The war may have ended, but the trauma of Afghanistan hasn’t ended for our veterans
The world watched as the Taliban seized control of Afghanistan, some say erasing 20 years of work and sacrifice. Most Americans are feeling a range of emotions, but the news is even harder for veterans. Many veterans are asking themselves, “Was it worth it? Was all of my sacrifice wasted?” These veterans carry the weight, the scars of more than 2,300 Americans killed and 20,000 wounded in a 20-year war that cost the U.S. an estimated $2.26 trillion, and now veterans are grappling with the unavoidable feeling that all their blood, sweat and tears were for naught.
For veterans who are struggling right now — whether dealing with depression, post-traumatic stress disorder, traumatic brain injury, or simply having a hard time watching the events in Afghanistan unfold — they should know there is help.
Since October 2001, more than 775,000 U.S. troops were deployed to Afghanistan. Early evidence suggests that the number suffering from psychological injuries from these deployments is far greater than the number suffering from the physical injuries. Prolonged exposure to combat-related stress, often over multiple tours, takes a serious toll. We may not see the damage, but it is there.
According to the Department of Veterans Affairs, PTSD afflicts up to 1 in 5 veterans who deployed to Iraq and Afghanistan, and as many as 1 in 3 Vietnam veterans have struggled with PTSD in their lifetimes. As many as 500,000 U.S. troops who served in Afghanistan and Iraq have been diagnosed with PTSD. These figures suggest that psychological trauma is a staggering burden on active-duty troops, veterans and society.
Because the medical community did not understand the science of PTSD until recently, past treatments varied from heavy drugs to hospitalization to simply telling patients to try to put their experiences behind them. But today, clinicians increasingly rely on emerging therapies along with psychotherapy and medication in a holistic treatment approach.
In 2017, the VA and Department of Defense developed clinical practice guidelines for the treatment of PTSD. The guidelines recommend using individualized treatments called trauma-focused psychotherapy. The most common therapies for combat veterans are:
Prolonged Exposure Therapy
Veterans suffering from PTSD often try to avoid anything that reminds them of their prior trauma because these stimuli cause an emotional and/or physical reaction. Unfortunately, this avoidance only reinforces their fear. In PE therapy, patients are repeatedly exposed to the stimuli in a safe way, and eventually modify or reduce their fear response. This helps veterans to manage their condition and lead a more normal life.
Cognitive Processing Therapy
After a trauma, it’s common to have repeated negative thoughts and get “stuck” on the traumatic event. CPT helps the patient learn to identify and change these thought patterns. In CPT, the therapist helps the patient identify their “stuck points” and use cognitive restructuring to create a more accurate and balanced interpretation of the traumatic event. This therapy helps patients to get past recurring thoughts, such as self-blame, shame and hindsight.
Eye Movement Desensitization and Reprocessing
People with PTSD react negatively to the memory of their traumas because the brain has not adequately processed the experience. EMDR can help them process these upsetting memories and separate the memory from thoughts and feelings experienced at the time. The patient focuses on specific sounds or movements while they talk about the traumatic event with a therapist. This helps the brain work through the traumatic memories and resolve the associated distress. Over time, they change how they react to memories of their traumatic event.
Beyond these therapies, we have seen great success in some emerging treatments, including mindfulness and meditation and art-and-craft therapy.
Mindfulness and meditation
Many therapists and patients have found that adding mindfulness and meditation to traditional therapy can be beneficial for veterans with PTSD. Mindfulness means focusing attention on sensory perceptions and bodily sensations and includes meditation, yoga, breathing exercises, and tai chi. Mindfulness has been shown to lower heart rate and blood pressure, and it has been an effective way for people in all walks of life to deal with stress.
Craft therapy shows promise as an adjunct treatment for PTSD. Craft therapy helps veterans take their minds off events that may have led to their illness. Engaging in craft activities has been shown to address cognitive, neurological and sensory-motor needs by focusing the brain on performance skills. Veterans who are engaged in craft groups report a greater sense of pride and purpose and have opportunities to develop a sense of camaraderie. An organization that is near and dear to my heart, Help Heal Veterans, has known this for quite some time. In fact, for 50 years Heal Vets has been providing craft therapy to active-duty military and veterans.
What is truly impressive to me as a physician, however, is what those who have used craft therapy kits have to say:
— 94% said the kits helped them have a more positive outlook on life.
— 81% said the kits helped improve their relationships with family and friends.
— 89% said our kits helped relieve their pain. On average, there was a 63% drop in pain scale when using craft therapy kits.
— 78% of respondents who had a physical injury or wound said our kits helped with their condition.
— 98% said the kits took their mind off of problems.
— 97% of respondents with behavioral health issues (PTSD, depression, anxiety) said the kits helped them feel better.
— 75% of respondents with history of TBI said our kits helped them.
Because PTSD is such a heterogeneous disorder, any treatment plan should be individualized, and one must consider current life stressors and comorbid conditions such as chronic pain, substance abuse and traumatic brain injury.
As a former naval medical officer who specializes in traumatic brain injury, I can attest that there is no one-size-fits-all approach. But using a combination of traditional and emerging therapies can provide much needed support for our wounded troops and veterans. We need to embrace these therapies.
Keith Stuessi served in the U.S. Navy for 23 years as a family practice/sports medicine physician and retired as a captain. His last tour was as medical director of the Concussion Care Clinic at Naval Hospital Camp Pendleton, Calif. He now serves on the Board of Directors of Help Heal Veterans, which provides free therapeutic arts-and-craft kits to U.S. veterans and active duty military personnel.