There are several studies claiming a 70-percent improvement rate for returning warriors who are treated for combat stress with various cognitive behavioral therapies and/or prolonged exposure strategies. But this is a misleading number.
What this doesn't take into account is the fact that of those with persistent combat stress, only half will seek out treatment in the first place.
The main barrier to seeking help isn't stigma, the reason that's usually cited as the primary problem; surveys show it's actually distrust of mental health providers, both civilian and military, that keeps our service members away.
I'll get back to that in a bit. But for now, back to the numbers: 50 percent won't go for treatment in the first place.
And of the 50 percent who actually do go, 60 percent drop out -- many after their first session (or during it). The reasons for this are two-fold. First, edgy warfighters with combat stress are easily spooked by well-meaning but clueless therapists who don't understand enough about warrior culture to engage them and understand them; and, two, although there are treatments that work for PTSD, that's not what most of our providers are offering.
So we lose 60 percent of them right off the bat -- a shame, really, because many of them had to be talked, cajoled, begged and hard-assed into giving it a try in the first place, and a one-time opportunity to do some good gets lost for good. Sadly, most therapists don't know that they have about 20 minutes to prove that they have something to offer before that service member bolts out the door, never to return.
So now we're talking about 40 percent sticking around, reaping some benefit from therapy. But keep in mind that that's 40 percent of the 50 percent who will give it a try. So, if we do the math, that's 20 percent -- a far cry from the 70 percent touted in some of these studies. (In research terminology, we're talking about Intent to Treat stats or ITT, the true number that takes into account the non-random loss of participants.) And experts like Charles Hoge, a psychiatrist/epidemiologist who's studied this, says the reality is probably closer to 15 percent.
With the anticipated drawdown from Afghanistan and Iraq, we'll have around 1.2 million returning warriors, 30 percent of whom are likely to have some kind of combat stress (and that's not taking into account the moral injury all troops suffer, from the grief, shame, guilt, woulda-shoulda-couldas and personal crises that exposure to war imposes on everyone).
Thirty percent of 1.2 million is around 360,000 service members returning to this country with PTSD, many of them coming back to no jobs, fractured families, financial difficulties and a sense of utter alienation from civilian society and the life they once led, not to mention the people they once were.
To make matters worse, these returning warriors will also be suffering the loss of their cohort of fellow warfighters -- those they fought with, who feel closer to them than family, the only ones who totally get what they've been through and how it's changed them. This loss is huge and comes at the worst time.
Most of these service members will get better, with or without help; some will stay pretty messed up. And a percentage will be very, very disoriented and angry -- and keep in mind, these are trained snipers, bombers and fighters. We need to help them for humanitarian reasons and because we owe them, but also because this slice of the population could pose a threat to public safety.
That's why it's so important that Michelle Obama and Jill Biden are speaking up for more community and business support for our returning warriors, vets and their families. May they please keep it up.
In the meantime, what can we do with this information? Well, here are some starter thoughts:
- We need to bring our military, VA and civilian therapists up to speed -- on warrior culture, strategies of engagement and effective protocols for dealing with combat stress and military sexual trauma.
Because of these concerns, Fort Sill in Lawton, Okla., is launching a guided imagery experiment through its Resiliency Center, to see if drill sergeants, master sergeants and field officers can alleviate some suffering by giving out guided imagery audios to their soldiers and their families. We'll let you know how it goes.