WASHINGTON (Army News Service, Sept. 23, 2014) – The most effective way to treat post-traumatic stress disorder is to stay in treatment and, if possible, attend therapy with a friend or loved one, said Lt. Col. (Dr.) Gary Wynn.
Wynn, who is assistant chair, Department of Psychiatry at the Uniformed Services University of the Health Sciences and a scientist at the Center for the Study of Traumatic Stress, spoke today, at the Psychological Health and Resilience Summit at Defense Health Headquarters, Falls Church, Virginia. His topic was “Post-Traumatic Stress Disorder.”
A survey of some 400 Iraq and Afghanistan veterans revealed that “by session eight, 70 percent were out the door,” he said, adding that treatments typically take about 12 sessions. “They won’t see the benefits if they don’t stay.”
Staying in treatment is “even more important than what kind of treatment you give them,” he added.
Another word of advice from the doc: therapy “works better when you do it together with a partner.” When patients stay in treatment, the healthful benefits have been shown to be longer lasting than those who skip out, and partnering with someone in treatment adds to the effectiveness.
There are so many types of treatment out there that it can be confusing for doctors, not to mention patients, Wynn said, citing three categories with many choices within each:
DRUGS
At this time, there are only two drugs approved for post-traumatic stress disorder, known as PTSD, by the Food and Drug Administration, Wynn said: Paroxetine or Paxil and Sertraline or Zoloft.
However, there are a lot of other drugs in use and a lot of trials currently taking place, so a lot more information will be known about those drugs in the future. Some are showing promise.
The best advice for now: “Find a physician who specializes in PTSD psychopharmacology before thinking about anti-psychotic drugs,” he said.
NON-CONVENTIONAL
Think herbal remedies, mind and body “hands-on stuff,” he said.
Do they work?
Some of them do, “but we’re really not sure why,” he admitted.
It’s hard to get clinical trials with limited research dollars, he said. It’s also hard to measure and track.
For instance, some have found Brazilian Jujitsu Therapy to be effective, Wynn said. But, just what types of moves and how many moves are needed for it to work are just two of many variables that would need to be controlled for, he said.
Aroma Therapy is another. It’s effective in some “but we’re not sure why.” Homeopathy can be effective but it too is hard to test, he said.
So far, there have been very few studies on non-traditional treatments, he said.
However, that doesn’t mean they should all be rejected out of hand. Again, more will be learned in time, he predicted.
Wynn himself said he advocates some of these non-traditional approaches. “Virtual reality is probably the most robust and very compelling” and as a bonus, more patients stay in treatment.
Besides Virtual Reality Therapy, Wynn said he often suggests yoga. “It definitely does no harm, but we’re not sure of its specific mechanisms of helping.” It seems to work though.
Acupuncture seems effective as well, he said, as is Art Therapy.
PSYCHOTHERAPY
Psychotherapies almost all have good evidence of being effective, Wynn said. These therapies include: Trauma-Focused, Image Rehearsal, Web-based Cognitive Behavioral, Dialectical Behavior, Acceptance and Commitment, Exposure, Cognitive, Stress Management, Eye Movement Desensitization and Preprocessing and on and on.
Which psychotherapy to choose then?
“The patient’s preference is most important,” he said. “The patient should feel empowered.”
Wynn explains that he often offers the patient a choice between two therapies. “They may not completely understand the choice. I just want them to make the choice so they feel like they own it.”
Another thing about treatments, he said, is that veterans from Vietnam, the Gulf War, Iraq and Afghanistan all respond similarly to therapy, as long as they attend all of the required sessions.
One last prescription from the doc: don’t be afraid to seek help.
Wynn has dealt with a number of Soldiers suffering from PTSD and their initial response is to deny having any problems. Admitting the need for help is the first step.