Combat Related Posttraumatic Stress Disorder (CR-PTSD) affects military service men and women at estimated rates varying from 6% to 31% (How Common Is PTSD? n.p.). The Department of Veterans Affairs (VA) uses traditional methods of treatment for PTSD; however, due to veteran specific challenges and barriers, traditional PTSD treatment methods often lose their efficacy. Other veterans’ organizations, such as the Wounded Warrior Project, are finding success using alternative and holistic treatment methods targeting the treatment of CR-PTSD. By incorporating holistic methods, VA practitioners can tailor treatment to the specific needs of those with combat experience, reduce the use of opioids (and the potential for opioid abuse), and increase patients involvement in their recovery. Therefore, I propose the VA create, fund, and conduct a pilot study on the incorporation of alternative and holistic treatment methods on the improvement of the symptoms of CR-PTSD.
Currently, the VA treats veterans with CR-PTSD using cognitive behavioral therapy, psychopharmacology, and Eye Movement Desensitization and Reprocessing (EMDR) typical effective PTSD treatment methods (Treatment of PTSD n.p.). The VA offers treatment for PTSD at every medical center with specialists trained in PTSD. There are also VA community based outpatient clinics and the option for telemental health care treatment if a clinic is too geographically distant (Treatment Programs in the U.S. Department of Veterans Affairs n.p.).
There are challenges and barriers involved when providing treatment for CR-PTSD. Some of those challenges include getting participants to engage, high intensity anger, avoidance, and emotional regulation difficulties (Gelkopf, et. al. 485). Those struggling with CR-PTSD often struggle with the stigma of being seen as weak for seeking out help, as well as a distrust of mental health care system, especially if the treatment is government system related (Gelkopf, et. al. 485). Veterans struggling with CR-PTSD frequently struggle with a lack of hope for recovery and a fear of things getting worse as they relive the trauma (Gelkopf, et. al. 485). Another fear is that if they recover from CR-PTSD, their disability payments may be reduced. Holistic and alternative methods of treatment focus more on the posttraumatic growth of veterans rather than their trauma so veterans are more likely to engage and have faith in their treatment program.
Common effective therapies in the treatment of PTSD symptoms, such as exposure therapy (ET) and cognitive behavioral therapy (CBT), do not have the same levels of significant clinical gain when used to treat CR-PTSD (Steinberg & Eisner 11). Frueh and colleges found ET’s focus on anxiety, avoidance, and fear reduction had a limited effect on the social withdrawal, anger control, and interpersonal difficulties faced by those struggling with PTSD (Gelkopf, et. al. 486). CBT does little to assist with the alcohol use, levels of avoidance, and depression of combat veterans which leads to a high dropout rate (Gelkopf, et. al. 486). Heblig and Fehm found clients with CR-PTSD do not want to do the homework often required with CBT (Gelkopf, et. al. 486). Veterans are more likely to remain in their treatment programs and complete the work necessary for recovery with nontraditional methods (Steinberg & Eisner 12).
Therapy involving the use of medications alone is also not the most effective route to follow when treating for CR-PTSD. The focus on treating the somatic symptoms of CR-PTSD has resulted in an almost doubling of opioid analgesic prescriptions, which leaves veterans more susceptible to opioid related injuries and accidents (Carrola & Corbin-Burdick 3). At the PTSD2015 forum in Brisbane, Rick Collins, the founder of US non-profit organization Veterans 360 stated, “The greatest success in managing PTS has come from a holistic approach including engagement, education, employment and healing rather than pharmacological support.” (FED n.p.). He believes health care professionals are more interested in treating clients with a prescription pad, rather than alternative methods (FED n.p.). Inappropriate pharmacotherapy also harms veterans by perpetuating the already negative stigmas associated with mental health care (Carrola & Corbin-Burdick 4).
Holistic methods, to include the wellness model, mindfulness based interventions (MBI), nature adventure rehabilitation (NAR), and the posttraumatic growth model, focus on posttraumatic growth which allows for healthy changes in relationships, positive self-views, and growth in life philosophy (Carrola & Corbin-Burdick 6). Studies on MBI are showing
changes to the grey matter in the brains of those struggling with PTSD following the MBIS (Steinberg & Eisner 12). NAR incorporates groups working together in experiential leaning, a system fairly familiar to service members. Studies are finding that NAR is effective in helping adults make significant changes in their mental health-related beliefs (Gelkopf, et. al. 486). One of the larger veteran organizations that utilizes alternative and holistic techniques is the Wounded Warrior Project.
With CR-PTSD affecting almost a quarter of veterans, the VA needs to utilize the most effective treatment strategies. Through the incorporation of holistic methods, VA practitioners can provide more effective treatment to the specific needs of combat exposed veterans, reduce the misuse of psychopharmaceuticals, and increase patient involvement in recovery. Studies have shown that traditional methods of treatment for PTSD are often less effective in the treatment of CR-PTSD. The VA needs to follow the lead of the Wounded Warrior Project in utilizing alternative and holistic treatment methods to treat CR-PTSD. It is necessary for the VA to create, fund, and conduct a pilot study on the incorporation of alternative and holistic treatment methods on the improvement of the symptomology of CR-PTSD.
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