It’s no secret that the awareness and treatment of PTSD has failed to keep pace with the use of soldiers on the battlefield. The 21st century has the dubious claim of making the most coordinated efforts so far to address this disparity, and Veterans Affairs is on the leading edge of that undertaking. Despite the failures of the past, the VA is committed to discovering the best path forward for its soldiers both before and after their service ends.

A Full-Body Problem

The impact of PTSD on a human body is an overwhelmingly comprehensive set of problems to figure out. A significant portion of the work done by the National Center for PTSD since its founding in 1989 has simply been devoted to identifying the areas of specialized research vital to understanding and treating the disease.

Alongside the work of other researchers, this field has grown to include a range of therapeutic options including:

Cognitive Processing Therapy: This approach, built on the work of Dr. Patricia Resick, serves as a kind of tutorial and instructional guide to patterns of thought. Digging into the traumatic source of the negative thoughts, which direction they’re going, and where the danger zones are. The goal, ultimately, is to learn how to navigate those trauma patterns well enough to begin to restructure them.

In 2020, a gendered component to this method was proposed. Evidence suggests that emotional symptoms tend towards depression for women and anger problems for men. Despite their origins from the same disease, these symptoms need to be dealt with on their own terms in order to provide the best treatment for each patient.

Present-Centered Therapy: This approach seeks to remove the trauma from the therapy component entirely, and focus instead on staying in the moment and building an internal structure of calm awareness as a counterweight to that trauma.
This methodology is *not* as effective as CPT in helping people recover and move on….however it is *far* more effective than CPT at actually keeping patients in the room. The cost of CPT’s effectiveness is the emotional toll that confronting trauma takes, and that’s different for every patient that tries it. PCT is sometimes the only treatment a patient will respond to.

Combination Therapies:It may seem obvious, and it can definitely seem overwhelming for patients bouncing around to different specialists, but the importance of the art of combining therapeutic strategies can’t be overstated. As more and more options become available, even as more and more elements of PTSD are pulled apart and examined, finding the right path forward for any single patient can be a daunting task.

Here, psychopharmacology has found an increasingly responsible place to fit into a strategy of care. Prazoin was used for years as a treatment for nightmares, and as recently as 2018 was proven to be no more effective than a placebo. This sort of news is disheartening, but it emphasizes the larger truth that there is no “PTSD drug” for anyone suffering to achieve meaningful relief.

The problem of PTSD is too large and complex to simply medicate away. It could be easily argued that a portion of the opioid epidemic has been the result of doctors trying and failing to find the pill that addresses the stark variety of PTSD symptoms.

In better news, the modern VA is demonstrating a holistic, evidence-based approach to the problem. Just as importantly, with increased outreach for veterans suffering from addictions and suicidal thoughts, the VA is addressing the symptoms of their own past failures to take PTSD as seriously as they do now.