Here's a great story of a treatment concept that has great promise. They really want to retain those Iraq and Afghan vets. It saves a fortune.... ed.
Army Chief of Staff Gen. George Casey: Replicate Fort Bliss PTSD Program
Army News Service|by Virginia Reza
FORT BLISS, Texas - Army Chief of Staff Gen. George Casey visited Fort Bliss July 13 and said that an innovative program there to treat post-traumatic stress disorders ought to be replicated at other locations across the Army.
The "Restoration and Resilience Center" at Fort Bliss is a specialized treatment facility for Soldiers with PTSD who want to remain in the Army. The center is run by Dr. John Fortunato, a Benedictine monk, Vietnam veteran and clinical psychologist.
"Unfortunately you can't package John Fortunato and move him around and it really takes someone with that passion to drive these kinds of operations," Gen. Casey said, "but there are some of the elements of this that are clearly exportable, and we will do that."
Fortunato opened the unique treatment facility one year ago in July 2007. It all started when he worked at the Soldiers' outpatient clinic at Bliss, treating servicemembers who were coming back from deployment and diagnosed with PTSD. Their treatment consisted of medication and group counseling and very little individual counseling, due to insufficient staff. If, in the course of three months Soldiers were not fit for duty, they had to be medically discharged.
"There were two things about that, that didn't seem right," Fortunato said. "I got tired of Soldiers crying in my office, telling me they did not want to get out, that the Army was their life, and that's all they knew, and all I could say is, 'Sorry, we have to discharge you.' It tore me up."
The other thing that didn't seem right to him was signing paperwork stating Soldiers had derived "maximum benefits on inpatient and outpatient treatment."
"I thought, that is not true, because we haven't really tried hard enough to rehabilitate them. There were so many issues we were not addressing."
Fortunato said during his sessions with the Soldiers at the clinic, his intuition helped him realize they needed more than just psychological treatment. As he counseled them, he noticed their hands and feet constantly tapping and shaking through entire sessions. Spiritual questions and isolation were other symptoms he observed. So he came up with the idea to build a place where physical and psychological aspects could be treated to help Soldiers who wanted to remain in the military.
The task would not be easy, as the center he had in mind was not a typical Army facility. Nevertheless, he persisted and pleaded and finally got the funding and square footage to open the center.
His first instinct was to design a place where Soldiers could go and feel comfortable. He did not want them isolated in their rooms because he said, Soldiers diagnosed with PTSD are easily over-stimulated and don't want to be around anybody.
"Only - we can't leave them there," he said. "So I had to sort of seduce them out of their rooms."
So Fortunato decided the center would have to look like a lodge at a ski resort. The entrance to the facility is equipped with oversized leather, mission-style chairs, wood floors and the sound of trickling water from a cascading fountain that sits in the lobby has a calming effect. At the end of a hallway, is an Asian-looking room with background therapeutic sounds, called the meditation room.
"This room has a purpose," Fortunato said. "You can sense the music playing, which is based on breathing, and if you spend three minutes in this room with the door shut, without anyone talking you, you will find that your mental state has changed."
Fortunato said that during treatments, Soldiers have to stir up memories they don't want to remember, but that are necessary in order for them to work through them. This procedure arouses them, and by going inside the room, the ambiance helps them calm down again, he said.
"So there is a lot of traffic in and out of this room," he said. "You will sometimes find four Soldiers just sitting here, and we want them to do that.
"And let me say that regardless of what your faith is, there is always something that makes our life meaningful," Fortunato added. "We all have some notion about why relationships are important and who we are. All those issues are questioned by Soldiers in war. They come home and they have to deal with questions they usually don't have the ability to handle ... And I'm not offering any particular answers, but God have mercy, we have to help Soldiers answer those questions ... so that they can get on with their lives."
A group of therapists and a chaplain help Soldiers raise painful questions so they can get through the grief they have been holding on to, which he said is one of the things Soldiers resist most.
"In theater if you lose a buddy, here is what you do: drink water, stuff it down and go back out on the road," Fortunato said. "Because you don't have time to grieve, and that is what a Soldier has to do. But when you come back and you have done that for a whole year, you have a load of grief you haven't done."
Another issue Fortunato said the military was not addressing before was the physical aspect. He said many post-deployment Soldiers constantly tap their feet and hands.
"In order to stay alive, their bodies have been hyper-aroused for so long, that they come back and cannot turn it off," he said. "Their body doesn't even remember how to relax again, and because of that they don't sleep and are irritable."
