addition, bibliographies of pub-
dividual, manualized, trauma-focused and distant social levels. The individual lications included in the sample were
psychotherapy as first-line treatment level addresses the interactive styles of examined manually to identify any
for PTSD, when patient preferred persons with PTSD. For example, the articles that were not captured in the
and readily available (Management of model identifies affective reactions to electronic database search.
Posttraumatic Stress Disorder Work other people, close friends, or groups The following key terms were used
Group, 2017). Treating symptoms as social affects. Anger, shame/guilt, to conduct the search: interpersonal
that affect psychosocial function- and aggression can lead to interper- functioning, psychosocial functioning,
ing can improve quality of life for the sonal avoidance, social withdrawal, and social adjustment, social cognition, social
Veteran population (Schnurr, Hayes, partner violence (Maercker & Hecker, competence, social outcomes, social skills,
Lunney, McFall, & Uddo, 2006), and 2016). The close relationship level con- social functioning, marriage functioning,
improvement in PTSD symptoms may centrates on intimate relationships, marriage satisfaction, romantic relation-
also improve psychosocial functioning such as romantic and family relation- ships, work functioning, work satisfac-
(Schnurr et al., 2006). ships. The social interaction within this tion, employment, parenting, education,
Despite the recognized importance level can be supportive or maladaptive. school functioning, family functioning,
of addressing psychosocial functioning Finally, the distant social level involves family members, friendship, friendship
in PTSD, the impact of evidence-based societal and cultural belonging within satisfaction, relationship quality, close re-
psychotherapy (EBP) interventions for groups (Maercker & Horn, 2013). lationships, posttraumatic stress disorder,
PTSD on psychosocial functioning has PTSD, veteran, soldier, military, veter-
not been adequately investigated. Most METHOD ans, evidence-based interventions, thera-
PTSD intervention studies focus only Design py, and intervention. The search terms
on PTSD symptom change, considering The current integrative review fol- moderator, mediator, and predictor were
psychosocial functioning as a second- lowed the well-established method- included to explore the conditions un-

JOURNAL OF PSYCHOSOCIAL NURSING • VOL. 57, NO. 10, 2019 25

 pects of psychosocial functioning as
associated factors was retained. Six ar-
ticles were selected, and an additional
article was added from manual reviews
of the bibliographies. A total of seven
articles were included in the current
integrative review (Figure 1).

