It is Time to Rethink our Approach to PTSD

This Month’s Expert: Diagnosis and Treatment of PTSD Matthew J. Friedman, MD, PhDApril marked the 100th anniversary of the U.S. entry into World War I. For many, World War I is forgotten and perhaps insignificant, partly because of being overshadowed by the sensationalism of World War II, fought and won by the iconic “Greatest Generation.”

Many of us do not appreciate the significance of World War I and the immeasurable impact it had on the 20th century and our lives.

U.S. involvement from April 16, 1917 to Nov. 11, 1918 was an explosive period of growth and innovation in our social, economic and political landscape. However, from the darker side of this period came the intellectual foundation for our current understanding of the psychological wounds of war. The most notable is post-traumatic stress disorder – simply referred to as PTSD.

Two years before the U.S. entered into World War I, British soldiers were struggling with its psychological impact. Thousands of soldiers were made combat-ineffective because of tremors, loss of balance, headaches and other symptoms. Military doctors believed the symptoms were a neurological manifestation of shock waves caused by exploding shells, resulting in the inaccurate label of “shell shock.”

Early treatments for shell shock utilized shock therapy, frontal lobotomies and institutionalization. While clearly considered crude and inappropriate today, these were the best the medical community had based on their understanding of the condition.

Battle Fatigue

Understanding of the psychological wounds of combat improved during World War II. The term “battle fatigue” dominated the psychiatric nomenclature. And while many military leaders viewed the condition as a byproduct of cowardice, the frontline medics knew it was not that simple. Treatments became more humane and included rest away from front lines, as well as counseling and medications.

Television brought the Vietnam War into our homes with images of returning veterans struggling with PTSD. While PTSD rates were low in the early years of the war, they rose to about 30 percent toward the close. Exact reasons for that trend are unknown, but perhaps it is partly tied to the lack of support and welcome from a public firmly against an incredibly unpopular war.

Today, 16 years into the longest period of war in our nation’s history, we’re still fighting PTSD. The prevalence rate in post-9/11 veterans hasn’t changed from that of their predecessors from earlier conflicts.

What also has not significantly changed are the treatments we have provided our veterans over the past several decades – largely, talk-therapy and pharmaceuticals. While we have made advances in treatments since World War I, the numbers reveal that we have not won this fight. It is estimated that between 500,000 to 700,000 post-9/11 veterans are struggling with the symptoms of PTSD; only half of them seek treatment from the Veterans Administration, and a much smaller number actually complete treatment and report improvement.

One hundred years after shell shock, it is time to change our approach to viewing and treating PTSD and teach our veterans how to capitalize on their individual struggles. Let us get away from the medical model that reduces our combat veterans to a set of symptoms and start harnessing their inner strength and turn their struggles into new possibilities, purpose and meaning.

Posttraumatic Growth

This novel concept is called “posttraumatic growth,” or “PTG.” PTG is not new. Its premise is well-articulated by all major religions in sacred texts and other ancient literature. It is the simple recognition that from our deepest struggles we can become stronger. PTG moves beyond recovery from traumatic events, to facilitate the process of actually growing to be a stronger, healthier and better version of ourselves.

A growing number of experts in psychology and psychiatry believe that PTG can be cultivated in veterans. In fact, more than 30 years of research by psychologists Richard Tedeschi and Lawrence Calhoun, the fathers of modern-day PTG, establishes a strong foundation for this belief.

We do not contend that the facilitation of PTG in veterans should replace talk-therapy or medication; nor are our comments about their limitations an indictment of their importance and usefulness. However, we believe that leveraging veterans’ inner strength and resources, helping them find their inner compass, and encouraging them to explore new possibilities for psychological, relational and spiritual growth recognize what they have gained from their combat experiences versus what they have lost.

A previous version of this article appeared in the Houston Chronicle and was authored by Dr. Moore and Mr. Ken Falke, retired Navy Master Chief Petty Officer and chairman of Boulder Crest Retreat for Military and Veteran Wellness and the EOD Warrior Foundation.


It is Time to Rethink our Approach to PTSD

Bret Moore, Psy.D.

Dr. Moore is a board-certified clinical psychologist and prescribing psychologist in San Antonio, TX. His recent book Taking Control of Anxiety: Small Steps for Getting the Best of Worry, Stress, and Fear was developed as a self-help guide for people struggling with anxiety and for therapists to use with their patients. Dr. Moore is also coauthor of the Handbook of Clinical Psychopharmacology for Therapists-Ninth Edition and Child and Adolescent Psychopharmacology Made Simple-Fourth Edition.


APA Reference
Moore, B. (2017). It is Time to Rethink our Approach to PTSD. Psych Central. Retrieved on October 27, 2020, from


Scientifically Reviewed
Last updated: 31 May 2017
Last reviewed: By John M. Grohol, Psy.D. on 31 May 2017
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