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December 5, 2016

Finding a way through PTSD that doesn’t rely on drugs

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The Washington Post – Last fall, Shaun Durfey and five other veterans sat in a circle and drew their family trees. Durfey, a 29-year-old former Marine, had served three tours in the Middle East. Upon his return to the States, he’d been given a host of medications for insomnia, depression and post-traumatic stress disorder, or PTSD, and he had spent hours at a Veterans Affairs hospital talking about the wartime deaths of friends. But his doctors had never probed his family history, which included painful memories of childhood neglect. Now, Durfey was being asked to speak openly about these experiences.

“ ‘There’s no shame in the bad parts of your life,’ ” Durfey recalled members of the group telling him. “ ‘Just lay it out.’ So I did.” Then the vets gathered around a bonfire and burned their family trees. “It was a symbolic pledge to stop the trauma,” Durfey said. “I felt like I was starting my life anew.”

Durfey had left his wife and four children in Michigan to attend the Warrior PATHH (Progressive and Alternative Training for Healing Heroes) at Boulder Crest Retreat, a 37-acre private facility in the Blue Ridge Mountains of Virginia. Since it opened in 2013, more than 112 combat vets have participated in the free, week-long Warrior program. Another 2,400 veterans, spouses and caregivers have visited the center for family stays and workshops.

Boulder Crest is not the only post-deployment retreat for service members, but its founders say they believe they have hit upon a unique approach for addressing combat trauma: It’s a program aimed at encouraging personal growth that eschews medication. And they say they believe it is superior to the classical psychological interventions typically practiced by the Department of Veterans Affairs.

In many ways, the Boulder Crest approach is designed as a contrast to VA. Instead of visiting a doctor’s office, participants spend a week outdoors — kayaking, hiking, riding horses and shooting arrows. Activities and group discussions are led not by clinicians but by other combat veterans. And instead of medication, exposure therapy and cognitive processing therapy, vets explore their family histories, examining why they enlisted in the first place.

The Warrior PATHH uses Trans­cendental Meditation to teach stress and anger management; yoga and hiking to promote a healthy lifestyle and address physical ailments; solo kayaking trips to encourage reflection; and archery to teach patience and focus. Through small-group discussions, journaling and creative exercises (such as creating a family tree), vets explore how to incorporate soldiering skills such as tenacity, teamwork and organization into their professional and family lives.

Together, these methods are meant to facilitate post-traumatic growth, or PTG — based on the idea that with the right tools, survivors can emerge as people who are stronger, happier and healthier than they were before the traumatic event occurred.

An outcome

PTG is not a clinical approach but rather an outcome. “It’s the direct result of struggling with the aftermath of trauma,” said Richard Tedeschi, a professor of psychology at the University of North Carolina at Charlotte who has studied PTG for more than 30 years, in trauma survivors, bereaved individuals, victims of violent crime and veterans.

Research suggests that PTG is a real phenomenon, but it’s unclear why some people experience it and some do not. There’s also no proven method for making PTG happen,which has created some skepticism about how much it really helps. Tedeschi said he believes Boulder Crest may have found a way, and he has designed a study to test it. Along with former Army psychologist Bret Moore, Tedeschi will track 50 Boulder Crest participants for the next two years. Standard interventions for PTSD have “understandably focused on reducing distress symptoms,” Tedeschi said. “Now we’re trying to focus on trauma survivorship.”

The man behind Boulder Crest is Ken Falke, a former Navy explosive ordnance-disposal (EOD) technician and master chief petty officer, who served in Bosnia in 1998 and made several trips to Afghanistan and Iraq as a civilian contractor between 2003 and 2010.

Over the past decade, Falke visited scores of wounded EOD veterans at VA facilities around Washington through a nonprofit he and his wife founded in 2007. He was dismayed by how many of them were struggling. “The current treatments for PTSD aren’t working for combat veterans,” he said.

According to the Department of Veterans Affairs, between 11 and 20 percent of veterans who served in Iraq and Afghanistan have PTSD in a given year. But a 2015 study reported that while “robust evidence” supports the effectiveness of exposure therapy and cognitive processing therapy, 60 percent of Iraq and Afghanistan veterans seen in routine clinical care “failed to begin or dropped out” of PTSD treatments. And up to 50 percent of those who did follow through “fail to show clinically significant improvements.”

Falke is especially critical of what he said is too much reliance on medication by standard therapies for depression. That, he maintains, prevents veterans from confronting “the underlying issues of PTSD demons head on” — demons that, he says, “are often from childhood and combat.”

Falke’s doubts about therapies driven by medication come from his own experience after a traumatic brain injury and broken back that he said he suffered during a 1989 parachute jump. “My relief came from holistic treatments, especially chiropractic,” he said. “I value alternatives to Western medicine because of this.”

When Shaun Durfey arrived at Boulder Crest, he says, he was taking high dosages of five medications prescribed by VA doctors but still “was shut down, isolated from family and friends.”

