Progress Against PTSD
Alternative Treatment in Action at VA in White River Junction
Yoga instructor Brianna Renner, of Newport, N.H., leads veterans through a yoga session at the VA Medical Center in White River Junction, Vt., on July 3, 2014. Veterans from left, Bill Birkmaier, of Lebanon, N.H., and Russell Cantlin, of Enfield.
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Paula Schnurr, the acting executive director at the VA's National Center for Post-traumatic Stress Disorder, in White River Junction, Vt., on July 10, 2014. Valley News - Jennifer Hauck Purchase photo reprints »
VA Medical Center psychiatry residents from left, Sibylle Delaloye and Hera Ashfaq watch a demonstration with Dr. Freda Dreher as she describes an acupuncture treatment with Carol Hitchcock, an employee at the VA who was being treated for shoulder pain. (Valley News - Jennifer Hauck) Purchase photo reprints »
David Morgan, founder of Vermont Vet to Vet, Morgan was at the VA Medical Center in White River Junction, Vt. on July 10, 2014.
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White River Junction — “Give yourself permission to let go of anything that does not serve you in the moment.” That was the advice that Brianna Renner, a 34-year-old yoga instructor, gave in a soft but distinct voice to three veterans — all men nearly twice her age — sitting in front of her on rubber mats in Room G103B at the Veterans Affairs Medical Center.
The July 4 holiday was a few hours away. The hallways were fairly quiet at the hospital, which anchors a network of clinics that provide medical care for 75,000 veterans in northern New England. Attendance was light at the midday yoga gathering.
But the session — one of a twice-a-week series that Renner and fellow instructor Laura Hanson began offering in April out of their concern for veterans coping with post-traumatic stress disorder and other health woes — continued in earnest.
Yoga is just one of a growing array of treatments — acupuncture, hypnosis, recreational therapies and meditation are some others — that VA hospitals in White River Junction and elsewhere now offer patients battling PTSD, chronic pain, addiction and other maladies. And while their effectiveness remains largely unproven, the therapies have given caregivers additional tools to complement conventional treatments and have been embraced by some veterans.
At the same time, there has also been substantial and more measurable progress in the treatment of PTSD with conventional therapies, including two forms of psychotherapy and some medications.
“Not everyone is going to recover 100 percent, at least with the treatments we have now, but most people are going to find their lives significantly improved,” said Paula Schnurr, acting director of the VA’s National Center for Post-Traumatic Stress Disorder in White River Junction.
Inside Room G103B, Renner, a former Marine herself, gently guided the breathing, thoughts and postures of three students, who were there to find relief from physical aches and pains. Renner wanted the participants to focus on the moment, but a clear reminder not to ignore the past came via the words sewn into a quilt hanging on the wall: “We will not falter, we will not fear, we will not fail, we will not forget: Sept. 11, 2001.”
Since that day, about 2 million Americans have been deployed to fight wars in Iraq and Afghanistan. Many — including a significant number from northern New England — have returned with post-traumatic distress disorder.
No precise tally exists. Nearly 119,000 service men and women who were deployed in 21st-century U.S. wars in Iraq and Afghanistan were later diagnosed with post-traumatic stress disorder, according to the Congressional Research Service. Another 34,000 without deployment in either theater received the same diagnosis in that time frame.
But the actual prevalence is much higher, according to the national center for PTSD, which estimates that from 10 percent to 18 percent of the veterans who served in the two Middle Eastern wars in the past 15 years developed PTSD — as many as 360,000.
Post-traumatic stress disorder refers to symptoms that persist “after a terrifying ordeal that involved physical harm or the threat of physical harm,” according to the National Institute of Mental Health. Some are “re-experiencing symptoms” such as dreams and flashbacks, while others include avoidance behaviors, numbness and hyperarousal, including difficulty sleeping.
And PTSD can wreak havoc. David Morgan, a 53-year-old veteran who lives in Northfield, Vt., and developed PTSD, recalled bad dreams that disrupted his sleep every night. Morgan, who survived a military sexual trauma, said he was also “suicidal at one time,” avoided certain places and isolated himself.
PTSD also takes an indirect toll. Those with PTSD have high rates of tobacco use, substance abuse, depression, anxiety, heart disease, obesity, diabetes, chronic fatigue, dementia and stomach, skin and musculoskeletal disorders, according to a 2012 article in the journal Military Medicine. The authors estimated the cost for a lifetime of treatment for a single veteran with PTSD and depression at $1.25 million.
And PTSD is not just a military phenomenon. About 7 percent of the adult population — and nearly one in 10 women — have PTSD over the course of their lives. Survivors of sexual abuse, terrorist attacks, physical assaults, serious accidents or natural disasters may see otherwise normal reactions to stress persist for more than three months and become PTSD, according to the national center.
But service men and women face particular risks. For example, roughly nine of 10 soldiers and Marines who served in Iraq reported seeing dead bodies, according to the national center. Just about as many were shot at, attacked, received rocket or mortar fire or knew someone who was killed or seriously injured.
‘Highly Effective’ Treatment
So the VA has stepped into the front line to address PTSD and has achieved good results using certain well-tested and proven forms of talk therapy, Schnurr said. Sometimes a veteran with PTSD is taught how to handle thoughts of their trauma. Another method leads a veteran to confront situations he or she has been avoiding.
“These treatments are highly effective, and the results are long term,” Schnurr said.
But specialists are still working to get the word out and change perceptions from a time when, according to Schnurr, “many older veterans felt like PTSD was something they had to live with, that it was chronic.” Today, she added, “that’s not true.”