RESULTS
Data Presentation
Relevant publications were arranged
in a matrix as follows: author and year,
intervention and population, study
method/design, relevant outcomes and
measures, relevant findings, and level
of evidence (Table 1). The Critical
Appraisal Skills Programme (CASP)
criteria were used to evaluate the qual-
ity of the studies, and level of evidence
was evaluated using the Oxford Center
for Evidence-Based Medicine (2011)
criteria. The sample studies varied in
quality and level of evidence. However,
overall, studies met criteria for most of
the required components of the chosen
appraisal tools. Table 2 presents the
Figure 1. PRISMA flow diagram (Moher et al., 2009). Socio-Interpersonal Framework Model
Note. EBP = evidence-based psychotherapy; PTSD = posttraumatic stress disorder. of PTSD levels included in each of the
sample studies.
der which PTSD treatment is effective studies and evidence, a 10-year limit
as it related to psychosocial function- was applied. Socio-Interpersonal Framework Model
ing. Inclusion criteria were studies: of PTSD
● that investigated psychosocial Search Outcomes None of the studies in the sample
functioning as a primary or secondary The literature search in MEDLINE, used the Socio-Interpersonal Frame-
outcome; CINAHL, and PsycINFO resulted in work model of PTSD. Only one study,
● conducted with Veterans diag- 18 articles, none of which were rel- the exploratory chart review, described
nosed with PTSD; evant manuscripts. To expand the using a theoretical framework: the
● that tested EBP interventions search, the search terms predictor, mod- Anderson Behavioral model. The for-
(e.g., prolonged exposure [PE], cogni- erator, and mediator were removed. The mulation of the distant social relation-
tive-behavioral therapy [CBT], cogni- revised search resulted in 738 publica- ship level of the Socio-Interpersonal
tive processing therapy [CPT]); tions with no duplicates. All 738 ar- Framework Model of PTSD was ex-
● examining predictors, mod- ticles were screened for eligibility by panded to include work-related func-
erators, and mediators of treatment; reading titles and abstracts, leaving tioning, student status, social activi-
and research conducted with adults 70 full-text articles for additional re- ties, and social detachment, because
(age >18 years). view. Sixty-four articles were removed each factor was applicable to the third
Exclusion criteria were: because they did not meet inclusion level of societal and cultural sphere
● non-English articles; criteria. Five articles presented reports (Maercker & Hecker, 2016). Factors at
● articles not published in peer- of studies in which researchers investi- the distant social level were most com-
reviewed journals; gated various domains of psychosocial monly addressed (Table 2).
● pharmaceutical interventions; functioning. There was limited dis- Individual Level. The Clinician
● traumatic brain injury diagnosis; cussion on the conditions of effective Administered PTSD Scale (CAPS)
● dissertations; and PTSD treatment to improve psychoso- four-item subset was administered to
● literature reviews. cial functioning; therefore, one article measure social and emotional func-
Furthermore, because the primary in which the researchers evaluated tioning in one of the sampled studies;
interest is in the most recent research PTSD symptom improvement and as- two items on the CAPS subset ad-

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 TABLE 1
EVIDENCE FROM SELECTED STUDIES

Intervention and Relevant Outcomes and

Study Population Study Design Measures Relevant Findingsa CASPb/LOEc
Beidel, Frueh, Uhde, PE vs TMT RCT Social and emotional PE and TMT showed decrease in 8/1b
Wong, & Mentrikoski N = 49 (male) functioning weekly episodes of verbal rage
(2011) (p < 0.01) and improved social and
Patient ratings CAPS subset of emotional functioning (p < 0.001)
4-item subset
Ehlers et al. (2014) 7-day CBT vs CBT vs RCT Psychosocial-related disability Intensive 7-day CBT (d = 1.60, 10/1b
emotion-focused (difficulty in work, social life, p < 0.002) and standard CBT
supportive therapy leisure activities, family life, and (d = 1.50, p < 0.002) delivered over
N = 121 home) 3 months, improved psychosocial
functioning
Sheehan Disability Scale

JOURNAL OF PSYCHOSOCIAL NURSING • VOL. 57, NO. 10, 2019

Holliday, Williams, Bird, CPT vs PCT RCT Psychosocial and health CPT and PCT improved social 9/1b
Mullen, & Surís (2015) N = 45 functioning domains functioning domain (symptoms
interfere with social activities)
SF36 (p = 0.025) and role emotional domain
(work and daily activities issue due to
emotional problems) (p = 0.050)
Monson et al. (2012) CPT vs wait list Retrospective Social adjustment (spouse, CPT improved extended family 12/1b
N = 46 cohort family, extended family, relationships, and housework
housework, work, and social/ completion (range, η2 = 0.08 to 0.11)
leisure activities domains)
Improvements in emotional
PTSD symptom clusters numbing were associated with
associations with changes in improvement in overall, extended
social adjustment domains family, and housework adjustment
(ß = 0.35 to 0.55)
SAS
Improvement in avoidance was
associated with decline in extended
family adjustment (ß = –0.34),
but improvement in housework
(ß = 0.30)

