Psychotherapeutic Interventions for Older, Non-Active Military Veterans With PTSD: An Integrative Review of Types, Effectiveness, and Clinical Outcomes

Military veterans in later adulthood are at increased risk for chronic posttraumatic stress disorder (PTSD), often characterized by cumulative trauma exposure, high levels of psychiatric and medical comorbidity, and prolonged symptom persistence. Although several evidence-based psychotherapies for PTSD are available, their effectiveness and clinical characteristics when implemented with older, non-active military veterans remain insufficiently synthesized. This integrative review aimed to examine psychotherapeutic interventions for PTSD in this population, focusing on intervention types, clinical outcomes, treatment acceptability, and strength of evidence. Following Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols guidelines, a comprehensive search was conducted in March 2024 across five electronic databases. Quantitative, qualitative, mixed-methods studies, and case studies published in English or Portuguese were eligible for inclusion. Of the 1,073 records identified, 23 studies met the inclusion criteria. Trauma-focused interventions were the most frequently studied, including prolonged exposure (PE), cognitive processing therapy (CPT), and exposure-based variants. Among studies with sufficient statistical reporting, trauma-focused therapies demonstrated the most consistent reductions in PTSD symptoms, with moderate to large effect sizes reported for PE, CPT, and multimodal motion-assisted memory desensitization and reconsolidation (3MDR). In contrast, relaxation-based and psychoeducational interventions were associated with smaller, inconsistent, or non-significant effects. Overall, findings support trauma-focused psychotherapies as the most robustly supported interventions for reducing PTSD symptoms in older, non-active military veterans. However, substantial heterogeneity in study design, outcome measurement, statistical reporting, and methodological quality limits comparability across studies and precludes quantitative synthesis, underscoring the need for more rigorous and standardized research to inform clinical decision-making in this aging veteran population.