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. 2026 Jan 22;17(1):2604993. doi: 10.1080/20008066.2025.2604993

Visual analysis of interventions and treatments for post-traumatic stress disorder in the military population over the past decade: a study based on the PubMed database

Análisis visual de las intervenciones y tratamientos para el trastorno por estrés postraumático en la población militar durante la última década: un estudio basado en la base de datos PubMed

Leling Zhu a,†, Haitao Zhu b,†, Wanjun Yang a, Wenmo Zhang c, Bing Xie a, Feifei Wang a, Chen Bian a,CONTACT
PMCID: PMC12829422  PMID: 41568434

ABSTRACT

Background: Research on PTSD treatment in military populations is expanding rapidly; it’s important to identify key research priorities and emerging trends from a comprehensive perspective.

Objective: This study reviewed trends in intervention and treatment research on post-traumatic stress disorder (Peterson et al., 2023) in military populations over the past decade.

Methods: A comprehensive search was conducted in the PubMed database for English-language articles published between 2014 and 2024, using the keywords ‘intervention or treatment,’ ‘PTSD,’ and ‘military.’ Studies were included if they focused on PTSD interventions targeting military personnel or veterans. A total of 1,280 relevant articles were identified and included in the analysis. Bibliometric methods – such as co-occurrence analysis, keyword clustering, and burst detection – were combined with a qualitative narrative synthesis to explore publication patterns and research hotspots.

Results: Results showed steady growth in the number of publications and citations. The articles appeared in 327 journals, with the top 10 journals specialising in trauma, clinical psychology, psychiatry, and military medicine. The United States and the University of Texas Health Science Center at San Antonio were the most prolific contributors. Keyword clustering revealed major research themes, including Prolonged Exposure Therapy, Cognitive Processing Therapy, Cognitive Behavioral Therapy, and Virtual Reality. Burst word analysis highlighted emerging topics such as dual diagnosis and heart rate variability.

Conclusions: The analysis revealed strong international and inter-institutional collaborations, reflecting a geographically and culturally diverse research landscape. These findings also provide valuable insights into the current state and future directions of PTSD intervention research in military populations.

KEYWORDS: Post-traumatic stress disorder, military population, interventions and treatments, bibliometric analysis, knowledge map

PALABRAS CLAVE: Trastorno por estrés postraumático, población militar, intervenciones y tratamientos, análisis bibliométrico

HIGHLIGHTS

  • Bibliometric analysis of interventions and treatments for military PTSD publications from 2014 to 2024 identified trends, important findings and key players in this field.

  • This analysis highlighted primary research themes and a temporal evolution in therapeutic approaches, along with emerging areas of interest such as dual diagnosis and heart rate variability.

  • The analysis also highlighted significant international and inter-institutional collaborations; however, the distribution of activity across different regions remains uneven.

1. Introduction

Post-traumatic stress disorder (PTSD) is a highly prevalent, debilitating condition among military populations, characterised by intrusive memories, nightmares, hyperarousal, and emotional numbing (Hadlandsmyth et al., 2024; Obuobi-Donkor et al., 2022; Yehuda et al., 2015). Compared to civilians, service members and veterans face repeated traumatic events, including combat, explosions, and life-threatening injuries, leading to distinct comorbidities and complex treatment responses (Grinsill et al., 2024). As PTSD cases continue to rise among military populations in the context of persistent global and regional conflicts, the consequences extend beyond the individual, burdening families, straining public health resources, and increasing the overall social burden (Obuobi-Donkor et al., 2022). Given these challenges, it is important to review the literature on the effectiveness and limitations of various interventions for military-related PTSD.

Various treatments for military-related PTSD have been developed, with prolonged exposure (PE), cognitive processing therapy (CPT), and eye movement desensitisation and reprocessing (EMDR) recommended as first-line options by the U.S. Department of Veterans Affairs (VA) (Kitaj & Goff, 2024). While effective in military populations (Goetter, Blackburn, et al., 2021; Köhler et al., 2017), studies show that military personnel tend to be more treatment-resistant than civilians, resulting in less improvement (Kitchiner et al., 2019; Köhler et al., 2017). This discrepancy is linked to the unique nature of combat trauma and military training, which reinforce hyperarousal, emotional suppression, and vigilance – traits adaptive in combat but that may impede engagement and emotional processing in therapy (Kitaj & Goff, 2024). Alongside psychotherapeutic options, pharmacological treatments like SSRIs – specifically sertraline and paroxetine – are FDA-approved for PTSD (Moore et al., 2021). However, evidence for their efficacy remains limited, and pharmacotherapy generally underperforms compared to psychotherapy (Bertolini et al., 2022). Only 20–30% of patients achieve full remission with SSRIs (Berger et al., 2009), and some studies show no significant difference from placebo (Bertolini et al., 2022). Moreover, concerns over side effects and polypharmacy are especially pertinent for military populations, who are more prone to multiple PTSD medications (Raut et al., 2025).

