Who Gets Better from Combat Stress (And How)

There are several studies claiming a 70-percent improvement rate for returning warriors who are treated for combat stress with various cognitive behavioral therapies and/or prolonged exposure strategies. But this is a misleading number.

What this doesn't take into account is the fact that of those with persistent combat stress, only half will seek out treatment in the first place.

The main barrier to seeking help isn't stigma, the reason that's usually cited as the primary problem; surveys show it's actually distrust of mental health providers, both civilian and military, that keeps our service members away.

I'll get back to that in a bit. But for now, back to the numbers: 50 percent won't go for treatment in the first place.

And of the 50 percent who actually do go, 60 percent drop out -- many after their first session (or during it). The reasons for this are two-fold. First, edgy warfighters with combat stress are easily spooked by well-meaning but clueless therapists who don't understand enough about warrior culture to engage them and understand them; and, two, although there are treatments that work for PTSD, that's not what most of our providers are offering.

So we lose 60 percent of them right off the bat -- a shame, really, because many of them had to be talked, cajoled, begged and hard-assed into giving it a try in the first place, and a one-time opportunity to do some good gets lost for good. Sadly, most therapists don't know that they have about 20 minutes to prove that they have something to offer before that service member bolts out the door, never to return.

So now we're talking about 40 percent sticking around, reaping some benefit from therapy. But keep in mind that that's 40 percent of the 50 percent who will give it a try. So, if we do the math, that's 20 percent -- a far cry from the 70 percent touted in some of these studies. (In research terminology, we're talking about Intent to Treat stats or ITT, the true number that takes into account the non-random loss of participants.) And experts like Charles Hoge, a psychiatrist/epidemiologist who's studied this, says the reality is probably closer to 15 percent.

With the anticipated drawdown from Afghanistan and Iraq, we'll have around 1.2 million returning warriors, 30 percent of whom are likely to have some kind of combat stress (and that's not taking into account the moral injury all troops suffer, from the grief, shame, guilt, woulda-shoulda-couldas and personal crises that exposure to war imposes on everyone).

Thirty percent of 1.2 million is around 360,000 service members returning to this country with PTSD, many of them coming back to no jobs, fractured families, financial difficulties and a sense of utter alienation from civilian society and the life they once led, not to mention the people they once were.

To make matters worse, these returning warriors will also be suffering the loss of their cohort of fellow warfighters -- those they fought with, who feel closer to them than family, the only ones who totally get what they've been through and how it's changed them. This loss is huge and comes at the worst time.

Most of these service members will get better, with or without help; some will stay pretty messed up. And a percentage will be very, very disoriented and angry -- and keep in mind, these are trained snipers, bombers and fighters. We need to help them for humanitarian reasons and because we owe them, but also because this slice of the population could pose a threat to public safety.

That's why it's so important that Michelle Obama and Jill Biden are speaking up for more community and business support for our returning warriors, vets and their families. May they please keep it up.

In the meantime, what can we do with this information? Well, here are some starter thoughts:

• We need to bring our military, VA and civilian therapists up to speed -- on warrior culture, strategies of engagement and effective protocols for dealing with combat stress and military sexual trauma.
• We need to make the command structure, and especially the NCOs, part of the solution; these are the leaders that our combat troops trust. Sergeants can encourage their troubled men and women to get help, and they'll actually listen to them.
• We need to use digital resources to supplement the limited human resources that we have available to meet the ever-growing need. Guided imagery, mindfulness-based stress reduction (MBSR), progressive relaxation, breath work and yoga-nidra audio programs are effective interventions that can be delivered electronically -- our troops' and vets' preferred mode of receiving help, by the way.
• We need more community-based help from regular, non-mental-health-type institutions -- churches, schools, community colleges, businesses and the like -- to help our troops feel like they've truly come home.

Because of these concerns, Fort Sill in Lawton, Okla., is launching a guided imagery experiment through its Resiliency Center, to see if drill sergeants, master sergeants and field officers can alleviate some suffering by giving out guided imagery audios to their soldiers and their families. We'll let you know how it goes.

