Posts Tagged ‘PTSD’

Bridging Access to PTSD Care in Primary Care

soldier hugs fatherEmory Healthcare Veterans Program (EHVP) is known for its innovative research when it comes to treating posttraumatic stress disorder (PTSD). Now the team behind the research is working to make treatment more accessible nationwide. In her role as Director of Mental Health Research and Program Evaluation at the Atlanta Veterans Affairs Medical Center, Dr. Sheila Rauch, EHVP’s Clinical Director, works to make PTSD care more accessible within the VA by utilizing a version of prolonged exposure for embedded mental health workers in primary care.

After demonstrating the effectiveness of the protocol to reduce PTSD symptoms in primary care, Dr. Rauch designed a program to train primary care mental health providers so they are better prepared to help patients struggling with PTSD.

“PTSD is a disorder of avoidance; any hurdle to receiving care could be a reason someone seeking help will go back to avoiding, so we are working to reduce barriers to care. There is no wrong door, we want to assist everyone who comes in looking to treat their PTSD and we want to do it as soon and as quickly as possible,” said Dr. Rauch.

“There is still a large population of those with PTSD who do not seek care, so we are working to find ways to provide treatment that is not only effective but also can be accessed quickly because this population will most likely not follow through with treatment the first time they reach out.”

What is Prolonged Exposure Therapy?

Prolonged exposure therapy involves working with patients to help them approach the memories and reminders of trauma so that they are the ones in control of their lives—not the trauma. PTSD is a disorder of avoidance and prolonged exposure therapy gives the patient the tools needed to approach the memory and the people, places and situations they had been avoiding.

“At its bones, the treatment is simple relearning, doing what you are afraid of over and over again and it gets easier,” said Dr. Rauch.

Three common components of prolonged exposure therapy are:

  • Psychoeducation
  • Imaginal Exposure
  • In Vivo

Psychoeducation provides a foundation of information on how PTSD develops and how treatment works. This foundation helps the patient and provider speak the same language and lets the patient begin to learn how to approach instead of avoid.

During imaginal exposure, the patient is asked to narrate the feared situation to the clinician multiple times. This narration is an important step because it allows the patient to finally process the trauma that occurred and understand why it was so disarming in the first place.

In Vivo (a Latin phrase translated as “in the living”) is a method used to take the tools learned during therapy sessions into a real-world setting. If the patient is working to overcome a fear of driving, for example, an in vivo session may include the clinician and patient driving through Atlanta traffic.

All three components of prolonged exposure therapy work together to help patients overcome the fear of the traumatic experience and begin processing what they had been avoiding for so long.

What Does a Prolonged Exposure Primary Care Session Look Like?

Prolonged exposure primary care (PE-PC) includes four to eight 30-minute sessions provided in primary care as opposed to specialty mental health. Since most people suffering with PTSD prefer to receive their care in a primary care setting with the providers they know, this option really increases access to effective PTSD care. The treatment can also be conducted through telehealth (a web-based platform) to increase reach.

“We are setting up a process to reach patients where they are instead of waiting for them to come to us because any hurdle could become a reason to go back to avoiding care,” said Dr. Rauch.

Emory Healthcare Veterans Program

EHVP provides expert, collaborative care for post-9/11 veterans and service members in the United States, regardless of discharge status. Conditions treated include PTSD, traumatic brain injury, military sexual trauma, depression and anxiety. Learn more about the program by calling 888-514-5345 or visiting the website at emoryhealthcare.org/veterans.

To learn more about the Emory Healthcare Veterans Program and stay updated, sign up for our newsletter.

 

Using Virtual Reality as Therapy for PTSD

virtual reality exposure therapy for ptsdJune is Post-Traumatic Stress Disorder (PTSD) Awareness Month and Emory Healthcare Veterans Program would like to share how it uses Prolonged Exposure therapy and Virtual Reality Exposure therapy to heal invisible wounds. Our highly skilled team of professionals is led by world-renowned Emory clinical psychologist Barbara Rothbaum, Ph.D., who has been working in the PTSD field since 1986 and pioneered Virtual Reality Exposure therapy as a treatment for PTSD in veterans and service members. In exposure therapy, we help people confront reminders of the traumatic event, but in a therapeutic manner so that their distress decreases.

Prolonged Exposure Therapy

There are many approaches to treating PTSD, and after several decades of research, our program has determined Prolonged Exposure therapy to be the most successful in healing invisible wounds. This process treats PTSD by asking the patient to recall the memory repeatedly, and in a therapeutic manner, so that he/she will feel more comfortable with the memory and gain a sense of mastery over the experience, rather than experiencing anxiety and avoidance. Avoidance is a common behavior for those suffering from PTSD, and although facing the memory head-on appears intimidating, revisiting the wound is the only way to heal it.