27
28
TABLE 1 (CONTINUED)
EVIDENCE FROM SELECTED STUDIES

Intervention and Relevant Outcomes and

Study Population Study Design Measures Relevant Findingsa CASPb/LOEc
Myers, Haller, Angkaw, CPT individual vs CPT Retrospective Predisposing characteristics CPT or PE individual therapy 12/2b
Harik, & Norman (2018) group vs PE chart review (sex, age, race) showed significant improvement
N = 82 (male) in PTSD symptoms with treatment
Enabling resources (treatment completion (d = 0.64)
format, student status, distance
to the VA) Veterans who completed evidence-
based psychotherapy and identified
Needs factors (reporting as students showed greater
problems to their provider reduction in PTSD symptoms
about work, family or significant compared to Veterans who were
others, sleep, anger) as not students (ηp2 = 0.06, p = 0.024)
predictors of PTSD symptom
improvement and treatment Veterans who reported problems
completion with family members or significant
others were more likely to complete
treatment (OR = 3.8, 95% CI [1.32,
10.97], p = 0.014)

Age, gender, ethnicity, race did not

predict treatment response
Schnurr & Lunney (2012) PE vs PCT Secondary analysis Occupational impairment PE and PCT showed no significant 12/2b
N = 218 (female) change in occupational satisfaction
Retrospective Occupational satisfaction but significant reduction in work
cohort impairment (PE: d = –0.33, p < 0.01)
CAPS QOLI (PCT: d = –0.29, p <0.01)

Participants who no longer

met PTSD criteria had greater
improvements (range, d = 0.16 to
–0.84, p < 0.01)

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 TABLE 1 (CONTINUED)
EVIDENCE FROM SELECTED STUDIES

Intervention and Relevant Outcomes and

Study Population Study Design Measures Relevant Findingsa CASPb/LOEc
Schnurr & Lunney (2016) PE vs PCT Secondary analysis PTSD symptom change groups: No differences were found between 11/2b
N =235 (female) Retrospective no response, response, loss of PE and PCT on outcome
cohort diagnosis, and remission
Loss of PTSD diagnosis vs response
Clinician-rated social and is associated with improvement
occupational impairment, self- in clinician-rated social (OR = 4.65,
reported functional impairment 95% CI [1.75, 12.36], p < 0.01)
(role emotional, role physical, and occupational impairment
social functioning scale) (OR = 3.54, 95% CI [1.44, 8.73],
p < 0.01)
SF36

JOURNAL OF PSYCHOSOCIAL NURSING • VOL. 57, NO. 10, 2019

CAPS PTSD symptom change showed
improvement between groups;
improvement from no change to
remission, suggesting as PTSD
symptoms decreased psychosocial
functioning improved

Note. CASP = Critical Appraisal Skills Programme; LOE = level of evidence; PE = prolonged exposure; TMT = trauma management therapy; RCT = randomized controlled trial; CAPS = Clinician
Administered PTSD Scale; CBT = cognitive-behavioral therapy; CPT = cognitive processing therapy; PCT = present centered therapy; SF36 = Short-Form 36 Health Survey; PTSD = posttraumatic stress
disorder; SAS = Social Adjustment Scale; OR = odds ratio; CI = confidence interval; QOLI = Quality of Life Inventory.
a
Effect size included if reported.
b
Scoring: RCT = 0 to 10, with 10 being the highest quality. Cohort = 0 to 12, with 12 being the highest quality.
c
Scoring: 1a = systematic reviews of RCTs; 1b = individual RCTs; 2a = systematic reviews of cohort studies; 2b = individual cohort study or low-quality RCTs; 2c = “outcomes” research, ecological studies;
3a = systematic reviews of case control studies; 3b = individual case-control study; 4 = case series; and 5 = expert opinion .

