Suicide and Treatment of PTSD at the VA

AUSTIN, TX, March 05, 2013 (Press-News.org) Despite a high percentage of soldiers with posttraumatic stress disorder (PTSD) and the increasing rates of suicide, the Department of Defense has failed to research one of the most effective and widely recognized trauma treatments, Eye Movement Desensitization and Reprocessing (EMDR). EMDR is included as a first line treatment for PTSD in numerous national and international practice guidelines as well as in the Veterans Administration/Department of Defense's (VA/DoD) own Clinical Practice Guideline for the Management of Post-Traumatic Stress (2010). See EMDR research and practice guidelines at the website below.

Early studies using EMDR with military personnel found that EMDR was effective and led to remission of PTSD symptoms in 78 percent of soldiers (Carlson, et. al., 1998). EMDR was also better tolerated by the soldiers than the military's commonly used talk therapy, Cognitive Processing Therapy (CPT). This may be because EMDR is less dependent on the person with PTSD having to talk about the event and there are no homework assignments. Despite early studies using EMDR to treat PTSD in the military that were very promising, proposals for additional studies were denied.

Although a growing body of evidence over the last twenty years has shown that EMDR is an effective trauma treatment for civilians, the Department of Defense has funded no studies that evaluate the effectiveness of EMDR for treating PTSD among military personnel. The Department of Defense has, however, funded millions of dollars of research on what are considered adjunct therapies for PTSD according to clinical practice guidelines. These include pets, acupuncture, transcendental meditation, emotional freedom technique, tai chi, art therapy, reiki, yoga, and pharmaceutical agents (GAO, 2011). Drug studies include derivations of such drugs as marijuana and Ecstasy.

None of the Department of Defense studies compared the effectiveness of pharmaceutical agents and EMDR. A 2007 a study of civilians compared the effectiveness of EMDR and Fluoxetine (Prozac) and found that patients with PTSD who were treated with EMDR were symptom free after 6 months of treatment while none of the patients treated with Fluoxetine were symptom-free (van der Kolk). Eight months later, the EMDR patients were still symptom-free. This study could be easily replicated by the Department of Defense.

Not only does EMDR therapy appear to be more effective than pharmaceutical treatment for alleviating PTSD, it is also more effective than the military's primary therapy program, Cognitive Process Therapy (CPT). Remission rates for CPT and exposure, another type of therapy used at the VA for PTSD, are documented at 40% while EMDR is 78% (Schnurr et.al., 2007). A recent Congressional Report noted that CPT was completed by only 40% of soldiers who enrolled in the program (CBO, 2012). The notoriously high drop out rate and recidivism for CPT begs the question: Why are there No Funded Studies of EMDR by The Department of Defense And Why Is Training in EMDR Not Offered to Mental Health Clinicians at the VA?

Current suicide prevention activities of the Department of Defense, while necessary, are insufficient to stem the rising suicide rates. So far, the DoD has instituted a suicide prevention hot line and educated commanders and fellow soldiers about the signs of suicide. However, this is not enough. Treatment must also focus on one of the most serious risk factors that contribute to depression and suicide, untreated or inadequately treated PTSD. Effective methods for treating PTSD are available but the VA has provided their mental health clinicians with only CPT or Prolonged Exposure training not EMDR training (CBO, 2011). The Department of Defense needs to develop a research program that includes information on how EMDR works, which type of treatment (prolonged exposure, EMDR, or CPT) is more effective with which type of trauma, or symptom pattern, or presentation, or personality. It is time to determine how to best match treatment to the person's needs. This should then be followed by protocols for treatment and training for military therapists in all evidence-based therapies.

While pharmaceutical companies profit and it is easier to prescribe medications than to conduct psychotherapy, the evidence indicates that the human cost of pharmaceutical treatment is high and increasing. Psychoactive prescription drugs are increasingly implicated as the causative agent of the high suicide rate of our military. Of the troops with posttraumatic stress disorder, 80 percent are given psychoactive drugs with 89% of these prescribed antidepressants (Rosenheck, 2008). Antidepressants have been linked to suicidal thoughts/behaviors and black box warnings alert consumers and prescribers to these risks. It is interesting that the VA and DoD have ignored studies that have shown that psychotherapy is a more effective treatment for PTSD than medication. At 5-month follow-up after treatment, only 20% of those with PTSD who received psychotherapy still had PTSD compared to 60% of those on medication and 58% of those who received placebo (Shalev et. al, 2012). So why give medications at all when a sugar pill is just as effective without all the side effects? It is time to stop prescribing and to start providing evidence-based treatment.

A Time magazine cover article (July 23, 2012) reported that more soldiers have committed suicide than have died in the war in Afghanistan. The military/veteran mental health system is being overwhelmed and needs all the evidence-based psychotherapies as treatments to alleviate human suffering and counteract the enormous wave of tragic outcomes. There is an ethical mandate and a moral responsibility to provide our troops with all the best psychotherapies available. EMDR is one of the evidence-based therapies that should be available for the treatment of posttraumatic stress disorder for all veterans and active duty service men and women.

Kate Wheeler Ph.D., APRN-BC, FAAN
President
EMDR International Association
Professor
Fairfield University
Fairfield, CT

Carlson, J. G., Chemtob, C. M., Rusnack, K., Hedlund, N. L., &Muraoka, M. Y. (1998). Eye movement desensitization and reprocessing for combat-related posttraumatic stress disorder. Journal of Traumatic Stress, 11, 3-24.

Congressional Budget Office (2012). The Veterans Health Administration's Treatment Of PTSD And Traumatic Brain Injury Among Recent Combat Veterans. Congress of the United States.

Government Accountability Office. January 2011. VA Health Care: VA spends millions on post-traumatic stress disorder research and incorporates research outcomes into guidelines and policy for post-traumatic stress disorder services. Subcommittee on Health, Committee on Veterans' Affairs, House of Representatives. Report to the Ranking member, Report 11-32.

Rosenheck, M.S. (2008). Pharmacotherapy of PTSD in the U.S. Department of Veterans Affairs: diagnostic- and symptom-guided drug selection. Journal of Clinical Psychiatry. 69(6):959-65.

Schnurr, P. P., Friedman, M. J., Engel, C. C., Foa, E. B., Shea, M. T., Chow, B. K., Bernardy, N. (2007) Cognitive behavioral therapy for posttraumatic stress disorder in women: A randomized controlled trial. Journal of the American Medical Association, 297, 820-830.

Shalev, A.Y., Ankri, Y.L, Israeli-Shalev, Y., Peleg, T., Adessky, R.S., & Freedman, S.A., (2012). Prevention of posttraumatic stress disorder by early treatment: Results from the Jerusalem trauma outreach and prevention study. Archives of General Psychiatry, 69, 166-176.

van der Kolk, B. A., Spinazzola, J., Blaustein, M. E., Hopper, J. W., Hopper, E. K, et al. (2007). A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), Fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: Treatment effects and long-term maintenance. Journal of Clinical Psychiatry, 68(1) pp. 37-46.

About EMDRIA
Formed in 1995, the EMDR International Association is a professional association where EMDR practitioners and EMDR researchers seek the highest standards for the clinical use of Eye Movement Desensitization and Reprocessing (EMDR).

Website: http://www.emdria.org