Family and Medical Leave Act Suggestions for Veteran With Ptsd and Tbi
P T. 2016 Oct; 41(x): 623-627, 632-634.
PTSD Treatment for Veterans: What's Working, What's New, and What's Adjacent
Miriam Reisman
More a decade of war in the Middle Eastward has pushed post-traumatic stress disorder (PTSD) to the forefront of public health concerns. The last several years have seen a dramatic increment in the number of Iraq and Afghanistan state of war veterans seeking help for PTSD,1 shining a spotlight on this debilitating condition and raising critical questions about appropriate treatment options and barriers to care.
While PTSD extends far beyond the military—affecting about 8 million American adults in a given year2—the problem is specially acute amongst war veterans. Not simply are recent veterans at college risk of suffering from PTSD than those in the general population,iii they also face unique barriers to accessing adequate handling.4 These include the requirement that they have either an honorable or general discharge to access Department of Veterans Affairs (VA) medical benefits, long waiting lists at VA medical centers, and the social stigma associated with mental illness within armed forces communities.4 , 5 According to a study conducted by the RAND Eye for Military Health Policy Enquiry, less than half of returning veterans needing mental health services receive any treatment at all, and of those receiving treatment for PTSD and major depression, less than one-third are receiving evidence-based intendance.5
PTSD in Combat Veterans
The beingness of state of war-induced psychological trauma probable goes dorsum equally far as warfare itself, with i of its first mentions past the Greek historian Herodotus. In writing about the Battle of Marathon in 490 b.c., Herodotus described an Athenian warrior who went permanently blind when the soldier standing adjacent to him was killed, although the blinded soldier himself had non been wounded.half dozen Such accounts of psychological symptoms following military trauma are featured in the literature of many early cultures, and it is theorized that ancient soldiers experienced the stresses of war in much the same fashion as their modern-solar day counterparts.7
The symptoms and syndrome of PTSD became increasingly evident during the American Civil War (1861–1865).8 Oftentimes referred to every bit the country'southward bloodiest disharmonize, the Civil War saw the first widespread use of rapid-fire rifles, scope sights, and other innovations in weaponry that profoundly increased destructiveness in battle and left those who survived with a myriad of physical and psychological injuries.
The Ceremonious State of war also marked the showtime of formal medical attempts to address the psychological effects of combat on military machine veterans. Jacob Mendez Da Costa (1833–1900), a cardiologist and assistant surgeon in the U.S. Army, undertook research on "irritable centre" (neurocirculatory asthenia) in soldiers, and during the Civil War, this PTSD-similar disorder was referred to as "Da Costa'south syndrome." ix Da Costa reported in the American Journal of Medical Scientific discipline that the disorder, marked past shortness of jiff, rapid pulse, and fatigue, is well-nigh commonly observed in soldiers during times of stress, especially when fear is involved.9
Over the next century of American warfare, PTSD would be described by many dissimilar names and diagnoses, including "trounce daze" (World War I), "boxing fatigue" (Globe War II), and "post-Vietnam syndrome." An estimated 700,000 Vietnam veterans—almost 25% of those who served in the war—accept required some form of psychological intendance for the delayed effects of combat exposure.10 The diagnosis of PTSD was non adopted until the late 1970s, and it became official in 1980 with inclusion in the 3rd edition of the Diagnostic and Statistical Transmission of Mental Disorders.xi
Prevalence of PTSD in Veterans
Estimates of PTSD prevalence rates amidst returning service members vary widely beyond wars and eras. In 1 major study of threescore,000 Iraq and Afghanistan veterans, 13.5% of deployed and nondeployed veterans screened positive for PTSD,12 while other studies evidence the rate to exist equally high as 20% to 30%.5 , 13 As many as 500,000 U.S. troops who served in these wars over the past 13 years have been diagnosed with PTSD.fourteen
It is not clear if PTSD is more mutual in Iraq and Afghanistan veterans than in those of previous conflicts, but the current wars present a unique gear up of circumstances that contribute heavily to mental wellness issues. According to Paula P. Schnurr, PhD, Executive Manager of the VA National Center for PTSD, the urban-way warfare tactics in Afghanistan and Iraq, marked by guerrilla attacks, roadside improvised explosive devices, and the uncertain distinction between safe zones and battle zones, may trigger more mail-traumatic stress in surviving war machine members than conventional fighting.15
In improver, Dr. Schnurr notes, improvements in protective gear and battleground medicine accept profoundly increased survivability—but at a loftier cost. "Between the mode we're protecting the troops and responding to injuries on the ground, a lot of soldiers are surviving with very significant injuries who would not necessarily have survived earlier," she says. "And they're returning stateside with both the concrete and psychological trauma."
