My father-in-law recently passed away at the impressive age of 100. I met him when he was in his early 50s, long after he had flown more than 50 missions as a B-17 tail gunner during World War II. He never spoke about his combat experiences, and he didn’t watch war movies. It wasn’t until he was in his early 80s — 60 years after he completed his military service — that he finally began to talk about the war.
I’m still not sure what spurred him to discuss his experiences after all those years. He never underwent therapy, and his avoidance was never diagnosed. The world’s understanding of post-traumatic stress disorder has come a long way from dated terms such as “soldier’s heart” and “shell shock,” but there’s still plenty of work ahead in diagnosing and treating the disorder.
How Modern Treatments Have Helped Combat PTSD
It wasn’t long ago that PTSD and its symptoms, which include flashbacks, nightmares, and severe anxiety, were thought to be incurable. That dire outlook has changed thanks to the U.S. Department of Veterans Affairs and its decades of evidenced-based treatments for the mental condition.
Cognitive processing therapy and prolonged exposure therapy have proven to be two of the most effective treatments for PTSD. The VA rolled out CPT and PE about a decade ago with help from the National Center for PTSD and several subject matter experts. It allowed for a more comprehensive, structured approach that ultimately improved outcomes and consistency of care.
CPT involves patients writing and reading aloud a narrative of their traumatic events to help process them. Meanwhile, PE sees patients gradually and systematically confront trauma-related situations, places and people both directly and via memories.
Data evaluating the effectiveness of the two treatments shows that patients who undergo PE or CPT therapy experience “statistically reliable and clinically meaningful improvement” in PTSD and depression symptoms. They are an improvement over prior approaches — or no approach at all — and have a structured focus that can be taught to medical professionals and implemented. Both strategies are effective, but they need to be handled correctly with a system of checks to ensure clients are following through with homework outside of the sessions.
A Lack of Money and Consistency
If CPT and PE are so successful, why aren’t the acronyms nearly as universal as PTSD? There are several factors at play. The most obvious, however, is that PTSD — and its respective therapies — is sorely in need of money and consistency to fuel future treatment breakthroughs.
Money is critical to ensure service delivery, and the VA doesn’t seem to have the capacity to meet current needs. This is particularly important for the population of combat veterans who are homeless and have difficulty accessing care. Funding is equally important for research. Without the necessary money, it’s impossible to stay on the cutting edge of PTSD research and treatment.
Funding will help matters, but consistency in treatment is equally important. Patients must receive consistent, high-quality services regardless of the VA location they visit. That hasn’t been the case, with a recent study finding no guidance or consensus in the VA system on the number of patients who should receive CPT and PE. Some clinics treat 10 percent of their population with the therapies, and others offer them to more than half of patients.
While progress has been made, additional research is sorely needed. CPT and PE aren't viable treatments for everyone, so it's important to continue working to find new or complementary solutions. The ongoing need for funding plays a pivotal role in this.
One of the only positive things to come out of 9/11 and the more than 16 years since is a newfound respect for our military men and women. While it’s vital to handle any physical wounds caused by wartime trauma, the psychological ones can be just as detrimental.
A study published in late 2016 found that many medical professionals who once thought PTSD was incurable have seen noninvasive therapies such as CPT and PE show improvement among patients. With adequate funding and consistent treatment across the board, we can help heal the damage caused by military trauma.
Bill Topaz, a publishing and content expert, is the president of Anxiety.org, which offers high-quality healthcare information contributed by top researchers and experts from around the world. Bill is a graduate of Northwestern University’s Medill School of Journalism. His career has focused on consumer, educational, and scientific/medical publishing in media corporations such as the Tribune Company and Disney.