New Approaches To Treating PTSD For Veterans—And Civilians

Cognitive processing therapy expands options for PTSD patients.

For our January 2015 Top Doctors issue, we talked with Cincinnati VA Medical Center’s Psychiatrist Kathleen M. Chard about growing options for PTSD treatments and clinics:

“Post-traumatic Stress Disorder is a mental health disorder that happens to some people after they experience a significant traumatic event. Twenty or so years ago people began looking for ways to harness cognitive behavioral therapy, which was one of the best therapies we knew for depression and for panic. Two therapies emerged for PTSD. Prolonged exposure therapy combines reimagining the trauma in the office with in-vivo exposures—we have them put themselves in a situation where things might trigger [symptoms], so they can realize that they can manage their fears.

The other therapy—the exact opposite—is cognitive processing therapy. I’m one of the co-authors. We look at the cognitions the person has created due to the trauma: the thoughts and self-condemnations that may not even be based on reality. Instead of I made a mistake on X mission, they think I will always make a mistake. We gently walk them through the evidence, asking: ‘Does this really make sense to tell yourself this?’

Some people are desperate to have someone listen objectively to the story. For other people, the idea of telling their story is the whole reason they’ve never gone to therapy. I can say: ‘That’s OK. I have an entire therapy that will allow you to never tell me the full story.’

I started at the VA June 1, 2004. I was asked to make it one of the best evidence-based treatment programs for PTSD. I started with 10 staff; we now have 34. We started with a small residential men’s program. In 2007 we opened the third women’s treatment program in the U.S.; we’ve been recognized by the Inspector General as a best practice for women’s care. In 2012 we opened the first ever traumatic brain injury PTSD program in the VA system. [Now] half the people who come to our Ft. Thomas location come from outside of our network—we’re treating active duty, reserve, and guard. It’s not uncommon for me to get a call from a psychiatrist in Afghanistan or Iraq.

We tell people now that it takes nine to 15 sessions, regardless of which therapy they choose. We look at people five years later, some of them 10 years, and amazingly—just as we were hoping—therapy sticks.

The UC Health Stress Center came about because I was receiving a large number of phone calls asking where to get good quality PTSD treatment for civilians, so I put forward a proposal to create the center. Thanks to the Joey Votto Foundation and its partners, we began seeing people formally in July 2014. For people with children, we can also add a parent management training program. We just got funding for a combined grant between Children’s, UC, and the VA to look at couples-based treatment with and without the parent management training for families of service members.

The main message is that you can get help. PTSD is a very treatable disorder if we can just get people to come into the clinic.”
as told to Lisa Murtha

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