U.S. Puts More Soldiers into PTSD Treatment

Vietnam War veterans with post-traumatic stress disorder (PTSD) returned home in the 1960s and 1970s to a virtual mental-health desert.

"You couldn’t have written a worse-case scenario (for PTSD care) than the post-Vietnam era," said Matthew Friedman, executive director of the National Center for PTSD, who spoke at a conference on mental-health care last year, sponsored by the Department of Veterans Affairs.

PTSD wasn’t recognized as an official diagnosis until 1980. Treatments available were sporadic and primitive, with a heavy emphasis on medication.

Since 2002, however, both the Pentagon and the VA have steadily ramped up new ways to treat the tens of thousands of soldiers returning from Iraq and Afghanistan who suffer from PTSD and other mental-health wounds.

There is much disagreement, however, on which treatment is the most effective.

The Institute of Medicine of the National Academy of Sciences, a Washington, D.C.-based nonprofit agency, reported in December that only prolonged exposure therapy shows signs of effectiveness.

The therapy focuses on the patient working closely with a therapist "to reframe the experience, and you begin in tiny, tiny steps to conquer it," said L.B. Wish, a psychologist who works with trauma victims in Sarasota, Fla.

"What happens is instead of the whole story unraveling, you do it inch by inch by inch," Wish said. "So at every point that you develop a reaction, you go back and say, ‘OK, let’s redo that reaction, let’s rethink that, let’s conquer that.’"

A more high-tech, but related approach that has garnered national attention is Virtual Iraq, a modified X-Box game developed at the University of Southern California with funding from the U.S. Navy.

Virtual Iraq exposes combat veterans to an intensive simulation of the traumas that haunt them, said Albert "Skip" Rizzo, director of the USC Institute for Creative Technologies.

"What we try to do with exposure therapy is bring a person back to those events, have them relive them and talk about them — emotionally process the memories," said Rizzo, a psychologist.

Paula Schnurr, deputy executive director of the national PTSD center, insists cognitive therapy has shown the highest success rate.

Cognitive therapy requires patients, under a counselor’s direction, to reinterpret traumatic events and restructure beliefs disrupted by them.

Instead of focusing on the traumatic event and associated emotions, the veteran and the therapist "go at the thoughts and try to help the veterans change the thoughts," Schnurr said.

Another technique for treating PTSD is known as Eye Movement Desensitization and Reprocessing, or EMDR, Wish said. EMDR is based on the observation that moving the eyes in a certain way can relieve emotional stress.

"It has to do with training all parts of your brain to refocus and to rebuild neuron connections that overpower the ones you don’t want," Wish said.

Researchers have determined a genetic component plays a role in why some veterans develop PTSD. Other factors include childhood trauma, such as abuse or the death of a parent.

Wish, the Florida psychologist, acknowledged that PTSD is usually a lifelong condition, but he said it is highly manageable.

"What you can do is avoid adopting an identity as a victim," she said.