Thursday, May 14, 2015

The Department of Veterans Affairs and PTSD Paper


The U.S. Veterans Affairs and Post Traumatic Stress Disorder
There are many issues in this world that remain unresolved for various reasons. I believe that one reason why things remain unresolved is because we fail to analyze things with an interdisciplinary approach. Interdisciplinary is defined as a cognitive process that evaluates different disciplines’ views to find common ground among them and better understand an issue or problem (Repko123). Approaching problems with an interdisciplinary approach is important because many problems cannot be solved by a single discipline.
            A very debated issue in today’s society is the United States Department of Veterans Affairs. The Veterans Affairs system, also known as the VA, is a government organization that was founded in 1930 which provides benefits for people who served in the military (United States Department of Veterans Affairs 2014).  The reason why the VA system is so heavily debated is because many people question whether or not veterans receive the benefits and care they deserve and were promised. A very common disability among service men and women is Post Traumatic Stress Disorder. Many veterans diagnosed with PTSD receive benefits and treatment through the VA. With PTSD being such a common disorder, it is questionable as to whether or not Veterans Affairs provides quality care for PTSD patients. Men and women who have served for our country and put their life at risk for our freedom without a doubt deserve superb care.
            Treatment of PTSD is very complex. The severity of the disorder varies drastically from person to person; therefore, treatment is going to vary from person to person, as well. Additionally, as if the disorder is not complex enough, the VA is also a very intricate system. There are numerous processes veterans must go through in order to get diagnosed and to receive treatment. The approach to treating PTSD patients through the VA must integrate concepts and practices from multiple disciplines. For example, PTSD should not be treated by psychologists alone. Occupational therapists, psychologists, psychiatrists, social workers, pharmacologists, acupuncturists, yoga instructors, dog trainers, and organization leaders all can contribute to the treatment of PTSD. Potentially relevant disciplines include psychology, sociology, natural sciences, biology, pharmacology, exercise science and economics. The most relevant include psychology, pharmacology, and economics. Psychologists incorporate cognitive behavioral therapy, pharmacologists can administer certain medications, and the economy fuels the VA and various foundations.
            After conducting a literature search and researching the topic, it is very evident that psychology is one of the most relevant disciplines to the treatment of PTSD through the VA.  Cognitive based therapy includes Cognitive Processing Therapy and Prolonged Exposure Therapy. These forms of therapy have proven to have positive effects on PTSD. Cognitive Processing Therapy aims to change how a patient perceives the trauma they experienced. It also aims to help the patient comprehend how they may bring stress onto themselves and, as a result, make their condition worse. Veterans should be able to effectively deal with feelings of anger, guilt, and being afraid following cognitive therapy (United States Department of Veterans Affairs 2014). It is common that we associate bad memories with being afraid, being fearful, and angry. However, Prolonged Exposure Therapy aims to desensitize veterans of their bad memories. By talking about those memories and what types of feelings they evoke, veterans are able to gain better control of their feelings, thoughts, and actions (United States Department of Veterans Affairs 2014). Eye Movement Desensitization and Reprocessing is another treatment that is commonly used for PTSD. Eye Movement Desensitization and Reprocessing is being implemented for treatment of PTSD, as well. This involves the patient tracking the movement of a therapist's hand or foot with their eyes. The therapist may tap their hand or foot, while the patient recalls their traumatic memories. This allows the patient to openly talk about what they went through or witnessed while focusing on something else (United States Department of Veterans Affairs 2014). In addition, pharmacology is commonly used in treating PTSD. Different medications have proven to be effective in helping people cope with their PTSD and various symptoms that they experience. For example, selective serotonin reuptake inhibitors, which are classified as an antidepressant, are commonly prescribed (United States Department of Veterans Affairs 2014).
            While these treatments have proven to be effective, there are other areas to explore as well. Group therapy, family therapy, acupuncture, yoga, medical marijuana, psychodynamic psychotherapy, and the use of service dogs are all alternative routes that are worth exploring.
Group therapy is a form of treatment where veterans can come together and discuss their experiences with each other. This could be helpful for people who benefit sharing memories with people similar to them and who personally understand what they're going through (United States Department of Veterans Affairs 2014). 
Psychodynamic psychotherapy helps veterans comprehend how their traumatic experience from the past impact how they feel presently. This helps veterans gain control of their feelings and identifies what memories cause PTSD symptoms (United States Department of Veterans Affairs 2014). 
Family therapy is beneficial for veterans with families. PTSD can affect a veteran's family tremendously. Not only does the veteran get counseled, but so does the family. This is an opportunity for both the veteran and their family to express their fears, concerns, stressors and more. This type of therapy can be essential in building a solid support group for the veteran at home (United States Department of Veterans Affairs 2014). 