29
 functioning as measured by CAPS
TABLE 2 (Beidel et al., 2011).
SOCIO-INTERPERSONAL FRAMEWORK Close Relationship Level. Two instru-
MODEL OF PTSD LEVELS INCLUDED IN STUDIES ments were used to assess psychosocial
functioning at the close relationship
Close level. The Social Adjustment Scale
Individual Relationship Distant Social (SAS) was used to measure overall
Study Level Level Level social adjustment, which assesses mul-
Beidel et al. (2011) X X tiple domains, including spouse (i.e.,
Ehlers et al. (2014) X X role as a spouse), family (i.e., being a
member of a family unit), extended
Holliday et al. (2015) X
family (i.e., relationship with extended
Monson et al. (2012) X X family members), housework, school-
Myers et al. (2018) X work, work, social and leisure activi-
Schnurr & Lunney (2012) X ties, parenting, and income (Monson
Schnurr & Lunney (2016) X et al., 2012). The Sheehan Disability
Scale measures impairment in various
psychosocial functioning domains; a
Note. PTSD = posttraumatic stress disorder. portion of the scale measures second-
level factors by assessing family life and
home life (Ehlers et al., 2014).
In one study, clients who received
TABLE 3 CPT showed improvement in overall
EVIDENCE-BASED PSYCHOTHERAPY INTERVENTIONS social adjustment compared to those
on a wait list to receive treatment
Intervention Description
(Monson et al., 2012). In addition to
Prolonged exposure Concentrates on repetitive imagined improvements in overall social adjust-
and/or in vivo exposure to the ment, improvements in extended fam-
traumatic event ily relationships and housework scores
Cognitive processing therapy Involves modifying maladaptive were also noted. When standard CBT
cognitive coping strategies related to and intensive 7-day CBT were com-
traumatic events pared, both treatments were effec-
Cognitive-behavioral therapy for PTSD Works on restructuring negative tive in improving overall psychosocial
cognitions to decrease the ongoing functioning–related disability as mea-
sense of threat; based on Ehlers and sured by the Sheehan Disability Scale
Clark’s model of PTSD (Ehlers et al., 2014).
Present centered therapy Focuses on issues experienced by the
Distant Social Level. The follow-
Veteran at the time of treatment as a
ing instruments were used to as-
result of PTSD
sess psychosocial functioning at
this level: CAPS, investigator-
designed self-reports, Quality of life
Note. PTSD = posttraumatic stress disorder. Inventory (QOLI); Sheehan Disability
Adapted from Management of Posttraumatic Stress Disorder Work Group (2017) and Ehlers et Scale; and the Short Form 36 Health
al. (2014). Survey (SF36).
Social functioning, defined as inter-
est in social activities and social de-
dressed the individual level, includ- management therapy (TMT), which tachment, was measured by a subset of
ing range of affect and anger con- incorporates PE and social emotional questions on the CAPS tool. Partici-
trol. In addition, written self-reports rehabilitation training. Participants pants completed self-reports to record
were used to record and measure the in both groups had lower PTSD symp- information related to social activities.
number and severity of anger, rage, tomology after treatment and showed Occupation-related outcomes were
and anxiety episodes (Beidel, Frueh, a reduction in self-reported weekly measured via clinician-rated occupa-
Uhde, Wong, & Mentrikoski, 2011). episodes of verbal rage. Furthermore, tional impairment with CAPS and
In the study by Beidel et al. (2011), participants in both treatment groups by the occupational satisfaction item
Veterans received PE alone or trauma showed improvement in emotional on the QOLI. The Sheehan Disabil-