Comorbidity of PTSD in Veterans
Complicating the diagnosis and assessment of PTSD in military veterans are the high rates of psychiatric comorbidity.2 Depression is the nigh common comorbidity of PTSD in veterans. Results from a large national survey testify that major depressive disorder (MDD) is nearly three to five times more likely to emerge in those with PTSD than those without PTSD.16 A large meta-analysis composed of 57 studies, across both armed forces and civilian samples, plant an MDD and PTSD comorbidity rate of 52%.17
Other common psychiatric comorbidities of PTSD in military veterans include anxiety and substance abuse or dependence.eighteen – 20 The National Vietnam Veterans Readjustment Study, conducted in the 1980s, found that 74% of Vietnam veterans with PTSD had a comorbid substance employ disorder (SUD).21 In one report of recent veterans, 63% of those who met the diagnostic criteria for alcohol employ disorders (AUDs) or drug use disorders had co-occurring PTSD, while the PTSD prevalence amid those who met criteria for both AUDs and drug use disorders (e.thousand., alcohol dependence and cocaine abuse) was 76%.22
Studies also suggest that veterans with comorbid PTSD and SUD are more than difficult and costly to treat than those with either disorder solitary considering of poorer social performance, higher rates of suicide attempts, worse treatment adherence, and less comeback during handling than those without comorbid PTSD.23 , 24
PTSD is associated with physical hurting symptoms, too. For veterans returning from Republic of iraq and Transitional islamic state of afghanistan, chronic pain continues to be one of the nigh oftentimes reported symptoms.25 , 26 Approximately xv% to 35% of patients with chronic pain also have PTSD.27
Risk Factors for PTSD in Veterans
A number of factors have been shown to increment the take a chance of PTSD in the veteran population, including (in some studies) younger age at the time of the trauma, racial minority condition, lower socioeconomic status, lower military rank, lower didactics, higher number of deployments, longer deployments, prior psychological problems, and lack of social back up from family unit, friends, and community (Tabular array i).28 PTSD is also strongly associated with generalized concrete and cognitive wellness symptoms attributed to mild traumatic brain injury (concussion).29
Table 1
Significant Take a chance Factors for Combat-Related PTSD in Military Personnel and Veterans28
| Factors | Odds Ratio (95% CI) |
|---|---|
| Pretraumatic Factors | |
| Female gender | 1.63 (one.32–2.01) |
| Nonwhite race | one.18 (1.06–i.31) |
| Lower didactics level | 1.33 (i.14– 1.54) |
| Lower rank (nonofficer) | two.18 (one.84–2.57) |
| Army equally co-operative of service | 2.30 (one.76–3.02) |
| Gainsay specialization | 1.69 (i.39–2.06) |
| Number of deployments (≥ ii) | 1.24 (1.ten–1.39) |
| Longer length of deployments | 1.28 (1.13–1.45) |
| Adverse life events | 1.99 (1.55–2.57) |
| Prior trauma | 1.thirteen (ane.01–1.26) |
| Psychological problem(southward) | 1.49 (1.22–one.82) |
| Peritrauma Factors | |
| Combat exposure | 2.10 (1.73–2.54) |
| Discharged a weapon | 4.32 (2.threescore–7.18) |
| Saw someone wounded/killed | 3.12 (2.xl–4.06) |
| Astringent trauma | ii.91 (1.85–4.56) |
| Deployment-related stressor | 2.69 (one.46–4.96) |
| Mail-Trauma Factors | |
| Postdeployment support (yes) | 0.37 (0.xviii–0.77) |
