In the article, “PTSD Treatment for Veterans: What’s Working, What’s New, and What’s Next”, published in October of 2016 in the Pharmacy and Therapeutics Journal, Miriam Reisman discusses Post Traumatic Stress Disorder in veterans and the treatment that veterans who suffer from PTSD have tried that failed and also treatments that are working. Reisman also discusses the obstacles that veterans who have PSTD go through in order to get treatment. Additionally, Reisman briefly explores the significant amount go veterans who have PTSD as opposed to regular people, who haven’t fought in a war.
Veterans who are victims of PTSD often find it a little difficult to attain the right kind of treatment for their needs and, in some cases, any treatment at all. Reisman states that “According to a study conducted by the RAND Center for Military Health Policy Research, less than half of returning veterans needing mental health services receive any treatment at all, and of those receiving treatment for PTSD and major depression, less than one-third are receiving evidence-based care”. Although it is more likely for veterans to have PTSD than people who haven’t fought in wars, they still have the hardest time receiving proper treatment. Furthermore, if they are receiving treatment, the treatment isn’t the best they could receive, thus, not helping them the way they need it. If their PTSD isn’t treated properly then it could result in the condition getting worse, making the veterans suffer. Veterans are often too poor to afford the treatment for the PTSD or, if they happen to be undergoing treatment, the treatment isn’t usually up to par and it isn’t helping their case. I think it is a good thing that she mentioned this because, otherwise, people wouldn’t understand how hard it would be for veterans to get the help that they need.
Because of the significantly large number of soldiers who are diagnosed with PTSD, the term was initially coined in war terms to describe the aftermath of the wars. Reisman says, “…PTSD would be described by many different names and diagnoses, including ‘shell shock’ (World War I), ‘battle fatigue’ (World War II), and ‘post-Vietnam syndrome’”. This is really important to know and I like that Reisman brought it up because the idea of the disorder began because of the way veterans were after war. Although soldiers aren’t the only people to suffer from PTSD, it is more commonly diagnosed in veterans and the fact that it was only described in “war terms” show that it affects them more and they suffer more as well. While some soldiers do return home with physical injuries that will heal, most of them also come back with the mental issue of having PTSD. Before regular people were diagnosed with PTSD, it’s relevance only pertained to those who fought in war or had any vulnerability to combat.
As if PTSD wasn’t enough, veterans are shown to have comorbidity of PTSD. Reisman discusses that “Complicating the diagnosis and assessment of PTSD in military veterans are the high rates of psychiatric comorbidity”. This shows just how intense it is for veterans returning home after war. Not only do they return with PTSD, which is an immense struggle within itself, but some of them have added depression, anxiety, substance abuse, and chronic pain. This makes it even harder for them to be treated because of the higher cost of treating not only one condition but multiple at a time.
Reisman also mentions a graph that shows the risk factors of how likely someone is to succumb to PTSD. The highest risk factors are being of female gender, being of non-white race, combat exposure, low education level, number and length of deployments, and psychological problems. Even though not all veterans and soldiers fall victim to Post-traumatic stress disorder, if many of them meet these risk factors, the likelihood of them attaining PTSD are much higher and, for most of the risk factors, they are not something within anyone’s control. One of them that Reisman talks about more in-depth is being a female serving in the army and the high risk of getting PTSD by military or civilian sexual assault while serving in the army, otherwise known as “military sexual trauma”. Women are beginning to take on more and more roles in the military, and because of this fact, the possibility of women experiencing PTSD because of their exposure to combat in the military increases in a considerable amount. Reisman also notes that it’s incredibly important to understand the pre-war traumatic risks so that doctors and therapists are able to give the right treatment needed for the soldiers before their problems become chronic or persistent.
In terms of diagnosing PTSD in soldiers and veterans, it must be done the correct way in order to ensure that the right treatment is given to the soldier or veteran. To diagnose PTSD, Reisman says that the best way to do so is with "structured interviews and self-report questionnaires”. The PTSD Scale, found in the DSM 5, is a valuable tool for clinicians to help diagnose PTSD and understand just how severe it is as well. They administer a 30 to 60-minute interview with the soldier and it has been proven to be useful to help with the diagnosis of Post-traumatic stress disorder. It’s important to know the level of extent of the PTSD that they have in order to prescribe the right treatment. Using a scale to assess their feelings and thoughts after the war is a way that, Reisman describes, soldiers can coherently describe the ways they feel after the war. By having them assess themselves on their own, it is known to be beneficial for them, so that they can receive the treatment prescribed for their needs. I agree with Reisman here because I do believe it’s important to allow the victims of PTSD their own voice in the process of undergoing their treatment. I agree that, instead of treating veterans by going in blindly, the decision of the treatment should be based on their own self-assessment of their chronic symptoms.
