Spend some time with Kathleen Chard, PhD, at the Cincinnati Department of Veterans Affairs (VA) Medical Center facility in Ft. Thomas, Ky., and it’s obvious how much she cares about her patients. As she leads a tour of the space occupied by the Posttraumatic Stress Disorder (PTSD) and Anxiety Disorders Division, she’s greeted with enthusiasm by patients and staff alike. Returning the greetings with equal enthusiasm, she demonstrates how important the program is to the well-being of the thousands of veterans who have been successfully treated during her nine years at the center.
As director of the PTSD and Anxiety Disorders Division, Chard is responsible for a sprawling program that is well suited to the quiet Ft. Thomas campus about eight miles from the main VA campus near the UC College of Medicine, where Chard is an associate professor of clinical psychiatry. Its components include both outpatient and residential (seven-week) PTSD programs for men and women, plus an intensive eight-week residential program for veterans with traumatic brain injury (TBI)/PTSD and telehealth services to VA clinics throughout Ohio. Male and female military veterans of all eras are eligible for services at VA facilities, and the trauma does not have to be confined to their years in the military.
It’s a program that has grown into a national model since Chard arrived on the scene in 2004, bringing her enthusiasm and knowledge to a centrally located area ripe for transformation.
"When I was hired, we had a 10-person clinic and a 12-person men’s residential program that was half full. One of the things we quickly decided to do was get that residential program to the point where we’d have more people coming in. And then I realized, ‘There’s nowhere for women with PTSD to go in this area.’ So in January of 2007 we became the third women’s residential program in the nation—the others were bookends on the coasts.”
Still, Chard was well aware of unmet needs for veterans. Traumatic brain injuries— involving sudden damage to the brain caused by an outside force to the head—had emerged as "signature wound” of U.S. soldiers in Iraq and Afghanistan. "We decided in 2010 it was time to start looking at traumatic brain injury,” she says. "So we opened a TBI program in 2011 (construction was completed in 2012) that became the first traumatic brain injury/PTSD program in the nation.”
In the meantime, that 10-person clinic grew to a staff of more than 30 as the program expanded to meet demand. "Fifty percent of our patients come from outside of this network,” Chard says. "We treat active duty, reserve and guard. I’ve had a Marine flown over from Afghanistan, treated in our program and sent back. We also had a young woman from Ramstein Air Base in Germany who was told she couldn’t continue in her career because her PTSD was getting in the way. She wanted a career in the military, and after treatment here she was able to make the career choice she had always wanted and continue in the military.”
Looking to the future, Chard is confident that her program can handle the demands created by continuing U.S. military involvement in world hot spots. "If we get a referral, we’ve got an opening,” she says. "The VA has done an outstanding job of getting ahead of the curve. We’ve always had space when people needed it here.”
As for PTSD treatment itself, "What I hope to see is more people acknowledging that we need to get to PTSD earlier,” she says. "And motivational enhancement will be important, to help people not only get ready to go through trauma therapy, but also to stay with it.”
According to the National Institute of Mental Health (NIMH), posttraumatic stress disorder (PTSD) is a type of anxiety disorder that some people get after seeing or living through a dangerous event. People who have PTSD may feel stressed or frightened even when they’re no longer in danger.
Anyone can get PTSD at any age. This includes war veterans and survivors of physical and sexual assault, abuse, accidents, disasters and many other serious events.
Symptoms of PTSD fall into three main categories: Re-experiencing the event, such as flashbacks or repeated upsetting memories; avoidance, such as feeling detached or having a lack of interest in normal activities; and hyper-arousal, such as difficult concentrating or startling easily.
Types of PTSD Therapy
The PTSD and Anxiety Disorders Division at the Cincinnati Department of Veterans Affairs (VA) Medical Center emphasizes evidence-based treatments—those that have been well researched and have been shown to work for treating a specific condition such as PTSD. Course-of-treatment decisions are made on a case-by-case basis following discussion between the patient and treatment providers.
Cognitive Processing Therapy (CPT): A cognitive-behavioral therapy that focuses on thoughts and feelings. The focus is on identifying how traumatic experiences changed the patient’s thoughts and beliefs and how the patient’s thoughts influence current feelings and behaviors. Patients identify and challenge unhelpful thoughts through structured therapy sessions and practice assignments. (Kathleen Chard, PhD, is co-author of the CPT military/veteran manual and the national CPT implementation director for the Department of Veterans Affairs.)
Prolonged Exposure (PE): A cognitive-behavioral treatment that focuses on decreasing symptoms of PTSD by addressing the common causes and treatments in four ways—education about treatment and common reactions to trauma, breathing retraining, in vivo ("in real life”) exposure and imaginal exposure. The therapy allows patients to work through painful memories in a safe and supportive environment and engage with activities they have been avoiding because of the trauma.
Virtual Reality Exposure Therapy (VRET): A type of Prolonged Exposure, this therapy involves a computer simulation of settings that are triggers for PTSD episodes. For example, the patient—seated at a video terminal and wearing headphones—could experience the sights, sounds, weather and level of violence of a combat situation. The therapist, seated at a computer nearby, replicates the experience and can even add smells and vibrations via special software.
Chard is one of three co-investigators of a recently approved 17-site, $9 million VA Cooperative Studies Program study that will compare Cognitive Processing Therapy with Prolonged Exposure head to head in an effort to predict which is more likely to benefit certain patients.
The division also offers first-stage treatment for veterans with PTSD and co-occurring alcohol or drug problems, traumatic nightmare therapy, a PTSD educational group, PTSD coping skills, PTSD women’s group and couples therapy.