Pointing to a 2012 study in which four out of five patients experienced no recurrence of PTSD symptoms five years after treatment with one of the main talk therapies, Schnurr paused as she searched for the best way to express how dramatic that result was.
“Scientists are cautious, so we’re uncomfortable using the word ‘cure,’” she said. “But 80 percent recovery of that magnitude — I would not correct you if you used that word.”
Schnurr said drugs can also be useful in treating PTSD symptoms, but still not as effective as talk therapy.
“Right now the best cognitive therapies we have are more effective than the best medication we have,” she said. “Both are effective, but right now the best of the best are the psychotherapies.”
And then there are the unconventional therapies that are used as complementary treatments in most of the VA’s PTSD programs, often to relieve stress and anxiety. Use of such treatments is “rapidly evolving,” Schnurr said. “There’s a lot of interest and research.”
At the White River Junction VA, complementary or alternative therapies available to veterans include hypnosis, mindfulness groups, yoga, acupuncture, aquatic and various recreational therapies, said Lanier Summerall, the chief of mental health services.
But the effectiveness of these treatments has yet to be proved in rigorous scientific tests, Schnurr cautioned: “Right now there is insufficient evidence to talk about any (complementary or alternative medicine) as a treatment for PTSD.”
Schnurr said that among the various alternative or complementary PTSD treatments, meditation had gone the furthest toward scientific verification: “Meditation is looking very promising.”
Morgan, the Northfield vet, believes that meditation and hypnosis helped. Although reluctant at first, his trust in the psychologist who had been treating him for nearly a decade helped persuade him to try these unconventional treatments. “I think I really benefited from it,” he said. Now he can initiate his own meditation sessions, and his bad dreams occur only two or three times a month and “not every night like it used to be.”
Morgan said his recovery has also benefited from talk and group therapy, his participation in a Vermont-based personalized wellness program and his role as president of Vermont Vet-to-Vet, a peer support organization: “Apparently, something worked.”
Inspired to Help Fellow Veterans
I nitiative and care don’t always wait for science. For example, it was a desire to use yoga to aid fellow veterans with PTSD that propelled Renner toward a yoga mat in the White River Junction VA.
Yoga originated in India and combines “physical postures, breathing techniques and meditation or relaxation,” according to the National Center for Alternative and Complementary Medicine of the National Institutes for Health. In the United States, about one in 20 adults practice yoga. Among that group, one in six use yoga to treat back pain or other medical conditions.
Renner, who was 12 when she decided to become a Marine and 17 when she signed her enlistment papers, was trained as an avionics technician and left the Marines in 2003. She began learning yoga the next year while expecting her first child. Last year, she and her husband moved to Newport, N.H., where she became manager of the Flowing Forms yoga studio.
While attending a workshop at the Kripalu Center for Yoga and Health in Stockbridge, Mass., Renner saw a veteran with a guide dog and was inspired to look for a way to use her skills to help her fellow veterans. A later conversation with a Flowing Forms student persuaded Renner to seek training that would enable her to address the needs of veterans with PTSD.
So far, Renner and Hanson aren’t aware of anyone with PTSD among the five to eight regular attendees of their twice-a-week sessions. But the three veterans in her July 3 session enthusiastically embraced yoga as a help in staying active, easing back pain and increasing their physical range of motion.
“If you don’t use it, you’ll lose it,” said Russell Cantlin, a 68-year-old Army veteran from Enfield.
“If you do these types of exercises, you don’t hurt yourself,” said Bill Birkmaier, 70, a Navy veteran from Lebanon.
But a recent scientific study failed to prove that yoga was useful in directly attacking PTSD. While patients who participated in 12 sessions of yoga had “significant decreases in PTSD symptoms,” their improvement was no better than those in a control group who received “warm and empathetic attention” from scientists conducting the study, which was published in the April 2014 J ournal of Traumatic Stress.
There is some evidence of the effectiveness of acupuncture. Patients in an early trial of acupuncture as a treatment for depression, anxiety and other PTSD-related symptoms showed results comparable to those who received talk therapy, according to an 2011 article in the Journal of Nervous and Mental Disease. But a year later, PTSD Research Quarterly recommended “withholding judgment about (acupuncture’s) effectiveness for PTSD” pending further research.
In the meantime, Summerall and two other doctors from the White River Junction VA completed a nine-month acupuncture training course at the Harvard Medical School. The impetus for seeking the training was acupuncture’s proven effectiveness in treating chronic pain and their awareness that symptoms frequently overlap, especially among younger veterans, Summerall said.
“For veterans with chronic pain, a substantial majority also have psychological issues and many have PTSD,” she said.
Even if not effective as direct treatments for PTSD, unconventional treatments promise to support and encourage veterans to stick with conventional treatment regimens of talk therapy and medication. A 2012 article in PTSD Research Quarterly that found “very limited empirical evidence of (alternative therapies’) effectiveness” in treating PTSD suggested that those treatments might well be useful as adjuncts to other treatments “or as a gateway to additional services for patients who initially refuse other approaches.”
Schnurr agreed. “Some treatments are designed to treat PTSD symptoms,” she said. “Other treatments are designed to help people who have PTSD treat other conditions that are not necessarily PTSD that they might have.”
So did Morgan. “As veterans have a broader view of what’s out there, there’s a better chance that they’re going to be successful,” he said. “It gives you more tools for your toolbox.”
Rick Jurgens can be reached at firstname.lastname@example.org or 603-727-3229.