We’ve already learned a ton from Principal Investigator Jennifer Strauss’ amazing work at Duke Medical Center/Durham V.A., resulting in a far more compatible and effective selection of audio segments, as well as a shortening of the length of time for the intervention from 12 to 8 weeks, among other things. Needless to say, we want to keep fine-tuning these downloadable interventions as much as possible, so they can deliver maximum good in minimal time.
First off, Dr. Tarazon reiterated that the treatment du jour for returning troops these days is Cognitive Behavioral Therapy and Prolonged Exposure – an effective but initially distressing method that usually means seeing a specially trained therapist for 12 weeks.
Many don’t make it past the first few sessions, so they don’t reap the benefits. So Dr. Tarazon found herself preparing her vets with guided imagery, building up their relaxation response and self-regulation skills, so they could tolerate the therapy long enough to get better. (A lot of therapists in the V.A. are doing this – we hear this all the time.)
Additionally, she said something I’ve also heard many times before: that most of the troops are pretty averse to getting counseling in the first place. It’s seen as shameful and demeaning; they worry it will label them ‘crazy’; and they fear having it on their record. (Indeed, two separate V.A. surveys showed that the method of choice for returning troops was self-help audio via downloads. Counseling was very low on the list.)
So for those that won’t see a counselor, she uses the guided imagery as the main intervention – it’s something they can administer themselves. Here are some of the things she’s learned along the way:
- Most troops avoid counseling. For this reason, they just make it a policy to see and screen everyone. Pretty smart if you’ve got the staff.
- Probably about 70% respond well to guided imagery.
- Guided imagery makes prolonged exposure tolerable when offered first.
- Many have forgotten how to relax or are afraid to, and are in an intense alarm state much of the time. This manifests as anger or anxiety or both.
- For those who can’t let go with guided imagery, she uses biofeedback.
- For those who try too hard to listen “correctly” to the imagery, she has them work with the music only.
- Guided imagery was a big help for sleep.
- The Walking Meditation on the Relieve Stress CD was great for those who were too antsy to sit and listen – it gave them something to do.
- The Stress Hardiness and the Anger & Forgiveness imagery tended to be very helpful.
- They preferred a woman’s voice to a man’s (Dr. Strauss reported this too.) Best guess for why: maybe it’s easier for both men and women to be vulnerable with a woman.
- She was able to get a small grant to buy excellent, refurbished iPod Nanos for only $80/apiece. Recommended tracks were taken home and loaded into personal listening devices.
- She heard a lot complaints about Critical Incident Stress Debriefing (CISD), a method used on location in the combat theater. They felt it was useless or worse.
- They aren’t so much into yoga. Martial arts like Qigong are more compatible.
- The Healing Trauma imagery was very helpful, but something she generally saved for people in treatment with her, because of its intensity. (This is also well-used by people dealing with seasoned, long-ago traumas).
- The most popular tracks for recent returnees tended to be short ones that weren’t overly demanding emotionally – her list:
By the way, the typical soldier she sees is male and about 22-23 years old. About one in ten is a woman.
This kind of practical feedback is invaluable to us and hopefully to many of you too. Major kudos and hats off to Dr. T for everything she’s doing.
Stay tuned. We’ll be reporting more as we learn it.