SCHINNEN, Netherlands - In the first European training of its kind, more than 150 healthcare providers from military installations scattered throughout the theater received instruction earlier this fall on the care and treatment of posttraumatic stress disorder and its related ailments.

Dr. Nancy Bernardy, a clinical psychologist and director of the Army Community Service at U.S. Army Garrison Schinnen, helped organize the event and presented sessions on the diagnosis of PTSD and cognitive-behavioral treatments.

Bernardy cites research conducted by Walter Reed Army Medical Center in Washington, D.C., that shows at least 17 to 20 percent of Soldiers have continuing symptoms of depression and/or PTSD after returning from combat. "If that percentage holds - and other research suggests the numbers are higher - then we are looking at a sizeable population of Soldiers who will need treatment for PTSD down the road," said Bernardy.

The training conference provided health care providers a unique opportunity to learn about PTSD and how to detect subtle symptoms that might reflect underlying problems. The training, held in the German cities of Bad Kissingen and Heidelberg, attracted primary care physicians, behavioral science providers, nurses and senior medical technicians as part of the RESPECT-MIL program, which is directed by the Army Surgeon General to provide primary-care based screening, assessment, treatment, and referral of Soldiers with depression and PTSD.

"There is a tremendous amount of knowledge now about PTSD," Bernardy said. "Before the Vietnam War, it was not even considered a psychiatric diagnosis, but since the early 1980s, we have learned a great deal about it. More importantly, there are some effective treatments out there that can help,"

This is the first conflict in which Soldiers are being evaluated and monitored for PTSD symptoms while they are still on active duty, Bernardy notes.

"The ongoing research at Walter Reed is invaluable because it is providing us with information on PTSD rates and comorbid depression while Soldiers are still in the conflict," she explained, which provides care providers far more opportunities to reach Soldiers with treatment, so long as the provider makes an accurate diagnosis.

The training sessions featured presentations by a number of professionals, including Dr. Kathleen Chard, a clinical psychologist from the Cincinnati Veterans Administration, who authored the treatment manual of cognitive-processing therapy that is one of only two treatments for PTSD recently endorsed by the Department of Veterans Affairs. Dr. (Col.) Eric Vermetten, a psychiatrist in the Royal Dutch Military who directs a PTSD research and treatment unit at Utrecht, Netherlands, provided an overview on the neurobiology of PTSD.

Dr. E. Lanier Summerall, a psychiatrist at Dartmouth Medical School, spoke about screening, assessment, diagnosis and treatment of mild traumatic brain injury, which is quickly coming to be considered the hallmark medical injury of the current conflicts in Iraq and Afghanistan.

Dr. (Capt.) Martine Heuting, a clinical psychologist with the Royal Dutch Military, provided a glimpse of her recent deployment to Afghanistan and her experiences while there. Breakout sessions followed, with group discussions focusing on:

*Ways to reduce the stigma associated with mental health services among the military;
*Problems of burn-out that many seasoned health providers are experiencing;
*Afghanistan and Iraq experiences shared by members of the audience;
*The need to get this valuable information out to all service providers.

At Schinnen, Army Community Services and garrison chaplains offer Battlemind training to all deployed Soldiers and their spouses through family readiness groups, which includes education on PTSD symptoms and ways to help build resiliency.

"By 'normalizing' the symptoms, Soldiers and family members understand that they aren't going crazy and that their reactions are normal responses," Bernardy said. "The earlier these symptoms are addressed, the better the chances for a positive outcome. That's why training care providers is also a critical part of this strategy."