Defense Centers of Excellence provides a brief statement regarding complimentary and alternative medicine: "Complementary and alternative medicine (CAM) approaches are often considered alternative to typical medical practices. Acupuncture is often considered a CAM treatment. There is some evidence that acupuncture may improve PTSD symptoms and acupuncture may be considered a treatment for patients with PTSD. Broadly, other forms of CAM include natural products, mind-body medicine, body manipulation and movement techniques, and energy techniques. Overall, there is insufficient evidence to recommend CAM approaches as a first line of treatment for PTSD. Several CAM approaches, such as mindfulness and yoga, are similar to traditional medical relaxation techniques and may be considered as adjunctive treatment of hyperarousal symptoms, although the relative effectiveness of these treatments is unknown. CAM approaches may be considered for patients who refuse other treatments, but providers should consider the risks of CAM approaches and keep in mind that treatments that have a limited evidence base for effectiveness also have a limited evidence base for potential harm and side effects (Defense Center Of Excellence 2015)."
Additionally, an article in the New York Times discusses psychomotor therapy as a successful treatment for PTSD. Bessel van der Kolk, a Dutch psychiatrist, practiced psychomotor therapy on an Iraq War veteran. Pyschomotor therapy was developed by a dancer named Albert Pesso. This therapy involved PTSD victims reenacting their experiences with other people. While the veteran plays out what happened, people serve as characters in his story and recreate his experience. During the traumatic portion of the experience, the characters feed the veteran words of encouragement and forgiveness. Recreating the experience allows the veteran to associate those positive feelings with their memory rather than their negative associations, which lead to symptoms of PTSD. The article stated that this kind of therapy is not commonly practiced or supported, however, this psychiatrist believes it can really benefit some people (Interlandi 2014).
In contrast, in a WQAD article the topic of medical marijuana is discussed. Recently at an Illinois Medical Cannabis Advisory Board meeting, it was suggested that PTSD be added as a condition that elicits the use of medical marijuana (Simmons 2015).
Many of these treatments are not clinically supported. Fortunately, because PTSD is such a significant issue, more funding is being provided for suicide prevention, which unfortunately sometimes is a result of people who suffer from PTSD (Parnell 2015). Additionally, a law was passed this year with the intention of improving the VA's psychiatric services and suicide prevention (Parnell 2015). Perhaps some of this funding should also go towards researching these various alternative and non-traditional treatments.
While cognitive behavioral therapy, family therapy, group therapy, psychodynamic psychotherapy and psychomotor therapy all fall under the discipline of psychology, there are many different disciplines involved in the treatment of PTSD. For instance, pharmacology is a popular discipline involved through the distribution of medications and exercise science is involved through the implementation of yoga. Due to the severity of PTSD varying so much, it is important the degree and types of treatments vary as well. Additionally, it is important to understand that perhaps medications and cognitive behavioral therapy do not work for every veteran. It is likely that Exposure Therapy does not work for every veteran with PTSD but maybe acupuncture would. It is essential that we explore all options due to the wide range of severity in PTSD. 
Furthermore, a system needs to be developed that aids physicians in being able to better diagnose veterans. Physicians report having a hard time distinguishing people who genuinely have PTSD and people who are claiming to have PTSD to receive the benefits. This is where economics ties in. We need people to stop taking advantage of the system so that those who truly need it and deserve it can receive their maximum benefits and be taken care of. Some service men and women exaggerate or fabricate symptoms of PTSD to receive the benefits. In an article produced by LA Times, it was stated that about half of veterans claiming to have PTSD are exaggerating or lying about their symptoms (Zarembo 2014). Payments to veterans with PTSD are approximately $49 billion (Zarembo 2014). What is concerning is how much of those payments are going to people who are not genuinely suffering from PTSD. Zarembo brings up a great point that something that might traumatize one person may not even bother another. These kinds of predicaments make it challenging for physicians to properly and accurately diagnose veterans. A diagnosis for a disorder like PTSD that relies heavily on what the patient reports is a tough call to make. How is someone able to or even allowed to accuse someone of fabricating symptoms for something as serious and as tragic as PTSD? Additionally, there are online forums instructing service members what to do when they go in for their evaluation prior to separating from the military. For instance, "Dress poorly and don't shower, refuse to sit with your back to the door, and constantly scan the room (Zarembo 2014)." This kind of behavior is frustrating for not only physicians, but victims of PTSD. Physicians are challenged with properly diagnosing veterans, however, it can only be assumed that veterans who suffer from PTSD are outraged to hear of people exaggerating symptoms or lying completely to receive benefits. 
In addition to all of the treatments proven effective and those that are still in the shadows, organizations, foundations, and campaigns help bring awareness to the problem as well as support veterans with PTSD in many different ways. It is essential that veterans are provided with various support groups, organizations, and funds. Fortunately, there are many different support groups, organizations, and foundations solely for veterans and veterans with PTSD.
