Development of a Veteran-Informed Meaning, Purposeful Action & Recovery Therapy (MPART) for Treatment of PTSD

Purpose: Although a recovery perspective focused on enhancing life meaning and empowering purposeful action has been enthusiastically adopted for use with some seriously mentally ill populations, it has not yet been applied to a posttraumatic stress disorder (PTSD) patient population on a wide scale – despite research showing that failure in meaning-making is prevalent in PTSD (e.g. Owens, Steger, Whitesell & Herrera, 2009). Moreover, although the pursuit of meaningful goals is associated with well-being, data collected in our clinic suggest that impoverished future views and pessimism about the likelihood of achieving goals are common among veterans seeking treatment for PTSD. We describe efforts to fill this gap through the development of a life purpose and meaning-making group treatment model tailored to a VA PTSD clinic population. This model, called Meaning, Purposeful Action & Recovery Therapy (MPART), is informed by social, cultural, and clinical psychological theory and was developed by a VA social worker and psychiatrist in collaboration with veterans receiving treatment in the PTSD clinic.

Methods: The development of MPART has entailed a multi-phased collaborative process, consisting of 1) a focus group conducted with veterans (n=8) focused on perceived needs, and revealing themes of recovery and meaning-making; 2) creation of a sample manual through interdisciplinary collaboration among VA clinicians, informed by focus group outcomes, consultation with individual veterans, and a thorough review of existing treatment models; and 3) a trial run with veterans (n=12) involving continual group and individual feedback and ongoing manual revision.

Results: We present a reflective discussion of this inclusive development process, including feedback from veteran participants focused on themes of increased sense of empowerment, hope, and purpose. Next, we present outcomes of this process through description of the current MPART treatment manual. Based on the assumption that effective PTSD treatment requires not only symptom reduction, but also the building and reinforcement of a sense of life meaning and purpose, the MPART model aims to promote identification of strengths, values and goals, and the initiation of purposeful action. It utilizes a multifaceted theoretical approach, incorporating a strengths-based recovery perspective supplemented by elements of logotherapy, posttraumatic growth theory, flexible use of active and acceptance coping, and mindfulness skills training, with a culmination in training for and adopting a volunteer role in a community and/or VA setting. Following ten sessions led by clinicians, participants continue to meet in a veteran-led format to provide ongoing support as they engage in individual and group mentorship and other volunteer activity.

Implications: Reflection on the development of MPART highlights the importance of involving clients in the intervention development process, both to inform content and as a therapeutic device. It further emphasizes the critical role of perceived meaning and purpose in the lives of veterans struggling with PTSD, and proposes a model for addressing deficits in these areas. Methods for ongoing and future program evaluation will be discussed, as will suggestions for other researchers and clinicians with interest in incorporating the MPART model or other recovery-oriented treatments in the VA system and elsewhere.