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ity Scale assesses work, leisure activi- members or significant others was as- cupational satisfaction and impairment
ties, and the social life of participants sociated with completion of EBP treat- (Schnurr & Lunney, 2012). Other
(Ehlers et al., 2014). The SF36 assesses ment. Therefore, the relationship be- studies investigated domains includ-
psychosocial and health functioning tween social and treatment success may ing social adjustment and psychosocial
domains, such as social functioning, be bidirectional. Predisposing factors and health functioning (Beidel et al.,
work, and social and daily activities (e.g., sex, race, ethnicity, military sex- 2011; Holliday et al., 2015; Monson
(Holliday, Williams, Bird, Mullen, & ual trauma) were not associated with et al., 2012). Researchers in one study
Surís, 2015). improvements in PTSD or completion explored the association among PTSD
Improvement in social functioning of EBP treatment. symptom improvement, status as a
occurred with PE and TMT interven- student, and family relationship sta-
tions (Beidel et al., 2011). However, DISCUSSION tus (Myers et al., 2018). In addition,
the group that received TMT demon- The current integrative review had sampled studies explored conditions
strated greater improvements in self- several aims. The first aim was to gain in which aspects of psychosocial func-
reported frequency and duration of a better understanding of EBP inter- tioning showed the greatest improve-
social activities. Occupational impair-
ment improved following PE and pres-
ent centered therapy (PCT); however,
occupational satisfaction showed no
improvement with these treatments
(Schnurr & Lunney, 2012). CBT was ...Addressing the core PTSD symptoms of emotional
effective in improving overall work and numbing and effortful avoidance can improve
social life (Ehlers et al., 2014). CPT
and PCT improved functioning in the select psychosocial functioning domains...
psychosocial domains related to prob-
lems with social, work, and daily activi-
ties as measured by the SF36 (Holliday
et al., 2015).

Conditions for Symptom Change ventions and their effect on psychoso- ment (Monson et al., 2012; Schnurr &
CPT improved the core PTSD cial functioning among Veterans with Lunney, 2016). Most studies also mea-
symptom emotional numbing (individ- PTSD. The second aim was to explore sured additional variables such as qual-
ual level factor), which was associated factors that may facilitate improve- ity of life, depression, and anxiety. EBP
with improvements in overall social, ment in this area. In addition, the interventions included CPT, PE, CBT
extended family, and housework adjust- Socio-Interpersonal Framework Model for PTSD, and PCT (Table 3).
ment (Monson et al., 2012). Further- of PTSD was used to synthesize and or- The main purpose was to explore
more, participants who received CPT ganize findings. conditions that may facilitate improve-
demonstrated improvements in the All sampled studies used quantita- ments related to psychosocial function-
core PTSD symptom effortful avoid- tive methods; three studies were ran- ing after EBP. However, identifying
ance (individual level factor), which domized controlled trials (RCTs), three these conditions was challenging due
was associated with an improvement studies were secondary analyses of to limited available literature. Despite
in housework adjustment, but with a RCTs conducted by the author of the the scarcity of data, results indicated
decline in extended family adjustment current integrative review, and one was that addressing the core PTSD symp-
(Monson et al., 2012). Improvements an exploratory chart review. Six studies toms of emotional numbing and effort-
in various aspects of psychosocial func- were conducted in the United States, ful avoidance can improve select psy-
tioning, such as occupational impair- and one study was conducted in the chosocial functioning domains, such as
ments, were reported when partici- United Kingdom. social and extended family adjustment.
pants no longer met PTSD diagnostic Psychosocial functioning was not al- These findings are in line with other
criteria (Schnurr & Lunney, 2012, ways mentioned directly, and terminol- research studies that report that emo-
2016). Veterans who identified as stu- ogy associated with this concept varied. tional numbing is negatively associated
dents (distant social level factor) and Studies examined multiple domains of with psychosocial functioning related
completed EBP, PE, or PCT had greater psychosocial functioning. For example, to relationship satisfaction (Campbell
PTSD symptom reduction compared to in one study, researchers measured psy- & Renshaw, 2013).
non-students (Myers, Haller, Angkaw, chosocial functioning related to dis- Loss of PTSD diagnosis can im-
Harik, & Norman, 2018). In addition, ability (Ehlers et al., 2014), whereas in prove psychosocial functioning as well,
experiencing problems with family another study, researchers assessed oc- and researchers suggest that treating

