Studies show that about 20 percent of Iraq and Afghanistan veterans have post-traumatic stress disorder and/or depression. That adds up to more than 100,000 cases. The VA hospital employs two different psychiatric approaches to the condition, and now a new study will help doctors decide which one works best for which kinds of patients.
Todd McCosco has been one of those patients. He’s 43, and has spent most of his adult life in the Air Force.
These days, as a student at Lyndon State College, he sometimes hangs out in the veterans’ lounge wearing a Wounded Warrior cap and swapping memories with other former soldiers. When he served in Iraq, his unit frequently came under mortar attack.
“And you feel powerless and you just, I guess, shut down part of you. And the part that ramps up is survivability,” he recalled.
When he left the Air Force, he just couldn’t shake that ramped-up “survivability” mode. He also felt guilty because he thought he had put his own survival ahead of his subordinates. His nightmares got so bad he sought help at the VA hospital, and started interactive therapy sessions conducted through closed-circuit television.
“They taught me to basically assess the situation and keep telling myself that you’re not in Iraq, you’re here, it’s not going to happen here,”he said.
The VA also gave McCosco an app for his mobile device to help manage his symptoms. To demonstrate, he pulled out his smart phone and taps on a distress meter that looks like a thermometer.
“I pulled it all the way to a nine and then you hit next….And it goes right down to what triggered you on that trauma. For example, it goes, “drove under a bridge. In USA, not Iraq, civilians on the highway, driving my own truck,” he said.
"An older woman who's had sexual trauma might do better with one treatment, and a younger man who's had combat trauma and was also physically abused in childhood might do better with another treatment." - National Center for PTSD Deputy Director Paula Schnurr
The “PTSD Coach” app, which can also be found online, helps the patient logically conclude that he or she is probably not now in the kind of danger that was present on the battlefield. That’s called cognitive processing therapy, or CPT.
But there’s also another approach called “prolonged exposure,” or PE. Sonya Norman, a VA therapist practicing in San Diego, says PE relies less on logic and more on helping a patient safely re-experience the trauma emotionally until the memories become manageable.
“Staying in the memory for a sustained period of time, really trying to re-tell it, re-experience, which we don’t do so much in CPT,” she explained.
But her challenge is deciding which therapy to use on any given patient: cognitive processing, or prolonged exposure. So the National Center for PTSD at White River Junction is launching a clinical trial to compare their effects on a wide variety of patients. Paula Schnurr is the Center’s Deputy Director and lead investigator for the ten million dollar study of PTSD patients in 17 locations.
“An older woman who’s had sexual trauma might do better with one treatment and a younger man who’s had combat trauma and was also physically abused in childhood might do better with another treatment,” Schnurr said.
Schnurr hopes the study will give therapists evidence-based guidelines based on demographic and other patient information.
Back at Lyndon State, Todd McCosco says cognitive therapy was probably the right choice for him, because the same powers of logic that helped him survive a war are now helping him manage his PTSD -- and get a college degree.
In fact, on a recent chilly evening, in an outdoor wilderness responder class that required students to role play medical emergencies, he had no trouble taking on the role of an emergency responder.
