ARMY AL&T
symptoms—irritability, insomnia, impaired attention, and headache, for example. More than a dozen research projects are devoted to distinguishing between mild TBI and PTSD.
With PTSD, too, a complicating ele- ment is “co-morbities,” simultaneous health problems such as depression, substance abuse, and the prescribed use of strong pain medications. All of these can influence which treatment option to use, Gilman said.
The Army’s continuum of PTSD research (see chart on Page 32) includes
development of a validated animal model of trauma exposure to evaluate pharmacological treatments for PTSD, as well as:
• Prevention/education and training— The Navy and Army are working together to tackle the stigma asso- ciated with seeking help for PTSD or other mental health issues, by developing a media-based stigma reduction program for Soldiers and Marines that targets the factors influ- encing the decision to seek treatment and identifies barriers to care. As a cultural issue, stigma “will require
This instrumented head form is used for helmet testing, which itself is an area with unanswered questions. (U.S. Army photo courtesy of ARL.)
a period of sustained intervention before we make a dent,” Gilman noted. “We can’t wait until the stig- ma is gone before addressing other aspects of PTSD.”
• Early screening and intervention— A nearly completed study called Enhanced Resilience Training Through Cognitive Disclosure used emotionally expressive writing as an early intervention for Soldiers who have returned recently from combat. It found this approach to be unsuited to Soldiers with high levels of combat exposure, however.
• Assessment—A multimodal diagnostic approach is needed that distinguishes between TBI and PTSD with adequate sensitivity and specificity. Researchers are seeking the best combination of techniques including imaging, neurophysiologi- cal biomarkers, and neuropsychiatric testing. While health care practitio- ners may not place a high priority on the distinction, it is “a very big deal” in the military’s consideration of whether and how to award the Purple Heart to Soldiers with TBI, Gilman said.
• Treatment—The Army is exploring virtual reality (VR) technology and cell phone platforms to assess PTSD treatment options, and the use of VR to administer treatment, particularly for service members located far from medical facilities.
• Recovery—Given that PTSD tends to be chronic and causes recurring prob- lems, a randomized trial is underway to compare management of follow-up behavioral therapy over the telephone and Internet, continuous care man- agement by a nurse supervised by a psychiatrist, and computer-guided care management based on patient prefer- ence and the severity of symptoms, all ways to make effective care more accessible and appealing to patients. The results of this research will feed into other initiatives to expand mili- tary medical care using cell phones and the Internet, Gilman said.
APRIL –JUNE 2011 33
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