Given limited healthcare resources and low variability in clinical care, some researchers recommend adding integrative therapy as an adjunct for military-related PTSD (Sornborger et al., 2017). This holistic, individualised approach combines techniques such as mind-body interventions, art therapy, animal-assisted therapy, and exercise to address clients’ unique needs (Sornborger et al., 2017). Evidence suggests that integrative therapy effectively targets comorbid symptoms often unaddressed by conventional treatments, while promoting self-management and self-care skills with minimal to no adverse side effects (Grubaugh et al., 2019; Li et al., 2024; Sornborger et al., 2017). In addition to treatment efficacy, access to care (Fletcher et al., 2022), intervention adherence and drop-out rate (Berke et al., 2019) are also concerns of researchers, prompting exploration of alternative therapy formats, delivery methods, and care settings (Balderrama-Durbin et al., 2024; Haun et al., 2023). For example, researchers adapted psychotherapy into more condensed treatment formats, such as intensive and massive treatment programmes, and found that it remains effective (Hendriks et al., 2018; Holliday et al., 2025; Peterson et al., 2023) with significantly lower dropout rates (Goetter, Tanev, et al., 2021). Additionally, researchers also explored web-based, mobile, or brief interventions can enhance access and reduce dropout rates among military populations (Haun et al., 2023; Thompson-Hollands et al., 2021).

Despite decades of research, the literature on military PTSD interventions remains fragmented, addressing treatment efficacy, adherence, and dropout rates without systematic integration. To clarify this landscape, identify trends, gaps, and future directions, a timely and comprehensive review is necessary. Bibliometric analysis, which involves analyzing bibliographic records within a research field to provide an overview of the underlying knowledge domain, offers a transparent and reproducible approach to synthesising research through statistical evaluation of scientific output (Chen, 2017; Chen & Song, 2019). With the advancement of scientific mapping technologies, bibliometric analysis has become increasingly prevalent across various research fields, particularly in clinical practice (Lazarides et al., 2025). This approach provides insights to guide future research, clinical practice, and evidence-based policy development. As a result, this study aimed to perform a bibliometric analysis of military PTSD interventions over the past decade, mapping the field’s structure, key focus areas, and developmental trends.

2. Materials and methods

2.1. Database

PubMed encompasses a broad spectrum of disciplines, including medicine, nursing, veterinary medicine, healthcare systems, and clinical sciences. Given that the research topic of PTSD falls mainly within the medical field, the PubMed database (covering the period from January 2014 to December 2024) was chosen as the primary data source for this study.

2.2. Selection criteria

Inclusion criteria were as follows: (1) English literature included in PubMed; (2) research that included inventions for military population with PTSD; (3) original research, systematic review, or reports.

Exclusion criteria included: (1) literature not available in the PubMed database at the time of retrieval; (2) participants who are not part of the military population; and (3) literature unrelated to interventions or treatments for PTSD.

2.3. Data collection

Index: Search query: ((PTSD OR post-traumatic stress disorder [MeSH Major Topic]) AND (military OR veteran OR soldier [MeSH Major Topic])) AND (intervention OR treatment [MeSH Major Topic]).

The initial search identified a total of 7,433 articles, covering the period from 1973 to June 2025. We then applied a filter to include only articles published between 2014 and 2024, resulting in 5,330 articles. Next, we selected articles available in full text and written in English, narrowing the count to 5,168. Subsequently, two authors (LZ, WY) independently screened the titles and abstracts of all records to determine eligibility for inclusion. Inter-rater reliability for inclusion/exclusion decisions was high (Cohen’s kappa = 0.988), and disagreements were resolved through discussion with a third reviewer (CB). Thus, the screening process resulted in the inclusion of 1,280 articles considered appropriate for formal analysis. Figure 1 depicts the entire search process.

