Veterans with mental health conditions like post-traumatic stress disorder (PTSD) or depression suffer at higher rates than civilians. Unfortunately, they often encounter numerous obstacles in their recovery path, from insurance coverage to wait times. Some find care, but end up in years of therapy. Or they must try and adjust to multiple medications before finding relief, if they find it at all.
But two veterans who have dedicated their lives’ work to the cause seemed to have cracked the code to speedy recovery.
Clinical psychologist Craig Bryan, Psy.D., ABPP and his wife AnnaBelle Bryan are behind a cutting edge initiative at Ohio State Wexner Medical Center—an intensive treatment program called The Suicide and Trauma Reduction Initiative for Veterans (STRIVE).
Craig was the lead author on a recent study, published in the Journal of Anxiety Disorders, that found that STRIVE resolves PTSD for 70% of patients and reduces suicide attempts by 76%. Originally developed to reduce suicide rates among service members, STRIVE is now making an impact for anyone with PTSD.
Combating spiking rates in PTSD
The upward trend of veteran suicide gained attention in 2021, when the suicide rate jumped to four times the number of soldiers lost to active military operations since 9/11. In 2023, the Office of Veterans Affairs (VA) announced veterans could receive both inpatient and outpatient acute suicidal crisis care without being enrolled at the VA, at no cost. By the end of the year, 50,000 veterans had done so.
The VA also reports that the risk of PTSD is higher for veterans than civilians and higher for female veterans than male. The risk also varies based on which service era a veteran served. Those in Operations Iraqi Freedom and/or Enduring Freedom have some of the highest rates, with 29% having PTSD at some point in their lives.
The Bryans, both Air Force veterans, witnessed this firsthand when they met in Iraq tending to soldiers as psychologists, sometimes in short sprints of only a few days before the soldiers headed back out into battle. Craig was running the Traumatic Brain Injury Clinic, and he’d assess soldiers as they were flown into Bilad, and while they were there, he’d start to treat their traumas.
Before moving to Ohio almost four years ago, the Bryans started their program at the University of Utah, using a two-week therapy approach they’d developed during deployment to combat zones.
“We didn’t have the luxury of scheduling weekly therapy sessions with someone in Iraq. I had maybe four or five days with them… we’d meet sometimes [up to] three times per day. I would maximize the dose [of therapy sessions], and it was working.”
After the military, the couple decided to continue the approach. Before long, they had the reputation of being able to treat suicidal thoughts in two weeks. Now, the program has eight clinicians.
How STRIVE, a PTSD treatment for veterans, works
STRIVE has a brick-and-mortar clinic and offers virtual outpatient therapy. Some patients have been referred by health care providers who send them to STRIVE specialists. But Craig says that the majority of patients are self-referred. He estimates that STRIVE has had up to 400 service members and veterans come through the program, and a year ago, they started treating civilians, too.
STRIVE has a research-focused arm of the program that analyzes how treatments are working and why. In addition, the initiative offers peer support programs outside the health care system that recognize most of the people who die by suicide aren’t actively in treatment and don’t have an official medical diagnosis, Craig says, adding, “That element of our program is focused on the role of firearm access and how that contributes to suicide risk amongst military personnel and veterans.”
STRIVE puts research into action
Craig credits the program’s success in treating veterans in just two weeks, with little need for additional treatment after, to a strong foundation in scientific, evidence-based research.
For example, recent research they conducted helped them understand that a new intervention called “crisis response planning” led to faster reductions in suicidal ideation and a 50% reduction in suicide attempts. It involves a series of steps:
- Patients tell the story of their suicidal crisis, a narrative of “how they got from point A to B.” Suicidal thoughts don’t “come out of nowhere,” Craig says.
- They retrace their steps to determine the warning signs that they were headed down a dangerous thought path.
- Patients then process and leverage what they learned in the story to recognize those warning signs.
- Once they notice the signs, patients can implement strategies in a checklist that will help them navigate challenging mental spaces.
“We talk to people about why they want to live. When you are suicidal, you want to die, but there are things that hold you back, because you also want to live. So let’s talk about that,” Craig adds.
This is different from typical “safety planning” strategies for suicide in that it includes storytelling, and instead of a worksheet, the clinician moves through the story with the patient, helping them “understand why” and screen out unhelpful strategies.
Patients have told Craig this approach makes sense to them because it’s personalized, and there’s a logic to it. One patient who had a safety plan from an ER trip for mental health shared it’s the same information, but “now I can actually see myself using it and it makes sense to me… it’s more detailed and customized.”
Help for veterans with PTSD: Honing in on the issue
Some patients tell the Bryans they’ve been going to therapy “for years.” So why does a two-week program help them? Craig says for PTSD patients, it’s a laser-focused approach—zeroing in on the thing they don’t want to talk about.
“They say, ‘You hold me accountable, not letting me get off track, not letting me avoid. You keep bringing me back to the core was the thing that helped me overcome this trauma,’” Craig says. He asks his patients: “‘Are you willing to talk about the thing you don’t want to talk about to have a good life?’ Most patients say ‘yes—I want to be a parent, I want to go out again, I want to have a social life. I’m tired of being imprisoned by my memories and thoughts,’” he says.
For many veterans, those imprisoning thoughts aren’t what you might think—they’re not always flashbacks to battles and triggers from fireworks like you see in the movies.
“It’s probably closer to a third, maybe up to 40% [military-related trauma]. What we see that’s more common is sexual victimization, interpersonal violence and childhood abuse,” Craig notes. Then, pile on combat exposure and some veterans are set up for PTSD.
“It’s more common than not that veterans we work with have been exposed to multiple traumatic events… but the majority are saying the thing that bothers them the most… is surprisingly not combat-related,” Craig says.
The future of mental health treatment
Not all veterans, of course, can be cured by these eight clinicians’ innovative approach. “It’s probably not feasible for OSU to be the sole source of this treatment,” Craig notes.
Current research is digging into the prospect of identifying mental health patients’ most vulnerable times via a wearable device, like a FitBit. The wearables, in addition, can give providers more information about sleep quality, which is essential for mental health recovery, Craig says. They can also help people who are in a suicidal thought pattern, especially given that what this looks like isn’t always what we think.
“We want to get to a place where we can use these tracking systems to… maybe signal when you’re in a vulnerable state. We can perhaps send a message to the phone saying you should go for a walk, do some breathing exercises or take out your crisis response plan, or think about your reasons for living.”
To see if you are eligible for a study or virtual or in-person care with STRIVE, or if you need resources for a mental health condition, contact [email protected]. If you are contemplating suicide, or know someone who is, call or text “988,” the suicide and crisis lifeline.
Photo by Zoran Zeremski/Shutterstock.com
