Recently, I wrote about a whitewater rafting program in Montana, the X Sports 4 Vets program, as therapy for post-traumatic stress disorder, and I remember talking with a vet named Steve Hale, who deployed to Iraq in 2004-05 with the Washington National Guard and who came home depressed and unable to socialize with others. The river outings gave him great exercise, an adrenaline rush and a feeling of teamwork with his rafting buddies, who were also vets.
"Every time I get out on the river, I come home with stories and big pleasant memories," Hale told me. "It does me a lot more good than the pills they've been throwing at me."
Perhaps, just perhaps, the Army is beginning to get a piece of this picture.
Last month, the U.S. Army Medical Command issued a report changing its policy on pharmaceuticals. It said that only Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) have shown evidence that they do enough good for a patient to justify the prescription.
It strongly cautioned against prescribing benzodiazepines and atypical antipsychotics, saying that they do more harm than good. “There is evidence to suggest that benzodiazepines may actually potentiate the acquisition of fear responses and worsen recovery from trauma,” it said. As to atypical antidepressants, it said: These medications have shown disappointing results in clinical trials in the treatment of PTSD.”
Last weekend, the Philadelphia Inquirer quoted the assistant secretary of defense, Dr. Jonathan Woodson, as saying that prescription rates for atypical antidepressants increased 10 times between 2002 and 2009: from 0.1 percent to 1 percent.
The Army also broadened its preferred list of psychotherapies for soldiers, saying that trauma-focused PTSD treatment can include narration (including imaginal exposure), cognitive restructuring, in-vivo exposure, relaxation or stress modulation skills, and psycho-education. It specifically mentioned programs such as Prolonged Exposure Therapy, Cognitive Processing Therapy, Eye Movement Desensitization and Reprocessing (EMDR), or “other forms of trauma-focused cognitive behavioral therapy, all of which have been shown to have generally equivalent effectiveness.”
Since PTSD often occurs in conjunction with other mental health problems, it encouraged multidisciplinary approaches, including hypnosis, art therapy, bio/neurofeedback, yoga, acupuncture, and massage.
The new policy noted that some patients may prefer such therapies to pharmaceuticals. “Matching evidence-based components to patient preferences is likely to help in fostering engagement and willingness to remain in treatment, which ultimately is one of the strongest predictors of overall treatment efficacy,” it said.
Attached to the report was a chilling article written last year for JAMA, the Journal of the American Medical Association. Dr. Charles W. Hoge of the Walter Reed Army Medical Center concluded: “With only 50 percent of veterans seeking care and a 40 percent recovery rate, current strategies will effectively reach no more than 20 percent of all veterans needing PTSD treatment.”
According to the Army, up to 25 percent of the more than 2 million troops deployed to combat zones in Iraq and Afghanistan may experience PTSD “with combat frequency and intensity being the strongest predictor of this condition.”
But four years ago, the Rand Corp. interviewed 1,965 vets and projected in its controversial 2008 report that 18.5 percent of all returning service members would meet the criteria for either PTSD or depression (14 percent for each, but there's some overlap), and that another 19.5 percent would experience a probable traumatic brain injury while overseas. Again after taking into account that overlap, it said 31 percent of all returning troops would suffer from one or all of those ailments.
The VA's actual treatment figures show 28.5 percent of the returning vets are seeking mental health care, which is right on track with the Rand Report. But while the Rand Report projected that some 320,000 American soldiers would need help for TBI, the VA says only 54,070 vets (a little over 4 percent of the returning vets) qualified for that diagnosis.
Finally, this blog has been modified, according to Psychology Today policy, to eliminate the names of specific drugs. A fuller blog can be found on my personal Web page: http://www.ericnewhouse.com/