Effective Treatment for Veterans with PTSD

If there is one at-risk population that goes underserved it is the veteran population suffering from PTSD. As the most recent VA study shows, every day up to 20 veterans commit suicide because they are not finding the help they need to deal with their trauma-related issues (Military Times, 2016).

Helping veterans to receive treatment is not easy, however, as there are a number of obstacles that get in the way—from the stigma of being seen as one suffering from a mental or emotional disorder to the problem of isolation, or PTSD being masked by other symptoms such as alcoholism or drug abuse and thus going untreated. This paper will discuss how care providers can more effectively treat veterans with PTSD by becoming aware of the challenges to effective treatment and identifying ways forward.

One of the main reasons that it is so difficult to treat veterans for PTSD is that there is a taboo associated with trauma—especially for soldiers who are brought up in military culture in which they are not supposed to show fear or weakness. Admitting to a counselor that trauma has occurred and that one is suffering from PTSD-related symptoms is to appear vulnerable and exposed for a soldier.

It goes against the grain of the way they have been trained to process their feelings and emotions and to rely upon themselves and their inner strength to overcome obstacles. For that reason, as Gutner, Pedersen and Drummond (2018) point out, more veterans prefer to receive treatment for insomnia than they do for PTSD, even when testing positive for both and being given the option to choose treatment for both. The stigma of suffering from PTSD presents a significant obstacle to effectively treating veterans for PTSD.

Stigma, however, is not the only issue preventing veterans from receiving proper diagnosis and treatment. Some of them simply succumb to the effects of PTSD and disappear entirely. One of the major effects of PTSD is isolation: veterans become withdrawn from others, from their friends, families, and co-workers because they struggle to control their feelings and fears and thus end up closing off to everyone in an attempt to keep control of the situation.

As Military Times (2016) reports, “about 70 percent of veterans who took their own lives were not regular users of VA services.” In other words, they were too withdrawn and isolated from their communities to actually go seek out treatment on their own. If no one is looking out for them or intervening on their behalf, these individuals descend down into a dark pit from which it is almost impossible to return. 20 veteran suicides per day is a stark number and indicates the problems of PTSD for veterans are borderline-epidemic.

Currently, only 5% of all servicemen in the military health care system have received a diagnosis of PTSD (National Academy of Sciences, 2014). But when this number is compared to the staggering number of 20 suicides of veterans per day, the indication appears all too clear: many veterans are suffering from some form of trauma that is not being diagnosed or treated.

In other words, the diagnosis figure should likely be much higher than 5%: too many veterans are killing themselves for this 5% figure to be truly representative of the extent of the problem of PTSD in the military.

Yet, other issues—such as alcoholism and drug use also play a part: these are typically attempts by veterans to self-medicate, but if a care provider is not alert to this fact the veteran might only receive treatment for alcoholism or drug abuse without receiving counseling or therapy to help treat the underlying trauma driving the patient to self-medicate in the first place.

Mindfulness on the part of the care provider and the ability to ask the right questions while also showing support to the veteran so as not to turn him or her off from treatment is crucial. However, some medical experts have taken note of these obstacles and challenges and have developed methods to help veterans deal with PTSD. Two solutions that have been developed are: (a) Prolonged Exposure Therapy or PE, and (b) Cognitive Processing Therapy or CPT (Bergland, 2013).

As Bergland (2013) notes, PE “forces a patient to vividly remember every detail of a traumatic experience and verbalize the memories.” By getting the patient to put into words the experience of the trauma that is at the root of the veteran’s issues, the patient is able to bring the haunting memories and feelings into the foreground and up to the surface where they can be directly dealt with.

Instead of trying to suppress the memories and the horror or trying to repress the feelings and smother them out of the existence, the method of PE lets the patient address them full-on.

In a way, the patient is compelled to relive the experience all over again—but this time in a way in which the patient is supported by the therapist who guides the process and makes sure that the patient is not just pushing the experience away once more but rather processing it in a healthy way so that nothing gets repressed and pushed down into the subconscious where it can fester and cause the individual to try to cope through self-medication, which so often leads to even more problems.

PE is about owning up to what happened and facing the trauma once and for all. The basic idea underlying this method is that “hearing the traumatic memory repeatedly will neutralize its power from bubbling up from [the patient’s] subconscious memory and catching [the veteran] off guard” (Bergland, 2013). The other method of effectively treating PTSD is CPT.

CPT is a kind of group therapy in which each veteran writes an impact statement that describes how the trauma of war or battle has negatively impacted their lives. The impact statement typically shows how the soldier still feels like he or she is in the grip of combat, and many of the veterans in the group will share a feeling of wanting to return to war because that is where they knew the most camaraderie and had the most support in their lives—from their fellow soldiers (Bergland, 2013).

Instead of returning to war, however, CPT allows them to develop new bonds with their fellow veterans, process their negative experiences and whatever guilt they might have, draw support and comfort from one another, and establish camaraderie anew in their civilian life. By talking about their feelings and symptoms, veterans engaging in the CPT method begin to understand themselves more fully and how their lives have been altered or scarred by war and trauma. Together with the rest of the group they find support, sympathy, faith, and healing.

Getting their issues out.