Reisman talks about the benefits of using cognitive behavioral therapy as it is seen to prove the most beneficial in helping Post-traumatic stress victims deal with their symptoms. Reisman says, “Of the wide variety of psychotherapies available, cognitive behavioral therapy (CBT) is considered to have the strongest evidence for reducing the symptoms of PTSD in veterans and has been shown to be more effective than any other nondrug treatment”. Additionally, she also mentions that physical exposure (PE) is 60% effective in treating victims of PTSD. Furthermore, she also describes the treatment of eye movement desensitization and reprocessing or EMDR. Reisman, here, is making a valid argument when she says, “Antidepressants have been the central focus of pharmacotherapy research in PTSD, but better treatments are greatly needed”. I completely agree with her here because, if no significant signs of antidepressants are working with victims of PTSD, then other methods need to be taken into account, especially considering that most of the antidepressants used are to treat depression, not Post-traumatic stress disorder.
Miriam Reisman then goes on to talk about alternative ways to go about treatment for PTSD in war veterans. She says, “Anticonvulsants or antiepileptic drugs, which affect the balance between glutamate and GABA by acting indirectly to affect these neurons when their neuronal receptor sites are activated, could also provide a useful option in the treatment of PTSD symptoms in patients who fail first-line pharmacotherapy”. She believes that using drugs, or medication, is a better alternative to those who aren’t treated with psychotherapy. She also believes that a combination of medication and psychotherapy are a more effective way of treating the symptoms of PTSD. I think that she has a point about using a combination of the two methods of treatment, but I also think that not all veterans and soldiers are able to handle that or even afford that kind of treatment. She should consider the obstacles she mentioned before about veterans having a hard time getting help before indulging in, what could possibly be, an expensive method of treatment.
With this being said, she goes on to emphasize her point on lowering this use of drugs when it shows to not be effective in treating the symptoms. Reisman goes on to say, “For patients with PTSD who do not respond to initial drug treatment, it may be necessary to explore additional pharmacotherapy options to control their symptoms”. I think she makes a valid point here because, if drugs are showing to not work, then clinicians and therapists should seek out other ways to help. Also to back up her claim of psychotherapy working better than drugs, she also states that Dr. Schnurr, also believes that “psychotherapy remains the most effective treatment for PTSD”. This is just another way to prove that Reisman is factual in her reason to add psychotherapy to the treatment of veterans who show signs of PTSD.
Reisman does a good job in emphasizing the idea that, in order to properly treat PTSD, one must have a thorough understanding of what exactly is happening in the brain of someone suffering from the disorder. She says, “Further understanding of the underlying physiological and neurological processes will be helpful in developing new and effective therapies to treat PTSD”. I 100% agree with her statement here because I believe that in order to advance treatment in veterans and soldiers suffering from the disorder, therapist and healthcare systems need to meticulously understand the other factors that are in play such as the physical and biological aspects. Otherwise, if therapists didn’t have an understanding of every factor, then they wouldn’t be able to prescribe the proper treatment to help relieve PTSD symptoms.
On top of getting care and treatment from doctors and therapists, Reisman believes that the community a victim of PTSD lives in is also critical in their journey of overcoming their symptoms. She states, “With veterans and their families increasingly seeking care outside of the VA system, community providers play a key role in helping to address these challenges”. I also believe that community plays a demanding and important role in the process of recovery. I think that, while it may not be the most important aspect of recovery, it’s definitely an influential element because they are going to be constantly surrounded by these people.
Reisman also expresses that the community should take the responsibility upon themselves to educate themselves about PTSD. She says, “With veterans and their families increasingly seeking care outside of the VA system, community providers play a key role in helping to address these challenges”. Again, I agree with her because, if the community surrounding a veteran or a soldier suffering from PTSD, then it won’t help the development of the victim. It might even make problems worse for the sufferer.
To conclude, I believe the Reisman makes some strong arguments that I agree with. Her suggestions to combine pharmacotherapy and psychotherapy are completely valid and could, possibly, result in a better, more efficient treatment for PTSD-stricken veterans and soldiers. She did a great job in providing statistics and data to back up her claims about the efficiency of drugs and self-assessments. This journal article, overall, has substantially increased my knowledge about this subject and this has widened my eyes to the world of the complicated treatments that are offered to war veterans soldiers suffering from PTSD. Reisman did a good job of raising awareness about the idea that PTSD is so much more complicated than other mental illnesses and disorders, so it has to be treated in different ways. She helped me understand that it shouldn’t be treated the same way someone with depression or anxiety is treated.