Therefore, servicemembers have to learn how to relax again. And to acquire the relaxation mode again, Fortunato designed a therapeutic program, which includes massages, acupuncture, Tai Chi, Yoga, Reiki, power walks and visits to the mall.
"You would think that going to the mall would be fun, but it is not fun for a post-deployment Soldier," Fortunato said. "There are too many people, too much noise, which sets them up for panic attacks. But we can't leave them there, so we teach them relaxation techniques to modulate stress and we take them to the mall."
The staff then ups the outings by taking them to a simulated indoor range, where Soldiers can fire real weapons. They start out with insurgent silhouettes, which then build up to ambush scenarios, which can be very challenging for some Soldiers, Fortunato said.
"But we have to challenge them if they want to stand up and be warriors again," he added.
Fortunato said there are reasons why servicemembers get PTSD that have nothing to do with character. A recent finding of a strong genetic predisposition is a factor that puts people at risk.
A 5-HTT gene serotonin transporter, which regulates anxiety and depression in the brain, contains "alleles," which can either be short or long. He said people with one or two short alleles become depressed more often after stressful events than individuals with two long alleles. Research is underway on combat-related disorders and some possibilities include deploying Soldiers with short alleles on medication, which will help inoculate them from getting PTSD.
"We are in the process of doing a research protocol with 400 Soldiers," Fortunato said. "WBAMC is considering that research protocol. And if we can show that it is true, then we move to the next step. The Army is very interested in doing the best thing for the Soldier and if we find that's what we need to do then we will do it."
Another of the many therapies in the program is the cognitive rehabilitation, which treats stress hormones that, if too high, can damage part of the brain that controls thinking, especially memory. By using the brain-train treatment at the R&R center, Soldiers can regain all their functions.
"It just takes work," Fortunato said. "It is like a muscle - you have to work it to make it better."
The program includes three phases: In the first three months, Soldiers receive 35 hours of treatment per week. Then it drops to 21 hours a week for another three months. After that, they go back to their units, but with seven-hour-a-week after care. So far, 12 out of 37 Soldiers have graduated and are back in their units.
Fortunato said he wants to deploy to Iraq in the future with a Combat Stress Control Unit as their unit psychologist.
(Virginia Reza writes for the Fort Bliss Monitor newspaper. Stephen Baack of the Monitor also contributed to this article.)
Heres another take on the story
Center Creates ‘Little Miracles’ in Treating Combat Stress
By Donna Miles
American Forces Press Service
FORT BLISS, Texas, May 9, 2008 – A revolutionary treatment program here is demonstrating “little miracles” as it gives new hope to soldiers afflicted with post-traumatic stress disorder who want to stay in the Army, its director reports.
The new program is the brainchild of clinical psychologist John E. Fortunato, who uses a holistic approach to treating PTSD at the new Fort Bliss Restoration and Resilience Center.
Fortunato conceded that his proposal “wasn’t an easy sell” initially, particularly because it wove yoga, massage therapy and other nontraditional approaches into its treatment program. But driven by the frustration of seeing soldiers with PTSD forced to leave the Army against their wishes, Fortunato pressed forward and won approval for his prototype program.
With $2.2 million in initial funding and a 1940s barracks building to rehab, he set out to launch the Restoration and Resilience Center in June 2006. The center opened last summer.
Fortunato was convinced traditional PTSD treatments weren’t long enough, intense enough or comprehensive enough. “So we set out to create a program to address all aspects of PTSD and treat the whole soldier,” he said.
The participants, all volunteers, take about one-half the doses of medications they’d typically get through community mental-health programs. “That’s because we’re doing a bunch of other things,” Fortunato said.
Many PTSD-afflicted soldiers experience “hyper-arousal,” which the center staff treats with techniques like medical massage and “Reiki,” a Japanese stress-reduction technique. Acupuncture has proven to be “extremely effective” in treating the anxiety, panic, and tension-induced physical pain many experience, Fortunato said.
There’s a big physical component to the program, too. The soldiers must walk at least 10,000 steps a day, including a daily 45-minute “power walk.” They play water polo three times a week, forcing interaction that Fortunato said many would rather avoid.
“That’s another piece of PTSD. They want to socially isolate. They don’t like to interact with other people,” he said. “So we have them interact with the people they feel most comfortable with: other soldiers with PTSD.”