Female gender has also been implicated as a potential risk factor for PTSD in veterans.28 , xxx A number of factors may business relationship for these findings, including a history of military or civilian sexual assault, which may increase a woman's hazard for PTSD.31 According to one report, during 2002–2003, approximately 22% of screened female person veterans reported armed services sexual trauma (MST), a term adopted by the VA to refer to sexual assault or repeated threatening sexual harassment that occurred while the veteran was in the military.32
Despite numerous studies, according to Dr. Schnurr, whether PTSD is a greater run a risk to female veterans than male veterans is still largely unknown. However, she says that equally women continue to play more active roles in the wars in Iraq and Transitional islamic state of afghanistan and are increasingly exposed to combat situations, their likelihood of experiencing PTSD rises.
More than research is needed to better sympathise these and other risk factors for PTSD and to help clinicians and other intendance providers offering the necessary treatment before symptoms become chronic.28 Several large VA studies are nether way that include both psychological and neurobiological measurement, Dr. Schnurr says. She notes the benefit of studying the effects of war-related acute stress in real time, using both pre- and mail-deployment assessments, likewise as data from armed forces members currently in theater. "These wars have given the states the best opportunity to longitudinally rails what happens to people and to examine the risk and resilience factors associated with the outcomes," she adds.
Defining and Redefining PTSD
The VA defines PTSD every bit "the development of characteristic and persistent symptoms along with difficulty performance after exposure to a life-threatening feel or to an effect that either involves a threat to life or serious injury." 29 In addition to military combat, PTSD can event from the feel or witnessing of a terrorist assail, violent crime and abuse, natural disasters, serious accidents, or violent personal assaults.
In 2013, the American Psychiatric Association revised the PTSD diagnostic criteria in the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5),33 moving PTSD from the class of "anxiety disorders" into a new class of "trauma and stressor-related disorders." Equally such, all of the conditions included in this nomenclature require exposure to a traumatic or stressful result as a diagnostic criterion. DSM-5 categorizes the symptoms that back-trail PTSD into four "clusters":
-
Intrusion—spontaneous memories of the traumatic event, recurrent dreams related to it, flashbacks, or other intense or prolonged psychological distress
-
Abstention—distressing memories, thoughts, feelings, or external reminders of the event
-
Negative cognitions and mood—myriad feelings including a distorted sense of blame of self or others, persistent negative emotions (e.g., fear, guilt, shame), feelings of detachment or alienation, and constricted touch (e.g., inability to experience positive emotions)
-
Arousal—ambitious, reckless, or cocky-destructive behavior; sleep disturbances; hypervigilance or related problems.33
PTSD tin can be either acute or chronic. The symptoms of acute PTSD concluding for at least ane month but less than 3 months after the traumatic consequence. In chronic PTSD, symptoms concluding for more than than iii months after exposure to trauma.34
PTSD Diagnosis and Assessment
Ii chief types of measures are used to help diagnose PTSD in veteran populations and assess its severity: structured interviews and cocky-report questionnaires.34 The Clinician-Administered PTSD Calibration for DSM-five (CAPS-five) is considered the gold standard for PTSD cess in both veterans and civilians.35 The detailed 30-item interview has proven useful across a wide diversity of settings and takes approximately 30 to 60 minutes to administer.
