Book Review—PTSD and Mild Traumatic Brain Injury: A Book Review

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Review By:
Omewha Beaton, PhD

Vasterling, J. J., Bryant, R. A., & Keane, T. M. (Eds.). (2012). PTSD and Mild Traumatic Brain Injury. New York, NY: Guilford Press (308 pages) ISBN-13: 978-1462503384 ISBN-10: 1462503381 ($60 hardback). 

PTSD and Mild Traumatic Brain Injury, edited by Vasterling, Bryant, and Keane, is a comprehensive compilation of works by leading experts in the fields of posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). PTSD and mTBI have garnered enhanced interest from the scientific community over recent years, due to the increased number of military personnel returning from the wars in Iraq and Afghanistan with trauma related injuries that met the PTSD or mTBI diagnostic criteria.

The volume consists of 12 chapters organized into five substantive parts: the background and conceptual framework, the clinical presentation and mechanisms, the commonly associated conditions, the clinical management, and the conclusion. Within these chapters, the editors discuss the complexities associated with caring for patients with mTBI and PTSD comorbidity.

The first part of the volume lays the foundation for the book, by providing an overview and a conceptual framework of the intersection between mTBI and PTSD.  Also addressed in this section are the operational definitions of mTBI and PTSD.  The definitions of mTBI and PTSD individually can be vague.  To reduce the ambiguity and standardize the claims in this volume, Vasterling, Bryant, and Keane operationalized PTSD according to the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision (DSM-IV-TR), while mTBI was operationalized based on two criteria: (1) the loss of consciousness (LOC) not exceeding 30 minutes, coupled with (2) post-traumatic amnesia (PTA) not exceeding 24 hours.

The second part of the volume explores the clinical expressions and neurobiological underpinnings of mTBI and PTSD.  The first half of this section addresses the importance of neuroimaging in advancing our knowledge of mTBI, the mechanism of neural injury, and the course of recovery from mTBI.  An evaluation of the literature suggests that disconnection, of some form, is the root of the neuropathology of mTBI.  The latter half of the section discusses the biological, environmental, and psychological etiologies of PTSD, which can be useful in the discovery of targeted treatment. Additionally, evidence suggests that the neurocognitive mechanisms of mTBI and PTSD overlap, which may result in common symptomatology.

In the third part of the volume, the researchers highlight the challenges clinicians are confronted with because of associated conditions.  It also emphasizes the importance of taking these associated conditions into consideration when assessing or treating individuals with co-morbid mTBI and PTSD.  This section focuses on two associated conditions: chronic pain and substance use disorder.  However, there are many more associated conditions (such as mood disorders and sleep disorders) that may hinder the assessment and treatment of comorbid mTBI and PTSD, mainly because of their shared symptoms.

The fourth part of the volume addresses the clinical management of comorbid mTBI and PTSD.  The assessment, treatment, and cost of delivering care to sufferers are presented in this section.  The contributors note two efficacious treatments for the individual disorders: cognitive rehabilitation therapy (CRT) for mTBI symptoms and cognitive behavioral intervention (CBI) for PTSD symptoms. However, there is no mention of a specific intervention for patients with both mTBI and PTSD.

In the fifth part of the volume, the researchers reiterate how the potential mechanisms underlying comorbidity influence recovery, and explain the assessment and intervention challenges clinicians face while caring for patients with comorbid mTBI and PTSD.  Vasterling, Bryant, and Keane conclude this volume by stressing the need to identify and manage reactions occurring at the intersection of mTBI and PTSD.

I believe this volume succinctly synthesizes the knowledge and impact of mTBI and PTSD comorbidity from an array of experts.  Consequently, this is an essential reference guide for a wide array of audiences, specifically: students, trauma specialists, and mental health professionals.  This is a timely resource, as we deal with the vexing problems associated with the complexities of comorbid mTBI and PTSD.  This book is a must-read reference tool for everyone treating PTSD and mTBI populations.