Figure 1.

Figure 1.

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Data collection process.

2.4. Data analysis

Bibliometrix R packages (4.4.1) (Aria & Cuccurullo, 2017) were used to analyze information on publication growth, authors, journals and total citations of each publication. CiteSpace (version 6.3.R3) (Chen, 2017; Chen & Song, 2019) was used to conduct network analysis of authors and co-occurrence keywords. The parameters of CiteSpace are as follows: time split between January 2014 and December 2024 (each slice is 1 year), the analysis items are selected as references, one node type is selected at a time, the selection criteria [g-index (k = 25)], and pruning (Pathfinder).

To examine the status and emerging trends in publications on PTSD treatment in military populations, we analyzed key bibliometric indicators, including the number of publications, total citations, influential journals and articles, collaboration networks among countries, institutions, and authors, as well as keyword frequency and co-occurrence. We also provided the betweenness centrality values, which indicate the importance as a bridge along the shortest paths between pairs of nodes; closeness centrality, which measures the efficiency of reaching the entire network based on the average shortest path length; the PageRank score, which reflects importance based on the recursive nature and volume of incoming connections; and burst strength, which captures the intensity of a sudden increase in the frequency of an entity over a specified time period (Chen, 2016). These indicators provide insights into research trends, international collaboration, emerging hotspots, and the global contributions of researchers in this field.

3. Results

3.1. Analysis of publication outputs and total citations

Since 2014, annual publications increased from 93 to 143, peaking in 2021 (Figure 2(A)). Total citations steadily grew, reaching 32,775 in 2024, highlighting the significance and impact of this research area. Notably, 2014 publications amassed 6,224 citations, and 2017 articles also had high influence with 5,812 citations – the second highest (Figure 2(B)).

Figure 2.

Figure 2.

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General characteristics of the literature reviewed for this study. A: Combined bar and stacked bar chart for annual publications and cumulative publications from 2014 to 2024; B: Combined bar and stacked bar chart for annual total citations and cumulative citations from 2014 to 2024.

3.2. Analysis of major journals and influential articles

Out of 327 journals, we identified the top 10 journals based on publication volume. Six journals – Journal of Traumatic Stress, Military Medicine, Psychological Trauma: Theory, Research, Practice and Policy, Journal of Clinical Psychology, Depression and Anxiety, and Journal of Consulting and Clinical Psychology – ranked in the top 10 across H-index, G-index, M-index, total citations, and first publication year, indicating consistent influence. Details are in Supplementary Table 1. Among a total of 1,280 articles, 5.31% of articles have no citations. Approximately 80.23% received 0–50 citations, 9.84% between 50–100, 3.28% between 100–200, and 1.33% over 200 citations. Supplementary Table 2 lists 17 articles with over 200 citations, including their total and normalised citations per year.

3.3. Analysis of collaboration network among countries

We identified 39 different author countries in our dataset. The three countries with the highest number of articles were the USA (n = 4737), Canada (n = 249), and Australia (n = 223). The collaboration network analysis between countries using the Louvain algorithm identified 3 distinct research clusters, with the United States emerging as the predominant network hub, demonstrating the highest ality metrics (betweenness centrality = 398.839, closeness centrality = 0.029, and PageRank score = 0.210). The analysis revealed particularly robust collaborative relationships between the United States and Australia (n = 223), Canada (n = 249), and Israel, as evidenced by the strongest network pathways (Figure 3(A)), indicating these bilateral connections serve as primary channels for international knowledge exchange in this research domain.

Figure 3.

Figure 3.

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A: The knowledge map of national cooperation network; B: The knowledge map of institutional cooperation network; C: The knowledge map of author cooperation network.

3.4. Analysis of collaboration network among institutions

The cooperation networks across 2343 institutions for the last decade were also retrieved. The top three institutions gathering the most important number of articles were the University of Texas Health Science Center at San Antonio (n = 240), the University of California (n = 222), and the National Center for PTSD (n = 202). The collaboration network analysis between institutions using the Leiden algorithm identified 3 distinct research clusters (Figure 3(B)), with the National Center for PTSD emerging as the predominant network hub, demonstrating the highest centrality metrics (betweenness centrality = 319.237, closeness centrality = 0.014, and PageRank score = 0.094).

