By Colleen Flaherty and Rose L. Thayer
Killeen Daily Herald
A private room at Logan's Roadhouse restaurant in Killeen buzzed with conversation last week, as soldiers and veterans shared their stories of dealing with combat-related post-traumatic stress disorder.
Invited by the National Academies Institute of Medicine, about 25 caregivers, patients, family members and community behavioral health specialists mingled with researchers who asked what issues or stumbling blocks they had encountered in their care and what improvements could be made.
Some suggested the military approach PTSD as it has suicide prevention - encouraging soldiers to check in with each other on a regular basis. Others suggested the military screen veterans over time for delayed-onset PTSD, not just during the immediate redeployment phase.
The 2010 National Defense Authorization Act mandated an independent study on the treatment of the disorder, which requires visits to Fort Hood, Fort Bliss in El Paso and Fort Campbell, Ky. The institute is the study's lead research agent.
"The committee is trying to identify the best way of treating PTSD, full spectrum," said Dr. Sandro Galea, chair of the institute's research committee, which spent two days at Fort Hood. The post was its first site visit.
The committee's four-year study will be released in two phases, Galea said. The first phase, which is scheduled for release next summer, will include information gathered during the site visits. The second phase will compare suggestions with current programs and care.
"We are trying to get a sense of how people feel. What do people feel are the challenges in prevention, assessment and diagnosis of PTSD," Galea said. "We hope to provide a clear recommendation that will result in and improve (Defense Department) care. They've been in support of our work because, in part, they see we can give them thoughts that might be useful."
Many studies on post
Galea's combat-related PTSD study is just the latest to center on Fort Hood, the military installation from which the most troops - some 700,000 - have deployed to the wars in Iraq and Afghanistan. Other ongoing and/or recently completed studies involving Fort Hood soldiers have tested a variety of pharmacological and psychotherapeutic treatments for the disorder.
Researchers, including STRONG STAR executive director Dr. Alan Peterson, called Fort Hood an ideal and necessary place to work. "It's the tip of the spear for the military," he said during a telephone interview from his office in San Antonio. "If we can figure out what worked for Fort Hood, it's likely that it will work at other installations, as well."
STRONG STAR was founded in 2008 as a research consortium after receiving $35 million from Congress to address PTSD in Iraq and Afghanistan war veterans. A collaboration between military, civilian and Veterans Affairs health care providers and researchers from across the country, the research group is based at the University of Texas Health Science Center at San Antonio. No less than 20 full-time researchers are supporting eight current studies at Fort Hood.
But the post's servicemen and women aren't guinea pigs, said Peterson, a retired Air Force psychologist. "In most of the studies, we're actually providing really good care designed to treat them as effectively as possible," he said.
He said two primary studies are testing treatments that have proven effective in civilian populations but have yet to be tested widely in military personnel.
The first is treating about 360 soldiers with prolonged exposure therapy. Led by Dr. Edna Foa of the University of Pennsylvania, the study involves recalling and confronting details of the traumatic combat incident.
The second study is led by Dr. Patricia Resick, a Boston-based psychiatry professor and an educator at the National Center for Post-traumatic Stress Disorder. It tests cognitive processing therapy in a variety of settings, including group ones.
Other STRONG STAR research studies at Fort Hood, include neuroimaging, genetic and environmental predictors, comorbidity of fibromyalgia and insomnia, and tracking the disorder's trajectory. A meta-study combining different research areas is planned.
"Everybody that's involved is very excited about (the research)," Peterson said. "We feel like it's the most important work of our careers. This entire generation of vets is coming home, and if we don't do something different, we'll have something similar to Vietnam, where 30 years from now we have people with combat-related PTSD that are not getting better."
Peterson said most STRONG STAR researchers have offices at Carl R. Darnall Army Medical Center, but requests to hospital administrators for comment on Fort Hood's role in combat-related PTSD research were not met last week.
Valuable testing ground
Recent research studies suggest that 5 to 17 percent of military personnel returning from deployments to Iraq and Afghanistan have symptoms of PTSD, according to information from STRONG STAR.
Dr. Paul Hicks, associate chief of staff for research at Central Texas Veterans Health Care System, is loosely collaborating with STRONG STAR on his study of the efficacy of Prozac in treating combat-related PTSD. More than 30 moderately to severely ill Fort Hood soldiers are involved.
Surprisingly, Hicks said, there's little current research on how successful antidepressants are in treating combat-related PTSD, and Fort Hood is a valuable testing ground.
"There are a lot of people who have been exposed to war trauma and many symptomatic people," he said.
Neither Peterson nor Hicks had findings to release. Their studies will continue through at least next year.
One study involving 139 Fort Hood soldiers was published in April's American Journal of Psychiatry. Co-authored by Dr. Michael J. Telch, principal investigator of the University of Texas at Austin's Texas Combat PTSD Risk Project, the study found that soldiers who avoided fearful facial imagery in visual stimulus screenings before deployment were more likely to report symptoms of combat-related PTSD following.
Telch's research focused on isolating possible factors that predispose soldiers to PTSD.
Fort Hood plays a strong role in PTSD research and that's a good thing, Telch said. "There's been a lot of increased recognition of the role of PTSD in the military and consequently much more quality research is being done."
What is PTSD?
Post-traumatic stress disorder is an anxiety condition that can occur after a person has been through a traumatic event, which is defined as something horrible and scary that is witnessed or experienced.
During this type of event, a person thinks his or her life or the lives of others are in danger. A person may feel afraid or feel as though he or she has no control over what is happening.
After the event, the person may feel scared, confused or angry.
If these feelings don't stop or get worse, he or she may have PTSD. These symptoms may disrupt a person's life, making it hard to continue with daily activities.
What are the symptoms?
There are four types of symptoms of PTSD: reliving the event, avoidance, numbing and feeling keyed up.
Symptoms usually start soon after the traumatic event, but they may not happen until months or years later. They also may come and go for many years.
If the symptoms last longer than four weeks, cause great distress or interfere with work or home life, it is probably PTSD.
Source: U.S. Department of Veterans Affairs