Field trips during the program take the soldiers to the local mall and Wal-mart, “two hells” to many of them because they’re too big, too crowded and too noisy, Fortunato said. “We teach them ways to regulate their stress level so they can handle those kinds of environments.”
Many afflicted soldiers have trouble with concentration and memory, Fortunato said. For them, the program’s mix of physical activity and calming techniques appears to help. They do yoga; tai chi, a Chinese martial art; “Quigong,” a centuries-old Chinese self-healing method; and biofeedback, which uses the mind to heal the body. “We have a meditation room that looks like it came out of a Zen monastery,” Fortunato said.
The program aims to repair the physical damage to the “learning center” in many PTSD sufferers’ brains. That’s caused, Fortunato explained, when the body’s stress hormone is elevated too high and for too long -- as it commonly is among combat troops.
“The good news is, [the learning center] is one of only two parts of the brain that can grow new cells,” he said. So his program requires participants to sit at a computer several times a day, doing mental exercises to help them regain their cognitive functioning.
While confronting the physical aspects of PTSD, the program addresses the emotional and spiritual aspects, too.
“Few soldiers come back from war without terrible images and events in their head,” Fortunato said. Many “suck it up and soldier on” in the combat theater because they have no choice. But when they return home, these issues can percolate to the surface as nightmares, flashbacks and other problems.
Fortunato’s program uses “rehearsal therapy” to help participants confront their most painful memories and experiences. “The soldier tells the story, as painful as it is, over and over until you’ve emptied it of its emotional punch,” he said. “They are never going to forget the story, but it doesn’t have to have the grip on their guts that it did before.”
Meanwhile, many soldiers with PTSD find that their combat experience has shaken their core beliefs and values, Fortunato said. A chaplain helps them review “the big organizing things in their life” as they address the spiritual piece of their PTSD struggle. “We weren’t doing much to address this before,” but it’s critical to a soldier’s healing, he said.
Fortunato said there’s nothing monumental about the Recovery and Resilience Center’s approach to treating PTSD. “If you put all of that together, it isn’t magic,” he said. “None of it is magic. And do you know what? None of it is new. All we did is, we looked at the whole soldier and tried to treat all of him.”
The “whole soldier” approach appears to be paying off. Twelve of the 37 soldiers who volunteered for the program have graduated and returned to their units. Among the recent graduates is a soldier who was in a catatonic state in August, but now is free of all signs of PTSD.
“Little miracles are what we are watching happen,” Fortunato said.
So far, only two participants have washed out of the program, both taking medical discharges from the Army.
Fortunato is the first to say his program isn’t for everyone. “This is a hard program,” he said. “[Participants are] in treatment 35 hours a week [with] daily psychotherapy, daily group therapy [and] integrative medicine. They go from 8:30 in the morning until 4:30 every afternoon. You have to be highly motivated to put up with that much treatment.”
There’s no set timetable for completing the program, but Fortunato said he’s finding six months to be optimal for most soldiers. “As long as they are working hard, we are going to hang in with them,” he said.
The soldiers formed their own platoon, which they dubbed, “the Wolf Pack.” It’s a testament, Fortunato said, to the way they take care of each other and the strength they’ve shown in admitting they have PTSD and seeking treatment.
As the soldiers work to overcome their combat stress and return to their units, Fortunato said he’s convinced the program is in the Army’s best interest as well.
The cost alone of treating a soldier -- somewhere between $14,000 and $20,000 -- is a bargain to the force, he said. By comparison, he said it would cost about $400,000 to recruit and train a new soldier and provide lifetime disability payments and medical care to the discharged soldier.
“So why wouldn’t you do this?” Fortunato said. “I think the numbers are all in our favor.”
Defense Secretary Robert M. Gates appears to agree. He toured the Restoration and Resilience Center on May 1, calling the visit an “extraordinary experience.”
“They are doing some amazing things here in terms of helping soldiers who want to remain soldiers but who have been wounded with post-traumatic stress disorder,” he said. “It is a multi-month effort by a lot of caring people, and they are showing some real success in restoring these soldiers.”
Gates called the center an example of new approaches the military is taking to care for these troops. “This center here is illustrative of what can be done,” he said.
Gates said he’ll consider the idea of possibly replicating Fort Bliss’ prototype program to other posts.
Fortunato said he’s all for duplicating his effort, but emphasized that his program’s small size is a key to its success. The soldiers and staff all know each other, have nicknames for each other, and feel a personal commitment to each other. “We all love these guys,” he said.