The Need for Out of the Box Solutions in Mental Health Treatment

A recent Army Times piece explained that a mental health program aimed at reducing post-traumatic stress disorder (PTSD) will be expanded despite their own researchers finding no proven gains since 2009. This revelation is a vivid illustration of the need for out of the box solutions in mental health treatment and the delivery of healthcare at large. Continuing to expand a $50 million dollar per year program (now costing $75 million dollars annually) doesn't make much since when there are other viable alternatives that have not been adequately explored.

After more than a decade of wars in Iraq and Afghanistan, the rate soldiers returning home suffering from PTSD has skyrocketed. A study released last year by the Department of Veterans Affairs (VA) showed that 30 percent of the soldiers who have been treated since September 11, 2001 suffer from PTSD. The cost of the treatment for PTSD and other psychological disorders is also much more than troops who are not diagnosed with it. Troops who have been diagnosed with PTSD cost the VA an average of $8,300 the first year of treatment as opposed to $2,400 for those without it.

Dr. Kevin Kip, Professor and Executive Director of Research at the University of South Florida College of Nursing, has completed two studies on a therapy that can potentially revolutionize the way that PTSD and similar ailments are treated. The treatment was developed in 2008 by mental health therapist Laney Rosenzweig and is called Accelerated Resolution Therapy (ART). ART involves a combination of evidence-based psychotherapies and use of eye movements. It differs from the conventional cognitive-behavioral therapies that are endorsed by the Department of Defense and VA. These therapies typically involve ten to twelve sessions with homework. ART is delivered in two to five one-hour sessions with no homework and does not require the patient (veteran) to disclose details of their traumatic experiences. The treatment is more of a medical procedure as opposed to "talk therapy."

The procedure begins with the person identifying and recalling the traumatic experience in their mind. This elicits a set of symptoms (e.g. increased heart rate, tightness in the chest). The person follows the therapist's hand to perform a series of left-to-right eye movements that eliminate or greatly reduce these symptoms and deal with the person's physiological response. The person then imagines a new, positive way that they would prefer to remember the experience. Through a process referred to as "imaging rescripting," the sets of eye movements help the patient to recreate a more positive way of remembering the experience. This results in a replacement of the negative images and the elimination or major reduction of the symptoms of PTSD that are attached to those images.

There have been two studies, one conducted among civilians and one among military personnel, conducted by Kip at the University of South Florida. Both studies have shown a significant reduction of PTSD symptoms in an average of less than four sessions, no homework, and with a treatment completion rate that exceeds 90 percent. Kip describes the current reluctance to the therapy within the military environment as largely systemic.

Specifically,VHA Handbook 1160.01 mandates first-line use of 2 other therapies known as prolonged exposure therapy and cognitive processing therapy, and moreover, a performance metric within the VA system known as "OEF #41" requires veterans with PTSD to receive at least 8 sessions within 14 weeks of time of one of the endorsed VA therapies. Thus, at present use of ART is not permitted within the VA system, and its brevity does not comply with the minimum 8-session performance standard.

Bureaucratic barriers to new techniques and treatments such as the 8 session minimum performance standard should be revised to make room for the exploration of advanced techniques in the delivery of healthcare. New forms of treatment like ART should be seriously considered and trials of the therapy should be supported. Future studies that show the effectiveness of ART would justify its implementation on a large scale as a viable alternative to the status quo.