Center Creates 'Little Miracles' in Treating Combat Stress

By Donna Miles
American Forces Press Service

May 9, 2008 - A revolutionary treatment program here is demonstrating "little miracles" as it gives new hope to soldiers afflicted with post-traumatic stress disorder who want to stay in the Army , its director reports. The new program is the brainchild of clinical psychologist John E. Fortunato, who uses a holistic approach to treating PTSD at the new Fort Bliss Restoration and Resilience Center.

Fortunato conceded that his proposal "wasn't an easy sell" initially, particularly because it wove yoga, massage therapy and other nontraditional approaches into its treatment program. But driven by the frustration of seeing soldiers with PTSD forced to leave the Army against their wishes, Fortunato pressed forward and won approval for his prototype program.

With $2.2 million in initial funding and a 1940s barracks building to rehab, he set out to launch the Restoration and Resilience Center in June 2006. The center opened last summer.

Fortunato was convinced traditional PTSD treatments weren't long enough, intense enough or comprehensive enough. "So we set out to create a program to address all aspects of PTSD and treat the whole soldier," he said.

The participants, all volunteers, take about one-half the doses of medications they'd typically get through community mental-health programs. "That's because we're doing a bunch of other things," Fortunato said.

Many PTSD-afflicted soldiers experience "hyper-arousal," which the center staff treats with techniques like medical massage and "Reiki," a Japanese stress-reduction technique. Acupuncture has proven to be "extremely effective" in treating the anxiety, panic, and tension-induced physical pain many experience, Fortunato said.

There's a big physical component to the program, too. The soldiers must walk at least 10,000 steps a day, including a daily 45-minute "power walk." They play water polo three times a week, forcing interaction that Fortunato said many would rather avoid.

"That's another piece of PTSD. They want to socially isolate. They don't like to interact with other people," he said. "So we have them interact with the people they feel most comfortable with: other soldiers with PTSD."

Field trips during the program take the soldiers to the local mall and Wal-mart, "two hells" to many of them because they're too big, too crowded and too noisy, Fortunato said. "We teach them ways to regulate their stress level so they can handle those kinds of environments."

Many afflicted soldiers have trouble with concentration and memory, Fortunato said. For them, the program's mix of physical activity and calming techniques appears to help. They do yoga; tai chi, a Chinese martial art; "Quigong," a centuries-old Chinese self-healing method; and biofeedback, which uses the mind to heal the body. "We have a meditation room that looks like it came out of a Zen monastery," Fortunato said.

The program aims to repair the physical damage to the "learning center" in many PTSD sufferers' brains. That's caused, Fortunato explained, when the body's stress hormone is elevated too high and for too long -- as it commonly is among combat troops.

"The good news is, [the learning center] is one of only two parts of the brain that can grow new cells," he said. So his program requires participants to sit at a computer several times a day, doing mental exercises to help them regain their cognitive functioning.

While confronting the physical aspects of PTSD, the program addresses the emotional and spiritual aspects, too.

"Few soldiers come back from war without terrible images and events in their head," Fortunato said. Many "suck it up and soldier on" in the combat theater because they have no choice. But when they return home, these issues can percolate to the surface as nightmares, flashbacks and other problems.

Fortunato's program uses "rehearsal therapy" to help participants confront their most painful memories and experiences. "The soldier tells the story, as painful as it is, over and over until you've emptied it of its emotional punch," he said. "They are never going to forget the story, but it doesn't have to have the grip on their guts that it did before."

Meanwhile, many soldiers with PTSD find that their combat experience has shaken their core beliefs and values, Fortunato said. A chaplain helps them review "the big organizing things in their life" as they address the spiritual piece of their PTSD struggle. "We weren't doing much to address this before," but it's critical to a soldier's healing, he said.

Fortunato said there's nothing monumental about the Recovery and Resilience Center's approach to treating PTSD. "If you put all of that together, it isn't magic," he said. "None of it is magic. And do you know what? None of it is new. All we did is, we looked at the whole soldier and tried to treat all of him."

The "whole soldier" approach appears to be paying off. Twelve of the 37 soldiers who volunteered for the program have graduated and returned to their units. Among the recent graduates is a soldier who was in a catatonic state in August, but now is free of all signs of PTSD.

"Little miracles are what we are watching happen," Fortunato said.

So far, only two participants have washed out of the program, both taking medical discharges from the Army.

Fortunato is the first to say his program isn't for everyone. "This is a hard program," he said. "[Participants are] in treatment 35 hours a week [with] daily psychotherapy, daily group therapy [and] integrative medicine. They go from 8:30 in the morning until 4:30 every afternoon. You have to be highly motivated to put up with that much treatment."

There's no set timetable for completing the program, but Fortunato said he's finding six months to be optimal for most soldiers. "As long as they are working hard, we are going to hang in with them," he said.

The soldiers formed their own platoon, which they dubbed, "the Wolf Pack." It's a testament, Fortunato said, to the way they take care of each other and the strength they've shown in admitting they have PTSD and seeking treatment.

As the soldiers work to overcome their combat stress and return to their units, Fortunato said he's convinced the program is in the Army's best interest as well.

The cost alone of treating a soldier -- somewhere between $14,000 and $20,000 -- is a bargain to the force, he said. By comparison, he said it would cost about $400,000 to recruit and train a new soldier and provide lifetime disability payments and medical care to the discharged soldier.

"So why wouldn't you do this?" Fortunato said. "I think the numbers are all in our favor."

Defense Secretary Robert M. Gates appears to agree. He toured the Restoration and Resilience Center on May 1, calling the visit an "extraordinary experience."

"They are doing some amazing things here in terms of helping soldiers who want to remain soldiers but who have been wounded with post-traumatic stress disorder," he said. "It is a multi-month effort by a lot of caring people, and they are showing some real success in restoring these soldiers."

Gates called the center an example of new approaches the military is taking to care for these troops. "This center here is illustrative of what can be done," he said.

Gates said he'll consider the idea of possibly replicating Fort Bliss' prototype program to other posts.

Fortunato said he's all for duplicating his effort, but emphasized that his program's small size is a key to its success. The soldiers and staff all know each other, have nicknames for each other, and feel a personal commitment to each other. "We all love these guys," he said.