For some, war memories tumble out without warning, disrupting otherwise normal moments in their lives.
Others need the tools to change how they're approaching the world, since their current approach just isn't working. Yet others still need a spiritual nudge, a reminder that there may be room in their spiritual beliefs for forgiveness, if needed, and that the spirit can provide inspiration and hope to heal the mind.
Issues like these are being addressed daily in the Pinnacle Intensive Outpatient Program, a behavioral health program at Madigan Army Medical Center which offers servicemembers both group and individual therapy for four to six weeks. While the program offers a specialized track for patients with post-traumatic stress, it also offers a skills track for those who need to work on emotional skills; these patients may be living with anxiety, depression, interpersonal problems, anger, or other issues. A third track focusing on addictions medicine (or substance abuse) is planned to begin in July.
The program, which is offered to all five services, gives patients a step-down or a step-up treatment option between the once-a-week therapy offered in traditional outpatient care and the inpatient psychiatric unit here.
"There's a huge gap in care between those two models, and I think IOP is really the bridge between those two," said Dr. Timothy Hoyt, the director of the IOP. For patients discharging from the inpatient unit, the half-day sessions of the IOP can serve as a step-down program to ease them into transitioning back to their units and their lives.
"We give that sort of cushion where if they're still struggling with some issues, or suicidal ideation, that they have a place to continue to process those things, and they have enough touch points that we're able to track day-to-day how (their) risk is changing," Hoyt said.
The PTS track has 10 to 15 patients work together through an exposure-based treatment to face head on the causes of their trauma, to examine the thoughts and emotions of what's happened to them, and to challenge those beliefs and restructure those thoughts.
The key to this group therapy is the feedback from the other servicemembers, said Hoyt. A common exercise if a patient blames himself for his trauma is to ask the rest of the group if they think that person is even partially to blame for what happened; most of the time, the answer is no.
"That feedback from their comrades is way more convincing than hearing their therapist telling them the exact same thing," Hoyt said.
It's in this group that patients also work on containing those war, or otherwise traumatic, memories that can show up without warning. The aim is to organize those memories so that they can be accessed when needed but otherwise stay in the background.
"It's a lofty goal, but it's doable," Hoyt said.
While the PTS track focuses solely on that issue, the skills track includes patients with a mix of diagnoses and issues, such as issues with their families, with the Army, or other life stressors. The goal is to improve how patients function in their daily lives by focusing on areas such as problem solving, symptom management, and trust building. The ancillary therapies like art therapy also help patients to explore their deeper emotions.
Both the skills and PTS tracks also offer a spiritual component by a chaplain and a Buddhist priest co-facilitator. They ask the groups provocative questions to get into spirituality, self-blame, self-identity, and self-worth, said Chaplain (Maj.) George Wallace, Madigan's deputy chief for the Department of Ministry and Pastoral Care and a senior chaplain clinician.
"We wrestle with questions of guilt, moral injury, of betrayal," he said. They try to reach patients where they are spiritually, and offer instruction on mindfulness and meditation.
At the end of the groups, of patients wrestling with spirituality and emotions, behavior and beliefs, the hope is that they will function better in their everyday lives. Since many join the IOP because family members ask them to get help, seeing those relationships repaired is sometimes the best real-world results that staff see.
"We've really seen these guys get back into their own lives and reengage with the people they love. Those for me are the best outcomes," said Hoyt.
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