The well-validated PTSD Checklist for DSM-5 (PCL-5) is 1 of the virtually commonly used self-study measures of PTSD.36 Assistants of the xx-item questionnaire is required past the VA for veterans beingness treated for PTSD equally part of a national endeavor to establish PTSD outcome measures. The PCL-5 tin exist completed in five to vii minutes.36
Another widely used self-report measure for veterans is the Mississippi Scale for Combat-Related PTSD, a 35-detail questionnaire in which respondents are asked to rate how they experience nigh each particular using a five-point Likert calibration (e.1000., "Before I entered the military, I had more close friends than I have at present." [1 = not at all true to five = extremely true]).37
Nonpharmacological Treatment Of PTSD in Veterans
The use of psychological interventions is regarded as a offset-line approach for PTSD past a range of authoritative sources.38 – 40 Of the wide variety of psychotherapies available, cognitive behavioral therapy (CBT) is considered to accept the strongest evidence for reducing the symptoms of PTSD in veterans and has been shown to be more effective than any other nondrug treatment.41
Two of the about studied types of CBT—cognitive processing therapy (CPT) and prolonged exposure (PE) therapy—are recommended as first-line treatments in PTSD exercise guidelines around the world, including the guideline jointly issued by the VA and the Department of Defense (DoD).29 , 38 – 42
First adult to treat the symptoms of PTSD in sexual assault victims,42 CPT focuses on the touch of the trauma. In CPT, the therapist helps the patient identify negative thoughts related to the event, sympathize how they can cause stress, supercede those thoughts, and cope with the upsetting feelings.
PE therapy has been shown to be constructive in lx% of veterans with PTSD.43 During the handling, repeated revisiting of the trauma in a safe, clinical setting helps the patient change how he or she reacts to memories of traumatic experiences, every bit well as learn how to main fear- and stress-inducing situations moving forward. PE and CPT treatments each take approximately 12 weekly sessions to complete.44 , 45
EMDR
In one case highly controversial, centre-move desensitization and reprocessing (EMDR) has been gaining acceptance and is now recommended as an effective treatment for PTSD in both civilian and gainsay-related cases in a wide range of practice guidelines.29 , 40 , 46 , 47 In EMDR, the therapist guides patients to make eye movements or follow hand taps, for instance, at the same time they are recounting traumatic events. The full general theory backside EMDR is that focusing on other stimuli while revisiting the feel helps the patient reprocess traumatic data until information technology is no longer psychologically disruptive.
Pharmacotherapy of PTSD in Veterans
Some patients do not respond adequately to nondrug treatment alone, may prefer medications, or may benefit from a combination of medication and psychotherapy. In these cases, pharmacotherapy is also recommended as a showtime-line approach for PTSD.38 – 40
Selective Serotonin Reuptake Inhibitors
Antidepressants are currently the preferred initial class of medications for PTSD, with the strongest empirical evidence available to back up the use of the selective serotonin reuptake inhibitors (SSRIs).48 Currently, sertraline and paroxetine are the just drugs approved by the Food and Drug Assistants (FDA) for the treatment of PTSD.49
All other medications for PTSD are used off-characterization and have merely empirical support and practice guideline support.49 These include the SSRI fluoxetine and the serotonin norepinephrine reuptake inhibitor (SNRI) venlafaxine, which are recommended as showtime-line treatments in the VA/DoD Clinical Practice Guideline for PTSD. Venlafaxine acts primarily equally an SSRI at lower dosages and as a combined SNRI at college dosages.
