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Veteran’s Fact Sheet

Veteran’s Fact Sheet

A General’s New Mission: Leading a Charge Against PTSD

Brig. Gen. Donald C. Bolduc, commander of American Special Operations Forces in Africa, tells soldiers that it is all right to get help for brain injuries and mental health problems. CreditAndrew Harnik/Associated Press

STUTTGART, Germany — It might have been the 2,000-pound bomb that dropped near him in Afghanistan, killing several comrades. Or maybe it was the helicopter crash he managed to survive. It could have been the battlefield explosions that detonated all around him over eight combat tours.

Whatever the cause, the symptoms were clear. Brig. Gen. Donald C. Bolduc suffered frequent headaches. He was moody. He could not sleep. He was out of sorts; even his balance was off. He realized it every time he walked down the street holding hands with his wife, Sharon, leaning into her just a little too close.

Despite all the signs of post-traumatic stress disorder, it took 12 years from his first battlefield trauma for him to seek care. After all, he thought, he was a Green Beret in the Army’s Special Forces. He needed to be tough.

General Bolduc learned that not only did he suffer from PTSD, but he also had a bullet-size spot on his brain, an injury probably dating to his helicopter crash in Afghanistan in 2005.

Now, after three years of treatment, General Bolduc is doing better. And, in his role as commander of American Special Operations Forces in Africa, he has become an evangelist for letting soldiers know that it is all right to get help for brain injuries and mental health problems.

“I’ve really seen a difference in myself,” General Bolduc, 54, said. “There are still the nonbelievers. We’ve got to get to them.”

That means changing attitudes that equate mental illness with weakness. Donald J. Trump, the Republican presidential candidate,said in a speech this week that some veterans returning from war “can’t handle” the stress. Mr. Trump was arguing for mental health services, but the remark drew scorn from veterans’ groups that work to reduce the stigma. Mr. Trump’s campaign has said his remarks were taken out of context. A spokesman for General Bolduc declined to comment.

On a recent afternoon, General Bolduc, his starched uniform weighed down by a giant patch of colorful ribbons and medals across his chest, stood ramrod straight at the Stuttgart headquarters from which he commands Special Operations fighters battling the Islamic State, Boko Haram, the Shabab and other terrorist groups in Africa, and he declared, “I’m in counseling.”

General Bolduc wants soldiers under his command — who are stationed in some of the continent’s most difficult parts — to know that seeking help will not hurt their careers. In his opinion, PTSD is the same as a broken arm.

“The powerful thing is that I can use myself as an example,” General Bolduc said. “And thank goodness not everybody can do that. But I’m able to do it, so that has some sort of different type of credibility to it.”

Other high-ranking officers have come forward to talk about their struggles with post-combat stress and brain injuries. And in recent years, Special Operations commanders have become more open about urging their soldiers to get treatment.

Gen. Joseph L. Votel, then the head of the United States Special Operations Command, spoke to CNN last spring about ending the stigma tied to seeking treatment. “It is absolutely normal and expected that you will ask for help,” he said.

The stigma can be particularly acute in specialized military units, like the Green Berets and the Navy SEALs, that are trained for the toughest assignments and consider intervention a sign of weakness.
Yet the Department of Defense estimates that almost a quarter of all injuries suffered in the conflicts in Afghanistan and Iraq were brain injuries. As many as 20 percent of veterans of those two conflicts experience PTSD.

Traumatic brain injuries and PTSD share symptoms like headaches, depression and, sometimes, suicidal behavior. The consequences of not getting help can be severe: In the past four years, more than 2,000 active and reserve military personnel have killed themselves, according to the department.

Across the military base in Stuttgart, suicide prevention and PTSD brochures are positioned on desktops and hallway tables. The base has a Preservation of the Force and Family center, a program created specifically for Special Operations Forces, where anyone can seek help for behavioral issues, including alcohol or drug abuse, and counseling for family and financial problems.

When commanders rented a movie theater last year for a screening of the latest “Star Wars” movie, General Bolduc made sure that the free tickets had to be picked up at the center, to get soldiers comfortable with stepping inside the door.

On base, officers talk openly about mood swings, making their wives cry and other indicators that led them to seek help.

General Bolduc, who took command in April 2015, encourages these kinds of honest conversations. In speeches to his leadership team and in visits to his troops in Africa, and every time a new soldier comes into his fold, he tells his personal story and urges anyone experiencing the same kinds of symptoms to get help.

A native of Laconia, N.H., General Bolduc said he had wanted to join the Special Forces ever since as a young boy he watched the movie “The Green Berets” with his grandfather.

