From Stars and Stripes
By Matthew Burke
Army Sgt. Angel Morrow watched as countless Marines and soldiers she knew were killed or maimed by improvised explosive devices in Afghanistan
The woman they called “Momma Medic,” the medical readiness noncommissioned officer in charge of her Oregon National Guard unit, returned to the United States in 2010 and processed 650 soldiers, about 70 of which had “severe issues” from the deployment.
When one of her soldiers shot and killed himself outside her office, she started to break.
“I did everything I could for him,” she said.
She became reclusive, showing signs of post-traumatic stress disorder: anxiety, anger, severe depression. She thought she was “going crazy” and took a medical leave of absence. A few months later, she resigned her active-duty position.
Veterans Affairs doctors prescribed her several different drugs that didn’t help. The two civilian counselors she saw did not understand military life.
Morrow might have become a suicide statistic — one of the 18 veterans who kill themselves every day on average — had she not found Bianca, a 70-pound pit bull.
“She was that little buddy I needed,” Morrow said. “She gave me that sense of purpose I was lacking.”
With Bianca’s help, Morrow’s outlook improved, and she started volunteering at the Willamette Humane Society. In April, the 29-year-old returned to her unit on active duty.
Alternative approaches that heal mind, body and soul — therapy dogs, outdoor retreats, acupuncture, art and music programs — have been touted by researchers, doctors and servicemembers. Now, supporters are just waiting for science to catch up.
While these and other methods have not undergone the same rigorous trials as more traditional approaches, the military and the VA are now incorporating alternative therapies into their traditional treatment regimes.
Initial research indicates alternative methods work when used in tandem with trauma-focused therapy and medication.
“I think they have a role,” said Dr. Charles Hoge, author of “Once a Warrior, Always a Warrior” and the former director of the top U.S. research program in the psychological and neurological consequences of war at Walter Reed Army Institute of Research.
By relying on traditional treatment alone in the past, doctors from the Department of Veterans Affairs admit that too many fell through the cracks.
“I don’t feel people were mistreated — maybe undertreated,” said Dr. David Cifu, national director of the Department of Veterans Affairs’ physical medicine and rehabilitation program. “They were getting the right treatment just not the integrated approach.”
He believes a complex treatment regimen is needed for complex issues like PTSD and traumatic brain injury.
“The key is, the right stuff for the right patient at the right time,” Cifu said. “The veteran needs to be your guide.”
Researchers testAlternative therapies
More than 300,000 veterans who deployed from 2001 to 2008 had PTSD or major depression, and a partially overlapping 320,000 suffered a probable TBI event, according to a report by the RAND Corporation that was released in 2008. The report also stated that only about half of veterans in need of care seek it.
Until a few years ago, the culture at the VA and DOD was largely dismissive of alternative therapies used to complement traditional care. Cifu said that as PTSD and TBI began to be seen as multisymptom issues instead of singular ones, treatments like acupuncture and meditation began to creep in.
Using counseling and prescriptions alone to treat PTSD and TBI “wasn’t working,” he said.
In 2007, the War Related Illness and Injury Study Center at the Veterans Affairs Medical Center in Washington began offering complementary integrative approaches, according to Dr. Matthew Reinhard, a clinical neuropsychologist and WRIISC director.
“Veterans satisfaction has been outstanding and we see continual increases in requests for these services,” Reinhard said in an email. “Particularly for veterans with multisymptom difficult-to-diagnose and difficult-to-treat problems, there can be ongoing physical pain or psychological disabilities or difficulties, which can be difficult to cope with. So, veterans, their families, and their care providers are seeking additional means of addressing these challenges.”
So far at the VA, only acupuncture and meditation are accepted evidence-based treatments, Hoge said.
“It’s very important with PTSD to get evidence-based care,” said Hoge, who believes that therapy and medication should be the first line of treatment instead of relying on alternatives alone.
“It is important to establish the scientific evidence to support the use/provision of complementary and alternative approaches for Veterans’ health care needs,” Veterans Affairs spokeswoman Michele Hammonds wrote in an email. “We are engaged in trying to establish the evidence-based platform for these techniques following rigorous clinical trials.”
Research is being conducted on acupuncture, dietary supplements, exercise, playing music as therapy, bright light therapy, yoga and other options, according to Hammonds and grant records.
Doctors and veterans have reported improvements in a number of conditions after alternative treatments, including pain, anger, insomnia, bowel function, hypervigilance, depression and the ability to interact socially.
However, the scientific results are often mixed.