Although SSRIs are associated with an overall response rate of approximately 60% in patients with PTSD, only xx% to 30% of patients reach complete remission.l In a study of extended-release (ER) venlafaxine, the response rate was 78%, and the remission rate was 40% (both assessed with an abbreviated version of CAPS) in patients with PTSD.51 Hyperarousal, however, did not testify significant improvement. The ER formulation of venlafaxine is approved for patients with major depressive disorder, generalized feet disorder, social anxiety disorder, and panic disorder.52
Second-Line Therapies
Second-line therapies for PTSD are less strongly supported by evidence and may have more side effects. They include nefazodone, mirtazapine, tricyclic antidepressants, and monoamine oxidase inhibitors.53 – 55 Prazosin has been establish to exist effective in randomized clinical trials in decreasing nightmares in PTSD. It blocks the noradrenergic stimulation of the alpha1 receptor. Its effectiveness for PTSD symptoms other than nightmares has not been determined at this time.56 , 57
Alternative Pathways
Antidepressants have been the fundamental focus of pharmacotherapy research in PTSD, simply amend treatments are profoundly needed. "Right at present, the interest is in novel medication development rather than simply relying only on the SSRIs that nosotros have considering we only get and so far with them," Dr. Schnurr says.
Researchers are looking closely at the function of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) and the excitatory neurotransmitter glutamate in PTSD. Both GABA and glutamate play a role in encoding fear memories, and therapeutic enquiry targeting these systems may open new avenues of treatment for PTSD. For example, the novel multimodal anti depressant vortioxetine (Trintellix, Takeda) modulates GABA and glutamate neurotransmission.
Co-ordinate to ClinicalTrials.gov, several ongoing studies are investigating the efficacy of vortioxetine and another new multimodal antidepressant, vilazodone (Viibryd, Allergan), in PTSD. Both drugs accept been approved past the FDA for the treatment of low just not for PTSD.
Anticonvulsants or antiepileptic drugs, which bear upon the balance betwixt glutamate and GABA past interim indirectly to impact these neurons when their neuronal receptor sites are activated, could too provide a useful option in treatment of PTSD symptoms in patients who neglect kickoff-line pharmacotherapy. Topiramate, an anticonvulsant used to care for certain types of seizures, has demonstrated promising results in randomized controlled trials with civilians and veterans with PTSD.58 Topiramate is currently listed in the VA/DoD Clinical Practice Guideline for PTSD every bit having no demonstrated benefit, and further studies are needed regarding the place of this drug in PTSD handling.59
Clinical enquiry too suggests that smoking cannabis (marijuana) is associated with reduced PTSD symptoms in some patients. One study indicated that PTSD patients reported an average 75% reduction in CAPS symptom scores while using cannabis.60
Although the use of medical marijuana to treat PTSD remains controversial, contempo deportment by the federal authorities have brought veterans closer to being able to obtain medical marijuana. In April 2016, the Drug Enforcement Administration approved the first-ever controlled clinical trial to study the effectiveness of cannabis as a handling for PTSD in military veterans, and in May, Congress voted to elevator a federal ban that has prevented veterans' access to medical marijuana through the VA in states that allow information technology. Medical marijuana is legal in 23 states and the Commune of Columbia for the treatment of glaucoma, cancer, man immunodeficiency virus, and other conditions.
Suggested nonpharmacological and pharmacological treatments for PTSD are listed in Tabular array 2.
Table two
Selected Treatments for PTSD in Veterans
| First-Line | Second-Line | Alternative Pathways |
|---|---|---|
| Nonpharmacological29 , 38 – 47 | ||
| ||
| Pharmacological48 – 60 | ||
|
|
|
Combined Pharmacotherapy and Psychotherapy
Medications and psychotherapies are used both separately and in combination to treat the symptoms of PTSD, besides as related comorbid diagnoses. Guidelines suggest a combination may enhance handling response, specially in those with more severe PTSD or in those who accept not responded to either approach alone.61 For example, studies have shown combined SSRIs and psychotherapy appear to exist more constructive than treatment with either intervention used solitary.62
Reducing Benzodiazepine Employ Among Veterans
The VA/DoD Clinical Practice Guideline for PTSD cautions confronting any employ of benzodiazepines to manage core PTSD symptoms considering bear witness suggests that they are not constructive and may fifty-fifty exist harmful.29 All the same, despite this guidance, nigh one-third of VA patients beingness treated for PTSD nationally were prescribed benzodiazepines in 2012, says Nancy Bernardy, PhD, Associate Director for Clinical Networking at the VA National Center for PTSD.