“For all Bolduc males, service to country is a requirement,” said General Bolduc, whose two brothers also joined the Special Forces. “My grandfather didn’t care what service, but he did feel that it was an obligation.”

He earned his ROTC commission in 1989, graduating from Salem State College in Massachusetts, and later earned a master’s degree in security technologies from the United States Army War College.

Last month, General Bolduc awarded a Purple Heart to an airman 11 years after he had received a brain injury during a mortar attack in Iraq. The airman, Tech. Sgt. David Nafe, had experienced memory loss and migraines for years.

General Bolduc made a fuss, summoning his staff to a ceremony for the award. The military publication Stars and Stripes published an articleabout Sergeant Nafe on its front page. In front of the audience gathered for the ceremony, the general told the soldier he could relate to him.

“When people look at you, you look completely normal,” General Bolduc said. “And then they see how you act and they say, ‘God bless, what’s wrong with that guy?’ ”

The Defense Department and the Veterans Health Administration have worked to improve mental health services. Yet many service members do not regularly seek care, according to a 2014 report from the RAND Corporation, a think thank that conducts government studies.

That procrastination is exacerbated by the hypermacho culture of Special Operations, General Bolduc said, where high-stress tours leave members especially vulnerable. Members wait an average of 13 years and 3 months to seek treatment for injuries that are not catastrophic, according to Sarah McNary, a nurse in charge of traumatic brain injury cases at Landstuhl Regional Medical Center in Germany, who first persuaded General Bolduc to submit to a brain examination.

When a bomb dropped on his position in Afghanistan in 2001 — a friendly fire accident — General Bolduc’s hip was badly damaged. He declined medical treatment and pushed ahead with the mission, an offensive on Kandahar, and later needed hip-replacement surgery.

An average-size man at 5-foot-7 and 145 pounds, General Bolduc is so fit and focused that even if he were wearing overalls he would probably be identifiable as a Green Beret. Yet he has a soft side, offering a handshake or a hug to everyone he meets on a stroll around the base.

“He’s Captain America,” said Lt. Col. Nathan Broshear, a spokesman for Special Operations Command Africa.

Now, the general goes to counseling sessions with his wife, who for years urged him to seek treatment.

“The doctors love it because I’m still guarded,” he said. “First of all, you feel funny even talking about it. You’re not likely to give them your real symptoms. But your wife is going to say, ‘That’s a load of crap.’ ”

About a month ago, while visiting a team under his command, General Bolduc asked how many of the men had been close to blasts, bombs and mortar shells. Everyone raised a hand.

“Then I said, ‘How many of you have sought treatment?’ ” he said. “No one’s hand went up.”

General Bolduc told them his own story, and afterward, all of the men decided to get exams. Doctors found a tumor in one soldier’s brain.

He was flown to Walter Reed National Military Medical Center, near Washington, where he is being evaluated.

SLEEP PROBLEMS PERSIST AFTER PTSD TREATMENT, STUDY OF ACTIVE TROOPS FINDS

BY BRET MOORE,DEC 9, 2016
Sleep disturbance is one of the most common issues individuals with PTSD face. Specifically, insomnia and nightmares plague the vast majority of those struggling with the disorder. 

Although it is assumed to be high, relatively little is known about the actual prevalence of sleep disturbances in veterans with PTSD. Any clinician who treats veterans with PTSD will likely tell you that most, if not all, of their patients suffer from sleep problems to some degree. 

Relatedly, it is assumed that sleep disturbances improve with evidence-based PTSD treatments. However, to what degree is unclear.  

In an effort to gain better clarity on these issues, researchers from the University of Texas Health Science Center at San Antonio, and colleagues from several other prestigious academic institutions, asked these questions to over 100 active-duty service members. Their findings were published in the November issue of Psychological Trauma and were shocking. 

Not surprisingly, insomnia was the most frequently reported PTSD symptom prior to treatment. A whopping 92 percent acknowledged some degree of difficulty falling or staying asleep. Although not as high as insomnia, 69 percent of the same group reported suffering from nightmares. 

The surprising, and somewhat disheartening news, is that approximately three-fourths of service members still reported insomnia as a problem after PTSD treatment.  And around half still struggled with nightmares. 

The researchers took an even deeper look into the results and found additional important information. For those service members who no longer met criteria for PTSD after successful treatment, more than half continued to report insomnia, and 13 percent continued to report problems with nightmares. Again, this is from those troops who made such significant improvement that they no longer had enough symptoms to retain the PTSD diagnosis. 

In my opinion, there are two important take-home messages from this study. 

First, sleep problems will likely continue in many people with PTSD, even in those service members who benefit greatly from treatment. Therefore, it is important to manage expectations. There are few — if any — complete “cures” in psychology and psychiatry, but this doesn’t mean you can’t go on to lead a rewarding and fulfilling life. Keep in mind, many people without PTSD struggle with sleep. 

