TIME Mental Health/Psychology

How Effective Are PTSD Treatments for Veterans?

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Though many treatments for PTSD can alleviate symptoms, veterans continue to meet the criteria for the disorder

A new study published Tuesday suggests commonly used first-line treatments for PTSD in veterans may not work as well as medical experts once thought.

The number of American veterans who suffer from PTSD continues to be a serious national public health problem. Recent data show that more than 200,000 Vietnam War veterans still have PTSD, and other research shows that around 13% of Iraq or Afghanistan veterans who experienced combat have PTSD. The numbers continue to climb. As TIME previously reported, PTSD diagnoses among deployed troops grew by 400% from 2004 to 2012.

Now new research, published Tuesday in the Journal of the American Medical Association, reveals that go-to treatments for the disorder may not be as effective as many in the medical community may have believed or hoped. To reach their findings, researchers from the Steven and Alexandra Cohen Veterans Center for Post-Traumatic Stress and Traumatic Brain Injury at NYU Langone Medical Center reviewed 36 randomized control trials of psychotherapy treatments for veterans suffering from PTSD over a 35-year span. Two of the most commonly used treatments—and the most widely studied—are cognitive processing therapy (CPT) and prolonged exposure (PE) therapy.

CPT is a treatment that focuses on changing dysfunctional thoughts, and exposure therapy is meant to help patients face what’s causing them stress and fear.

The research showed that while up to 70% of the men and women who received CPT or PE experienced symptom improvements, around two-thirds of people receiving the treatments still met the criteria for a PTSD diagnosis after treatment. The researchers note that current veterans affairs policies emphasize the use of the two methods as treatments of choice.

The researchers also argued that veterans with PTSD are likely to have worse outcomes from treatment compared to civilians with PTSD. Though the researchers are unsure why that is, there’s some speculation: “Compared to civilian traumas such as car accidents and natural disasters, military deployment involves repeated and extended trauma exposure,” says study author Maria M. Steenkamp, an assistant professor of psychiatry at NYU Langone. “It also involves not just life-threat, but exposure to traumatic losses and morally compromising experiences that create shame and guilt.” Veterans are also more likely to have additional mental health issues such as anxiety or substance abuse, she adds.

The researchers also raise the question of whether focusing on trauma during PTSD treatment is really that effective. Based on their review of the trials, they found that when CPT and PE were compared to non-trauma focused psychotherapy, patients showed similar improvement.

However, not everyone agrees that the findings should be cast in such a light. Dr. Paula Schnurr, the executive director of the National Center for PTSD under the U.S. Department of Veterans Affairs says there’s not consensus that veterans have a more difficult time overcoming PTSD symptoms compared to civilians, and adds that some people who treat veterans feel avoiding fears and trauma perpetuates problems, rather than processes them. In addition, symptom improvement is an important part of PTSD treatment since it improves veterans’ quality of life. Schnurr was not involved in the study, though some of her own research was analyzed in it.

“If a person has a meaningful response, they have a meaningful improvement in their quality of life,” says Schnurr, adding that many treatments for other mental health conditions have similar outcomes. “As scientists we will always try to enhance the effectiveness of these treatments for more people…My takeaway message [from the study] is one of optimism and also encouragement for people to seek treatment.”

The researchers say other treatment options should continue to be explored, and there are practitioners who are trying different methods, from acupuncture to healing touch therapy. Another new study published Tuesday in JAMA looked at 116 veterans with PTSD who either underwent mindfulness-based stress reduction therapy that focused on being present and non-judgmental in the moment or a present-centered group therapy that focused on current life problems. The results showed that those in the mindfulness group had a greater improvement in self-reported PTSD symptom severity. However, they were no more likely to lose their PTSD diagnosis.

There may not be a cure yet for PTSD, but the amount of research looking into how to improve or innovate treatments is encouraging. Veterans who need support can find resources here.

TIME Solutions That Matter

See How Robotics Is Changing What It Means to Be Disabled

At the Human Engineering Research Laboratories (HERL) in Pittsburgh, Pa., veterans, engineers, doctors and researchers are working together to improve the lives of people with disabilities. Since 1994, Dr. Rory Cooper and his team have been solving everyday problems of people with disabilities and inventing new technologies to change the way people with disabilities interact with and experience the world around them

TIME Mental Health/Psychology

More Than 200,000 Vietnam Vets Still Have PTSD

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New research reveals considerable PTSD in some vets, even decades after war

Many veterans who served in the Vietnam War still have war-zone-related post-traumatic stress disorder, according to a new study published in JAMA Psychiatry.

