For Veterans, a Surge of New Treatments for Trauma



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MENTAL HEALTH, PTSD, VETERANS Suicide is now the leading cause of death in the army. More soldiers die by suicide than in combat or vehicle accidents, and rates are rising: July, with 38 suicides among active duty and reserve soldiers, was the worst month since the Army began counting. General Lloyd Austin III, the army’s second in command, called suicide “the worst enemy I have faced in my 37 years in the army.” This Thursday, the Army is calling a “Suicide Stand-Down.” All units will devote the day to suicide prevention.

There are many reasons a soldier will take his own life, but one major factor is post-traumatic stress.

Anyone who undergoes trauma can experience post-traumatic stress disorder — victims of rape and other crimes, family violence, a car accident. It is epidemic, however, among soldiers, especially those who see combat. People with PTSD re-experience their trauma over and over, with nightmares or flashbacks. They are hyperaroused: the slam of a car door at home can suddenly send their minds back to Iraq. And they limit their lives by avoiding things that can bring on the anxiety — driving, for instance, or being in a crowd.

PTSD has affected soldiers since war began, but the Vietnam War was the first in which the American military started to see it as a brain injury rather than a sign of cowardice or shirking. A study of Vietnam vets 20 years after the conflict found that a quarter of vets who served in Vietnam still had full or partial PTSD.

America’s current wars may create even more suffering for those who fought them. In the Afghanistan and Iraq conflicts soldiers have been returned to these wars again and again, and they face a deadly new weapon — improvised explosive devices, or I.E.D.’s — which cause brain injuries that, terrible in themselves, also seem to intensify PTSD. “We surmise PTSD will be worse,” said Dr. James Kelly, the director of the National Intrepid Center of Excellence, which studies and treats the intersection of PTSD and traumatic brain injury. “Some people are on their 10th deployment. Previously, people didn’t have those doses. And there are multiple blast exposures and other blunt blows to the head. This kind of thing is new to us.”


When we think about treating PTSD, we usually picture a single patient and a psychotherapist. The two treatments in widest use are, in fact, just that: cognitive processing therapy, where patients learn to think about their experiences in a different way, and prolonged exposure, in which the therapist guides the patient through re-experiencing his trauma again and again, to teach the brain to process it differently.

These therapies help a lot of veterans — about 40 percent of those who go through treatment are cured. But there are many, many more suffering veterans who are not helped. It’s not just that these treatments don’t work for everyone — no therapy does. More important, they are not broad enough. PTSD is often accompanied by and entwined with other serious problems — depression, sleep disorders, chronic pain and substance abuse. Sometimes these resolve if the PTSD does, but often they require specific attention — which the standard PTSD therapies don’t provide.

There is another way these treatments need broadening — they need to reach more people. The military and Veterans Affairs hospitals do not have enough psychotherapists to offer them on the necessary scale. And many soldiers are wary of psychotherapy and afraid of the stigma it carries.

Today, the military is fighting that stigma. The V.A. is trying to integrate mental health care into primary health care; soldiers are now routinely screened for issues like PTSD, depression or substance abuse. An ad campaign called AboutFace features dozens of vets talking about their PTSD and how they got better — the point is: they are people just like you. A new program called Comprehensive Soldier and Family Fitness builds in resilience training for all soldiers at every phase — pre-deployment, in theater, upon return. It seeks to make regular mental health exercises as routine for soldiers as physical training.

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