Sean Brack knew he needed to get help after he came home from his third deployment to Iraq. In late 2010, he walked into a Fort Hood clinic seeking relief from the bursts of anger, nightmares and flashes of suicidal thoughts.
Fort Hood was in the midst of an unfolding suicide crisis. The next year, a record 22 soldiers would kill themselves. “At that point it was a mill,” Brack remembers. “It was like ‘Let’s get ’em in here, here’s a handful of Prozac, you’ll be fine.’ It just didn’t feel right.”
But then he heard about an experimental therapy that had just arrived at Fort Hood. A type of talk-based treatment, it had a track record of successfully treating post-traumatic stress disorder among civilians, but it hadn’t yet been studied among active-duty combat veterans.
The six-week program changed his life. “If I hadn’t gone through the program, you never know,” Brack said. “It’s possible I wouldn’t even be here.”
Now there’s evidence the therapy that saved Brack has the potential to help large numbers of soldiers struggling to live with the violence they lived through in war zones.
Last month, researchers announced the findings of a three-year study of the cognitive processing therapy at Fort Hood, and the results could transform how PTSD is treated on military installations.
In the largest study ever of an evidence-based treatment for PTSD among active-duty military personnel, 40 to 50 percent of soldiers showed recovery from PTSD after 12 sessions of talk therapy, results that held up in six-month follow-ups, according to soldiers’ scores on specialized PTSD testing. The results were better for soldiers who received individual treatment as opposed to group treatment.
The need for a better PTSD treatment is great: A recent Rand Corporation study found recovery rates of less than 20 percent for active-duty soldiers who sought treatment. And the use of prescription drugs to treat veterans with PTSD has had fatal consequences. A 2012 American-Statesman investigation of Texas combat veterans who died after returning home found that more than one-third of those diagnosed with PTSD died of an overdose, often due to pharmaceuticals.
In addition to fewer PTSD symptoms such as nightmares, flashbacks or feelings of detachment, follow-up testing to the cognitive therapy also revealed soldiers were less depressed and suicidal. On average, the 268 soldiers who participated in the study had been deployed more than two times.
It made sense to conduct the study at Fort Hood, the Army’s busiest deployment hub during a decade of war in Iraq and Afghanistan, said Alan Peterson, co-director of the study and head of the STRONG STAR Consortium, a multi-institutional research group funded by the Defense Department and based at the University of Texas Health Science Center at San Antonio.
Today there are 30 therapists from the UT center embedded at Fort Hood’s Darnall Army Medical Center, treating soldiers and conducting research.
“Nowhere in the Department of Defense is there a bigger research cell,” he said. “It’s a benefit to Fort Hood because we screen lots of soldiers. … Everyone got gold standard care.”
Researchers say the results show that PTSD recovery is possible in a matter of weeks, providing hope for service members seeking to remain in the military as well as those seeking to transition quickly to civilian life.
“A common misbelief is that combat PTSD is a chronic, lifelong condition that’s very difficult to treat,” Peterson said. “If we intervene early, there is a good percentage you can turn the corner on.”
“Think in a different way”
Cognitive processing therapy helps service members learn to think about their traumatic experiences in a clearer way, without “distorted thoughts” that perpetuate feelings of guilt, blame and anger, researchers say.
“If you teach them to think in a different way, that’s a set of tools they have now,” said Duke University School of Medicine professor Patricia Resick, who developed the therapy two decades ago and served as principal investigator on the study. “When we treat them they are treated, they don’t relapse. … They are able to see (their triggering incident) differently. They don’t automatically blame themselves.”
Cognitive processing therapy is one of two widely used talk treatments for PTSD. The other is prolonged exposure therapy, which calls for individuals to re-imagine their traumatic experiences in an effort to strip the memories of their power.
Resick was excited when she got a call from Peterson to work on the STRONG STAR study. “It was the first time we got a chance to see if it could work with active military,” she said.
The Department of Veterans Affairs already uses the treatment regularly for those who have left active duty.
