New approach to PTSD offers servicemembers greater privacy, reduced stigma

  • Published
  • By Lt. Col. Lesa Spivey
  • 59th Medical Wing Public Affairs
LACKLAND AIR FORCE BASE, Texas (AFNS) --  Servicemembers seeking help for deployment-related post-traumatic stress disorder now have the option of being treated through primary care channels at a new pilot program offered at Wilford Hall Medical Center here.

The primary goal of this new research program is to offer effective therapy for PTSD within the primary care environment, where servicemembers are likely to feel more comfortable seeking mental health assistance.

Servicemembers who wish to participate in this type of treatment program simply schedule an appointment with their primary care manager and go to their primary care facility, just as they would for any other treatment. The primary care manager then refers the servicemember to the behavioral health consultant who works in the primary care clinic. This process helps to mainstream the treatment alongside other, more routine care. It is hoped that, as a result, a servicemember will feel less isolated or ostracized and be more willing to ask for help.

PTSD is caused by exposure to a traumatic event that involves actual or threatened death or serious injury. An individual who is experiencing PTSD symptoms may have been personally threatened or injured, or he or she might have witnessed the death or serious injury of another. In either case, the severity of PTSD is directly related to the level of threat to the person's life or the lives of others while in the combat environment.

PTSD is one of the top health concerns for servicemembers returning from combat duty in Iraq and Afghanistan. Recent studies of Operation Iraqi Freedom and Operation Enduring Freedom veterans suggest that 5 to 17 percent of U.S. military personnel returning from deployments have PTSD symptoms and as many as 25 percent report some psychological problems.

Almost 2 million U.S. military personnel have deployed in support of OIF/OEF, and estimates in this population indicate that 100,000 to 300,000 OIF/OEF veterans are at significant risk for chronic PTSD.

The most effective treatment for PTSD is cognitive-behavioral therapy that helps the servicemember deal more directly with the distressing memories, feelings and thoughts related to combat exposure. Typically, these treatments are only available in the mental health clinic.

Until now, no studies have been conducted on offering cognitive-behavioral treatment for PTSD in a primary care setting. However, with research conducted by the South Texas Research Organizational Network Guiding Studies on Trauma and Resilience, or STRONG STAR, doctors at Wilford Hall and Brooke Army Medical Centers in San Antonio have been able to launch the initial study and treatment of this kind.

STRONG STAR is a multidisciplinary and multi-institutional research consortium funded by Department of Defense officials to develop and evaluate the most effective early interventions possible for the detection, prevention and treatment of combat-related PTSD in active-duty military personnel and recently discharged veterans. Under the leadership of the University of Texas Health Science Center at San Antonio, the consortium brings together the expertise of civilian, military and Veterans Administration institutions and investigators, striving together to make major scientific advances in military PTSD research and prevent the onset of chronic PTSD in a new generation of veterans. For more information about the STRONG STAR and its various research programs, visit www.strongstar.org.

The STRONG STAR program offering PTSD treatment through primary care began in February at WHMC and in April at BAMC. Since then, at least 13 servicemembers have enrolled in the pilot study and participated in the PTSD treatment. That number is expected to increase as the program ramps up at BAMC and comes online at the San Antonio VA.

"This is a significant number since there is a possibility that none of these patients would have sought treatment for PTSD without this intervening step. Many people just won't go to a mental health facility," said Lt. Col. (Dr.) Jeff Cigrang, chairman of the department of psychology at WHMC and principal investigator for the study. "Often, servicemembers who need help do not seek it for months to years after their return from deployment. In many cases, it is a spouse or other family member who is affected by the servicemember's irritability, social withdrawal or emotional numbing that encourages them to seek help. Once symptoms are identified, an additional benefit to offering this treatment in the primary care setting is that appointments are more accessible, so patients experience less wait time to see a doctor."

The treatment in primary care is more abbreviated and less time-intensive than the options offered at the mental health clinic, so servicemembers are able to schedule appointments better in conjunction with their work schedules.

Treatment involves face-to-face meetings with a behavioral health consultant and completion of homework assignments between appointments. Servicemembers are generally treated in four to six appointments over two to three months, and each appointment lasts 30 minutes. At the completion of the primary care treatment, the servicemember has the option, if needed, of referral to other, more intensive treatments for PTSD.

"We are hopeful that this relatively brief treatment in primary care will be the solution for many service members with PTSD," said Dr. Laura Avila, study co-investigator at BAMC. "For others, it may serve as a good first step to getting the additional help they need from mental health specialty services."

Patients participating in the study are responding well and progressing through various stages of treatment. Some have already completed the program successfully. After treatment, doctors follow-up with the patients at intervals of one month, six months and one year.

"Servicemembers who have sought out this treatment post-deployment come from various career fields, including medical, mortuary affairs, security forces, transportation and others," Doctor Cigrang said. "It's important that we get the word out that seeking help for PTSD is as vital as being treated for any other medical condition and there should be no stigma or shame associated with it."

Doctor Cigrang recommended that servicemembers with an interest in getting help for deployment-related PTSD speak with their primary care manager about a referral to behavioral health consultation services at their primary care clinic.