Exposure therapy — which asks trauma survivors to talk about an event over and over, thereby lessening its emotional power — had had only “mild success,” he said, in reducing his PTSD symptoms.

“Everything from the VA was about my [military] service,” he said. At Boulder Crest, “they dug down into what was hurting you, brought that out and complemented it with activities that bring you down from being so wound up.”

A year later, Durfey is off four of the drugs and takes the fifth, for knee pain, only as needed. He sees his VA therapist intermittently. “I’m closer with my wife. I’m feeling emotions — joy, sadness, good and bad. That’s from the tools [Boulder Crest] gave me,” he said.

When Daniel Traeder returned home from his third combat tour as a Special Operations dog handler in 2006, he said, he approached each day as if he were still deployed, on edge and aggressive. On his way to work, Traeder, 48, would get into altercations with other drivers. “It was like I was in Baghdad looking for IEDs,” he said.

Still, he was not motivated to seek treatment. “I always denied having an issue,” he said. He was also skeptical of the VA: “I’ve always known the VA exudes benign neglect and not to go there unless you have to,” he said. When Trae­der’s marriage threatened to unravel, a friend recommended Boulder Crest.

During the Warrior PATHH, Traeder was told that ancient Greek soldiers would walk through a labyrinth before battle and lay down objects linked to home when they reached the center of it. After battle, they walked the labyrinth again, put down their weapons and picked up the symbols of home. It wasn’t until Traeder traversed a replica of one of those Greek mazes at Boulder Crest that he started making sense of his behavior. “We never dropped our swords, never dropped our shields,” he said.

Tedeschi said many of the veterans he has worked with come from families where there’s “not a lot of affection or there’s abuse or instability.” Such individuals, he said, are more likely to suffer from PTSD after a traumatic experience.

Tedeschi said these vets are also more likely to re-enter civilian life “without confidence or connection or feeling understood.” The Boulder Crest emphasis on exploring one’s past, he said, lets them “see the whole picture of this and make sense of the struggle. Once they [do], it’s easier for them to see what to do next.”

In addition, vets are encouraged to see their military experiences and skills as useful in civilian life. “In combat, you have to protect other people and rely on other people. You have to be persistent. You have to get organized and be ready. And all of these habits and approaches to a mission can be useful in the civilian world,” Tedeschi said.

The archery portion of the Warrior PATHH program, which requires the same focus as shooting a gun, resonated with Traeder, for example, because he had grown up bow hunting. Instead of thinking of the weapon as a way to kill an enemy, as one might about a gun, “it gives me a reason to go out into the woods and be quiet,” he said. “You can do it for a positive reason, rather than for killing someone.”

Finally, Boulder Crest tells veterans they must carry their preparedness and leadership skills from the battlefield to the home front. “Be the leader our nation needs you to be,” Falke said. “Do something for someone other than yourself or even your family.”

Boulder Crest officials said 95 percent of combat vets who have participated in their Warrior PATHH program continue to participate in the monthly video chats that help Boulder Crest keep track of their emotional health and keep them focused on setting and accomplishing goals. Four of the five veterans interviewed for this article said their relationships with their spouses and children have improved and that they’re less reliant on medication. They said that they draw on the support of fellow PATHH members through monthly video chats.

Durfey has participated in these sessions since the retreat. In addition, the vets from his PATHH group have a more informal online forum, where they post about their lives and struggles. “If someone’s in trouble, we’ll talk about it,” he said.

Still, the PTG philosophy has its critics. Some people worry that the emphasis on growth creates unreasonable expectations of trauma survivors. What if people don’t feel healthier, more optimistic or closer to their families after a week at Boulder Crest? What if they need to continue psychotherapy and medication? A 2015 study in the journal Clinical Psychological Science found that in a sample of soldiers who spent time in Iraq, the “more perceived growth five months postdeployment was associated with more post-traumatic stress 15 months postdeployment.”

Some skepticism

Iris M. Engelhard, the study’s lead author and a professor of clinical psychology at Utrecht University in the Netherlands, said that “some scientists have argued that [self-perceived growth] may involve illusory and self-deceptive aspects and represent avoidant or defensive coping, which may impede recovery.”

Falke agreed that PATHH isn’t for everyone — including, for example, veterans with drug addictions. “We’ve had people come through who needed a lot more work, and we recommended they go to an inpatient facility or rehab,” he said. About half of those who come to Boulder Crest are enrolled at VA, he said, and they seek out his program because their government-sponsored care isn’t working.

Tedeschi’s study of the Boulder Crest approach won’t conclude until June 2018. It will track participants’ mental health using both traditional measures of symptom reduction (sleep, appetite and prevalence of flashbacks) and measures of PTG, such as whether vets say they have seen their relationships improve, have set new priorities and feel more appreciation for life.

To Durfey, the results for him are already clear.

He is extremely appreciative of his VA doctors, but he said even his psychiatrist noticed a difference in him after the Warrior PATHH.

“What the VA was trying to do with all their meds and their therapy, I did in five days at Boulder Crest,” he said.