The Battle Buddy Foundation accepts donations and partners with other organizations to provide service dogs to qualifying veterans. The goal of this foundation is to allow wounded veterans, physically and/or mentally, to presume a normal life and adapt to the civilian world with the help of a service dog (TBBF 2015). The service dogs serve as not only a guard dog but also a dog that has the ability to wake their owners up from night terrors, watch their back so the person doesn’t feel anxious, guide them through crowded situations, and more.
Stop Soldier Suicide is another organization established by a veteran. The organization does not claim to be a team of medical professionals but rather a bridge to help service members get help. They are made up of veterans and active duty service men and women. They connect with the service member, they assess and triage, and then they help transition and follow up. The service member can either contact them through their Facebook page, partner organizations, or their 24/7 Resource Center. They then talk with the person and assess their individual needs and the severity of those needs. They will connect them to the proper resource to get them the right help that is best suited for them. Additionally, if they are in crisis and do not want to contact the VA crisis hotline, they will connect them with a VA counselor and stay on the phone with them while they get help. They follow up with people who reached out to them for up to 2 years depending on the severity of the person's needs and the help they received (Stop Soldier Suicide 2014). 
#22KILL is a nonprofit Honor Courage Commitment, Inc. campaign that advocates for the prevention of suicide. They provide people with the VA crisis hotline, as well as Team #22KILL. Team #22KILL is made up of 1,150 active duty men and women, reservists, and veterans who provide their contact information for people in need. Anyone can access their contact information and call them to simply talk, vent, seek guidance, or ask advice. Additionally, they host events, fundraisers, and more. They are commonly recognized for their #22KILL rings that people wear to support those who serve or have served for our country (HCC, Inc. 2015).
Although these may not be considered treatments, they are benefits to service men and women. These are organizations, foundations, and campaigns that support the battles service members face and help them live a normal and enjoyable life, free of fear. 
I believe this topic is the epitome of a problem that requires an interdisciplinary approach. This problem is so complex and important to our society; it is not possible for a single discipline to resolve it. Researching this problem with an interdisciplinary approach opened my eyes to a much bigger picture. It is not as simple as solving PTSD through the VA system with psychology, this problem involves much more than that; there are so many different pieces to the puzzle. Treating PTSD is a very complex process in itself and it does not have a single answer that will solve everything.            
Additionally, the VA is a multipart system that attempts to treat a wide range of PTSD with treatments that have proven to be most effective. To advance we need to find a way to distinguish the severity of PTSD among veterans. We also need to prescribe treatments that fit the person and not just because it is most effective. That being said, some treatments that are not supported by research need to be explored further so that they can be utilized or put to rest. For instance, yoga, acupuncture, psychomotor therapy, and medical marijuana. In addition to treatments, outside organizations, foundations, and campaigns are just as important. Having foundations such as The Battle Buddy Foundation can further benefit veterans. This is why assessing this problem with an interdisciplinary approach is key. Treating a veteran with PTSD with cognitive behavioral therapy alone may be effective, but not as effective when combined with a service dog, a yoga routine, monthly acupuncture, and more. Assessing the problem from all angles, and not just one, is essential to delivering veterans the quality care they deserve.
            The Veterans Affairs system and its involvement with patients diagnosed with post traumatic stress disorder is a very complicated and multifaceted topic that cannot be broken down and resolved in a single research paper. However, assessing the topic and conducting research can take us one step closer to guaranteeing quality care for our veterans.
My Interdisciplinary Studies degree that mirrors an Allied Health Science track incorporates Biology, Chemistry, and Physical Education. This major has taught me to assess situations, such as this one, with an interdisciplinary approach drawing from each discipline. Being able to study three different disciplines and integrate them together, I have been able to more comprehensively understand problems and situations. I currently work as a High Intensity Tactical Trainer on Camp Lejeune in North Carolina. I physically train marines and sailors daily to prepare them for deployment and to help them post-deployment. PTSD can be a very sensitive topic for many people, so it is not often that I am made aware of a marine or sailors mental health. However, for those marines and sailors who do have PTSD who come to my training sessions, perhaps our workouts not only prepare them physically but also mentally. Maybe physically training helps people with PTSD because it puts their focus elsewhere and releases endorphins. I am grateful for having the opportunity to major in Interdisciplinary Studies. Any problem can be approached with an interdisciplinary approach, and it is those approaches that will lead to comprehensive solutions for the better of others and ourselves.





