Residential Treatment Program Offers Hope for PTSD Patients

by U.S. Medicine

March 10, 2011

PTSD-residential.jpgWASHINGTON, DC—Active duty servicemembers with combat-related PTSD who have not experienced improvements in their condition in outpatient care have a new option for treatment.

Overcoming Adversity and Stress Injury Support (OASIS) is the Navy’s first residential program for servicemembers with combat-related PTSD. Located on the Naval Medical Center San Diego (NMCSD) campus at Naval Base Point Loma, the pilot program was created in response to servicemembers’ request for more intensive care for PTSD.

“There were people out there participating in the best evidence-based care as outpatients, but they still were not getting the results that they wanted with that level of care,” said Navy Lt Cmdr Paul Sargent, MD, division officer of NMCSD’s OASIS program. “The nature of the problem was too severe for them to focus on it as an outpatient.”

The 10-week residential program resulted from that need and began treating patients in August 2010. It is currently treating 12 patients at a time, with the goal of reaching 20 patients by July 2011. Active duty servicemembers suffering from combat PTSD whose symptoms have not improved with outpatient treatment are eligible for the program. “All of our patients have tried other types of therapy and it just hasn’t worked,” said Sargent. “So this isn’t the place where people are going to come to start. This is when other treatments haven’t worked.”

Caring for PTSD Patients

The program has a multidisciplinary treatment staff and utilizes a comprehensive approach to care using evidence-based therapies and integrative approaches.

Currently, the program runs two cohorts of patients at a time for the 10-week period. Since trust can often be an issue, the first two weeks of treatment are focused on building teams, and generating unit cohesion so that participants have formed the bonds of trust they need to have the conversations and engage in the therapy they need. “What we find is that over the course of the 10 weeks, we may have one cohort in week two and another may be in week six,” he said. “Those people who are further along in treatment provide a great benefit to those who are coming behind them, both in terms of helping them understand the techniques, but also giving them hope.”

The first two weeks of treatment concentrate on team building among the patients, relaxation, education, and supportive psychotherapy. Patients then engage in eight weeks of Cognitive Processing Therapy for their PTSD, in addition to continued education and training targeted at symptom improvement.

During their daily schedule patients participate in various groups to deal with specific issues like insomnia, vocational rehab, anger management, as well as addiction.

In addition, courses are offered such as yoga, meditation, spirituality, recreation therapy, and art therapy, among others. Having a mix of options for patients is important because of the wide range of issues they may be struggling with. For example, the program offers spirituality groups because patients often deal with the “moral injuries,” of war, Sargent explained.

Exercise is also a crucial part of the schedule in the program, Sargent said. “Exercise becomes a very important part of the treatment, not only for physical well being, but it helps to improve sleep later on that evening. Exercise has been demonstrated to be as effective as an antidepressant medication in mild to moderate depression. Most of our patients have both PTSD and major depressive disorder, so this exercise piece is an important component.”

Every Saturday, the program also offers family skills training that spouses are encouraged to attend. “We encourage spouses to come and participate in treatment with the patient, so they can not only see the improvement as they go along, but also have an understanding of what it takes to gain that improvement,” Sargent said. “So when a servicemember is discharged, the spouse becomes a very helpful factor in maintaining the improvement that they get while they are in treatment.”

Patients meet two nights a week with Vietnam and OIF/OEF combat veterans at the Veterans Village of San Diego. This allows the servicemembers to not only discuss common issues that they have faced, but it also introduces the servicemembers undergoing treatment—many of whom may be transitioning out of the military—to a community of veterans with whom they can find support and comraderie.

Sustaining Improvements

One of the strengths of OASIS is that it is so collaborative, Sargent said. The program includes volunteer meditation and yoga instructors, volunteers from the Chaplain Corps that teach the program’s spirituality course, and a VA vocational rehab specialist that helps servicemembers develop their resumes and build their job hunting skills. Another collaborator, Project Families OverComing Under Stress (FOCUS), provides resources and training for family members of servicemembers who have PTSD.

While a 10-week stay might sound long, Sargent said it is appropriate. The therapeutic benefit from building rapport and building trust with the patients over the first few weeks allows them to engage more deeply in the treatment.

Program officials would like to see symptoms reduced in patients by at least 30% over the 10-week period. The goal is to return 25% of the patients back to full active duty, he said. “On the surface, that may not sound like a lot, but in fact without this program all of these patients would be going to Physical Evaluation Board or administrative separation based on whatever factors are going on, because they have all failed outpatient treatment,” said Sargent.

The OASIS staff do not “write medical boards,” Sargent emphasized. “That is an important point because people oftentimes are afraid if they come into treatment they will ‘medboard me,’ and that is absolutely not true.”

After completing the program patients can participate in an OASIS after-care program in which they can come back twice a month to participate in groups with the patients they built bonds with during their stay.

The participation of the family and the bonds that are developed with other patients in treatment are important because patients can continue to use that support after treatment. “Oftentimes, people come to us very symptomatic and they leave with reduced symptoms, but they are not going to leave treatment after 10 weeks completely symptom free,” he said. “They are going to have to understand the tools that we give them and how to use those to keep their symptoms in check as they move forward.”

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