ART helps improve mental health of homeless veterans

| Departments, EPI-BIO, Monday Letter, Our Research

USF College of Public Health’s Dr. Kevin Kip, professor in the Department of Epidemiology and Biostatistics, compared the results of 23 homeless veterans and 94 veterans in the community who received treatment for symptoms of post-traumatic stress disorder (PTSD) with a new treatment, accelerated resolution therapy (ART).

“We wanted to see how well the therapy worked in both groups because individuals who are homeless usually have many other life challenges, and we weren’t really sure what the response to the therapy would be for homeless vs. non-homeless veterans,” Kip said.

The study, “Evaluation of Brief Treatment of Symptoms of Psychological Trauma among Veterans residing in a Homeless Shelter by Use of Accelerated Resolution Therapy (ART)” is published in the journal, Nursing Outlook.

Kevin Kip, PhD, FAHA (Photo by Caitlin Keough).

Kevin Kip, PhD, FAHA (Photo by Caitlin Keough).

The therapy is usually completed in about three or four sessions depending on the amount and extent of the veteran’s traumatic experience(s).

Before the therapy took place, Kip and his research team collected baseline characteristics from the veterans. These characteristics included: age, how much combat exposure they had, trauma experienced, their symptoms of PTSD, if they had any alcohol or substance abuse problems, and their overall health.

The veterans then began their ART sessions.

Each session covers working through one significant traumatic experience from the past, with the therapy occurring in two phases. The first phase starts with the veteran being asked to just think, not talk, about the original experience, as if they were reliving it in their mind. This technique is called imaginable exposure.

During the imaginable exposure phase, the veteran will relive the experience in their mind which will usually cause a range of physiological reactions. The therapist will ask the veteran how they feel from head to toe. Whatever symptom the veteran might be feeling, the therapist will then ask them to focus on the specific symptom.  This will occur as the patient follows with their eyes the therapist’s hand as it moves back and forth 40 times in front of their face. This is called smooth pursuit eye movements.

Diego Hernandez, visiting assistant professor of the USF College of Nursing, demonstrates a smooth pursuit eye movement technique used in ART (Photo courtesy of USF Health).

Diego Hernandez, visiting assistant professor of the USF College of Nursing, demonstrates a smooth pursuit eye movement technique used in ART (Photo courtesy of USF Health).

“Something appears to happen during imaginable exposure where telling the brain to focus on the symptom and moving your eyes seems to quiet down some of the physiological reactions. So that’s really the first part: to relive the prior experience, bring up the symptoms that relate to the experience, and then have the brain focus on the symptom while doing the eye movements which will quiet down some of the normal physiological reaction you get,” Kip said.

The second phase is called the director phase. During this phase, the veteran is asked to come up with a way in which they would rather remember the traumatic experience.

“Now the facts will never change, but they are asked to come up with a more positive scenario of the event, maybe a certain fight didn’t happen or maybe someone was just wounded in the leg instead of being killed, whatever solution they want,” Kip said.

The veterans are asked to think about the new scenario from beginning to end, almost like they are creating a movie script. During this they are again following the therapist’s hand back and forth with eye movements.

“The premise behind this is that every time you bring up a really emotional memory, the brain thinks about it and repackages, changes, and stores the memory a little bit differently, even if we don’t want it to. This is called memory reconsolidation and it’s a process that happens automatically,” Kip said. “Part of the beauty of this therapy is that if bringing up this memory is going to change at least a little anyways, why not try to focus on something really positive and change it in a positive way?”

The session then ends after this phase with the therapist sometimes asking the veteran to envision crossing over a bridge to a new life without the traumatic experience.

Kip’s results showed that for both types of veterans, their level of PTSD symptoms went down substantially and that the comorbidities, disorders that are associated with PTSD, such as depression, anxiety and pain, decreased as well.

“Their overall quality of life was significantly improved in both groups.” Kip said. “These are the kind of advantages we tend to see if you can effectively treat post-traumatic stress disorder.”

The results were what Kip expected, but there was one thing that was surprising to him. On average, even though it wasn’t dramatic, the responses in the homeless veteran population seemed to be a little bit better than the responses for veterans in the community.

Kip believes this may have to do with the fact that the homeless came in with a little more psychopathology, meaning in addition to PTSD, they had other or more severe mental health problems.

He said the only caveat was that only a little more than half of the homeless veterans completed the treatment.

Explanations for not completing treatment with ART tended to be reasons such as the homeless veteran moved away or that they found work somewhere else.

“The reasons didn’t seem to be related to the fact that they weren’t having a good treatment experience; it’s just their life circumstances are difficult and sometimes and they don’t stay long in these types of facilities. It is reassuring to know that it wasn’t that they found the therapy aversive, they just have so many other life challenges,” Kip said. “It’s important to note that if you’re trying to work with the homeless population that the ability to give a full course treatment may be a challenge.”

At the six-month mark, eight of the homeless veterans provided information on how they were doing. They reported strong reductions in their symptoms of PTSD and six of those eight were no longer homeless.

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Kip KE, D’Aoust RF, Hernandez DF, Girling SA, Cuttino B, Long MK, Rojas P, Wittenberg T, Abhayakumar A, Rosenzweig L, Evaluation of Brief Treatment of Symptoms of Psychological Trauma among Veterans Residing in a Homeless Shelter by Use of Accelerated Resolution Therapy (ART), Nursing Outlook (2016), doi: 10.1016/j.outlook.2016.04.006.

 

Story by Caitlin Keough, USF College of Public Health

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