The researchers, led by Dr. Charles R. Marmar, of the New York University Langone Medical Center, wanted to look at the prevalence of PTSD over time. Thanks to the National Vietnam Veterans Longitudinal Study, a study of PTSD in Vietnam vets done more than 25 years ago, they had historic data on the prevalence of PTSD; they conducted a follow-up to the study by gathering new data from the 1,450 veterans who were still alive and willing to participate in another round of PTSD assessments. From 2012-2013, researchers gathered from each vet a self-report health questionnaire, a telephone health survey or a clinical interview by phone. (Some vets participated in two or all three of the measures.)

MORE: Meet 15 Extraordinary Wounded Warriors Who Are Stronger Than Ever

The team determined that even now—40 years after the war ended—about 271,000 Vietnam vets have full war-zone-related PTSD plus war-zone PTSD that meets some diagnostic criteria. More than a third of the veterans who have current war-zone PTSD also have major depressive disorder.

MORE: “Hidden Wounds”: Battling PTSD With Music

Men who served in the Vietnam war had a war-zone-related PTSD prevalence of 4.5%; when factoring in vets who met some of the criteria, that number climbed to almost 11%. For women veterans, those prevalences were about 6% and 9%, respectively.

“An important minority of Vietnam veterans are symptomatic after four decades, with more than twice as many deteriorating as improving,” the study authors write. “Policy implications include the need for greater access to evidence-based mental health services; the importance of integrating mental health treatment into primary care in light of the nearly 20 percent mortality; attention to the stresses of aging, including retirement, chronic illness, declining social support and cognitive changes that create difficulties with the management of unwanted memories; and anticipating challenges that lie ahead for Iraq and Afghanistan veterans.”

TIME Veterans

Mitsubishi Apologizes for Using U.S. Prisoners as Slaves During World War II

It is the first private Japanese firm to make amends for wartime abuses

Executives of the Japanese firm Mitsubishi Materials issued a formal apology on Sunday to the American soldiers who were forced to work in the company’s mines while prisoners during World War II.

“Working conditions were extremely harsh and the POWs were subjected to severe hardship,” senior executive Hikaru Kimura said, speaking at a ceremony at Los Angeles’ Museum of Tolerance. “As the company that succeeded Mitsubishi Mining, we cannot help feeling a deep sense of ethical responsibility for this past tragedy.”

James Murphy, a 94-year-old veteran who stands among the few prisoners of war still living, openly expressed his appreciation after meeting with company representatives.

“For 70 years since the war ended, the prisoners of war who worked for these Japanese companies have asked for something very simple, they asked for an apology,” he said.

Murphy was one of the nearly 900 American soldiers imprisoned during the war at camps linked to Mitsubishi’s copper mines. The conditions, he told the Associated Press, were “slavery in every way.”

Mitsubishi’s apology comes three and a half weeks shy of the seventieth anniversary of Japan’s surrender, which confirmed the Allies’ victory in the war. In the years since, the Japanese government has mostly been diligent about making amends for its actions during and prior to the conflict, though this is the first time a private firm involved in the war effort has made a public apology. Nevertheless, residual tensions continue to sometimes strain Japan’s contemporary diplomatic efforts. A recent editorial by China’s Xinhua News Agency, a state-controlled press operation, looked to the iciness of Sino-Japanese relations and opined that “tensions can only be diffused when Japan, with honesty and sincerity, recognizes its ignominious past and, together with its Asian neighbors, promotes regional peace and development.”

TIME Congress

13 Reasons the Government Could Shut Down Again This Fall

Congress Convenes On Columbus Day As Government Shutdown Continues
Mark Wilson—Getty Images The U.S. Capitol in Washington in 2013.

Democrats and Republicans don't see eye to eye on spending

Do you miss the government shutdown? Don’t worry, another one could be coming as soon as this fall.

You might have thought the threat of another shutdown was shelved last year when congressional Budget Committee Chairs Rep. Paul Ryan and Sen. Patty Murray came to a two-year bipartisan deal to fund the government.

But the new Republican Congress blew up that deal, and a shutdown could be part of the fallout.

Republicans are now attempting to undo controversial cuts to military spending in the 2013 sequester. Democrats are having none of that: if the Pentagon gets its money, they argue, so too should entitlements, as was part of the original deal. Unless Republicans relent on this point, Democrats have vowed to block all 13 appropriations bills from coming to the Senate floor.

But even if those bills were to get voted on, odds are they won’t pass since they have dozens of provisions that Democrats object to — and which President Obama has threatened to veto.

If some sort of funding isn’t passed by the end of September, the government will shut down. Senate Majority Leader Mitch McConnell swears that will not happen on his watch, but for now the two sides aren’t even talking.

So what could cause a shutdown? Here’s a look at the 13 most controversial provisions, any one of which could trigger a partial or total government shutdown if Democrats and Republicans can’t come to an agreement.

