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Psychological Treatments for Combat Related Conditions in the 21 st Century

Psychological Treatments for Combat Related Conditions in the 21 st Century. Terence M. Keane, Ph.D. Associate Chief of Staff for Research VA Boston Healthcare System Professor of Psychiatry & Psychology Boston University May 26, 2005. OPERATION IRAQI FREEDOM.

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Psychological Treatments for Combat Related Conditions in the 21 st Century

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  1. Psychological Treatments for Combat Related Conditions in the 21st Century Terence M. Keane, Ph.D. Associate Chief of Staff for Research VA Boston Healthcare System Professor of Psychiatry & Psychology Boston University May 26, 2005

  2. OPERATION IRAQI FREEDOM

  3. AFGHANISTAN-ENDURING FREEDOM

  4. Goals Today • Review Known Psychological Outcomes of War • Characteristics of OEF-OIF Military/Veterans • Key Issues to Consider in Outcomes • Use of Evidence Base in Assessment • Use of Evidence Base in Treatment • Systems Issues in Delivery of Care • Disability and Compensation System • Future Research Needs and Directions.

  5. Adaptation to trauma over time “Growth” (Bonanno, 2004)

  6. PTSD Depression Substance Abuse Marital Problems Anger Psychoses Head Injuries Neurotox Exposures Physical Injuries Pain Rehabilitation Efforts Health Promotion Psychological Outcomes of War

  7. What are the stress exposures?……

  8. Casualties of War

  9. Incoming Wounded

  10. 15 MAY 2003

  11. Characteristics of Current Military • Age: mid 30’s • Professional Military with Families • Majority in Guards and Reserves • Females: 10-12% • Racial/Ethnic Diverse Workforce

  12. Warzone Stress & PTSD • Hoge, Castro et al. (2004) NEJM • Examined MH in Army and Marines • OEF and OIF Active Duty Military • 9% MH Prior to War Exposure • 11-18% MH DX Post Deployment • PTSD increases as Firefight Exposure Increases: • 4.5%, 9.3%, 12.7%, 19.3%

  13. Who develops PTSD….

  14. Evidence Based Risk Factors • Severity of the Traumatic Event • Absence of Social Support Post Event • Additional Life Stressors • Adverse Childhood Events • Low SES, Intelligence, Education • Prior Traumatic Exposure • Gender Brewin, et al. (2000)

  15. Early Treatment of PTSD • What are leading treatments for PTSD? • Can we deliver them to our returning soldiers? • Consistent with Goals of VA-DOD Joint Practice Guideline • Increase implementation of evidence-based intervention

  16. Therapist-assisted, Internet-based Psychological Care Uses the Internet to promote, prompt, and monitor self-help CBT Easy to Access & Use Developed from Evidence Based Practices Employs Assessment & Interventions Emphasis on Confidentiality

  17. What psychological treatments are available?…

  18. Mastering Traumatic Experiences “You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You must do the thing you think you cannot do.” Eleanor Roosevelt

  19. Evidence Based Treatment Options • Exposure to Trauma Memories • Anxiety Management Skill Training • Cognitive Therapy • Cognitive Processing Therapy • EMDR • Psychopharmacology with SSRI’s Foa, Keane, & Friedman (2000)

  20. How can people access the treatments?..

  21. Needs in MH Delivery Systems • Integration of VA-DOD Medical Records • Further Development of Shared Guidelines • Increased Focus on Families/Couples • Focus on Work and Rehabilitation • MH Focus in Primary Care • Internet Based Access to Treatment • Widespread Adoption of Telehealth

  22. Retooling of VA MH Professionals • Use of Evidence Based Psychological Care • Employ Interdisciplinary Models of Care • Train in Use of Telehealth • Train in Use of Internet for Care & Monitoring • Adoption of Systems for Promoting Access • Where Needed • When Needed

  23. Best Practices for Assessment for PTSD…

  24. Compensation & Disability • Psychologists conduct majority of C&P’s • Data suggest growing number of SC. • Development of Best Practice Guidelines in FY ’03. • Uneven use of Guidelines Due to Pressure. • Unknown impact of current system of C&P.

  25. Future Scientific Directions • Continued Studies of Cohorts (e.g. NVVLS) • Consider Longitudinal Studies of OEF-OIF • Focus on Functional Status & Disorders • Examine Impact of Telehealth • Study Effectiveness of Internet as Tool. • Employ Interdisciplinary Models & Impact • Study Interaction of Stress/PTSD/Health

  26. PTSD………………... Substance Abuse……. Neurotoxin Exposure.. Head Injury…………. Pain…………………. Couples Therapy…… Assessment…………. Internet Care………... Resick-Schnurr-Ruzek K.Humphries-Kivlahan R.White-J. Vasterling D. Delis R. Kerns C. Taft D. & L. King B. Litz Psychologist Resources in VA

  27. For Further Resources <www.ncptsd.org>

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