JOURNAL OF PSYCHOSOCIAL NURSING • VOL. 57, NO. 10, 2019 31

Veterans until they no longer meet di- ble recommendations and conclusions. best psychosocial functioning instru-
agnostic criteria for PTSD is beneficial. Studies exploring improvement in ment that can present more uniform
Myers et al. (2018) suggested that being psychosocial functioning domains fol- and comprehensive results (Fang et al.,
a student can be helpful and produces lowing EBP are similarly promising but 2015; Rodriguez et al., 2012).
a better response because students are limited in number. None of the studies Although impaired marital func-
familiar with homework and following integrated the complete Socio-Inter- tioning, parenting, and parent-child re-
instructions. This study (Myers et al., personal Framework Model of PTSD. lationships are associated with PTSD, a
2018) also determined that experienc- To minimize limitations, a medical ref- limited number of studies were identi-
ing an issue with family or significant erence librarian was consulted to assist fied in these areas, warranting further
others is associated with EBP treatment with the search strategy. In addition, a research (Rodriguez et al., 2012). Ad-
completion, suggesting that this factor methodological and theoretical frame- ditional research should thus focus on
is an important motivator to improve. work was used to perform the current parenting and marital domains at the
Although predisposing factors such as integrative review. individual and close relationship levels.
gender and ethnicity did not contribute Another limitation was the lack of The Socio-Interpersonal Framework
to treatment outcomes, it is important consistency associated with the mea- Model of PTSD provides an effective
to mention that the authors evaluated suring tools and terminology research- guide and can be applied in subsequent
only one such study. ers used to assess psychosocial func- studies related to psychosocial func-
Although most of the framework tioning. The CAPS measuring tool was tioning. EBP demonstrated effective-
factors were explored across the sample frequently used in various ways to mea- ness in improving various aspects of
studies, factors associated with the in- sure multiple psychosocial functioning psychosocial functioning.
dividual and close relationship level factors. However, the CAPS tool only
are under-investigated in the literature. provides a general assessment of occu- REFERENCES
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ser0000058 Myers, U.S., Haller, M., Angkaw, A.C., Harik,
Maercker, A., & Hecker, T. (2016). Broaden- J.M., & Norman, S.B. (2018). Evidence- Ms. Reich is PhD Student, Dr. Nemeth is
ing perspectives on trauma and recovery: based psychotherapy completion and symp- Professor, and Dr. Acierno is Professor, College of
A socio-interpersonal view of PTSD. Euro- tom improvement among returning combat Nursing, Medical University of South Carolina,
pean Journal of Psychotraumatology, 7, 29303- veterans with PTSD. Psychological Trauma: Charleston, South Carolina.
29309. doi:10.3402/ejpt.v7.29303 Theory, Research, Practice, and Policy, 11, The authors have disclosed no potential
Maercker, A., & Horn, A.B. (2013). A socio in- 216-223. doi:10.1037/tra0000360 conflicts of interest, financial or otherwise.
terpersonal perspective on PTSD: The case Rodriguez, P., Holowka, D.W., & Marx, B.P. Address correspondence to Kristina Reich,
for environments and interpersonal process- (2012). Assessment of posttraumatic stress PMHNP-BC, RN, PhD Student, College of Nursing,
es. Clinical Psychology & Psychotherapy, 20, disorder-related functional impairment: A Medical University of South Carolina, 99 Jonathan
465-481. doi:10.1002/cpp.1805 review. Journal of Rehabilitation Research and Lucas Street, MSC 160, Charleston, SC, 29425;
Management of Posttraumatic Stress Disorder Development, 49, 649-665. e-mail: [email protected].
Work Group. (2017). VA/DOD clinical prac- Schnurr, P.P., Hayes, A.F., Lunney, C.A., McFall, Received: February 16, 2019
tice guideline for the management of posttrau- M., & Uddo, M. (2006). Longitudinal analy- Accepted: April 26, 2019
matic stress disorder and acute stress disorder. sis of the relationship between symptoms and doi:10.3928/02793695-20190531-04
Retrieved from https://www.healthquality. quality of life in veterans treated for post-

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