“Web Therapy” for PTSD?

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On Labor Day 2010, armed with a 9 mm handgun, Iraq war veteran Sgt. Robert Quinones took three soldiers hostage at Georgia’s Fort Stewart hospital and demanded better mental health treatment: “I’ve done it the Army’s way. We’re going to do it my way now.”

“The Army’s way” that Quinones was referring to was 10-minute therapy sessions via videoconference. As Megan McCloskey, who reported on Quinones’ story for Stars and Stripes, wrote, it was “the best the Department of Veterans Affairs could offer.”

Since 9/11, more than 2.2 million Americans have served in Iraq or Afghanistan, and according to a landmark 2008 RAND study, nearly 20 percent of them — 300,000 total — reported post-traumatic stress disorder (PTSD) or major depression upon returning. Only slightly more than half of them have sought treatment, but that number is enough to overwhelm the military’s limited resources.

“It wasn’t that the Army or the VA didn’t try to care for Robby, it was that what they offered simply wasn’t good enough. And that, unfortunately, is not unusual.”

Lt. Gen. Eric B. Schoomaker, the Army’s top doctor, lauded videoconference therapy in a 2010 interview for our film The Wounded Platoon:

We’ve done that now successfully here in the United States. We started [at Tripler Army Medical Center] in Hawaii late last year with a pilot program in which we brought back a unit from combat and did one-on-one interviews in a parallel way using video teleconferencing and face-to-face behavioral health specialists and others. [We] found that the video teleconferencing worked very well, that soldiers accepted it very well. This generation of soldiers is very comfortable in a digital environment, either text messaging on their cell phones or working through a Skype camera.

I spoke to McCloskey to understand more about the Army’s use of this new technique, and how soldiers are responding.

How common is the use of videoconferencing therapy in the Army?

Videoconferencing is still fairly new, having only started in earnest last year, but it’s increasingly being relied upon to meet the heavy demand for mental heath services in the Army and the Department of Veterans Affairs. The Army’s vice chief of staff, Gen. Peter Chiarelli, often touts telemedicine as the way of the future for the Army. He has been a big proponent of expanding the programs.

How and why did it start?

The Army is overburdened. It doesn’t have enough mental health providers to take care of all the soldiers who need treatment for post-traumatic stress disorder and other issues, such as depression. The service has gone on a hiring frenzy in the last few years, but the Army, as well as the VA, is still understaffed.

Videoconferencing was a way to bridge the gap. It began in late 2009 with a pilot program in Hawaii to use videoconferencing for the mental health screenings that all soldiers go through when they return from deployment. Now it’s evolving as way to provide treatment. Videoconferencing extends the reach of the limited number of providers.  The Army also likes that it’s cost effective.

The Army and VA hope telemedicine will also help them reach soldiers and veterans who live in remote areas or who are too shamed by stigma to seek help in person.

How does the Army determine who gets videotherapy and who speaks to someone in person?

Much is dictated by location. There are areas of the country with fewer providers or longer wait times for appointments. Soldiers who live in those places are more likely to be referred to telemedicine. The Army and VA also say that severity of the issues faced by the soldier or veteran also comes in to play. Those who need more intensive care will be seen face-to-face with one-on-one counseling or in a group setting.  However, as we saw with Robert Quinones, that isn’t always the case. Availability of doctors is often the driving force.

What’s the reaction of soldiers and vets who use the therapy?

It seems to be mixed. I’ve heard from soldiers and veterans who don’t need long-term care say they don’t mind communicating that way and appreciate the ability to get care without traveling great distances. When it comes to the post-deployment mental health screenings, many of the young soldiers report a preference for the videoconferencing. But that’s different from actual therapy. Many of those who need more intensive counseling for PTSD or depression don’t like the impersonal nature of talking to a TV screen. For some, telemedicine doesn’t meet their needs and adds to their sense of isolation.

How exceptional is Robert Quinones’ story?

Well, the hostage situation certainly makes Quinones an outlier. But his story leading up to that point is a common tale. Like many soldiers with PTSD, he had trouble getting access to a Warrior Transition Unit when he was active duty, and then he had to jump through hoops with the VA. He lived 45 minutes from the nearest VA clinic and that clinic was too understaffed to treat him, so basically his care was outsourced to the larger Charleston, S.C., clinic through telemedicine. It wasn’t that the Army or the VA didn’t try to care for Robby, it was that what they offered simply wasn’t good enough. And that, unfortunately, is not unusual.

Is videoconference therapy working?

It’s hard to say. The Army’s studies of using videoconferencing for mental health screenings show positive results, but the jury is still out on the efficacy of therapy over the internet. Quinones is an extreme case, but his story could give one pause over whether videoconferencing is the best method to treat returning veterans with PTSD.

Bonus clip: It’s not just videoconference therapy; watch this excerpt our from Digital Nation project that shows how the Army is treating PTSD with virtual reality therapy.

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