3.5. Analysis of collaboration network among authors

The 1280 articles in our sample have 5,017 authors in total. Most of them are occasional contributors. Indeed, 71.82% of the authors have published a single paper, and only 5.47% have written 5 or more articles. Figure 3(C) shows the collaboration patterns among the top 100 authors based on publications. The collaboration network analysis between authors using the Leiden algorithm identified 7 distinct research clusters (Figure 3(C)). it was observed 5 most important authors, including:(1) Peterson Alan L (publications = 55, total citations = 1948, H-index = 21, betweenness centrality = 126.013, closeness centrality = 0.006, and PageRank score = 0.038); (2) Young-Mccaughan Stacey (publications = 50, total citations = 1712, H-index = 19, betweenness centrality = 117.619, closeness centrality = 0.006, and PageRank score = 0.037); (3) Mintz Jim (publications = 43, total citations = 1752, H-index = 21, betweenness centrality = 59.506, closeness centrality = 0.006, and PageRank score = 0.033); (4) Litz Brett T (publications = 37, total citations = 2437, H-index = 19, betweenness centrality = 156.127, closeness centrality = 0.006, and PageRank score = 0.028); (5) Dondanville Katherine A(publications = 33, total citations = 1335, H-index = 15, betweenness centrality = 79.867, closeness centrality = 0.006, and PageRank score = 0.027).

3.6. Analysis of research trends in military PTSD treatment

3.6.1. Analysis of important keywords

Figure 4(A) illustrates the knowledge map of the keyword distribution network, comprising 346 nodes, 560 edges, and a density of 0.0094. The size of each node reflects the frequency of the respective keywords. An edge connecting two nodes indicates that the corresponding keywords appear together in the same article, with the edge width representing the number of articles in which the keywords co-occur. Table 1 presents the top 10 keywords ranked by both frequency and centrality. The same set of words appears in both lists, although their order differs.

Figure 4.

Figure 4.

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A: The knowledge map of keyword distribution network; B: The knowledge map of keyword clustering; C: The keywords with the strongest citation burst.

Table 1.

Top 10 Keywords by count and centrality.

Keywords Count Keywords Centrality
Posttraumatic Stress Disorder 333 Posttraumatic Stress Disorder 0.86
Prolonged Exposure Therapy 59 Mental Health 0.17
Cognitive Processing Therapy 53 Prolonged Exposure Therapy 0.16
Mental Health 46 Cognitive Processing Therapy 0.09
Cognitive Behavioral Therapy 31 Virtual Reality 0.07
Virtual Reality 22 Randomized Controlled Trial 0.06
Exposure Therapy 21 Clinical Trials 0.06
Randomized Controlled Trial 20 Exposure Therapy 0.05
Military Sexual Trauma 20 Military Sexual Trauma 0.05
Clinical Trials 16 Cognitive Behavioral Therapy 0.04
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3.6.2. Analysis of research topic

To identify the most prominent topics in this area, we performed a keyword clustering analysis, yielding a weighted mean silhouette of 0.8795 and a modularity Q-value of 0.6224, indicating that the clustering quality is highly reliable. The results show that there are 11 keyword clusters, including posttraumatic stress disorder (cluster #0), prolonged exposure (cluster #1), mental health (cluster #2), military veterans (cluster #3), anxiety disorders (cluster #4), randomised controlled trial (cluster #5), cognitive processing therapy (cluster #6), acceptance and commitment therapy (cluster #7), dual diagnosis (cluster #8), posttraumatic stress (cluster #9) and heart rate variability (cluster #10). The timeline view can be seen in Figure 4(B), and specific cluster information can be seen in Table 2.

Table 2.

Keywords cluster information.