According to Dr. Bernardy, the rates of benzodiazepine use amidst veterans with PTSD are declining, merely focused interventions are needed to attain further reductions. She says the VA is studying the apply of an academic detailing approach to share decision back up tools around the appropriate use of these drugs.63 The initiative targets subgroups of veterans with PTSD in which there are increased rates of benzodiazepine prescription, including those with comorbid substance use disorders and those with comorbid traumatic brain injury. Designed to be used by providers with their patients, the decision support tools incorporate safe concerns related to the targeted subgroups and offering tapering guidance and information on alternative, evidence-based treatments for PTSD.
"It'south taken a while, simply we're beginning to see success," Dr. Bernardy says of the initiative, adding that the involvement of family members is an integral part of the tapering process. The VA is also looking at other models for increasing engagement in prove-based PTSD treatment through shared decision-making.
"Shared decision-making has not been used widely," Dr. Bernardy says. "And then we are trying to create a culture where providers come across with patients and discuss PTSD treatment options—the pros and cons of each—and and then let patients and family members brand the all-time decisions for their care."
Treatment-Resistant PTSD
For patients with PTSD who do non respond to initial drug treatment, it may be necessary to explore additional pharmacotherapy options to control their symptoms. A number of pharmacological agents, including antipsychotics, antiadrenergic drugs, and anxiolytics, take also demonstrated some efficacy in treating PTSD.64 , 65
However, for well-nigh pharmacological therapies, there is inadequate evidence regarding efficacy for PTSD, pointing to the need for more than clinical studies in this surface area.66 According to Dr. Schnurr, psychotherapy remains the most effective treatment for PTSD. "Antidepressants may be effective," she says, "but we run across more results—and we also see more than durable results—with the psychotherapies because they essentially go to the center of helping the patient address the problem."
Economic and Societal Brunt of PTSD
The demand for better solutions is shown by the immense economical and societal burden of PTSD. First-year treatment lonely for Iraq and Afghanistan veterans treated through the VA costs more than $two billion, or most $8,300 per person.67 Health intendance costs for veterans with PTSD are 3.5 times higher than costs for those without the disorder.67 According to the VA, PTSD was the 3rd most prevalent disability for veterans receiving compensation in 2012 (572,612 veterans), after hearing loss and tinnitus.68
PTSD and Suicide
Veterans at present account for twenty% of all suicides in the U.S., with the youngest (xviii–24 years of historic period) four times more likely to commit suicide than their nonveteran counterparts of the same age. An estimated 18 to 22 veterans dice from suicide each day.69 Co-ordinate to a recent study published in JAMA Psychiatry, the likelihood of suicide increases once a person leaves agile military service, and that risk is further increased in veterans whose service fourth dimension was less than four years.seventy
The association between PTSD and suicide has been a subject of argue, with some studies showing that PTSD alone is associated with suicidal ideation and behavior,71 , 72 and others indicating that the higher adventure is due to comorbid psychiatric conditions.73
Barriers to Constructive PTSD Treatment
Despite efforts to increase access to advisable mental health care, many military veterans continue to face barriers to getting PTSD treatment. The largest single barrier to timely access to care, according to a VA audit, is the lack of provider engagement availability.74 An acute shortage of doctors in the VA, particularly in chief intendance, combined with the rising population of veterans seeking treatment, has led to months-long waiting times.75
Poor availability of mental health services in many parts of the U.Due south. also presents a significant bulwark for Iraq and Afghanistan veterans and their families.76 Mental health specialists tend to concentrate in larger urban areas, and even in those areas, in that location are disparities in the per capita number of psychiatrists. Some rural areas have none.77 , 78 According to the VA Role of Rural Health, veterans from these areas are less likely than urban veterans to access mental health services, in part considering of the greater distances they must travel.79
I of the nigh frequently cited barriers to veterans getting timely and adequate care for PTSD is the social stigma associated with mental illness.lxxx , 81 Research indicates that service members may feel aback and embarrassed to seek treatment, perceive mental illness equally a sign of a weakness, or feel that it is possible to "tough it out."81
According to Dr. Schnurr, considerable effort has been made to destigmatize seeking mental wellness handling amidst military veterans. For example, the VA is developing initiatives to enhance collaborative care services that integrate mental and concrete health, which is thought to help minimize the stigma associated with PTSD. Additionally, the VA has implemented various outreach initiatives, such as the "Virtually Face" awareness campaign, a series of online videos that introduces viewers to veterans who have experienced PTSD and provides guidance on seeking care.
