Navy Psychologist Uses Nontraditional Methods to Improve Mental Healthcare

by U.S. Medicine

February 14, 2017

By Stephen Spotswood

Dr. Tracy Hejmanowski

JACKSONVILLE, FL—It was 7 a.m. on a Wednesday in January—a time when most clinical psychologists would be making their way to the hospital or clinic. But instead of heading to her office at the Naval Hospital Jacksonville Deployment Health Center, Tracy Hejmanowski, PhD, was driving an hour south of the city to begin a new patient on a course of equine-assisted therapy and introduce him to his 1,200-pound therapy companion.

Equine therapy is one of several nontraditional treatments Hejmanowski and her colleagues in Jacksonville have embraced in their mission to helping combat-exposed servicemembers readjust to civilian life.

“We bring combat veterans out into nature to work with animals, and they’re helping the horse get through anxiety,” Hejmanowski explained. “Horses are naturally vigilant, and they hold a lot of the same characteristics as combat veterans. It’s also a very kinetic experience—hands-on and very physical and motion-based. It speaks to our patients in that way.”

As the patients learn how to work with the horse and deal with the animal’s anxiety, they are also learning ways to deal with their own.

Another side benefit of the therapy when it’s conducted with a group of patients is that it creates a sense of camaraderie as a half-dozen servicemembers learn unfamiliar skills in an unfamiliar setting. The men—most of the patients Hejmanowski sees are men—will stay out in the parking lot long after the therapy has ended and talk, she said.

Hejmanowski was familiar with military medicine long before she became a Navy officer. The wife of a Navy medical provider, Hejmanowski volunteered at military treatment facilities wherever she and her husband were stationed. She pursued a naval officer’s commission in 2001 and served as the base psychologist at Naval Hospital, Rota, Spain, for three years. She was then transferred stateside to Naval Medical Center, Portsmouth, VA, where she worked to develop post-traumatic stress program initiatives. She and her family moved to Jacksonville and 2008 where she assumed a civilian post as program manager at the Deployment Health Center.

“Deployment psychology has evolved a lot over the years as the operational tempo has varied,” she explained. During the heavy years of the wars in Iraq and Afghanistan, the focus was on pre-deployment and ensuring servicemembers were physically and psychologically fit for duty. There was less focus on post-deployment.

“As our deployment rate has gone down, our utilization of mental health services has increased exponentially,” Hejmanowski said. “That’s a function of a couple of things. Servicemembers won’t take a knee. They won’t drop their pack. They’re very unwilling to stop and take care of themselves if there’s a danger of missing a deployment.”

As that danger fades, servicemembers start to look to care for themselves. Hejmanowski also sees many servicemembers who are approaching retirement—a natural source of stress as they start to contemplate life beyond the military.

“There’s still a natural stigma in the military to seeking mental health care,” Hejmanowski explained. “Though it’s much improved and we try to leverage that as much as possible. We make sure those who come in for care look out for one another as much as possible. But there’s a natural cultural barrier we have to work against. If somebody is even close to hanging around our office, we’ll walk them in the door, even informally, to break the ice.”

The medical professionals at the DHC provide the full range of traditional cognitive and behavioral therapies. But in the search to provide the best possible care, Hejmanowski said she is not afraid to work outside the box.

“I very much believe we have to meet our servicemembers where they’re at,” she said. “In some cases, these folks are infantry and have been spending the vast majority of their time being aggressive and waging war, and now they have to get to the task of turning that back off. They’re trained to be stoic, to put others before self. It’s an odd shift for them to come in for treatment.”

Which is another reason that nontraditional treatment modalities like equine therapy can be effective—it’s therapy that doesn’t come with the stigma of therapy.

Another program Hejmanowski helped introduce in Jacksonville is scuba diving training.

“This works for a lot of our folks with high blood pressure who are keyed up and anxious and aware of their surroundings. Instead of teaching them how to breathe in therapy, we took them to scuba training and brought them underwater and taught them how to breathe from the diaphragm. Now they have a physical memory. When they have a panic attack, they can tap into that much more readily.”

Scuba training comes with added benefits. The quiet peace of being underwater helps patients relax, and the weightlessness alleviates the lower back pain many servicemembers struggle with.

One of the biggest barriers Hejmanowski faces is the limitations of time and funding.  Nontraditional therapies—especially ones that involve an immersive element—require significant attention and resources.

A few years ago, Hejmanowski and her colleagues received a grant to run a one-year pilot for an intensive outpatient program. The three-week program had Hejmanowski and another psychologist working with eight veterans nine hours a day, Monday through Friday. The program involved a combination of traditional therapy, both group and one-on-one, and in-vivo work where the veterans were taken out as a group to experience public interactions that can provoke anxiety in patients suffering from post-traumatic stress.

“They were basically a platoon,” she said. “We had them doing all sorts of things. We’d take them down to a busy shopping district that’s the closest thing we have to an Iraqi town around here. We’d go out on a catamaran and go out on the water, then bring them out to lunch, which can be anxiety-provoking, then go scuba diving. It was a very comprehensive, 360-degree program that was fantastic. Our cohorts are still very close today.” 

The program ran for a year but shut down after the pilot ended. “It became unfeasible, because it was knocking us out of the clinic for long chunks of time,” Hejmanowski explained. “I’d love to stand that up again.”

Such intense, outside-the-box treatment might seem like a lot to ask of servicemembers. But Hejmanowski has found that, with this cohort, once they’re solidly in therapy they are the most dedicated patients imaginable.

“If they trust you and know you’re genuinely invested, they will lay their heart on the line,” she declared. “There’s an amazing amount of investment in this population, and that’s why I love working with them. They will do tremendously difficult therapy work.”

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