Late Breaking News
PTSD Program Seeks to Help Patients Move Forward
WASHINGTON, DC—When Army Maj Jeff Hall needed help after his deployments to Iraq he did not want to be coddled. That is why he believes that a PTSD program offered through DCoE’s Deployment Health Clinic (DHCC) was effective in helping him. “It wasn’t, “let’s all lie around on pillows and think about fluffy clouds,” said Hall.
The Specialized Care Program Track II is an intensive, three-week, multi-disciplinary treatment program offered by DHCC at WRAMC for patients with deployment-related stress and PTSD and/or difficulties adjusting to re-deployment.
The treatment program is group oriented, with three to eight individuals attending the program as a group. The program teaches patients strategies to deal with the physiological, behavioral, emotional, and cognitive effects of stress/trauma. “It is a multidisciplinary care program that is trying to bring, in a fairly intensive way over a three-week period of time, a lot of resources to the servicemember’s disposal, so that they can develop a clear management plan going forward from here,” said Army Col Charles Engel, MD, director of the DHCC.
After Hall returned from his second deployment in Iraq, he dealt with anger and eventually started having suicidal ideations. His commanding officer at the time realized he needed help and recommended him to the DHCC program, he explained. “I had, like, 800 television sets going on in my head and I was watching all 800 screens at the same time. It got to be so much noise that I was looking for the off button and the only off button I could find was to kill myself. The only problem was that I didn’t believe in suicide.”
Helping Those with PTSD
PTSD can be a fairly disorienting condition for those who experience it, Engel explained. “It is as though those things you could depend on, people you could depend on, systems you thought you could depend on, suddenly all those things are thrown into doubt because you have experienced things that you never thought you would experience.”
Those who suffer from PTSD deal with troubling symptoms that might include persistent nightmares and difficulty sleeping, hyperarousal, reliving the event, or feeling numb. There is not only a spectrum of severity for the condition, but some individuals may not meet the full case criteria for PTSD, but are still having post trauma symptoms.
Engel said that the philosophy of the DHCC is that there is “no easy one size fits all treatment for people with PTSD.” While some people with PTSD may not be ready to seek help yet, the Specialized Care Program is designed for those who have sought help and have exhausted local treatment resources for PTSD, or who have had treatment that has not helped.
A multi-disciplinary staff leads the program and each day of the three-week program is structured, including PTSD specific treatment elements and adjunctive treatment elements. The program not only addresses mental health issues, but also physical injuries that may be playing a part in how the soldier is feeling. “They meet on a daily basis with a psychotherapist, which is a psychologist, and work on issues in a one-on-one setting using an exposure-based Cognitive Behavioral Therapy model,” said Engel. “They are also meeting with a physician who is looking at their overall state of health and thinking about what medicine they are on and how that affects their traumatic stress symptoms. Often, what we find [is] that by the time that patients have gotten to this stage of treatment that they have been placed on a number of things.”
Engel explained that most of the patients in the program “end up on fewer medicines than when they started in the program.”
Participants take part in daily sessions, including group therapy and one-on-one sessions with a counselor. “From their perspective, they often feel like they help each other more than anything we can do,” according to Engel. “They create a support network, if you will, right here.”
Stress management is a major component of the program. Patients are taught to understand the physiology of stress and practice various forms of relaxation, such as yoga.
The program also has a physical therapist. Many patients with PTSD have associated physical injuries, so a physical therapist helps the servicemember understand how to exercise at appropriate levels.
In addition, pool therapy is done for those with pain syndromes. “We do some things that some people might say are complementary or alternative modalities,” said Engel. “We wouldn’t say these are evidence-based therapies, but when they are added into a program of psychotherapy and careful medication adjustments, they become part of an overall program of wellness.”
The program also holds seminars for the participants where PTSD topics are discussed, such as what PTSD is, what treatments exist, why chronic pain is common with PTSD, and how to find the right doctor. After the patients leave the program, the program has a case management system where the servicemember is followed for a minimum of 45 weeks after they leave.
Engel stated that while the three-week program is not a cure for PTSD, it helps patients in their journey of recovery. DHCC wants to create different options and programs for patients, since patients are often at different stages in terms of what they are willing to do to address PTSD.