Second, you may want to ask to be referred for a sleep-focused therapy in addition to the PTSD treatment. Treatments like Imagery Rehearsal Therapy and Cognitive-Behavioral Therapy for Insomnia have been proven successful for nightmares and insomnia. 

Bret A. Moore, Psy.D., is a board-certified clinical psychologist who served two tours in Iraq. Email him at kevlarforthemind@militarytimes.com. This column is for informational purposes only and is not intended to convey specific psychological or medical guidance. 

Duke Study Shows Therapy Effective For Military Sufferers Of PTSD

(RALEIGH (NC) NEWS & OBSERVER 28 NOV 16) … Gavin Stone

DURHAM – A well-known treatment for post-traumatic stress disorder in civilians significantly reduced PTSD symptoms in active-duty military personnel who took part in a study published last week by the Duke University School of Medicine.
The study, in the journal JAMA Psychiatry, is the largest randomized clinical trial to date to apply cognitive processing therapy, or CPT, which has been used among civilians for decades, to active-military patients who are suffering from PTSD. It found that while using the treatment in both group and individual sessions significantly reduced PTSD symptoms, individual treatment was nearly twice as effective.
The study divided 268 participants from the U.S. Army’s Fort Hood in Killeen, Texas, into two groups, one that would receive the individualized CPT, while the other half participated in group CPT sessions. While both groups showed significant improvement to their mental health over the course of 12 sessions, close to 50 percent of participants who were given individual CPT were able to progress to a point where they were no longer medically classified as suffering from PTSD. About 37 percent of the participants in the group sessions progressed to this point.
CPT is a method of treatment that involves evaluating the thoughts and beliefs associated with a patient’s traumatic experience, which for many in the military involves blaming themselves for events in combat that are out of their control, according to Patricia Resick, a professor of psychiatry and behavioral sciences at the Duke University School of Medicine and lead author of the study.
Resick said that this tendency comes from the belief that in a “just world” good things happen to good people, which for some could also mean that if something bad happens it’s because you’re a bad person.
“Instead of looking to the perpetrator of the trauma, they look to themselves to assign blame,” Resick said. “What we do is we systematically lead them through a series of steps to teach them to ask themselves questions so they can make more balanced statements about themselves.”
Resick developed CPT in the 1980s to treat victims of rape and other interpersonal trauma. But the treatment was not applied to combat-related PTSD and related conditions in military personnel and veterans until 2008 when the U.S. Departments of Defense and Veterans Affairs formed a national research consortium called STRONG STAR to study methods of detection, prevention, diagnosis, and treatment of the disorder.
Lt. Col. Alan Peterson, director of the STRONG STAR Consortium and professor of psychiatry at the University of Texas Health Science Center San Antonio, said civilian research groups had not tested CPT on military personnel because they had a difficult time modifying their treatments to meet the needs of those who have been in combat.
Peterson said that getting treatment for PTSD carries a stigma of weakness that can prevent patients from seeking it out, or even acknowledging that there is a problem.
“Sometimes they would rather deploy and walk across a mine field than sit down and tell someone what happened to them,” Peterson said. “If we called it the ‘PTSD Consortium,’ then no one would come in.”
Peterson said that the most important outcome of the study for him was that PTSD treatment need only last months, not a lifetime.
“Without the proper type of treatment, yes, people can suffer for a lifetime,” Peterson said. “That’s what we’re trying to correct.”
There are many ways to cope with PTSD, Peterson said, such as using service dogs, going hiking or on camping retreats, rafting, music, art and yoga, but these things do not get at the root cause of the patient’s PTSD.
“Part of what causes PTSD is there’s one or more really horrible events that have occurred, and you need to drill down on the thoughts and memories that go with that,” Peterson said. “CPT drills down on the beliefs the people have about themselves and the world and the future.”
Peterson said the Duke study has already spawned five new clinical trials which will seek to determine whether more individualized treatment plans than the standard 12-session model will be more effective in reaching those with more complex cases of PTSD who were part of the 50 percent that showed slower progress.
http://www.newsobserver.com/news/local/counties/durham-county/article117505033.html

Dog Tag 9/2/16

Survey Results

Songs and Stories MP-3 System

We received a copy of a survey of the Warriors in Transition Unit at Ft. Stewart. We did not ask for the study, but they were kind enough to share the results. They wanted to find out if the soldiers were using the MP-3 that we supplied through The Landings Military Family Relief Fund and how they were using the system.

