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New approach to PTSD offers servicemembers greater privacy, reduced stigma

  • Published
  • By Lt. Col. Lesa Spivey
  • 59th Medical Wing Public Affairs
LACKLAND AIR FORCE BASE, Texas --  Servicemembers seeking help for deployment-related Posttraumatic Stress Disorder now have the option of being treated through primary care channels, thanks to a new pilot program offered at Wilford Hall Medical Center.

The primary goal of this new research program is to offer effective therapy for PTSD within the primary care environment, where service members are likely to feel more comfortable seeking mental health assistance.

Servicemembers who wish to participate in this type of treatment program can schedule an appointment with their primary care manager and go to their primary care facility, just as they would for any other treatment. The primary care manager then refers the service member to the behavioral health consultant in the primary care clinic. This process helps mainstream the treatment alongside other, more routine care. The goal is that servicemembers will feel less isolated or ostracized and be more willing to ask for help.

PTSD is caused by exposure to a traumatic event involving actual or threatened death or serious injury. An individual experiencing PTSD symptoms may have been personally threatened or injured, or he or she might have witnessed the death or serious injury of another. In either case, the severity of PTSD is directly related to the level of threat to the person's life or the lives of others while in the combat environment.
PTSD is one of the top health concerns for service members returning from combat duty in Iraq and Afghanistan. Recent studies of Operation Iraqi Freedom and Operation Enduring Freedom veterans suggest that 5 to 17 percent of U.S. military personnel returning from deployments have PTSD symptoms and as many as 25 percent report some psychological problems.

Of the almost 2 million U.S. military personnel who have deployed in support of OIF/OEF, between 100,000 to 300,000 OIF/OEF veterans are at significant risk for chronic PTSD, said Lt. Col. (Dr.) Jeff Cigrang, chairman of the Department of Psychology at WHMC and principal investigator for the study.

The most effective treatment for PTSD is cognitive-behavioral therapy that helps the service member deal more directly with the distressing memories, feelings and thoughts related to combat exposure, Dr. Cigrang said. Typically, these treatments are only available in the mental health clinic.

Until recently, no studies have been conducted on offering cognitive-behavioral treatment for PTSD in a primary care setting. However, thanks to research conducted by the South Texas Research Organizational Network Guiding Studies on Trauma and Resilience, or STRONG STAR, doctors at Wilford Hall and Brooke Army Medical Centers in San Antonio, Texas, have been able to launch the initial study and treatment of this kind.

STRONG STAR is a multidisciplinary and multi-institutional research consortium funded by the U.S. Department of Defense to develop and evaluate the most effective early interventions possible for the detection, prevention and treatment of combat-related PTSD in active-duty military personnel and recently discharged veterans.  

The STRONG STAR program, offering PTSD treatment through primary care, began in February at WHMC and in April at BAMC. Since then, at least 13 service members have enrolled in the pilot study and participated in the PTSD treatment. That number is expected to increase as the program ramps up at BAMC and comes online at the San Antonio VA.

"This is a significant number since there is a possibility that none of these patients would have sought treatment for PTSD without this intervening step. Many people just won't go to a mental health facility," Dr. Cigrang said. "Often, service members who need help do not seek it for months to years after their return from deployment. In many cases, it is a spouse or other family member who is affected by the servicemember's irritability, social withdrawal or emotional numbing that encourages them to seek help. Once symptoms are identified, an additional benefit to offering this treatment in the primary care setting is that appointments are more accessible, so patients experience less wait time to see a doctor."

The treatment in primary care is more abbreviated and less time-intensive than the options offered at the mental health clinic allowing servicemembers to schedule appointments in conjunction with their work schedules, he added.

Treatment involves face-to-face meetings with a behavioral health consultant and completion of homework assignments between appointments, Dr. Cigrang said. Servicemembers are generally treated in four to six appointments over two to three months, and each appointment lasts 30 minutes. When primary care treatment is complete, the servicemember has the option of referral to other, more intensive treatments for PTSD.

"We are hopeful that this relatively brief treatment in primary care will be the solution for many service members with PTSD," said Dr. Laura Avila, study co-investigator at BAMC. "For others, it may serve as a good first step to getting the additional help they need from mental health specialty services."

Patients participating in the study are responding well and progressing through various stages of treatment, Dr. Cigrang said. Some have already completed the program successfully. After treatment, doctors follow-up with the patients at intervals of one month, six months and one year.

"Servicemembers who have sought out this treatment post-deployment come from various career fields, including medical, mortuary affairs, security forces, transportation and others," said Dr. Cigrang. "It's important that we get the word out that seeking help for PTSD is as vital as being treated for any other medical condition and there should be no stigma or shame associated with it."

Dr. Cigrang recommended that servicemembers with an interest in getting help for deployment-related PTSD speak with their primary care manager about a referral to behavioral health consultation services at their primary care clinic. 

For more information about the STRONG STAR and its various research programs, visit www.strongstar.org.