“This form of treatment is successful because the trauma needs to be emotionally processed so it can become less painful. The process is similar to the grief process. When a loved one dies, it is extremely distressing, but by expressing that hurt (say, through crying), it gradually becomes less upsetting. Eventually, we can think about that person without crying, although the loss will always be sad. Those with PTSD devote much effort to avoiding thinking about the trauma because they mistakenly view the process of remembering as too agonizing to tolerate,” said Dr. Rothbaum.

Virtual Reality Exposure Therapy

Sometimes recalling the memory is difficult because it has been locked away for so long. Virtual Reality Exposure therapy is an extension of Prolonged Exposure therapy, which immerses the patient in a virtual world that is reminiscent of his or her traumatic memory. As the patient describes the memory to the therapist, the therapist is able to recreate scenes of the memory, complete with smells, vibrations, and landscapes.

“VR is a tool that helps to extend what we already do effectively, which is exposure therapy for PTSD and anxiety disorders. It helps to resolve some of the barriers we can sometimes encounter, like if a person is unable to connect fully with their traumatic memory, we can use VR to help strengthen that connection,” said Dr. Liza Zwiebach, a clinical psychologist with Emory Healthcare Veterans Program.

Dr. Rothbaum first used Virtual Reality Exposure therapy to help people overcome their fear of heights, then in helping her patients gain control over their fear of flying in airplanes. This innovative process proved just as effective as the standard practice of using an actual airport and airplane in treatment. In follow-ups months after therapy ended, 93 percent of treated patients reported flying in real airplanes. She then used Virtual Reality Exposure therapy to treat Vietnam veterans suffering from PTSD and developed the program Braveheart, which later became the Emory Healthcare Veterans Program.

“We wanted to see if the Virtual Reality Exposure therapy would have anything to offer them—as another treatment alternative. And it did. They got better,” said Dr. Rothbaum. “They’ve reported that it didn’t bother them anymore, these experiences that have been haunting them for decades.”

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How to Support Veterans with PTSD During 4th of July

With summer here and the 4th of July around the corner, Emory Healthcare Veterans Program would like to remind you that fireworks can cause discomfort for our combat Veterans. Good times for you can be agonizing for them, so please be mindful, courteous, and take the time to educate yourself and your family about PTSD.

 

1. Learn:

There are many resources available to learn about PTSD. Emory Healthcare Veterans Program would be happy to send one of our Veteran Outreach Coordinators to educate your organization about PTSD. If you are interested in this opportunity please contact us at 1-888-514-5345.

2. Be Aware:

Find out if any of your neighbors are combat Veterans. If they are, inform them that you will be celebrating with fireworks so that they will not be surprised and can prepare themselves. They do not wish to ruin your fun, but providing a warning allows them to make other arrangements if necessary.

3. Know the facts:

A high percentage of Veterans and servicemembers suffer from PTSD.  Treatment is available and very successful.

If you or a loved one is a post 9/11 Veteran or servicemember who struggles with symptoms of PTSD, TBI, depression or anxiety please contact one of our care coordinators the Emory Veterans Program Care Coordinators at 1-888-514-5345.

Dr. Rauch, Clinical Director of Emory Healthcare Veteran’s Program, talks about Veterans reintegration and mental health.

Most servicemembers will have some type of adjustment period after returning home from deployment. For each person the process is different depending on different variables during and after deployment. Mental health issues, traumatic brain injury and military sexual trauma can make that even more difficult. The Emory Veterans Program is here to help them reclaim their lives.

Question:
How long does it usually take to adjust to normal life again? How long should I wait to see someone if I’m still not feeling like my normal self?

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Dr. Rauch:
That is a good question. If at any time you’re having issues that you feel that you need or want help with, you should come see us. Readjustment often takes a year, and for some people longer, to feel like they’re really back in their life. The readjustment process is different for every individual and often depends on life’s variables, such as your job, social support and your family. It’s never too early to come talk with someone familiar with military service and deployment about your experience. Reintegration can be a difficult process. Mental health issues, traumatic brain injury and military sexual trauma can make that even harder. The Emory Veterans Program is here to help you reclaim your life.

Question:
My brother has seemed moody and depressed since he got back. Is there a good way for me to help him or encourage him to talk to someone about how he’s feeling?

sheila-rauch-avatarDr. Rauch:
It is common for returning veterans to have problems talking with people who have not deployed. While most veterans returning don’t have mental health issues, a significant minority may have problems with depression, posttraumatic stress or traumatic brain injury. Letting your brother know that you’re willing to listen or help is probably the best thing you can do. Sometimes it just takes patience to allow someone to open up.

