FACE-TO-FACE WITH PTSD
VA hospital finds surprising success providing post-traumatic stress disorder therapy via video
By Jeanette Steele12:01 a.m.May 5, 2013Updated10:38 p.m.May 3, 2013
If you suffered from mental anxiety to the point that your career was stunted, your life upside-down, would you want to get therapy through a video screen?
The answer is yes, according to San Diego veterans in a recent study of post-traumatic stress disorder therapy by the U.S. Department of Veterans Affairs.
The finding could be important, as the VA has been criticized — even sued by veterans groups and called incompetent by judges — for failing to provide adequate mental-health care to the generation of returning post-Sept. 11 military veterans.
Therapy by video conference allows a veteran to get care closer to home, or even at home.
It might save hours of driving time for people living in rural areas far from a VA clinic. Even in San Diego County, a veteran without a car might spend a whole morning on the bus in transit to the La Jolla VA hospital.
Now, research from the San Diego VA shows that veterans rate PTSD therapy by videoconference just as favorably — or even more favorably — as face-to-face counseling sessions.
It’s an interesting wrinkle to PTSD, one of the signature wounds of U.S. military veterans who served in Iraq or Afghanistan. The distance of the videoconference is reportedly comforting, as PTSD sufferers often report anxiousness in crowds and the desire to be alone.
The findings surprised even lead researcher Steven Thorp, who studied 207 local veterans involved in a 12-week course of PTSD therapy. It’s one of the largest VA studies to test new ways of delivering PTSD treatment.
“What was most striking was how easily people fell into this mode of treatment — both my therapists and subjects in the trials. From many of them we heard reports of, ‘After 5 or 10 minutes, I forgot I was on video entirely,’ ” said Thorp, a VA psychologist and associate professor with the University of California San Diego.
“The other big surprise was that some of our veterans and some of my therapists preferred the teleconferencing mode,” he said.
Iraq War veteran Tyrone Berry is one example.
Discharged in 2009, the former soldier went back to school and graduated with a degree in respiratory therapy.
Berry’s choice was inspired by his war service. He helped with medevac helicopter flights during two tours in Iraq, and the medical side of the work appealed to him.
But once he began working in clinics, his post-traumatic stress stirred. He just couldn’t face the sight of blood, or even enter a hospital without anxiety.
Now, he is working logistics for a San Diego technology company and is halfway through his PTSD care via videoconference.
At a recent session, Berry sat in a sterile beige office, looking at a blank video monitor.
There was a small electronic sound — bloop, bloop — and a woman’s face popped onto the 24-inch screen. It was Carrie Morrison, his therapist from the U.S. Veterans Affairs Department.
Berry’s two-hour therapy session had begun. He’s in a Mission Valley office building. She’s 15 miles away at the VA medical complex in La Jolla.
“I kind of like this way better. You don’t have to be totally face-to-face. It seems like you are. The interaction is the same to me,” said Berry, a 34-year-old Chula Vista resident.
“It’s less anxiety for me if there’s nobody in the room, and I’m just interacting with the television.”
Nationally, PTSD therapy through videoconference has gained momentum at the VA only in the past three to four years. But now the federal agency is diving in wholeheartedly.
About 4,000 veterans received PTSD therapy via videoconference in fiscal 2012, according to national statistics. So far this year, more than 3,000 got treatment that way.
The VA is also looking to increase the number of patients who receive therapy at home, through their personal computers. About 10,000 people will get a variety of therapies that way in 2013, according to department projections.
The San Diego study did find some drawbacks.
The camera only shows people from the waist up. In one case, the therapist didn’t realize her patient was in a wheelchair until the third session.
Fidgeting hands and feet can be missed. And one therapist couldn’t tell whether a patient was sniffling due to tears, or a cold.
Also, Thorp’s results revealed that in-person therapy patients showed more improvement by the end of 12 sessions.
However, the video conference patients continued to show improvement after therapy ended, and in six-month follow-ups, there was no difference between the two groups, he said.
The Navy has also embraced videoconferencing for mental-health care, in a more limited way.
San Diego Naval Medical Center in Balboa Park first used videoconference for therapy in 2010, a spokeswoman said. Counselors in San Diego can videoconference with a sailor or Marine in the field if no mental health provider is available at the service member’s location.
The private sector is also exploring the concept. The American Psychological Association has formed a task force to establish guidelines for the practice of “telepsychology.”
The idea doesn’t work for everyone.
In September 2010, an Army veteran took hostages at Fort Stewart, Ga., military hospital in an effort to get treatment for his severe PTSD. Leading up to that, the VA had offered the soldier videoconferencing appointments. He walked out after 10 minutes, disappointed at being faced with only a video screen, according to an account in the newspaper Stars and Stripes.
Thorp and other VA officials said PTSD patients can always opt for in-person therapy, though that may not be available as quickly, depending on the patient’s condition.
Thorp also said that safety procedures are discussed upfront. The veteran designates friends or family members who can be called for support in a crisis.
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