They found that:

  • 90% of those responding used the unit
  • 76% used it for music
  • 14% favored listing to books
  • 10% reported receiving the unit but had not yet used the device for various reasons.

The study also found that:

  • 52% of participants had downloaded from the web site.
  • Some soldiers were using their own device to download content.
  • A small number were unsure as to how to download content.

Conclusions:

  • While this is a small sample, it confirmed our belief that music helps those with sleep deprivation due to PTSD.
  • We need to address the downloading process so we will be developing an on line video tutorial on how to download content.

We thank Admiral, Paul Soderberg, (Retired) and the Landings Family Foundation for supporting this mission and sharing the results of the survey.

Dog Tag 6/12/16

The U.S. needs to revisit our PTSDtreatment guidelines

The U.S. needs to revisit our PTSDtreatment guidelines

By Bret Moore, Special to Military Times12:09 a.m. EDT May 15, 2016
ptsd-mind
(Photo: Thinkstock/Staff)
Post-traumatic stress disorder is arguably the most challenging problem combat veterans face. Estimates vary, but experts believe that between 10 and 20 percent of Iraq and Afghanistan veterans suffer from the disorder. This puts the actual number of men and women affected in the hundreds of thousands.
Considering that PTSD wreaks havoc on the veteran and their loved ones, and costs billions of dollars each year, finding and using the most effective treatments are critical.
Historically, medications and talk therapy have been considered “first-line treatments.” This basically means they should be used first, and if they fail, then you try something else.  In fact, the joint treatment guidelines published by the Department of Defense and Veterans Affairs Department puts medications and psychotherapy on equaling footing. The same is true for the American Psychiatric Association.
Not all agree.
Organizations from the United Kingdom and Australia and the World Health Organization take the position that trauma-focused psychotherapies such as prolonged exposure, cognitive processing therapy, and eye movement desensitization and reprocessing are most effective when it comes to PTSD treatment. Basically, their stance is that the evidence for meds is just not as strong. A recent study carried out by military and VA researchers, and published in the journal Depression and Anxiety, supports this position.
After weeding through more than 60,000 possibilities, the researchers identified 55 psychotherapy and medication studies for PTSD. This added up to around 6,300 total study participants.
What did they find? Trauma-focused psychotherapies outperformed psychotherapies that do not specifically discuss the trauma. They also beat out medications.
This does not mean other psychotherapies are useless. For example, the researchers noted that stress inoculation training is effective for PTSD. SIT is a credible talk therapy that has been around for decades. It just may not be as effective as the trauma-focused therapies.
The same is true for medications. Zoloft and Effexor are commonly used for PTSD, and they do work for some people. But again, they may not be as useful as certain psychotherapies.
The bottom line is that the current United States-based treatment guidelines for PTSD may need to join the ranks of their European and Australian counterparts. Specifically, medications likely need to be identified as “second-line” treatments. In other words, they should only be used if an effective talk therapy is not available.
The results of this study challenge the current status quo with regard to treating our combat veterans. It is time to take a close look at how we prioritize PTSD treatments and make adjustments to our national treatment guidelines as necessary.
Bret A. Moore, Psy.D., is a board-certified clinical psychologist who served two tours in Iraq. Email him at kevlarforthemind@militarytimes.com. This column is for informational purposes only and is not intended to convey specific psychological or medical guidance.

My Movie

DEA Okays PTSD Medical Cannabis Trials

Never say never.

The U.S. Drug Enforcement Administration has, at long last, approved a scientific study in which military veterans suffering from post-traumatic stress disorder will be treated with medical marijuana, potentially expanding the market for MMJ businesses.

More states could add PTSD to their list of approved conditions for medical cannabis if the study shows that MMJ can be an effective treatment for the ailment.

The Multidisciplinary Association for Psychedelic Studies (MAPS), a nonprofit research organization in California, has been trying to win the DEA’s permission to begin the scientific studies for years. The trials could now begin by late May, Dr. Sue Sisley, a researcher with the organization, said in an email.

The study will involve 76 veterans, and aim to test the “safety and efficacy” of several different MMJ strains on PTSD, according to a press release from MAPS. The trials will take place in Phoenix and at Johns Hopkins University in Baltimore. Blood analysis will be performed at the University of Colorado at Boulder.

Sisley, as the Phoenix New Times has reported over the years, was fired from the University of Arizona in 2014 after advocating for the study. But she persisted in her pursuit of clinical MMJ trials.

She and MAPS eventually were able to convince the state of Colorado to pony up $2.1 million to help pay for the study. And the DEA’s permission was the last piece of the puzzle, because the trials need the go-ahead to obtain legal MMJ from the University of Mississippi, where the National Institute on Drug Abuse grows it.

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