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NEW TREATMENTS BRING HOPE FOR COMBAT STRESS
PATIENTS -- Mental health professionals who
treat combat
veterans suffering from stress and trauma say
they
are optimistic about new, sometimes
controversial treatments.
Story here...
http://www.nctimes.com/articles/
2007/01/02/military/01_05_561_1_07.txt
Story below:
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New treatments bring hope for combat-stress patients
By: JOE BECK - Staff Writer
NORTH COUNTY -- Mental health professionals who treat combat veterans
suffering from stress and trauma say they are entering 2007 with growing
optimism about new, sometimes controversial treatments that show promise
in controlling or eliminating psychological damage from battlefield
experiences.
The hopefulness springs from a combination of therapists' personal
observations and a growing body of scientific research. The new
treatments use a variety of resources that range from technology
borrowed from video games to a pill, still in the experimental stage,
that until now had been used only to treat high blood pressure.
Jeffrey Matloff, program director of the post-traumatic stress disorder
clinical team at the Veterans Administration Medical Center in San
Diego, said the mental health profession has made dramatic strides in
treating post-traumatic stress disorder among veterans since the
American Psychiatric Association classified it as a diagnosable mental
disorder in 1980.
"There are new things out there that I've been impressed with," Matloff
said. "In 27 years of the diagnosis, there's a lot more clinical
experience and research that we can bring to bear with problems related
to PTSD."
The breakthroughs have come at a time when mounting casualties and
multiple deployments are imposing greater emotional and mental strain on
members of the military in Afghanistan and Iraq. A recent Veterans
Administration study showed a tenfold increase in Iraq and Afghanistan
war veterans who had sought treatment for symptoms linked to combat
stress in the previous 18 months, a trend affecting one-third of
veterans.
About 30 percent of those sent to war zones experience post-traumatic
stress disorder and an additional 20 percent to 25 percent suffer from
partial post-traumatic stress disorder at some point in their lives,
according to the National Center for Post-Traumatic Stress Disorder.
The center's Web site says that civilians who have been subjected to
rape, childhood neglect or abuse, threats with a weapon and physical
attack are also vulnerable to post-traumatic stress disorder.
'Exposure therapy' making waves
Many of the new techniques fall under a category of treatment that
mental health professionals call "exposure therapy," which involves
having the patient repeatedly relive a frightening experience under
controlled conditions to help him or her through the trauma.
One example of exposure therapy -- using computer game graphics and
software to simulate three-dimensional combat environments in Iraq --
appeared among the exhibits at a recent seminar at Naval Medical Center
San Diego on new strategies for treating physical and mental injuries
among combat veterans.
The exhibitor, Virtual Reality Medical Center of San Diego, has been
included in a $4 million project funded by the Office of Naval Research.
The goal of the project is to demonstrate whether virtual-reality
therapy qualifies as a "best practices" treatment for post-traumatic
stress disorder, according to the seminar's program.
The purpose of the therapy is to help clients gain control of their
anxiety by exposing them to controlled levels of stress through the
virtual-reality equipment. The entire treatment lasts 8 to 12 sessions,
most of which are 45 to 50 minutes, according to the Virtual Reality
Medical Center's Web site.
"I'm waiting to see what happens with their data, but intuitively it
makes a lot of sense," Matloff said. "With repeated exposure to a
traumatic event, anxiety, fear anger may dissipate."
Eye Movement Desensitization and Reprocessing, which some researchers
have cited as another example of exposure therapy, has been gaining
steady acceptance over the last 10 years. In 2004, the treatment
received the highest level of recommendation from the Department of
Defense and Department of Veterans Affairs for the treatment of
combat-related mental trauma.
The treatment involves an eight-step process that typically spans four
90-minute sessions. Part of the process requires the therapist to
instruct the client to focus on an image, negative thought or body
sensation while shifting his eyes back and forth following the
therapist's fingers as they move across the client's field of vision for
20 or 30 seconds.