 

Learn more about the Integrated Memory Care ClinicOr call for more information 1-888-514-5345

The Impact of Brain Injury on Veterans

Nearly 20% of deployed military personnel experience traumatic brain injury (TBI). TBIs are any brain injury caused by an outside force. These injuries can be “closed,” such as from a fall or motor vehicle accident or “open,” like from a gunshot wound.

Traumatic brain injuries range broadly from mild to severe. People with mild TBI (also called concussion) often fully recover within days to weeks, while those with severe TBI may have significant and sometimes permanent impairments. Fortunately, 70 – 90% of all TBIs in military personnel fall within the “mild” range.

Symptoms of Mild TBI

Traumatic brain injury can cause physical, cognitive and emotional difficulties.

Typical symptoms of mild TBI/concussion include:

  • Looking and feeling dazed
  • Being uncertain of what is happening; feeling confused
  • Having difficulty thinking clearly or responding correctly to simple questions
  • Being unable to describe events immediately before or after the injury occurred

Complications of Mild TBI

Although most with mild TBIs fully recover within a matter of days, a small percentage have symptoms that persist for months or even years. What causes this? Research shows outside factors may interfere with the brain’s recovery. What begins as a neurologic injury is complicated by other non-neurologic factors, such as chronic pain, side effects of medicines and psychological distress—all of which cause similar symptoms to TBI.

These outside factors are commonly experienced by veterans because in many cases their brain injuries were the result of a blast that also injured other parts of their bodies. In addition to their physical pain, injured veterans also commonly experience posttraumatic stress disorder (PTSD), anxiety disorders and depression.

Brain Injury Awareness Month: Not Alone

The Brain Injury Association of America (BIAA) leads the nation in observing March as Brain Injury Awareness Month. They work to build awareness of the condition and support individuals with brain injuries and their families.

Help for Veterans with TBI

Emory Healthcare Veterans Program offers expert and collaborative care to help heal the invisible wounds of war. Our comprehensive approach combines psychiatry, neurology, rehabilitative medicine and family support to help veterans reintegrate and reclaim their lives.

A coordinated treatment plan may include:

  • Cognitive rehabilitation
  • Education about typical recovery and common barriers
  • Management of orthopaedic injuries and chronic pain
  • Medication management
  • Psychotherapy
  • Complementary medicine (yoga, meditation, acupuncture, sleep medicine)

 

 

Learn more about the Integrated Memory Care Clinic

Call for more information, call 888-514-5345

Dr. Rothbaum on How PTSD Affects Veterans

Post-traumatic Stress Disorder (PTSD) is an anxiety disorder that can result from a traumatic or life-threatening event such as military combat. Thousands of servicemembers and Veterans struggle with PTSD. Often, they resist seeking help because of negative ideas about PTSD or the fear of what others might think. PTSD can affect personal relationships and even destroy families.

Question: Can you have PTSD even though you didn’t see combat?

Rothbaum_BarbaraDr. Rothbaum: Absolutely. PTSD can result from any event in which someone felt that they or someone they care about could be seriously injured or killed. Sexual assault survivors, motor vehicle crash survivors, natural disaster survivors, and many others develop PTSD. Approximately 10% of the US population at any given time has PTSD, and most of this is not from combat.

 

Question: What treatment options do you offer besides talking to a counselor? Talking has got me no where.

Rothbaum_BarbaraDr. Rothbaum: Good question. We offer what are known as evidence based treatments for PTSD, meaning that controlled studies have shown that these treatments work. “Talking therapy” alone is not one of the treatments that has been shown to work for PTSD. At Emory Healthcare Veterans Program, we are offering Prolonged Exposure (PE) therapy, Cognitive Processing Therapy (CPT), Virtual Reality Exposure Therapy (VRE), and others, as well as pharmacotherapy and the combination of pharmacotherapy and psychotherapy. We are offering two tiers of treatment: Tier I are the evidenced based treatments, and Tier II are more innovative treatments for folks who don’t receive an adequate response from Tier I treatments. You can learn more about the treatment options available at http://emoryhealthcare.org/veterans-program/treatments-services/index.html

 

Learn more about the Integrated Memory Care ClinicTo make an appointment, call 888-514-5345

You’re Not Alone: A Mental Health Message for our Veterans

Veterans are 15x more likely to suffer from PTSD. If you have a service-related mental health issue, you’re not alone. Get help today.Our veterans and service members are some of the most brave men and women in our country. They’re passionate and disciplined when it comes to protecting and serving our country, which is a commitment we’re grateful for every day.

The invisible wounds of war

That bravery continues off duty as well — many carry the heavy weight of the sights and experiences they encountered while serving. Consider these statistics:

  • 20 percent of veterans who served in Iraq or Afghanistan suffer from depression or post-traumatic stress disorder (PTSD).
  • A 2014 JAMA Psychiatry study found PTSD to be 15 times more likely for veterans and service members compared to civilians. The same report found depression to occur 5 times more frequently among military members than civilians.
  • The same study from JAMA found 1 in 4 active duty military members suffer from a mental health condition.

