On July 1, 2009 the US Department of Defense Military Health System website posted the following article by Captain Barry Lewis :
“Symptoms of combat stress and post-traumatic stress disorder (PTSD) include continual nightmares, avoidance behaviors, denial, grief, anger and fear.
Some soldiers, battling these and other symptoms, can be treated successfully as an outpatient while assuming their normal duties. For others, however, returning to work and becoming their old selves again were challenges recognized by several mental health professionals across the European theater.
We were looking at how we can best meet the needs of our clientele, and we were identifying that a lot of the soldiers needed more than once a week outpatient, individual therapy and probably needed more than once or twice a week group therapy,’ said Joseph Pehm, chief of Medical Social Work at Landstuhl Regional Medical Center (LRMC).
The solution came in the creation of an intensive eight-week therapeutic post-traumatic stress disorder Day treatment program called ‘evolution’ that began in March 2009 at LRMC. During the eight-hour days, patients enrolled in the program participate in multiple disciplines and interests, including art therapy, yoga and meditation classes, substance abuse groups, anger and grief management, tobacco cessation, pain management and multiple PTSD evidence-based practice protocols.
‘I am a great believer in the kitchen sink, meaning I throw everything, including the kitchen sink, and something will stick,’ said Dr. Daphne Brown, chief of the Division of Behavioral Health at LRMC. ‘And so we’ve come with all the evidence-based treatment for PTSD that we know about … We’ve taken everything that we can think of that will be of use in redirecting symptoms for these folks and put it into an eight-week program.’
Brown, Pehm and Sharon Stewart, a Red Cross volunteer who recently received a Psy.D. in psychology, said the program is designed from research into the effects of traumatic experience and mirrors successful PTSD programs at Walter Reed Army Medical Center and the Department of Veterans Affairs, as well as programs run by psychologists in the U.S.
‘We are building on the groundbreaking work that some of our peers and colleagues have done and just expanding it out,’ said Brown.
During treatment, patients begin the day with a community meeting where they discuss how well they feel and any additional issues or concerns since their last meeting. The remainder of the day depends on the curriculum scheduled for that week.
The first few weeks focus on learning basic coping skills such as how to reduce anxiety and fight fear, as well as yoga and meditation for relaxation. Eye movement desensitization and reprocessing (EMDR), an evidence-based practice for treating PTSD, is also conducted during the early phases of the treatment program.
‘The concept behind EMDR is that, essentially, memories become fixed in one part of our brain and they maintain their power and control over our emotions as long as they are fixed there,’ said Brown. ‘And if we can activate a different part of the brain while we’re experiencing that memory, we can help to remove some of that emotional valence from it. So we use physiological maneuvers to activate both sides of the brain.’
The goal at the beginning of the PTSD program is to provide patients with a number of tools they can use to help them calm down when feeling overwhelmed, especially before more intense therapy begins in the latter weeks. Cognitive processing therapy is used throughout the program. EMDR and prolonged exposure therapy are also available on an individual basis at the soldier’s request. All three techniques are research-based treatments.”
What are your thoughts about this new treatment approach?