Cluster ID Size Silhouette Mean (Year) Label (LLR)
0 Posttraumatic stress disorder 60 0.773 2018 Posttraumatic stress disorder (17.24, 1.0E-4); post-traumatic stress disorder (13.33, 0.001); ptsd (11.25, 0.001); nightmares (10.73, 0.005); mental health (8.79, 0.005)
1 Prolonged exposure 53 0.853 2017 Prolonged exposure (25.59, 1.0E-4); virtual reality (22.95, 1.0E-4); exposure therapy (22.32, 1.0E-4); clinical trial (12.83, 0.001); trauma-focused treatment (9.62, 0.005)
2 Mental Health 28 0.918 2019 Mental health (45.06, 1.0E-4); primary care (17.15, 1.0E-4); veterans health (13.36, 0.001); digital health (13.36, 0.001); posttraumatic stress disorder (10.1, 0.005)
3 Military veterans 26 0.933 2018 Military veterans (20.05, 1.0E-4); animal-assisted intervention (15.78, 1.0E-4); art therapy (15.44, 1.0E-4); human-animal interaction (15.44, 1.0E-4); psychiatric service dogs (10.28, 0.005)
4 Anxiety disorders 18 0.884 2018 Anxiety disorders (21.07, 1.0E-4); adult psychiatry (21.07, 1.0E-4); behavioural activation (21.07, 1.0E-4); major depressive disorder (20.66, 1.0E-4); depression & mood disorders (14, 0.001)
5 Randomised controlled trial 18 0.93 2020 Randomised controlled trial (25.99, 1.0E-4); military personnel (21.64, 1.0E-4); chronic pain (11.73, 0.001); cih (10.7, 0.005); dyad (10.7, 0.005)
6 Cognitive processing therapy 18 0.937 2019 Cognitive processing therapy (45.21, 1.0E-4); substance use disorder (14.91, 0.001); cognitive rehabilitation (9.93, 0.005); crisis response plan (9.93, 0.005); machine learning (6.28, 0.05)
7 Acceptance and commitment therapy 14 0.96 2018 Acceptance and commitment therapy (14.19, 0.001); qualitative research (7.63, 0.01); college student veterans (7.07, 0.01); patient experiences (7.07, 0.01); patient satisfaction (7.07, 0.01)
8 Dual diagnosis 12 0.882 2017 Dual diagnosis (17.71, 1.0E-4); stress disorders (13.92, 0.001); post-traumatic (13.92, 0.001); drug abuse (8.8, 0.005); outpatient treatment (8.8, 0.005)
9 Posttraumatic stress 10 0.961 2016 Posttraumatic stress (20.16, 1.0E-4); cognitive training (12.55, 0.001); qualitative (8.12, 0.005); complementary and alternative (8.12, 0.005); placebo-controlled trial (8.12, 0.005)
10 Heart rate variability 5 0.999 2018 Heart rate variability (21.92, 1.0E-4); hirrem (8.69, 0.005); autonomic nervous system (8.69, 0.005); closed-loop (8.69, 0.005); acoustic stimulation (8.69, 0.005)
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3.6.3. Analysis of research frontier

We further conducted burst detection of keywords to explore the frontier hot spots, and a total of 24 burst keywords were obtained, and the specific results can be seen in Figure 4(C). It indicated that ‘military personnel,’ ‘adult psychiatry,’ ‘equine-assisted therapy,’ ‘chronic pain,’ ‘trauma-focused treatment,’ and ‘moral injury’ were the topics most likely to influence future research on military PTSD treatment. The strongest word was ‘military veterans,’ which appeared in 2018–2021, with a burst strength of 3.5; followed by ‘randomized controlled trial,’ with a burst strength of 3.45; and ‘primary care,’ with a strength of 3.25.

4. Discussion

4.1. Research trend and major journals

This bibliometric analysis of military-related PTSD therapies over the past decade examined 1,280 articles, reflecting a growing and evolving body of literature. Both publication counts and citations steadily increased from 2014 to 2024, indicating rising scholarly interest. This trend may be driven by ongoing military operations, which heighten PTSD risk (Obuobi-Donkor et al., 2022), and continued advances and diversification in treatment approaches (Ranney et al., 2023; Wright et al., 2023).

The analyzed publications were distributed across 327 journals, with the top 10 accounting for 33.83% of total output. Their 5-Year Impact Factors ranged from 1.4 to 6.5, including four in the first quartile (Q1) of JCR. They primarily focus on trauma, clinical psychology, psychiatry, military medicine, and emotional disorders like depression and anxiety, reflecting the field’s interdisciplinarity and growth. Key studies in these core journals reveal shared challenges in PTSD treatment, such as low initiation, underutilisation, and high dropout rates (Hoge et al., 2014; Kehle-Forbes et al., 2016). In response to these barriers, research compares alternative treatment formats to boost engagement and outcomes, especially in military contexts (Foa et al., 2018; Goetter, Blackburn, et al., 2021; Resick et al., 2015). Overall, these findings underscore ongoing issues of accessibility, adherence, and long-term effectiveness, highlighting the need for more adaptable, context-sensitive interventions.

