Caring for a Veteran with PTSD: Essential Tools for Caregivers
Dr. Jennifer Perusini
In this expert interview, Jennifer N. Perusini, Ph.D., provides insightful information on caring for a Veteran with PTSD. She delves into the importance of understanding Post Traumatic Stress Disorder (PTSD) and the impact it has on Veterans, caregivers, and families, as well as the signs, symptoms, treatment approaches, and available resources. She also shares her vision on the future of PTSD treatment and discusses promising research in this area.
What should family caregivers know about PTSD and how it impacts Veterans, caregivers, and families?
Post Traumatic Stress Disorder (PTSD) is a serious mental health condition and growing medical concern in the United States and globally. It develops after exposure to a traumatic event and is marked by long-lasting, debilitating symptoms like flashbacks and hyper-reactivity. Military servicemembers and Veterans make up a large and important population of those suffering from PTSD due to traumatic deployment experiences.
As Veterans readjust to civilian life and cope with the ill effects of trauma, it can be exceptionally difficult for caregivers and families, especially for those living with Veterans with untreated PTSD. Because PTSD affects daily life functioning, caregivers may find themselves taking on a larger share of household tasks and extra day-to-day burdens. In cases of severe PTSD, it may be frustrating or frightening for caregivers to deal with their Veterans’ increased startle response, anger, and even suicidal ideation. It is important for caregivers to have patience and be familiar with available resources in their areas.
What signs and symptoms should caregivers look for when supporting a Veteran?
PTSD can cause a range of symptoms in Veterans, including heightened startle, avoidance of trauma triggers, nightmares and sleep disturbances, self-destructive behaviors like substance abuse, and increased depression and anxiety. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), to make a diagnosis, symptoms must be present for at least 30 days; people with PTSD often lose their normal daily functioning abilities as their responses become impaired and pervasive.
Trauma survivors with PTSD may have trouble with interpersonal relationships, including problems with trust and communication. Ideally, caregivers will recognize their Veterans’ triggers and encourage mental health treatment as close to symptom onset as possible without adding too much stress and pressure. Caregivers concerned about a loved one don’t need to wait and monitor for 30 days, in accordance with the DSM-V, before helping their loved one seek treatment.
What are evidence-based treatment approaches that can help Veterans manage PTSD?
Cognitive behavioral treatments like trauma-focused therapy (TFT) are first-line treatments for PTSD with the goal of reducing fear to trauma-associated stimuli. The two most studied and empirically-supported TFTs are Prolonged Exposure and Cognitive Processing Therapy, which involve confronting trauma-related thoughts and triggers.
The pharmacological strategy for first-time PTSD treatment includes SSRIs and one SNRI. The generic names for these antidepressant medications recommended for PTSD treatment are paroxetine and sertraline. They have a modest response rate in patients, approximately 60%. In addition, benzodiazepines are commonly prescribed for PTSD patients to treat symptoms of anxiety and insomnia.
Many experimental and illicit drugs are being researched in academic settings and in industry, such as MDMA, psilocybin, and ketamine. However, many of these drugs only alleviate a few symptoms and may be dangerous with high addiction potential. More research must be done to confirm the validity of these data sets and to determine whether the benefits outweigh the risks.
Historically, military personnel have been less likely to seek out or continue a treatment regimen despite significant resources provided by the VA (U.S. Department of Veterans Affairs) and nonprofit organizations. Treatment retention is a critical issue for the Veteran population to overcome. Before participating in or seeking out any of these treatment options, please consult a physician or other medical healthcare provider.
What common challenges do caregivers to Veterans with PTSD face and what are strategies for overcoming them?
Living with Veterans with PTSD may take a toll on families and caregivers. Military families in particular deal with the unique situation of having to cope with deployment cycles. For Veterans, reintegration may be incredibly taxing. Caregivers of Veterans with PTSD often suffer from their own stresses. They may notice an impact on their social lives, interpersonal relationships, and home life stability, as caring for someone with PTSD may be all-consuming. Caregivers should know that resources are also readily available for them.
While these challenges may feel difficult to overcome, one key element is having patience with their Veterans. They may find successful pathways forward by gently encouraging treatment for their Veterans and by trying to be as involved and supportive as possible, even when that may feel frustrating at times. When caregivers learn the warning signs of a relapse and identify potential personal PTSD triggers, they can move toward earlier intervention and have better success in treatment. Perhaps most importantly, caregivers must remember to care of themselves and pay attention to their own needs.
What resources are available?
Many resources are available for Veterans living with PTSD and their caregivers. The VA’s National Center for PTSD (www.ptsd.va.gov/) is a leading research organization and information source for PTSD. The VA’s Caregiver Support Program (www.caregiver.va.gov/) is dedicated to the health and well-being of caregivers. It offers services such as support, coaching, referrals, and skills training to caregivers of Veterans enrolled in the VA healthcare system. There are a multitude of nonprofit organizations that help both Veterans and caregivers, including PTSD Foundation of America (www.ptsdusa.org/) and the Elizabeth Dole Foundation (www.elizabethdolefoundation.org/). And lastly, if a Veteran or caregiver is in crisis or talks about suicide, the Veterans Crisis Line is available 24/7: Dial 988, then press 1; text 838255; or chat online at www.veteranscrisisline.net. The Veterans Crisis Line serves Veterans, service members, National Guard and Reserve members, and those who support them.
How do you envision the future of PTSD treatment? What research looks promising?
The PTSD treatment landscape is in desperate need of improvement. I started Neurovation Labs (www.neurovationlabs.com) to do just that. The company is leveraging a groundbreaking biomarker discovery to develop a novel precision medication for PTSD. Our therapeutic acts on the glutamate system, the brain’s major excitatory chemical messenger system. In particular, it inhibits glutamate receptors only in the brain’s fear center, the amygdala, which has been shown to be persistently overactive in people living with PTSD. This type of drug dampens the amygdala’s overactivity and thereby helps to reduce PTSD symptoms. Our preclinical data is very encouraging. Both the U.S. Army and Air Force military branches have helped fund our early research.
Neurovation Labs is pursuing this target because of very promising and consistent neuroscience data. I believe that all avenues of research should be explored, including a range of alternative therapies. In my view, we’ll make great progress on mental health diagnosis and treatment when we can recognize – and target – its physical impacts on the brain. My hope is that, one day, brain biomarkers will be how mental health disorders are diagnosed, rather than solely by clusters of vague and overlapping behavioral symptoms. As we continue down this path, we will work toward ending the stigma surrounding mental health and normalize seeking help.
Rose De Guzman is a neuroscientist and advocate for mental health. Despite the sex difference in mood disorder prevalence, pre-clinical studies that have led to anxiolytic drug discoveries have primarily focused on male brain and behavior. Her PhD work focused on sex differences in stress response and investigated the brain regions involved in stress response during the postpartum period. Her work has implications for sex-specific therapeutics, especially for perinatal and postpartum anxiety and depression.
As a postdoc at Harvard Medical School – Massachusetts General Hospital, she founded “Pathways to Science and Medicine” program to provide mentorship and opportunities to historically marginalized and under-recognized communities.