  1. Obamacare: Of course, the bills cut funding for the implementation of Obamacare — the same law that caused the last shutdown.
  2. The environment: The bills would essentially defund or block the President’s climate change plan—including his recently issued controversial rule for coal fired power plants, a clean water rule and a bunch of endangered species listings. All told there are more than 30 riders that environmental groups are protesting.
  3. Cybersecurity: On the heels of a massive breach of personal information for tens of millions of government employees, the GOP budgets would delay installation of cybersecurity upgrades to federal agencies to protect against foreign attacks and cut funding to protect the nation’s electronic grid from cyber attacks and extreme weather by 40%.
  4. Education: The GOP bills would cut nearly $6 billion in education funding, eliminating six pre-K-12 programs, slashing Head Start by $1.5 billion, cutting 21st Century Community Learning Centers by 10% and School Improvement Grants by 11% and $300 million in Pell Grants.
  5. Labor: As the President negotiates two of the largest free trade pacts in the world, he has pledged to ensure that they will meet fair labor standards and not empower countries to abuse their workforces. But the enforcement of these provisions falls on a Labor Department office, the same office that Republicans are looking to cut by 67%. Also on the chopping block: 5% of the Occupational Safety and Health Administration’s budget and 8% of the budget of the office that protects workers from wage theft and abuse.
  6. Veterans: Despite the ongoing scandal plaguing the Veterans Affairs Administration, the budgets cut $255 million from veterans medical care and $105 million from maintenance for VA hospitals.
  7. Consumer protection: The GOP bills would cut $200 million in funds to implement Wall Street re-regulation, or the Dodd-Frank bill passed in the wake of the financial crisis to prevent something like that from happening again. And it attempts to defund Sen. Elizabeth Warren’s darling, the Consumer Financial Protection Bureau, which was set up in the wake of the crisis to better protect Main Street from the risks Wall Street is taking.
  8. Women’s health: The bills cut funding for Title X family planning service programs, eliminating access to birth control for the 4.7 million clients that the programs served in 2012, preventing an estimated 1.2 million unintended pregnancies. They also slash funding to prevent teen pregnancies by 81%.
  9. Infrastructure: In the wake of a fire in a Chicago radar facility that knee capped Midwest air traffic for weeks as air traffic controllers tracked planes with pen and paper, the Transportation Department asked for more money for air traffic control. Instead, Republicans are seeking to cut $255 million from the air traffic control system. Other targets include: $479 million in cuts to water infrastructure $400 million in cuts to innovation grants and $1.7 billion in cuts to transit projects across the country.
  10. Job training: The bills propose cutting $650 million from job training programs.
  11. Wildfires and disease: The GOP budgets envision cutting $1 billion from funding to fight wildfires. Also on the chopping block: $500 million for the Agriculture Department to research diseases like the avian flu.
  12. National parks and national service: The bills cut the National Park Services budget by $321 million, despite the fact that the agency has a massive $11 billion backlog. It also cuts $340 million, or 29%, from AmeriCorps, which translates into 32,000 fewer members serving their communities.
  13. Health: The GOP budgets propose cutting lead paint removal in low-income households, potentially putting more than 2,000 children at risk. And they cut funding for 9,000 scientists’ research at the National Science Foundation.

TIME Mental Health/Psychology

How Fireworks Can Trigger PTSD

Fireworks will be going off with a bang all weekend, but for some, they cause more anxiety than celebration

You may see the signs popping up around your neighborhood this July 4—red, white and blue notices that indicate the home of a vet with the request to “Please be courteous with fireworks.”

The signs are the work of a Facebook-launched nonprofit, Military With PTSD, begun by Shawn Gourley, whose husband, Justin, served in the Navy for four years and returned with post traumatic stress disorder (PTSD). Sudden and loud noises can trigger episodes of PTSD, bringing veterans back to traumatic experiences they have lived through during their service. According to the U.S. Department of Veteran Affairs, up to 20% of military personnel who served in Iraq or Afghanistan experience PTSD each year.

The signs are posted on the lawns of veterans’ homes to alert people to be more considerate when setting off fireworks in the area. According to Gourley, who spoke to CNN, the group has mailed 2,500 signs, some of which were paid for by donations and others by the vets themselves, while 3,000 people remain on a waiting list.

The signs are not meant to quash any Fourth of July celebrations, but to raise awareness that the explosive sounds, flashes of light and smell of powder may trigger unwelcome memories for some. “If you are a veteran, on the one hand July 4th should be one of the most patriotic holidays that you feel a part of,” says Dr. John Markowitz, professor of psychiatry at Columbia University. “On the other hand, the rockets’ red glare and the bombs bursting in air are likely to evoke traumatic memories, and you might want to hide. It’s a tricky one.”