In addition, he noted that there is no set formula to cure PTSD. “We have things that can reduce symptoms, often dramatically ... but the reality is that this is an ongoing point of vulnerability for them.”
Dealing with the Aftermath of Deployment
For Hall, problems began to surface during his second deployment in Iraq when he began feeling frustrated that his unit seemed to lack a clear mission. That feeling was compounded when two soldiers that were in a tank unit attached to him were killed by an IED and a third soldier was severely injured.
Their deaths greatly impacted Hall, who was angry and couldn’t shake what happened when he returned home. “It was a feeling of hopelessness, helplessness, and extreme guilt. Even though I have learned through therapy and a lot of contemplation that I had nothing to do with their deaths, I squarely put that responsibility on my shoulders. I don’t know why. I don’t think that can be answered. I just did.”
His wife, Sheri, immediately knew something was wrong when he returned from that deployment. “I could tell by the look on his face and the look in his eyes that something wasn’t right.”
Hall continued serving in the military when he returned home, but was spiraling downward. While Hall was never physically violent towards his wife and two daughters, he felt extreme anger. “He would just get really angry and his eyes would get black. He would literally say things and then not remember what he was saying,” Sheri recalled.
One day in April 2008, Hall had what he calls his “PTSD breakdown,” and realized he could not go on. “I couldn’t walk outside my house. I couldn’t go to work, I felt completely defeated. I literally laid in the yard and couldn’t move. I was frozen. I felt like my career was over. I felt like everything I believed in was different now.”
Sheri had been in contact with Hall’s commanding officer at the time, Col Daniel Pinnell, who had also realized that Hall needed help. This led to Pinnell connecting Hall with the DHCC program. Hall said that when he was evaluated for the program he felt some hope when he realized the program’s personnel were not just asking him how he felt, but actually looked for injuries that could be causing his symptoms.
Hall invited his wife to attend the program at WRAMC with him. “During this whole period of time, even though I pushed my family away, I really didn’t want to lose my family. I just didn’t want them to have to experience what I was going through,”
The program was like an organized workday in which participants took part in different sessions and activities. Hall liked having Sheri in the group sessions because she was able to hear from other soldiers who had undergone similar experiences to his.
The program was also helpful to Sheri because it gave her a chance in counseling to let Hall know how his deployment had impacted her. “I was spread pretty thin and that wore me a little bit,” she said. “Then seeing Jeff going through the things that he was going through after he got home and keeping all of that inside, and never letting out how I really felt about anything, it gave me a chance to get that off my chest.”
The Process of Recovery
Hall, who has served in the military for about 17 years, still has unresolved physical health issues stemming from his deployments, but he credits the program with saving his life. “Even to this day I have problems tuning out some of my experiences, but they don’t own me like they did. [Now,] I can see depression on the skyline. The difference is that I can see it and I can move parallel to it, and I don’t let it wash over me too much. Before it would rush over me and I would be stuck for a month staring at a tree.”
Hall said he preferred the program to other behavioral help he encountered because DHCC personnel did not coddle him or feel sorry for him, something he say he “can’t tolerate.”
Returning to the daily grind of his life at the end of the program has not been without its challenges. Hall compares leaving the program at the end of three weeks to jumping out of a plane without a parachute. “If you get sent to Walter Reed from your unit they expect you to be healed when you come back, and that is not necessarily what happens. It was kind of fearful and I didn’t really know what to expect, but leaving the program I had felt like there was some help. I definitely didn’t feel as lost as I had when I went in.”
Sheri said that they now know how to cope much better when things do not go well, and that the program not only saved her husband’s life, but it saved their marriage. The couple now speaks at conferences and other forums to spread the message that it is okay to ask for help.
Hall, who now serves as the resilience director at Fort Riley, is eager to see the DHCC program replicated throughout DoD and has been trying for several months to get the program at Fort Riley.
Engel said that he too would like there to be broader implementation of the program. “We are in the process now with working with the Army, but it is more of a tri-center service effort, to develop a similar set of programs—regional programs—that are like the Specialized Care Program.”