Adventure Therapy for Combat Stress Reaction?

Contributor:  IDGA Editorial Staff
Posted:  10/31/2012  12:00:00 AM EDT
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Adventure Therapy: send a group of veterans on an Outward Bound sailing expedition for six days. What are the pro's and con's? Perhaps traditional therapies can be anxiety provoking, whereas this type of experience allows men and women to restore the bonds lost at the battlefields. This interview with Dr Sharon Wills, explores the unique approaches being taken for treatment of PTSD, TBI and Suicide prevention at the Austin Outpatient PTSD Clinical Team. Read on...


Dr Wills, tell us about your current role and areas of responsibility

I’m the team lead for the Austin Post Traumatic Stress Disorder Clinical team. The PTSD Clinical Team is a Specialty Clinic that treats Combat Stress Reactions resulting secondary to COMBAT EXPERIENCES, primarily in Post-911 Iraq or Afghanistan.  Limited Treatment is available for Veterans of Vietnam and Desert Storm.  Treatment requires initial participation in psycho-educational/skills training, and thereafter is primarily Exposure-based using Evidence-Based Therapies.  Treatment is time-limited and Intensive and it is not suitable for all Veterans.  Veterans are returned to their original providers at the end of the time limited treatment by PCT. I also have a grant to do outreach to university student veterans at the University of Texas and the Austin Community College system.


So tell us how PTSD is being assessed among veterans today in that region, and how (if at all) does PTSD assessment differ for veterans as opposed to civilians.

I think for veterans it’s probably more related to their combat experiences certainly. In my clinic we do not actually place a lot of emphasis on assessment because we do not require a diagnosis of PTSD in order to treat a veteran. Many of the veterans coming back now from Iraq and Afghanistan do not like the idea of having a mental health diagnosis—they would prefer to just be diagnosed as having Combat Stress Reaction, which is usually the term that we use.   Of available assessment measures, the Gold Standard is the Civilian Administered Post Traumatic Stress Disorder Scale, or CAPS, which requires a little bit of training and takes approximately an hour to an hour and a half to administer.  In many settings, people are given a screen, which is called a Post Traumatic Stress Checklist and comes in versions for military, civilians, and such as that. Everybody gets that who is seen in our clinic who is a combat veteran.  When using some of the Evidence-Based Therapies, such as Prolonged Exposure, the PCLS is used throughout the course of treatment to measure progress in symptom reduction.


Tell us about some of the latest PTSD and mental health discoveries that you and your team have been making at the Central Texas Veterans Health Care System.

One of the most recent of the Complementary and Alternative treatments is adventure therapy.  The young men and women who are coming back from Iraq and Afghanistan present different challenges in treatment. They very often don’t like to just sit still in a room and talk about their feelings. That’s uncomfortable and anxiety provoking. One of the things we’ve done recently is to participate with a group of veterans on an Outward Bound sailing expedition for six days. This kind of experience allows them to restore the bonds of connection that they lose when they leave an active duty military unit and also allows them to recapitulate their experience with their military unit, except they weren’t being shot at of course. They are currently studying the results and planning some research projects to establish the effectiveness of this treatment, but even anecdotally, the people who went on this excursion reported recovery of previously muted feelings, improvement in their ability to experience emotions, their sense of being able to cooperate with other people to reach a goal, and the experience in general restored their ability to connect to other people.   It was really amazing to watch this. We plan to do a lot more of this sort of thing. We also have a number of outside volunteers who provide contemporary and alternative medicines which sort of go under the rubric of alternative medicines—things like massage, acupuncture, tai chi, meditation, different kinds of relaxation techniques. These really seem to be really helpful as adjunctive-based treatments. Of course we use the evidence-based therapies in the recovery of traumatic memories, things like Prolonged Exposure, Cognitive Processing Therapy, and that sort of thing.


How does PTSD differ when it is accompanied by a traumatic brain injury vs. PTSD without traumatic brain injury?

Well PTSD does not produce the kind of cognitive impairments sometimes seen in TBI, but the additional frustration of cognitive limitations can interact with some of the irritability of PTSD appearing to increase the severity of the PTSD.  One of the things a more severe traumatic brain injury is more likely to do is lessen the ability to concentrate on the material in the exposure-based treatments.   What I see most often is that the difficulty in remembering specific things really gets in the way of some of the skill building and some of the ability to process the traumatic memories. I think that’s probably the most significant thing. Many people who have had TBI tend to have migraine headaches, and other chronic pain, really interferes with the ability to participate fully with some of the trauma treatments that are available.


Suicide prevention has become a large area of focus for the VA. How has your facility worked with PTSD patients to prevent this?

We have a suicide prevention coordinator inside every clinic, who supervises education of clinicians on suicide prevention techniques, and monitors how patients are assessed for suicide risk.  We’re required to follow very closely anyone who’s even deemed to be low risk for suicide.  The SPC is closely involved in the investigation of any suicide attempt or completion, and stays in close contact with patients who are deemed at high risk.


What new technologies could industry provide that would help you and your team with the assessment and treatment of PTSD and suicide? What would you ask from them?

From industry I think certainly (other than research), some of the things that address chronic pain, I think making contributions to things such as outdoor adventure programs, we could not have done the adventure program we did, except that various industrial concerns and private foundations funded Outward Bound to take OEF OIF veterans on these trips for nothing, and it’s essentially very expensive to do that for a veteran probably wouldn’t be able to afford it himself.

I think coming up with tools—I know when I was at the meeting in Baltimore there were a number of things that people were doing that seemed kind of interesting. I know one of the things I’ve seen the Alpha-stim machines, I don’t know how effective that is but a lot of the veterans seem to like it. There was a pen that recorded as people took notes, which was very helpful for some of these patients who got these when they left the active duty military. It enables them to, if they have trouble listening and processing information auditorially, the pen helps it, it will record it and it will talk back to you right away if you want it to.

Coming up with things like that that help veterans with memory and concentration.   I see Chronic Pain as one of the main issues on the forefront now, partly because of the injuries common in being the victim of an IED or other explosive device.  The men and women coming back from Iraq and Afghanistan, many of them, in fact the majority of the people I see, have chronic pain issues and most of them don’t want to depend on opioid medication. They would like something different and I think industry probably could play a big role there in terms of alternative pain management and funded research.

IDGA Editorial Staff Contributor:   IDGA Editorial Staff

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