PTSD, anxiety, traumatic brain injury (TBI), military sexual trauma (MST) and other mental health conditions can all occur as a result of military service. And, these health issues are every bit as serious as injuries we can see.

Healing these wounds

Our veterans and service members need access to quality mental health programs. They also need to know it’s okay to talk about their experiences. If someone you love may be suffering from a mental health issue, please check in with them regularly. Ask them how they’re doing and be ready to simply listen.

If you’re a veteran or service member suffering from any mental health symptom or condition, please reach out for help. Talk to a friend, family member or fellow veteran. Most importantly, don’t be afraid to seek professional help. You should never be embarrassed to get treatment for a mental health issue.

Honor our veterans and service members this Veterans Day by sharing this message with others. You can also help change the way the world sees mental health by taking the stigma-free pledge.

Do you want to learn more about the Emory Healthcare Veterans Program?

Yes, I want to learn more now.

A Look at the Emory Brain Health Center

More than 42 million people in the United States are fighting brain diseases such as depression, Alzheimer’s disease, post-traumatic stress disorder, stroke, epilepsy and Parkinson’s disease. In fact, chronic neurologic and psychiatric conditions are predicted to be the greatest health issue facing our aging population in the coming years.

To learn more about the Emory Brain Health Center and hear directly from patients about the care they received, please watch this video.

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Veterans Reintegration and Mental Health Live Chat

vet-ptsd-chatAre you experiencing a difficult reintegration process after returning from a military deployment? Are you a spouse or loved one with questions about how to best prepare for a service member’s return home and how to navigate this joyful yet stressful time?

Join Dr. Sheila Rauch, clinical director of the Emory Healthcare Veterans Program, for a live web chat Tuesday, November 10 at 12pm EST. You can ask questions and get real answers regarding PTSD, military deployment-related stress, and the complexities of reintegration. Register for this live chat here. 

When a deployed service member returns home, reintegration with friends and loved ones can be difficult; profoundly more so for those suffering from posttraumatic stress disorder (PTSD). Among other things, the contrast between a service member’s expectations upon returning home and what he or she actually experiences can create stress for everyone involved. Mental health issues, including PTSD, depression, substance misuse, grief, anger, and even suicide, may arise during this reintegration process. While any or all of these issues could occur, excellent treatment resources are available through the Emory Healthcare Veterans Program and the VA.

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Emory’s Veterans Program is Helping Heal the Invisible Wounds of War

military-familyEmory Healthcare launched Emory’s Veterans Program Sept. 1, a new program for veterans offering clinical care, research and education, focusing on comprehensive treatment for post-9/11 veterans suffering from Posttraumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI), anxiety, depression and conditions stemming from Military Sexual Trauma (MST). Comprised of several initiatives committed to the health and wellbeing of veterans, including Wounded Warrior Project’s newly established Warrior Care Network, Emory is one of four academic medical centers that make up the national network offering quality mental health care for post-9/11 veterans, at no cost to qualified individuals.

“Our program focuses on helping heal the invisible wounds of war, particularly posttraumatic stress disorder and traumatic brain injury,” says Barbara Rothbaum, PhD, director of Emory’s Veterans Program and professor of psychiatry and behavioral sciences at Emory University School of Medicine.

According to research conducted by RAND Corporation, about 18.5% of Operation Iraqi Freedom and Operation Enduring Freedom veterans suffer from PTSD or depression, and 19.5% report having experienced a traumatic brain injury during deployment.

Emory’s Veterans Program is collaborative by design and incorporates top specialists in psychiatry, psychology, neurology, rehabilitative medicine and wellness into a treatment team that assess each veteran’s needs in order to develop a comprehensive, individualized treatment plan.

“It is important to be able to meet a veteran where he is, and provide individualized treatment plans using a collaborative approach,” says Rothbaum. “We’re so committed to this that we have hired veterans to fill critical positions within the program to ensure we are appropriately meeting the needs of the service members we treat.”

Treating victims of military sexual trauma is another aspect of Emory’s Veterans Program. According to the Department of Veterans Affairs, an estimated 20,000 service members, both male and female, endured military sexual trauma in 2014 alone, ranging from sexually hostile work environments to rape. Treatment often involves prolonged exposure therapy that incorporates virtual reality technology as well as other types of therapy and medications.

Collaborating with the Center for Deployment Psychology and several other organizations, Emory’s Veterans Program strives to enhance providers’ ability to deliver quality care to veterans. The program provides free, specialized training to community behavioral health providers in understanding military culture and how it plays a part in the treatment of service members.

For more information about Emory’s Veterans Program, visit www.emoryhealthcare.org/veterans. To reach the Care Coordinator, call 888-514-5345.