References
Basu, M. (2014) "Why Suicide Rate among Veterans May Be More than 22 a Day - CNN.com." Cable News Network. Retrieved from http://www.cnn.com/2013/09/21/us/22-veteran-suicides-a-day/

Defense Center of Excellence (2015). PTSD Fact Sheet. Retrieved from http://www.dcoe.mil/Libraries/Documents/DCoE_PTSDFactSheet_20140410.pdf 

Defense Center of Excellence (2015). PTSD Treatment Options. Retrieved from http://www.dcoe.mil/PsychologicalHealth/PTSD_Treatment_Options.aspx   

Honor Courage Commitment, Inc. (2015). #22KILL. Retrieved from http://22kill.com

Interlandi, J. (2014) "A Revolutionary Approach to Treating PTSD." New York Times. Retrieved from http://www.nytimes.com/2014/05/25/magazine/a-revolutionary-approach-to-treating-ptsd.html?_r=0

Parnell, S. (2015) "We’re Not Doing Enough to Help Veterans with PTSD." Olean Times Herald. Retrieved from http://www.oleantimesherald.com/commentary/article_34cfd740-f346-11e4-bc66-a31d0251f42a.html

Repko, A. F. (2014). Introduction to Interdisciplinary Studies. Thousand Oaks, California: SAGE Publications, Inc.

Simmons, S. "Veteran Says Treating PTSD with Marijuana Is a Double-edged Sword." WQAD8. Wqad.com, 5 May 2015. Web.

Stop Soldier Suicide (2014). Our Approach. Retrieved from http://stopsoldiersuicide.org/about/our-approach/

The Battle Buddy Foundation (2015). Service Dog Program. Retrieved from http://tbbf.org/service-dog-program

United States Department of Veteran Affairs (2014). PTSD: National Center for PTSD. Retrieved from http://www.ptsd.va.gov/public/treatment/therapy-med/treatment-ptsd.asp

Zarembo, A. (2014). "As Disability Awards Grown, so Do Concerns with Veracity of PTSD Claims." Los Angeles Times. Retrieved from http://www.latimes.com/local/la-me-ptsd-disability-20140804-story.html#page=1





1 comment:

  1. Excellent work!! I think perhaps some of your research could have come from more scholarly journals within the fields that you were exploring, but you did a wonderful job putting this together without a lot of support from us at PSU (which includes me, but also a library staff and all the rest that you had to do without). You work your way through the Broad Model really thoroughly, and the end, where you talk about your own work now, is so compelling (I almost wish there was a bit more of your personal experience in here to make the research come alive a bit more). Great work in a tough situation working remotely like this. WELL DONE!

    ReplyDelete