The Roles of Unit Cohesion and Trait Resilience Among Active Duty Soldiers Receiving Group Cognitive Processing Treatment for PTSD

Purpose: This study examines the roles that internal trait resilience and external perceived unit cohesion plays in PTSD treatment gains among active duty soldiers who completed group Cognitive Processing Therapy or Present Centered Therapy. Research has documented the protective role that trait resilience plays against developing PTSD. This study examined whether trait resilience facilitates treatment gains. The study also examined the role that unit cohesion plays in soldiers’ PTSD treatment gains. The sample includes service members who deployed in support of Operation Iraqi Freedom or Operation Enduring Freedom and experienced a combat-related trauma. Methods: These data come from the first randomized clinical trial comparing cognitive processing therapy (CPT) to present-centered therapy for combat-related posttraumatic stress disorder in 93 active duty service members. Horizontal and Vertical Unit Cohesion was measured by the Walter Reed Army Institute of Research Military Vertical & Horizontal Cohesion Scales. Trait resilience was measured by the Responses to Stressful Events Scale (RSES). Both were measured at baseline and 12-month follow-up time points. Results: Multiple regression revealed that service members with the higher levels of vertical cohesion, or positive impressions and relationships with the commanders of their units, did better in PTSD treatment than those who had lower levels of vertical cohesion. Multiple regression also revealed that service members with the higher levels of horizontal cohesion, or positive impressions and relationships with peers in their units, did better in PTSD treatment than those who had lower levels of horizontal cohesion. Service members with more resiliency as measured by the RSES also proved to do better in group PTSD treatment than those with lower levels of resiliency. Improvement in treatment was based on changes (decreases) in scores from baseline seen on the PTSD Checklist (PCL) and on the PTSD Symptom Scale-Interview (PSS-I), both measured at the 12-month treatment follow up.  Practice Implications: Trait resilience proved to be an important factor in active duty soldiers’ treatment gains. Resiliency should be further studied in this population to learn how resiliency can be strengthened in soldiers, both before trauma, and during treatment, to support soldiers’ treatment gains. Unit cohesion is an important factor influencing soldiers' PTSD treatment gains. The military should encourage unit leaders to foster a supportive environment among its soldiers to improve horizontal cohesion, as well as between leaders and those who report to them to strengthen vertical cohesion. Regular assessment of soldiers’ perceptions of peer and leadership support should be conducted to identify opportunities to improve cohesion where it is lacking. Investing in creating more cohesive units could result in improved prognosis for soldiers seeking treatment for PTSD.