PTSD: Civilians fight for effective treatment: shots

Lauren Walls had lived with panic attacks, nightmares and flashbacks for years. The 26-year-old teacher from San Antonio sought the help of various mental health professionals, including five years and at least $ 20,000 with a therapist who used a Christian-based approach, considering his condition as part of a spiritual weakness. could be defeated – but his symptoms worsened. She reached a breaking point two years ago when she envisioned suicide.

In his search for help, Walls met a psychiatrist who diagnosed him with post-traumatic stress disorder. As a result, she sought a therapist specializing in trauma treatment, and it was at that point that she finally felt relief.

"It was like a world of difference," says Walls.

Seeing yourself as a person with PTSD was strange at first, Walls recalls. She is not a veteran and thought that the PTSD was a diagnosis reserved for the military. But her psychologist, Lindsay Bira, explained that Mr. Walls had probably developed the mental disorder after years of violence, neglect and poverty in childhood.

PTSD has long been associated with combatants and first responders who may be trauma victims in their work. It is also associated with victims of sexual assault, road accidents and natural disasters. But researchers have also learned that this can develop in adults who are chronically traumatized during childhood, who are physically, emotionally or sexually abused by caregivers, neglectful or overworked. other breaches of security.

Walls was lucky enough to find a therapist trained to treat PTSD. Apart from military and veteran health facilities, it is often difficult to find competent help.

A limited number of more than 423,000 mental health counselors, therapists, psychologists and psychiatrists from the United States are trained in two key therapies, Cognitive Therapy (CPT) and Extended Exposure Therapy (PE). These are treatments recommended as part of the care of a patient by the American Psychiatric Association and the Department of Veterans Affairs, who have studied the treatments for post-traumatic stress disorder as it affects patients. many members of the services.

There is no definitive count of people trained in these therapies and neither the American Psychiatric Association nor the American Psychological Association follow this data. A 2014 study by Rand Corp. revealed that only about one-third of the psychotherapists had taken the training. The VA claims that more than 6,000 of its therapists have, although lists of CPT and PE organizations list only a few hundred practitioners.

Nevertheless, the VA's National PTSD Center wants to expand access to these treatments, and regional groups, including those in Texas, are following suit. Texas needs more PTSD providers: it is the second country in terms of the number of victims of human trafficking, the first state in terms of refugee resettlement, the largest number of non-migrant children accompanied by all states and the second in California the number of members of military service – all the factors that increase the risk of PTSD.

UT Health San Antonio, a medical school and hospital at the University of Texas, explains to community mental health service providers how to administer both treatments for PTSD through its star training initiative strong. Funded by the Texas Veterans + Family Alliance Grant Program and the Bob Woodruff Foundation, this initiative has trained 500 providers since its launch in 2017. Most of the training takes place in San Antonio, and many of the participating mental health professionals are based in Texas, although they also come from Florida, Illinois and other states.

In February, about twenty therapists gathered in a conference room of the Faculty of Medicine. Calleen Friedel, a marriage and family therapist based in San Antonio, was one of them. She said that she saw more people with PTSD and that she often felt unable to help them.

"I would just do what I know and do my own reading," Friedel said. "And what I had taught at the Graduate School, it was more than 20 years ago."

The group has heard of one of the traditional treatments, Extended Exposure Therapy, which is gradually exposing patients to traumatic memories to help reduce their symptoms of PTSD. Strong Star also teaches Cognitive Therapy, which is about helping patients learn to reframe their thoughts about trauma. But the two therapies – often referred to as "evidence-based" because of the research supporting their effectiveness – have been slow to gain ground among psychotherapists because they require the therapist to follow a scenario and differ from the approach. routine treatment of mental health problems.

Edna Foa, who created Prolonged Exposure, said in a 2013 journal article that many psychotherapists were convinced that it was essential to delve into the inner life and the story of their patients. In contrast, highly structured and evidence-based treatments, with their pre- and post-session assessments and their emphasis on symptom relief, may seem "narrow and boring," she wrote.

In addition, some people living with PTSD have complained that treatments do not work for everyone. But, according to Foa and others, this targeted approach targets the brain mechanisms responsible for the symptoms of PTSD, and symptom relief is what many people with PTSD want.

Edwina Martin, a psychologist in Bonham, Texas, said that treatments such as those she studied at Strong Star were not common whereas she had completed her graduate studies there are more than 10 years. She now works in a VA health center after spending a decade in jails. She says that she wants these treatments for PTSD to be in her "tool bag".

The push to develop the trained workforce coincides with a growing understanding of the effects of trauma. The National Council of Behavioral Health, a non-profit organization of mental health providers, calls the trauma "an almost universal experience" for people with mental health and behavioral problems.

Because so many patients think that PTSD is essentially a military problem, Bira says, they face an obstacle to recovery.

"I understand all the time," says Bira. "The first steps in the treatment I see with civilians really concern education. [them] on what is PTSD and who can develop it ".

Kaiser Health News (KHN) is a non-profit news service covering health issues. It is an independent editorial program of the Kaiser Family Foundation which is not affiliated with Kaiser Permanente.