Filed under: Therapy
There’s a promising therapy that uses virtual-reality simulation to help treat service members with post-traumatic stress disorder (PTSD). According to the National Center for PTSD, 10–18% of returning Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) veterans experience PTSD. The good news is that treatments such as virtual-reality exposure therapy (VRET) might help them work through their challenges.
Trained therapists use VRET to re-create stressful events or situations such as combat scenarios in a virtual-reality environment. The patient wears a headset and interactively reacts to possible sights, smells, sounds, and vibrations that have been visually re-created. This makes the experience realistic for the patient as it provides a strong sense of “being there.” Veterans learn to work through emotions such as fear, tension, and anxiety in a safe environment.
Healthcare providers have successfully used virtual-reality simulation as a resilience-training tool too. It helps builds service members’ confidence and coping skills so they feel stronger and ready for what comes next.
Visit the National Center for PTSD to learn more about post-traumatic stress. Here’s what VRET looks like in action.
The brain can “feel” pain even after an arm and/or leg amputation, but a new treatment using mirrors can provide some relief. This common phenomenon, known as phantom limb pain (PLP), occurs in at least 75% of Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) veteran amputees. Although its causes aren’t fully understood, one theory is that there’s a mismatch between what your brain sees and what it feels.
Mirror therapy offers a promising treatment for those suffering from PLP. A long mirror is placed between the patient’s legs and set to face the intact limb. As the patient moves and watches the intact limb in the mirror’s reflection, the brain is “tricked” into seeing the missing limb. The brain “sees” the phantom limb moving in the mirror and quiets busy activity or bad memories. The mirror positively stimulates the brain, causing reorganization or rewiring; this helps relieve PLP.
Healthcare providers have successfully used mirror therapy to help single-limb amputees. They’ve also adjusted the approach for double-limb amputees. Using an adapted method, a physical therapist (PT) acts as the mirror. The PT sits beside the patient and then mimics or “mirrors” the amputee’s phantom limbs with his/her intact limbs. For example, if a patient complains of calf cramps, the PT can stretch his/her own calves while the patient observes and feels relief in their phantom limbs. They’re currently working on using virtual reality to take the approach a step further.
Art therapy is one more tool in the arsenal against PTSD and similar disorders. It uses various forms of artwork and creativity to explore feelings, confront emotional conflicts, improve self-awareness, manage behaviors and addictions, reduce anxiety, and increase self-esteem. Under the supervision of an experienced therapist, art therapy can improve general functioning, health, and well-being and can help in recovery from trauma.
Responses to traumatic experiences can include flashbacks and nightmares as your mind unconsciously tries to make sense of what happened. Art can be effective in helping your mind process, express, and even master traumatic experiences, because visual imagery can express what words can’t. Engaging in creative arts has been used specifically to help service members work through trauma. This kind of therapy involves working through your difficulties with a licensed therapist, but the same creative outlets can be great outside of therapy too. Find a craft or art that you find calming, enjoyable, and expressive. Engaging in the arts can be fun and therapeutic.
Pain can take a toll on you physically and emotionally, but there are some steps you can take to cope with it. First, know if your pain is “acute” or “chronic.” Acute pain is temporary, often stemming from injuries that will heal completely. Chronic pain is ongoing, lasting for more than 3 months. It’s hard to know what to do about chronic pain. And it’s a big problem: At least 25% of people in the U.S. suffer from it.
If you have pain, it’s important to see a medical provider to rule out something life-threatening. However, most injuries heal physically as much as possible after 3–6 months, so residual pain has more to do with complex mind-body processes than a clear-cut physical problem. Learn more about a 5-step structured approach you can use to tackle chronic pain from the video below developed by the DoD/VA Joint Pain Education Project and the Defense and Veterans Center for Integrative Pain Management.
Does it ever feel like there’s a baseball in your calf? Or what about that tight spot under your should blade? This might be something called a trigger point, more commonly known as a “knot.” Even experts aren’t completely sure what they’re made of, but they seem to be caused by overuse and/or bad biomechanics (that is, bad posture).
Getting rid of these annoying knots usually involves massaging the heck out of them. If you can reach the knot, you can massage it yourself to try to loosen it up. Or you can use things like foam rollers or massage balls to help. If that still doesn’t work, you can talk to your doctor about other treatments such as ultrasound, physical therapy, dry needling, acupuncture, or injecting the knot with medicine.
Even with these treatments available, it’s important to first avoid actions that create trigger points, such as poor posture or exercising without warming up. Don’t confuse trigger points with the sore muscles which can occur after a workout (delayed onset muscle soreness). This kind of soreness is usually harder to pinpoint but will go away on its own after a couple days or less.
Also, make sure you’re exercising with proper form. Ask a certified personal trainer, if you’re not sure. Keep in mind that if your pain began with an accident or lasts after trying treatments at home, you should consult your physician or other healthcare provider.