4.2. Cooperation analysis of country, institution and author

Most publications originated from the United States, accounting for 79.51%, followed by Canada (4.18%) and Australia (3.74%). The dominance of the USA is linked to its extensive military involvement, resulting in high PTSD rates among service members (Allen et al., 2021). Additionally, robust veteran support systems and substantial defense research funding have fostered ongoing academic and clinical focus on military mental health (Wiltsey Stirman et al., 2022).

Major American research centres such as the University of Texas Health Science Center at San Antonio, the University of California, and the National Center for PTSD are among the most prolific. The University of Texas Health Science Center at San Antonio focuses on multidisciplinary, translational research to improve health and reduce disparities (Research, 2025), and hosts four of the five most productive authors in the field. The fifth is affiliated with the Boston University Chobanian & Avedisian School of Medicine, which emphasises holistic, human-centered training for clinicians and researchers committed to academic excellence, social responsibility, and transformative care (Admissions, 2025).

Regarding authorship, 1,280 articles involved 5,017 authors, but only 5.47% contributed five or more articles. A core group of highly productive researchers, led by five authors forming a close collaboration network, dominates the field. This concentration of expertise, institutional resources, and networks provides a solid foundation for further innovation and cross-border partnerships to address military populations’ complex mental health needs.

4.3. Distribution of keywords

The co-occurrence analysis of keywords (excluding ‘posttraumatic stress disorder’) identified the top five terms as Prolonged Exposure Therapy, Cognitive Processing Therapy, Mental Health, Cognitive Behavioral Therapy, and Virtual Reality, highlighting key research hotspots in military-related PTSD treatments. Analysis of the top 24 burst keywords reveals a temporal shift in therapeutic focus: from CBT dominance in 2014–2016, to increased interest in exposure therapy and emotional freedom techniques during 2017–2020, and most recently (2020–2024), a rising focus on equine-assisted therapy and acceptance and commitment therapy (ACT).

Virtual reality (VR) has recently gained prominence as a versatile tool in PTSD treatment (Rizzo & Shilling, 2018). It is integrated into innovative approaches like motion-assisted multi-modular memory desensitisation and reconsolidation (3MDR) (Jones et al., 2022), transcranial magnetic stimulation (van ‘t Wout-Frank et al., 2024), and acceptance and commitment therapy (Dindo et al., 2023). These applications demonstrate the expanding use of technology in military-based therapies.

In broader research, a temporal shift emerged. Early studies focused on primary care models, collaborative care, and health service delivery, emphasising early PTSD detection and intervention within community and family contexts. Primary care was seen as ideal for integrating mental health services (Cigrang et al., 2015, 2017). Collaborative care improved treatment access and continuity, reducing stigma among military personnel (Woltmann et al., 2012). Over time, research interest shifted toward more intensive, trauma-focused treatments.

4.4. Analysis of research hotspots

The keyword cluster analysis further confirmed these thematic themes, revealing core mental health conditions (e.g. anxiety, depression, PTSD) and mainstream therapies (e.g. prolonged exposure, CPT, ACT). Notably, two emerging clusters also merit attention:

4.4.1. Dual diagnosis

Military-related PTSD frequently co-occurs with other mental health conditions such as depression, anxiety, substance use disorder (SUD), and alcohol use disorder (AUD) (Tripp et al., 2020; Wojcik et al., 2024), complicating treatment, increasing relapse risk, and impairing outcomes (Kitaj & Goff, 2024). While integrated treatments for co-occurring PTSD and SUD/AUD are emerging (Back et al., 2024; Kehle-Forbes et al., 2022), this area remains underexplored. Notably, burst keyword analysis indicates a shift from focus on PTSD and military sexual trauma toward more complex issues like chronic pain and moral injury, which often coexist with PTSD.

4.4.2. Heart rate variability (HRV)

Heart rate variability (HRV) is a key indicator of autonomic nervous system (ANS) function, increasingly linked to PTSD (Schneider & Schwerdtfeger, 2020). PTSD is associated with ANS dysregulation, making HRV a promising biomarker for treatment monitoring and outcome prediction in military populations (Schneider & Schwerdtfeger, 2020). Additionally, HRV biofeedback-based interventions have demonstrated therapeutic efficacy and feasibility, providing a mechanistic, non-pharmacological treatment alternative (Kenemore et al., 2024; Schuman et al., 2023).

