Treating PTSD in post-9/11 and other veterans is best undertaken with experts in prolonged exposure and cognitive processing therapy. Experts in these therapies can be found in person or via telehealth through the Warrior Care Networks. WCN providers also share their treatment models with primary care doctors and buddy system programs to expand their reach.
Sheila Rauch, PhD is the deputy director of the Emory Healthcare Veterans Program.
For information about treatments for PTSD visit The Treatment Hub.
The biggest barrier is we don’t have enough providers who are well-trained in these treatments, and this is a place where the Warrior Care Network can really provide a good resource at least for post 9/11 veterans. We have experts at all four of these centers. So, if you come to one of the Warrior Care Network sites, you know you’re going to get an expert in PE or CPT working with you. Even within VA, they’ve done very large really well-done training efforts, but in order for a veteran to get into an individual VA and get to that provider who has PE or CPT experience can be tough. It may take multiple visits, it may take multiple consults, and it may be hard to actually reach that person. And then the second issue is access, that they’re not distributed all over the world, they’re not distributed all over the country. So, telehealth is one way that we can help address that actually in two ways. First of all, we can have a large population who can be served by an individual person without necessarily physically needing to be there. That can also help with the expertise issue, that you can have hubs of people who are known for their PE or CPT expertise and so they’re getting calls from all over as far as where their license can allow them to practice. And then in addition to that, you have the patient-side barriers, which the first one is avoidance, which is part of PTSD. For most PTSD survivors, the time since trauma before they seek their first treatment is over 10 years. We’re doing better with that with lots of efforts for our post-9/11 service members that typically they’re coming in a little bit earlier, but it’s still usually many years after their trauma. So, that avoidance is one issue. In addition, there’s often a sense of starting and stopping. So, it may be that their motivation to change is really high one day, but then things get a little bit better, maybe they have a good week and then they’re less likely to follow through on getting that care and doing the assessment and coming in. So, those patient barriers that come in as well. But really, the thing that’s most difficult is finding a provider who knows how to do the treatments that work the best. Part of what I worked on in my career is actually improving access by taking the treatments that we know work and moving them into different models, moving them into different settings. So, I worked a lot on getting prolonged exposure. I’ve created a model that can be provided in primary care by primary care embedded mental health providers, and that’s really a key. So, getting treatments as simplified as possible so that they can be delivered by people in shorter sessions with less time but still the same efficacy, and that’s what we have with the prolonged exposure for primary care model that Jeff Sebring and I have been working on for many years. So, that’s one model is getting out of specialty mental health and into primary care, also getting to lay providers and peer-based providers, doing the buddy-to-buddy program where we’re actually training non-mental health providers in some brief exposure-based treatments and ways to connect people who may need more than what a lay provider can offer to specialty mental health so that we’re efficiently using the resources that we have. People who can remit from working with their lay provider then don’t need treatment, but the people who do will still get that bump up and step up to the next level of care. Measuring change in PTSD can be a pretty complex issue. Most of what people are looking at most commonly are self-report measures, which can be problematic. Some people are good reporters, some people over report, under report, and in the end, it’s all based on memory biases. So, in addition to those self-report measures, I’ve worked a lot on looking at psychophysiological assessments of biological systems that are associated with post-traumatic stress disorder so that we can move away from just having self-report measures and the biases that are associated with them to maybe having a more nuanced picture that includes biological measures as well as self-report. And hopefully, someday we’ll have a more objective litmus test for PTSD. I don’t know if we’ll get there, but that would be nice at some point. BrainLine is powered in part by Wounded Warrior Project to honor and empower post-9/11 injured service members, veterans, and their families.
Sheila A.M. Rauch, PhD, ABPP, is the Deputy Director of the Emory Healthcare Veterans Program and Director of Mental Health Research and Program Evaluation at the VA Atlanta Healthcare System. Dr. Rauch has been developing programs, conducting research and providing PTSD and Anxiety Disorders treatment for over 20 years. Her research focuses on examination of mechanisms involved in the development and treatment of PTSD and improving access to effective interventions.