IDF's post-traumatic stress sufferers get better therapy

Defense Ministry-appointed team presents unique model and guidelines for treating soldiers.

By JUDY SIEGEL-ITZKOVICH
IDF soldier nablus 298 (photo credit: AP)
IDF soldier nablus 298
(photo credit: AP)
Years - or even decades - of treatment for Israel Defense Forces veterans with chronic post-traumatic stress syndrome (PTSD) have not cured them or made them significantly better, despite a huge Defense Ministry investment in their treatment, says Prof. Arieh Shalev, chief of the psychiatry department at Hadassah University Medical Center in Ein Kerem, Jerusalem, and one of the world's leading experts in PTSD. This is because until the past decade, there was no medical evidence on what actually helps or who can benefit from the various treatments, Shalev told The Jerusalem Post on Thursday, when the team appointed by Defense Ministry's rehabilitation branch to deal with this issue last year presented a unique model and guidelines for treating veterans and current soldiers suffering from PTSD at Ramat Efal. The Hadassah psychiatrist spent years in the IDF, has worked with PTSD patients and even developed a simple blood test that can identify people very recently exposed to trauma who are likely to get PTSD. He was a partner in the ministry-appointed team, headed by Ze'ev Waisman and Dr. Dan Dolfin of the rehabilitation department. There are some 2,500 Israeli veterans suffering from PTSD due to traumatic experiences incurred during their military service. The team prepared scientific guidelines for the treatment of older PTSD victims as well as survivors of recent traumatic events in the military. The ministry, he said, has set up a Web site for professionals who can view the guidelines, ask questions and report on their progress in treating patients according to these recommendations. "Until the last 10 or 12 years, there was no systematic handling of IDF veterans with PTSD; they received all kinds of care according to the state of the art‚ treatments from 20 years ago, whether they were effective or not," he noted. "We spent a year collecting data and [discussing] our experiences, and conducted a survey of affected veterans that showed they did not improve over time but just underwent maintenance‚ to keep them going. That is good, but it is not curative, only supportive." Among the "treatments" that were not effective for this condition is long-term psychodynamic psychotherapy, said Shalev, noting that given on a weekly basis, it was very expensive. "The veterans did at least feel that they had somebody to talk to, but it didn't change their condition. The ministry felt obligated to supply it," he said Today, however, there are active treatments, especially for those freshly traumatized, including cognitive therapy and medications such as antidepressants called selective serotonin re-uptake inhibitors (SSRIs) that have been proven effective in many cases. Tranquilizers were given in the past, but they did not treat the problem and often worsened it, insisted Shalev. "No one treatment works for everybody. Short-term psychotherapy should be tried, but it doesn't always prove successful. Cognitive behavioral therapy, in which patients are gradually exposed to a traumatic trigger they experienced, could be effective, but it could also make things much worse," he said. With the team's new guidelines, "the ministry now has a tool to document progress and see if what it's spending is worth the money. The ministry's rehabilitation branch didn't know how to assess effectiveness. "Only 18 months ago were PTSD treatment guidelines issued in Australia, and in the US a few years ago, but these have to be updated," said Shalev. "We hope our guidelines will be adopted by the National Insurance Institute and other bodies."