Having advanced knowledge of a fireworks display can help some people with PTSD to better prepare and cope with any symptoms they may experience. “A big component of the startle response and PTSD is the unexpected,” says Rachel Tester, program director of the Law Enforcement, Active Duty, Emergency Responder (LEADER) Program at Harvard Medical School’s McLean Hospital. “When people are able to anticipate, they are able to put into place mechanisms they have to cope ahead of time.”

That might include things such as relaxation techniques or being able to see the fireworks show and therefore know that they’re coming, as well as having headphones, music or other distractions at the ready.

Such strategies may not work for every PTSD patient, but being more aware that the explosive celebrations of the holiday might affect those with PTSD is an important step toward ensuring that everyone can enjoy the holiday without fear, anxiety or pain.

TIME Crime

U.S. Police Killed Someone in Mental or Emotional Crisis Every 36 Hours This Year, Report Says

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In most cases, police were called not because of a crime but by a concerned bystander or loved one

Reporting released by the Washington Post on June 30 depicts an apparently stark reality when it comes to confrontations between police and people with mental illness in the U.S. The article draws from the newspaper’s tracking of every fatal police shooting in the country in the first six moths of 2015 — 462 in all — to present an in-depth look at those confrontations involving disturbed or distressed individuals.

During that time, police killed someone in mental or emotional crisis every 36 hours, including three men within 10 hours on April 25, the Post reports.

In most of those cases, the paper says, officers were not called to the scene because of reports of a crime but were rather responding to concerned bystanders or loved ones. Out of the 124 shootings examined in the report, 50 involved explicitly suicidal individuals. In 45 cases, police were explicitly asked for medical assistance or called after the individual had attempted to get medical assistance elsewhere. Nearly a dozen of those killed were veterans, and several suffered from PTSD.

Many of the responsible police agencies do not train their officers adequately to deal with distressed people, the article concludes. According to the Police Executive Research Forum, officers in training spend up to 60 hours learning to handle a gun and only eight hours each learning to neutralize taut situations and interact with mentally ill individuals. In fact, many of the tactics learned in training, such as shouting commands, can worsen the situation for already fragile people.

“This a national crisis,” Chuck Wexler, executive director of the Police Executive Research Forum, told the Post. “We have to get American police to rethink how they handle encounters with the mentally ill. Training has to change.”

Read more at the Washington Post

TIME Veterans

See Powerful Photos of Wounded Warrior Athletes

More than 600,000 Iraq and Afghanistan war veterans have been left partially or totally disabled from physical or psychological wounds received during their service. Ever year, hundreds of Wounded Warriors from every branch of military service compete in a variety of sports over 10 days at the Department of Defense's Warrior Games. What they have in common is the will to overcome

TIME White House

Obama Honors Fallen Soldiers on Memorial Day

Marks first Memorial Day since 9/11 without ground troops in combat

President Obama laid a wreath at the Tomb of the Unknown Soldier at Arlington Cemetery on Memorial Day to honor the men and women who have died serving in the U.S. military. Their sacrifice, he said, is “a debt we will never repay.”

Speaking in front of more than 5,000 attendees, Obama marked the first Memorial Day in 14 years that the U.S. hasn’t been involved in a major ground war, though a smaller American military presence remains in both Iraq and Afghanistan.

“This hallowed ground is more than a final resting place of heroes” Obama said. “It is a reflection of America itself. It is a reflection of our history.”

He specifically mentioned Spec. Wyatt Martin and Sgt. 1st Class Ramon Morris, who were the last two U.S. soldiers to die during combat missions in Afghanistan.

“These two men, these two heroes, if you passed them on the street you wouldn’t know that they were brothers,” Obama said. “They were bonded together to secure our liberty and keep us safe.”

More than 6,500 Americans have died in Iraq and Afghanistan in military operations that began after the terrorist attacks of Sept. 11, 2001.

Additional reporting by Maya Rhodan

TIME remembrance

See 228,000 Flags Planted for Memorial Day in 1 Minute

The ceremony at Arlington National Cemetery took over 1,000 soldiers 4 hours to complete

The 3rd U.S. Infantry Regiment, the distinguished Old Guard, honors the nation’s fallen soldiers each year by planting more than 228,000 American flags at every grave marker in Arlington National Cemetery ahead of Memorial Day weekend.

The annual “Flags-In” ceremony echoes the origins of Memorial Day traditions, when both Confederate and Union soldiers decorated the graves of their fallen compatriots after the Civil War. The Old Guard has conducted this tradition yearly since 1948.

TIME contributing photographer Brooks Kraft captured this year’s ceremony on Thursday. More than 1,000 soldiers participated in the ritual over a span of four hours at the sprawling Arlington National Cemetery near Washington.

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