In summary, Over the past decade, research priorities have shifted from traditional cognitive-behavioural models to trauma-focused and integrative strategies. Recent trends include the use of VR, emergence of equine-assisted therapy and ACT, and heightened focus on comorbidities and physiological markers like HRV, reflecting a broader, biopsychosocial approach to military-related PTSD.

4.5. Limitations and implications section

This study has several limitations that should be acknowledged. First, the bibliometric analysis relied solely on PubMed, excluding other major databases like Scopus, Web of Science, and Medline that offer broader coverage and citation data, potentially biasing the results. Second, only English-language publications were included, risking the omission of valuable non-English contributions. Third, PubMed’s lack of citation information prevented citation-based analyses such as co-citation and reference burst detection. Furthermore, as with any review relying on published data, the findings may be subject to publication bias (the ‘file drawer’ problem), whereby studies with null or non-significant results are less likely to be published, potentially leading to an overrepresentation of positive findings and active research areas. These constraints may affect the comprehensiveness and objectivity of the findings. Future research should incorporate multiple databases, multilingual sources, and citation analysis tools to enhance robustness.

Despite these limitations, the current review helps reduce fragmentation in the military PTSD intervention literature by systematically organising key research themes, including treatment approaches, treatment effectiveness, and treatment challenges, into a coherent framework. By tracing how these areas have evolved and interconnected, the study provides a clearer overview of the field and identifies areas where greater theoretical and methodological alignment is needed. In doing so, it offers researchers a systematic knowledge map that facilitates quick identification of foundational literature, core themes, and emerging research hotspots. Building on this integrative perspective, future research could adopt more multi-dimensional approaches that connect treatment outcomes with adherence mechanisms and contextual factors, thereby enabling more cumulative and coherent scientific progress. Beyond academic value, the review also offers practical implications for clinical practice and policy. The rising interest in personalised and technology-assisted interventions suggests a shift toward more accessible and scalable treatment models. Furthermore, identifying barriers to treatment adherence may help inform targeted support strategies within military healthcare systems. Taken together, these insights can guide the field toward transdiagnostic treatment paradigms, precision-oriented assessment, and deeper integration of emerging technologies in military PTSD prevention and intervention.

5. Conclusion

Research on military-related PTSD treatments has grown steadily, with the U.S. leading. While established trauma-focused therapies dominate, emerging approaches like acceptance and commitment therapy, equine-assisted therapy, and virtual reality show promise. Focus on comorbidities and physiological markers such as heart rate variability indicates a move toward integrated treatments. Despite these advances, the field remains fragmented and unevenly distributed geographically. Enhanced international collaboration and interdisciplinary research are essential to bridge these gaps. This bibliometric analysis highlights key trends and emerging topics, laying the groundwork for future efforts to improve evidence-based care for military personnel globally.

Supplementary Material

Supplymentary Tables . anon.docx
ZEPT_A_2604993_SM2951.docx (21.6KB, docx)

Acknowledgements

We have utilised Chat GPT-5 for language processing.

Funding Statement

Natural Science Foundation Project of Chongqing, Chongqing Science and Technology Commission, CSTB2023NSCQ-MSX0892 (Recipient: Chen Bian); Research Cultivation Fund of the First Affiliated Hospital of Chongqing Medical University, PYJJ2022-03 (Recipient: Haitao Zhu).

Authors’ contributions

Leling Zhu: Data analysis, Interpretation of data, Writing–Original Draft, Writing–Review & Editing; Haitao Zhu: Conceptualization, Funding acquisition; Wanjun Yang: Data acquisition; Wenmo Zhang: Writing – Review & Editing; Bing Xie: Data analysis; Feifei Wang: Writing – Review & Editing; Chen Bian: Conceptualization, Project Administration, Funding acquisition, Writing–Review & Editing.

Consent for publication

Not applicable.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical approval

Not applicable. The review was not registered and the review protocol was not prepared for this study.

Ethics approval and consent to participate

Not applicable. The review was not registered and the review protocol was not prepared for this study.

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Supplemental Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/20008066.2025.2604993.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplymentary Tables . anon.docx
ZEPT_A_2604993_SM2951.docx (21.6KB, docx)

Data Availability Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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