Though promising, the success rate among active-duty soldiers was lower than what researchers have found among civilians with PTSD who use cognitive processing therapy, Peterson said.
“What that tells us is that combat PTSD is more complicated,” he said. “We’ve only scratched the surface on the science behind this.”
Researchers say active-duty service members face particular barriers to recovery, including an environment filled with potential triggers such as the sound of artillery fire or the smell of military vehicles.
Peterson, a retired U.S. Air Force lieutenant colonel, said military personnel also are more likely than civilians to have witnessed multiple traumatic events. And military training, which stresses the importance of being responsible for your fellow soldier, can produce feelings of guilt and self-blame that inflame PTSD symptoms, researchers say.
“It gets them ready to fight, but, if you are too rigid in your thinking, you can believe that anything that happens to ‘my men is my responsibility,’” Resick said.
Resick added that, unlike in previous conflicts, such as World War II, the lines between combat and home have blurred. “(Previously) they came home on boats, it gave them time to process, to grieve, to talk with their buddies,” Resick said. “In these modern wars, you could be in the middle of a firefight one day and grocery shopping in your hometown two days later. It’s kind of mind-bending.”
Researchers have already begun follow-up studies, including one that looks at whether extending the traditional 12-session therapy to up to 24 sessions is more fruitful for active-duty service members. Peterson said he hopes the study’s results will lead to wider use of cognitive processing therapy on military installations.
War images hard to shake
Brack began his cognitive processing therapy with an assignment from his counselor: write about the incident that troubled him most. It wasn’t as straightforward a request as it sounded. “After years of toughing it out, you get this scarring,” he said. “There are so many layers, where do you even start?”
But Brack had noticed that his symptoms always worsened around Thanksgiving and the holidays, and his mind kept circling back to an incident during his first deployment in 2003, when he was a sergeant first class in Fort Hood’s 4th Infantry Division, one of the first units to invade Iraq.
On Thanksgiving day 2003, after a chow hall dinner of canned turkey loaf, Brack and his unit were called out to escort a battalion commander to a checkpoint outside of Baquba, about 30 miles northeast of Baghdad. The soldiers arrived to the aftermath of a firefight.
Two young Iraqi girls, about 10 or 12 years old, had been shot and killed. Brack, at the time the father of an infant daughter, had to place the girls in body bags and lift them into the back of a cargo truck.
The scene shook Brack, but he didn’t feel he could share his feelings with the younger soldiers he led as a noncommissioned officer. “The guys asked me, ‘Sarge, what’s going on?’ I said, ‘You really don’t want to know.’ They had all their issues to deal with. They didn’t need one more.”
Nor did he feel he could share with his higher-ranking peers. “You don’t want to give anyone the idea that you’re not holding it together, because they can lose confidence in you,” he said. “And that can be deadly.”
The incident became one of several that he would bury in the coming the years: “It hit me hard at the time, but the next day you move on and don’t think about it.”
While cognitive processing therapy didn’t require him to relive the incident over and over, Brack and other soldiers in his group therapy sessions discussed how traumatic events affected their lives and the symptoms that had ensnared them.
“Immediately you start talking with other people, and you realize you don’t need to be afraid of talking about it,” he said. “You’ve identified your incident, and you feel that weight come off your chest. You realize you’re not unique or weird or broken. It’s perfectly normal what you’re feeling.”
Brack says he learned to identify when he was beginning to enter a negative spiral of anger and frustration, usually set off by something small and trivial.
“It doesn’t work for everybody,” Brack said. “There were some people in my initial group who didn’t stay. They seemed intent of nursing their anger.”
He says the program helped him stay in the Army and make a fourth deployment to Afghanistan in 2011. More importantly, the experience led him to seek further help for traumatic brain injury and sleep disorders. After retiring from the Army in 2014 after a 20-year career, Brack is studying nursing at the University of Mary Hardin-Baylor in Belton and plans to use the lessons he learned at Fort Hood in the next phase of his life.
“I owe a lot to those folks,” he said.