Dropping out of PTSD Therapy Can Lead to Suicide by Vets

Suicide by vets, once they return back home from combat, or even years later, is a very disturbing reality most of us are aware of.  The current rate of suicide for vets is 22 a day.  Some have quoted more.  The number just reflects the magnitude of the problem.

In the New York Times, September 19, 2015 article titled “In Unit Stalked by Suicide, Veterans Try to Save One Another“ reporter Dave Phillips was outstanding in his empathy for the vets who served in “one of the hardest hit military units in Afghanistan, the Second Battalion, Seventh Marine Regiment.”  Mr. Phillips had the courage and willingness to feel their horrific pain at losing 13 of their Unit 2/7 veterans to suicide.  His article rightly demands our deepest attention (see link to it at the close of this post).

I would have hoped that the reporter would have done deeper research on methods of PTSD therapy from which veterans are dropping out. It’s a very relevant issue. He vaguely reported that:

The therapies, considered by the department to be the gold standard of evidence-based treatments, rely on having patients repeatedly revisit traumatic memories — remembrances that seem to cause many to quit. (my emphasis)

Another article just posted in Outlook, could at least identify the two therapies that require revisiting and describing their traumatic memories:

There are two common approaches: prolonged-exposure therapy (PE), which involves repeatedly and vividly revisiting the traumatic experience, and cognitive-processing therapy (CPT), which focuses on how a patient responds to events in his or her postwar lifePE and CPT have the best pedigree of any recognized therapy available, but neither technique works for everyone.

But this reporter, too, apparently just interviewed staff at a Veteran’s clinic to report such unscientific terms as “gold standard” and “best pedigree”.  Both did not do their own broader research about effective PTSD treatment.

If they had, they would have discovered EMDR therapy has an equal efficacy rate in the general population, and works more quickly than the other therapies, BUT does not require talking about the incidents.  The World Health Organization recommends only two treatments for PTSD:  CPT and EMDR Therapy, or Eye Movement Desensitization and Reprocessing.

Research with veterans has demonstrated that they prefer EMDR because they don’t have to talk about or describe their traumatic experience if they don’t want to.  In one study, the drop out rate for veterans undergoing the 3 therapies was 0% for EMDR patients, approximately 20% for CBT patients, and 40% for those receiving Prolonged Exposure Therapy.

When drop out rates translate to suicide by vets, and thus to soldiers lost AFTER they return home from the threat of the hostile war environment, it is time to look a lot closer at the issue.

3 soldiers

From a dissertation by C. Butler:1

Currently two seminal studies provide empirically supported treatments for PTSD and are among the treatments offered and endorsed within the Department of Veterans Affairs (VA). Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) receive funding, training, and clinical emphasis as a result of 40%–41% success in reducing or eliminating symptoms of PTSD in veterans (Monson2 et al., 2006; Schnurr3 et al., 2007).

In comparison, Eye Movement Desensitization and Reprocessing (EMDR) is a therapy that has shown great promise, with nearly 77.7% success in reducing or eliminating symptoms of PTSD in Vietnam veterans. However, EMDR has not been significantly reviewed since 1998. The primary study conducted by Carlson, Chemtob, Rusnak, Hedlund, and Muraoka4 (1998) has remained as the main guidepost of the potential of EMDR as an appropriate treatment for veterans with PTSD.

Though EMDR has been approved by the Department of Defense and the Veteran’s Administration for nearly 2 decades, it is still a political issue as to whether EMDR is available at your local veteran’s clinic.  As an EMDR therapist, I have considered the VA health care system to behave like a “feudal” system, with separate fiefdoms.  Confirming that point, I’ve told by a veteran that individual VA health care systems are operated much like individual ships, with the captain having all the power.  Just yesterday a military wife enthusiastically agreed with both these comparisons.  This uncoordinated leadership system seems to be a key reason there is no overseeing intelligence pulling together the three top therapies for PTSD, allowing veterans to have a choice.

It is high time that happens.  Perhaps the public and Congress need to get involved.  It is a matter of life and death for veterans who bravely serve our country’s ideals.

NOTE:  To see the original NY Times article,

 link here


©2015 Dana Terrell, LCSW, EAC

1Butler, C. M. (2012, August). Comparing the efficacy of eye movement desensitization and reprocessing to treatment as usual for veterans with military-related post-traumatic stress disorder. (Doctoral dissertation, Argosy University)

2 Monson, C. M., Schnurr, P. P., Resick, P. A., Friedman, M. J., Young-Xu, Y., & Stevens, S. P. (2006). Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. Journal of Counseling and Clinical Psychology, 24(5), 898–907.

3 Schnurr, P. P., Friedman, M. J., Engel, C. C., Foa, E. B., Shea, M. T., Chow, B. K., Bernardy, N. (2007). Cognitive behavioral therapy for posttraumatic stress disorder in women. Journal of the American Medical Association, 297(8), 820–830.

4Carlson, J. G., Chemtob, C. M., Rusnak, K., Hedlund, N. L., & Muraoka, M. Y. (1998). Eye movement desensitization and reprocessing (EMDR) treatment for combat-related post-traumatic stress disorder. Journal of Traumatic Stress11 (1), 3-23.