"Information technology's a civilization modify," Dr. Schnurr says. "By working at both the community level and within the organization, we are trying to comprehensively brand the changes that volition make it easier for veterans to recognize that they need assist and and then to seek aid."
In an effort to address admission to care issues, the VA is focusing on telehealth or the use of tele communications technology to provide behavioral health services to veterans diagnosed with PTSD. Telehealth, which tin can be both convenient and destigmatizing, has detail potential in rural areas, where a large portion (38%) of VA enrollees diagnosed with PTSD live. A contempo study of rural veterans with PTSD showed that receiving psychotherapy and related services via telephone or video conferencing can accept positive effects, including the initiation of and adherence to advisable treatment.82
In another study of rural veterans in VA intendance, patients who received treatment remotely had greater reductions in PTSD scores at half dozen months and at ane year than those who were offered on-site care. Co-ordinate to the researchers, participants in the telemedicine group were much more likely to engage in their ain care, a disquisitional component of recovery.82
Community-Based PTSD Intendance
Research indicates that customs-based mental health providers are non well prepared to take care of the special needs of military veterans and their families, including evidence- based handling of PTSD and depression.83 According to Dr. Schnurr, there has not been sufficient dissemination and implementation of the most effective psychotherapies in customs-based settings, such equally master care practices, behavioral health centers, substance-abuse treatment facilities, and hospital trauma centers. To help meet these needs, the VA developed the PTSD Consultation Programme for Community Providers (vog.av@tlusnocDSTP), which offers free education, training, information, consultation, and other resources to non-VA health professionals who treat veterans with PTSD.
A number of initiatives across the country provide training and/or treatment back up to providers who offering services to veterans with PTSD. The Center for Deployment Psychology, a nationwide network of medical centers, trains military and civilian behavioral health professionals to accost the emotional and psychological needs of military personnel and their families through live presentations, online learning resource, ongoing consultation, and teaching.84 Star Behavioral Health Providers is a resource for veterans, service members, and their families to locate behavioral health professionals with specialized preparation in understanding and treating war machine service members and their families.85 The service is currently offered in California, Michigan, New York, Indiana, Ohio, Georgia, and South Carolina.
Challenges and Opportunities Ahead
While many important advancements accept been made over the past few decades in understanding and treating symptoms of PTSD, the rising number of American veterans who suffer from the disorder continues to be a serious national public health trouble. Cognitive behavioral therapy is a widely accustomed method of treatment for PTSD, only there is clearly an urgent need to identify more constructive pharmacological approaches for the management of symptoms, as not all patients will reply adequately to psychotherapy or testify-based/kickoff-line pharmacotherapy. Further understanding of the underlying physiological and neurological processes will exist helpful in developing new and effective therapies to treat PTSD.
Research also suggests further opportunities for the VA and other health care systems to develop new and innovative means to overcome barriers to treating veterans with PTSD. With veterans and their families increasingly seeking care exterior of the VA system, community providers play a key function in helping to address these challenges. It is critical they receive the instruction, training, and tools to improve their understanding of and skills for addressing the needs of this unique population.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047000/
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