Mixed reviews for alternative therapies
Carole Herbster, a San Marcos psychologist, said she thought
eye-movement therapy was "totally weird and didn't pay a bit of
attention to it" at first, but persuaded herself to try it when she was
having trouble helping a sexual abuse victim with traditional
treatments. Now Herbster counts herself as a convert.
"It's incredibly useful for a wide variety of traumas," Herbster said.
She said her clients who have been helped by eye-movement therapy
include people suffering from their experiences in combat, vehicle
accidents and the 9/11 terrorist attacks.
Herbster said eye-movement therapy eliminated symptoms caused by
traumatic experiences in all but one of her clients. The Web site of the
Eye Movement Desensitization and Reprocessing Institute cites three
studies published in scientific journals that show the therapy
eliminating post-traumatic stress in 77 percent to 90 percent of
civilian clients.
Some mental health professionals continue to doubt the scientific
validity of eye-movement therapy, however. The institute's Web site says
some critics persist in calling the therapy "pseudoscience." Matloff of
the VA center said he stopped using eye-movement therapy after he tried
it on three patients. It failed with all three.
"They actually said they preferred going back to other types of
treatment," he said.
Another controversy has begun over the use of propranolol, an
experimental drug that is years away from gaining official approval.
Propranolol has been used for decades in treating high blood pressure
and is now igniting interest as a fast, effective, easy treatment for
dissolving the harmful emotional effects from memories that cause
post-traumatic stress disorder. The excitement stems from a 2002 study
that showed patients admitted to a hospital emergency room, most of them
car accident victims, displayed significantly fewer symptoms of
post-traumatic stress disorder than another group of patients who did
not receive propranolol.
The study, conducted by Dr. Roger Pitman, a professor of psychiatry at
the Harvard Medical School, impressed Army officials enough that they
have chosen Pitman for a grant that will be used to study the effects of
propranolol on military veterans suffering from post-traumatic stress
disorder this summer.
In a telephone interview, Pitman said he expects the study to run three
years and include 50 veterans from the Boston area.
Researchers study pill
Pitman said he hoped that patients yearning for a pill that can cure
post-traumatic stress disorder will not jump to hasty conclusions.
"We haven't really proven anything yet, and it's important that the
public should know about the negative as well as the positive
information," Pitman said.
"It's just research at this point," he added.
Pitman's Army study will differ from his emergency room study by using
patients who have already been diagnosed with post-traumatic stress
disorder, a condition that usually cannot be diagnosed until months
after a traumatic event. The emergency room patients in his first study
received propranolol within a few hours of their traumatic experience,
thus limiting the study to learning whether propranolol worked as a
preventative medication.
Dr. Murray Stein, a psychiatrist at UC San Diego, conducted a study
among emergency room patients that bore similarities to Pitman's first
study. Stein said he found "no benefit" to using propranolol to prevent
post-traumatic stress disorder among the 45 patients he studied.
"It's not definitive and conclusive, but it's enough that we decided not
to pursue it further," Stein said of propranolol.
Others who have studied Pitman's work warn that drugs with the potential
to alter human memories raise serious long-term social and moral
predicaments. The President's Council in Bioethics issued a report in
2003 declaring that harsh, painful memories are necessary, up to a
point, in maintaining a conscience that fully understands the difference
between right and wrong.
In one passage, the report warned that the possibility of using
propranolol and other drugs to tamper with memories "has already
elicited considerable public interest in and concern about their
potential uses in non-clinical settings: to prepare a soldier to kill
(or kill again) on the battlefield; to dull the sting of one's own
shameful acts; to allow a criminal to numb the memory of his or her
victims."
Matloff said lingering uncertainties about the effectiveness and the
ethics of the new treatments make it unlikely that any single approach
will come to be regarded as superior to all others in treating
post-traumatic stress disorder.
"There are, basically, some treatments that are going to be effective
with some people and some will be more effective with others. What we
really need to do is assess people to find out what treatment works best
for each person," he said.
-- Contact staff writer Joe Beck at (760) 740-3516 or
jbeck@nctimes.com.
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Larry Scott
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