 

 

 

Follow Belleruth Naparstek on Twitter: www.twitter.com/Belleruth

Comments

[Alison Rose Levy]

08:29 PM on 05/20/2011

Terrific piece-- on an important topic. Thanks so much, Belleruth!

[Vajara]

10:34 PM on 05/16/2011

Belleruth, I am asking all of our Alliance members to read your log as it is so in line with our mission and objectives as a community coalition to support and serve our returning warriors and their families. I also will make your progressive relaxation CD's available in our workshops as they are so great for helping our soldiers relax and learn to slow down their internal chatter and anger. You are the Best!!!

[Vajara]

09:00 AM on 05/16/2011

Thank you Belleruth for another valuable article related to claims of success treating our injured warriors. It is so true that our behavioral health system in the military, much like our community based mental health programs neither know how to engage our injured warriors nor understand or appreciate their culture. Perhaps this lack of understanding and awareness is related to the suicides and deaths reported. It has been our experience while treating injured warriors and their families in the Ft. Bliss Restoration & Resilience Center that no single treatment method is identified as the success for returning our warriors back to the Force fit for duty, but rather the extensive and intensive treatment with all of the evidence based integrative methods given that restores health.

Love and compassion can never be underestimated in the healing process.

It is also true that the mh labels offer a resistance for the injured to even accept treatment in a behavioral health clinic. It is for this reason that our Alliance offers training on "Engaging Injured Warriors and their Families with Integrative Health Practices" while working to connect every injured warrior and retired vet with a Battle Buddy-sponsor/advocate so that they have their back covered.

Thank you for presenting these essays on engaging and treating our injured and wounded with knowledge, understanding, compassion, respect and skill...they deserve the best comprehensive, holistic, extensive and intensive services known by our professional communities. http://jerryvest.pages.qpg.com

[Belleruth Naparstek]

07:12 AM on 05/18/2011

Vajara,
Thank you for posting your balanced, seasoned wisdom. I agree entirely - we need a whole toolbox of resources that our warriors can choose from - without feeling pathologized or alienated. Your Alliance programming sounds terrific... the battle buddy piece so critically important. Is there a place people can go to find out more about how you do what you do? We gotta spread this around!!

[Vajara]

09:31 AM on 05/18/2011

I appreicate your comment, recognition of what does work for our injured warriors and your persistence in keeping this discussion alive until our country provides holistic, intensive and extensive services for injured warriors and their families. Our Alliance is new but we have a great team organization and we are attracting new volunteers daily. Our local Vet Center is overwhelmed and they tell us that they won't be able to join us until later this summer.

Do visit our temporary website for announcements, mission and plans. Please stay in touch as we can use your great contributions to advance our common goals and activities. http://jerryvest.pages.qpg.com

[JOHNSPEAKS]

08:31 AM on 05/16/2011

Somebody that has a clue about -PTSD- and the culture of the military veterans and trying something different that might work? I have been telling people for years that they should think twice before they or there loved one gets involved with the mental health industry because of all the pain and suffering and experimentation and false hope of recovery? -You- have a better chance of recovery having a beer with your military comrades and talking with them? When I worked for a mental health rehabilitation facility (FH) in northern new jersey and interacted with thousands of mental health clients in the area on my own time? The clients who were the most stable were the ones who interacted with other clients who knew there pain and suffering and could offer better coping advice in there world than the bureaucratic mental health professionals who operated in a fanasty world???

[Belleruth Naparstek]

07:19 AM on 05/18/2011

Agreed. There is no substitute for the company of fellow warriors who get what you've experienced. What ever happened to group support? Except for Vet Centers, it's hard to come by in most communities. You hear that, churches and community colleges??
Certainly our mental health providers need to understand what they don't know before they can be of use; and we need to engage many other resources, because, even if all our providers were to get up to speed, there still wouldn't be enough of 'em anyway.