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3 Big Ideas from Dr. David Shulkin about Veterans, PTSD, and Nontraditional Therapies

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The Honorable David J. Shulkin, MD, the ninth Secretary of the US Department of Veterans Affairs (VA), recently shared his perspective on helping more veterans with PTSD in a Health Affairs blog post. Shulkin stresses that the VA has made significant progress in its behavioral health offerings like ensuring same day services for urgent behavioral health needs, integrating mental health therapy into much of its primary care delivery, and expanding access to care through tele-behavioral health programs. But he also stresses that the VA’s approach to PTSD treatment could be even better for veterans in need.

The troubling statistics tell the story. Recent studies of active-duty personnel with PTSD found that only 31 percent of patients recovered or improved as a result of current first-line treatments. That leaves a large percentage of veterans who suffer from PTSD with the ongoing symptoms of this often-debilitating condition. Even more troublingly, 20 veterans, on average, take their own lives each day, with studies finding a correlation between PTSD and suicide for veterans. That’s why urgent action is needed.

Here’s what to know about charting a better path forward to help more veterans:

    1. The VA’s current practice guidelines focus on three evidence-based therapies: VA guidelines suggest clinicians should consider one or more of three evidence-based therapies: prolonged exposure (PE) therapy, cognitive processing therapy (CPT), and eye movement desensitization and reprocessing (EMDR). The first-line therapies have helped many veterans but according to Shulkin, many other veterans have not benefited from these options, either because they haven’t sought care, haven’t responded to these treatments, or dropped out of treatment prematurely.
    2. The VA can achieve better care for veterans with PTSD by seeking out and validating alternative treatments that advance progress, access, and outcomes: Shulkin, who also serves as an advisor to Freespira, mentions respiratory modulation therapy as an adjunctive therapy for PTSD as a key example of innovation in action. He cites a recent study of the solution, published in September 2021, which was conducted with PTSD patients at California’s Palo Alto VA medical center. The study showed promising results. Shulkin also suggests that the VA consider covering treatments, like emotional support dogs, that show promise, and appear low risk and while they are being explored further.
    3. The VA can lead a revolution in behavioral health for veterans – and for all patients with PTSD to create a larger change in the world: As the largest provider of behavioral health care in the US, the VA is well positioned to explore therapies that may bring relief to people who suffer from PTSD. Shulkin emphasizes that the administration’s 2022 budget, which provides new dollars for the VA’s suicide prevention initiatives, may be helpful for the VA to expand treatment choices for veterans if they are within the department’s parameters for cost.

Lastly, he highlights the further importance of the VA leading this change in PTSD treatment and the overall behavioral health landscape. According to Shulkin, “if the VA can demonstrate that certain therapies are safe and effective, the private sector will be more open to adopting those treatments, and practitioners can learn from the VA’s experience in deciding whether to use them with their own patients who have PTSD. In the process, the VA will continue to serve veterans and lead in the area of behavioral health.”

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