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Who Gets Better from Combat Stress and How...

17 Apr

Hello again, everyone!

I’ve been studying some survey results from Charles Hoge MD et al, a psychiatrist-epidemiologist at Walter Reed, who reveals some fascinating and powerful data, a lot of which confirms what I’ve been thinking and saying all along (so of course I think it’s brilliant!! ☺).

For instance, there are a lot of studies claiming a 70% improvement rate for returning warriors who are treated for combat stress with various cognitive behavioral therapies and/or prolonged exposure.  But this is a distorted and 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 credited as the primary problem; it’s actually distrust of mental health providers, both civilian and military. 

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

And of the 50% who actually do go, 60% 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 clueless therapists who don’t understand enough about warrior language and culture to communicate or get where they’re coming from; and, two, although there are treatments that work for PTS, that’s not what most of our providers are offering.  

So we lose 60% 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 twenty minutes to prove they have something to offer before that troop bolts out the door, never to return.

So now we’re talking about 40% sticking around, reaping some benefit from therapy.  But, remember, dear reader: that’s 40% of the 50% who will give it a try.  So, if we do the math, that equals 20% - a far cry from the 70% touted in some of these studies. (In research terminology, we’re talking about Intent to Treat stats or ITT, the accurate number that avoids the bias associated with the non-random loss of participants.)  And Hoge says the reality is actually closer to a 15% improvement rate.

OK, so with the anticipated drawdown from Afghanistan and Iraq, we’ll have around 1.2 million returning warriors, 30% 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-coulda’s and personal crises that exposure to war imposes on everyone).  

Okay, so that’s around 360,000 service members returning to this country with PTS, 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, the people they once were.  

To make it harder, 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.  

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 PTS.

  • We need to make NCO’s part of the solution - these are the leaders our combat troops trust. Sergeants can encourage their troubled men and women to get help, and they’ll actually listen.

  • We need to use digital resources to supplement the limited human resources we have available to meet the ever-growing need.  Guided imagery, Mindfulness Based Stress Reduction, Progressive Relaxation, Breathwork 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 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.

Take care and be well!

Belleruth Naparstek

Psychotherapist, author and guided imagery pioneer Belleruth Naparstek is the creator of the popular Health Journeys guided imagery audio series. Her latest book on imagery and posttraumatic stress, Invisible Heroes: Survivors of Trauma and How They Heal (Bantam Dell), won the Spirituality & Health Top 50 Books Award