Walk into the new facility of the National Intrepid Center of Excellence (NICoE) on the campus of Naval Support Activity Bethesda, and one of the first things you will see is a sign commemorating the center’s origins, including the fact that the $65 million facility itself was donated by the Intrepid Fallen Heroes Fund. NICoE is committed to the interdisciplinary diagnosis, treatment, and long-term healing of Warfighters, and educational support for their families, from all branches of service.
Unlike many military environments, the facility is curved, spacious, quiet, and pleasant. Some notable features are the high ceilings, artwork, and state-of-the-art treatment rooms.
Patients at NICoE typically are active-duty service members with mild traumatic brain injuries (mTBI) combined with other psychological health conditions such as post-traumatic stress (PTS), anxiety, and depression. Most have already begun treatment elsewhere, often with many medications. The tranquil environment of NICoE instantly helps put them at ease and often leads to more effective treatment with fewer medications.
Recognizing that traditional therapies can’t heal all wounds, NICoE has rooms dedicated to art therapy, virtual reality, and meditation. Beautiful masks line the entrance to the art therapy room, providing a small glimpse into Warfighters’ individual and unique roads to recovery. The virtual reality room allows Warfighters to face traumatic scenarios at a pace that makes sense, an incredibly lifelike setting full of sound, movement, scents, and images. The spirituality room lets in natural light to a space with a beautiful wood floor surrounded by natural plants and a speaker system that plays sounds of nature.
An interdisciplinary approach, combining traditional and integrative medicine, contributes to NICoE’s 99% satisfaction rate, with more than 600 patients from all different services having completed their four-week program. There is no one-size-fits-all approach to healing, and the interdisciplinary makeup of the clinical team enables patients to pursue various treatment options. Providers can collaborate regularly and have cutting edge equipment at their disposal.
Patients usually bring a non-medical attendant, often a spouse or parent. Children also are welcome at NICoE. A private family room with frosted glass includes a children’s play area, and a playground is located behind the facility.
NICoE also focuses on research to help ensure long-term treatment success. There has been discussion of opening their doors to a wider range of Warfighter patients (treating more conditions) and opening more NICoE satellite centers. Referred to as Intrepid Spirits, such centers are open already at Fort Belvoir and Camp Lejeune. The Intrepid Spirit at Fort Campbell will open this summer, and ground was broken recently for one at Fort Bragg. Other bases that may receive an Intrepid Spirit include Forts Hood, Bliss, and Carson, along with Joint Base Lewis-McCord and Camp Pendleton.
Are you or is a service member you know going through rehab for an injury? Well it should be a comfort to know that there are people out there working hard to make sure you/they receive the best and most advanced forms of therapy and technology during rehab. The Center for Rehabilitation Sciences Research (CRSR) is headquartered at the Uniformed Services University, in Bethesda, MD, and their goals are to find solutions for improving rehabilitative care for injured service members and promote successful return to duty and reintegration. Most of their research is focused in the areas of orthopedic trauma, limb loss, and neurological complications, but they’re not working alone. Their expert team of researchers is partnered with other military medical facilities across the country, and they are committed to educating and training future healthcare providers within the military healthcare system. Visit the CRSR website to learn more about their current research, publications, and events.
Acupuncture is an ancient form of Chinese medicine. Thin needles are inserted into the skin at points of the body that are thought to regulate the body's flow of energy (also known as qi or chi). It often is used for common health concerns such as headaches and migraines, carpal tunnel syndrome, and back, joint, and chronic pain. For more in-depth information, read HPRC’s InfoReveal on acupuncture for pain management.
Transcutaneous Electrical Nerve Stimulation (TENS) is a sort of "electrical massage" that works by sending increased “traffic” to the brain to block pain signals. It may provide short-term relief for neuropathic/phantom, chronic, post-surgery, and arthritis pain, but it rarely offers long-term relief. For more in-depth information, read HPRC’s InfoReveal on TENS for pain management.
Virtual reality was first introduced as a therapy tool for people with anxiety disorders such as phobias, but it is now used for a wide range of conditions, from PTSD to childhood ADHD. In fact, it recently warranted its own symposium at Walter Reed National Military Medical Center, where experts exchanged ideas on the current state of research.
Virtual environments used in therapy sessions are created for the individual’s needs—for example, a noisy classroom for a child with ADHD, the re-creation of the 9/11 attacks for a firefighter or police officer, or “Virtual Iraq” for a soldier. “Virtual Afghanistan” is the newest creation and is already being used to help service members overcome PTSD. Active-duty men and women are gradually brought back to their traumatic event using the virtual world as the therapist provides verbal cues to facilitate the healing process.
With a view to mitigating future need for therapy, a series of episodes is currently being created to provide pre-deployment “Stress Resilience Training for Warfighters.” The goal is to help reduce the risk of PTSD and better prepare warriors for actual scenarios they will encounter in theater.
For more information about how to prevent and manage stress, visit HPRC’s Stress Management section.