For example, a VA-funded study in Milwaukee in 2010 set out to see the effects of music therapy on PTSD symptoms. Forty veterans were evaluated, then given six weeks of guitar lessons and evaluated again. While the results were good — including a 21 percent reduction in overall symptoms and a 37 percent increase in health-related quality of life — they weren’t statistically significant.
The value of the complementary approach is that veterans can try different alternative treatments to see which one works for them without relying on one method.
Army Staff Sgt. Leslie Wohlfeld, who suffers from PTSD from a 2003 deployment to Afghanistan and a previous sexual assault, went through numerous alternative treatments, including target nightmare therapy and muscle relaxation therapy. Nothing worked. The 48-year-old started making strides in her recovery after getting a therapy dog and attending a 2010 Project Odyssey retreat through the Wounded Warrior Project.
“There is something out there for us; we just need to find what works,” she said. “We need to be proactive in our healing process.”
‘One size doesn’t fit all’ with PTSD treatment
One of the biggest advocates for alternative and integrative approaches to treating PTSD has been the Wounded Warrior Project. The nonprofit’s Project Odyssey outdoor retreat offers physical activities and the companionship of fellow combat veterans and counselors. Other efforts include Warriors to Work, a job placement program, and an online resource site called Restore Warriors at www.restorewarriors.org.
According to WWP’s Combat Stress Recovery Program director, Maggie LaRocca, their goal is to offer alternative treatments that build trust and develop relationships that will empower servicemembers and veterans to seek further treatment. It also helps veterans navigate the VA system.
“One of the biggest challenges of the mental health system is that it is primarily built as a medical model often mired by stigma and a lot of misunderstanding,” LaRocca wrote in an email. “One of our goals is to help warriors understand how therapy works and how it can help.”
The demand is clear. In 2006, there were five Project Odyssey retreats; this year, there will be 50. They also offer a follow-up program that helps veterans set goals for their next step in the treatment process.
The range of options for veterans seeking solace is wide. Some focus on spirituality, while others look to stabilize families through outdoor activities like horseback riding.
“One size doesn’t fit all,” said Dr. Jill Bormann, of the VA hospital in San Diego. “Having a variety of tools or treatments to choose from, including holistic care, I believe, will ultimately produce the best health outcomes.”
Bormann, a research nurse scientist, has been researching the Mantram Repetition Program since 2001. The program involves an intervention where the veteran chooses a word or phrase with spiritual meaning. The word is then repeated silently, first when the veteran is in a nonstressful situation such as before falling asleep, and later to manage emotional activity during stressful events like nightmares. The treatment has been extremely effective, she said.
Others are finding success through painting and drawing.
Melissa Walker is an art therapist and Healing Arts Program Coordinator at the National Intrepid Center of Excellence at Walter Reed National Military Medical Center. She works with about 240 mostly active-duty servicemembers a year who suffer from PTSD or TBI and are referred to the center for a four-week intensive outpatient program. There are individual and group sessions in art, expressive writing and music.
“The list of benefits goes on: increased frustration tolerance, self-esteem, self-efficacy, self-awareness, sense of mastery, hand-eye coordination,” Walker wrote in an email.
She said art helps servicemembers unlock and deal with their darkest memories.
“One servicemember was shocked to find himself re-enacting the death of one of his buddies using clay in our initial session,” she said. “I think he left that session surprised but aware that the art therapy would be something that would help him.”
Retired Navy SEAL Marcus Luttrell established the Lone Survivor Foundation in February 2010 to help others.
A Navy Cross recipient who survived a Taliban ambush that claimed the lives of three SEALs in his team, Luttrell’s face was shredded and his body was riddled with shrapnel. He suffered a broken nose, torn rotator cuff and three cracked vertebrae. When he came home, he found that time on a Texas ranch with his family served him better in healing his physical wounds than any other treatment.
His foundation focuses on families and brings them to the ranch for outdoor and therapeutic activities, including work with horses. Their mission is to help veterans suffering from PTSD and TBI, but also physical injuries.
Pete Naschak, a retired Navy SEAL master chief and foundation president, said that Lone Survivor is a smaller boutique treatment vehicle. They also try and refer those in need to an ever-expanding network of alternative treatment approaches and reputable organizations.
“I truly don’t feel there is one solution for every injury,” he said.
Veterans unhappy with traditional treatment alone should do their research and talk to their doctor. If a VA clinician is unreceptive to alternatives, Cifu said, veterans should be clear about what they want.
“Be the integrator,” he said. “Be your own advocate.”
burkem@pstripes.osd.mil
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