WNPR

More Vets Get Alternative Treatment for PTSD, But Not Always Evidence-Based

Jul 18, 2016

The Department of Veterans Affairs estimates up to 30 percent of former service members — from the Vietnam War to Iraq and Afghanistan — have Post Traumatic Stress Disorder. 

They don’t all seek treatment, but among those who do, the VA said 20 to 40 percent don’t get better with the standard regimen of therapy, medication, or both. Increasingly, veterans are seeking out alternative mental health care, and much of it untested.

At Soldier On in Pittsfield, Massachusetts — a transitional housing organization for veterans — director Jack Downing has seen hundreds of clients cycle in and out of homelessness, depression, substance abuse, and other effects of trauma.

Soldier On offers psychotherapy and anti-depressants to deal with PTSD — the nightmares, flashbacks, anxiety — but Downing said many chronically ill vets don’t stick with the treatment.

“Much of what we do medically just doesn’t work,” Downing said. “We keep doing these things because we don’t know what else to do. As a result of that, we were looking for alternatives that would work.”

A couple years ago, Downing met Stephen Zodkoy, a New Jersey-based chiropractor who claimed to have a new way to make veterans feel better.

“As he explained how he did this process, it just made some sense to me,” Downing said..

Zodkoy’s methods are far from mainstream. He links PTSD to what he calls fatigue of the adrenal glands. He said he measures chemicals in his patients’ urine and then prescribes herbs and nutrition supplements to balance out their hormones.

Zodkoy also uses what’s called Neuro Emotional Technique, in which patients revisit traumatic memories while a chiropractor tests their muscle reaction and taps them on acupressure points.

“In all honesty, none of this is my idea,” said Zodkoy. “I’ve just basically taken the work that other people have done for decades and put it into a package that is efficient and effective.”

Soldier On said it’s recruited 450 veterans to try Zodkoy’s method. Thirty percent dropped out in the first two months.

Sam Bennett, a formerly homeless vet who now works at Soldier On, has lasted longer than that. He said he thinks it’s helped, though he never quite understood the chiropractic part, done by a colleague of Zodkoy’s.

“She did it and I thought, ‘What’s going on?'” Bennett said. “She was doing some things, she was giving me the diagnosis how this affected, she was going on and on. ‘Were you sad? Were you this?’ Talking about family stuff back in the past, stressful situations. That was good therapy.”

But he’s not sure if the muscle tapping helped. Neither is Noyal Moore, a Vietnam-era vet who tried the program.

Moore gives more credit to the supplements Zodkoy prescribed, though he can’t remember which kind. He’s pretty sure they’ve allowed him to rely less on a walker to get around and helped him improve his personal finances.

“Whatever they’re doing, it’s working!” he said with a laugh. “I can’t really say in medical terms.”

By Zodkoy’s own admission, there’s very little scientific evidence his program works as good or better than traditional therapy. He has anecdotal testimony and a survey he gave to 20 Marines — all of whom reported feeling better after his treatment.

But there have been no clinical trials or peer-reviewed studies. There’s no proof the treatment offers more than the passage of time, one-on-one attention or a placebo effect.

To Zodkoy, that doesn’t matter.

“Is it the herbs? Don’t know. Is it the one-on-one work? Don’t know. Is it placebo? Don’t know,” Zodkoy said. “But what I will say is this: I don’t care. As long as the veterans are feeling better, it’s a win.”

Another person who doesn’t care is Jack Downing, the Soldier On director, who said his group spends $200,000 a year from a private donor fund on Zodkoy’s program. He said he didn’t ask to see any research.

“I’m not a medical guy; I’m not looking to do any of that,” Downing said. “I know by the lack of decompensating episodes that are taking place in people’s lives that the quality of their life is better.”

That might be evidence enough for Soldier On, but not for many in the medical community.

“Look at blood-letting in the middle ages,” said Harriett Hall, a retired physician and Air Force colonel who edits the blog Science-Based Medicine. “They had all types of testimonials. It was in the textbooks, the doctors believed in it. They had gut feelings bloodletting worked.”

Hall said almost every treatment works for at least a few people, and in the case of PTSD, a large percentage actually recover on their own.

“So how do you know whether it was the treatment or not unless you’ve done a controlled study to find out?” she said.

Stephen Zodkoy’s PTSD treatment is certainly not the only unconventional one out there. In recent years, people have offered thought field therapy, energy healing, hot cups on people’s backs, electromagnetic therapy, sweat lodges. In Texas, a chiropractic clinic used state funding to spin vets around in chairs to stimulate the brain.

“When people are understandably desperate, understandably in pain, who can blame them? They may be seeking out new things and I’d be in the same boat,” said Emory University psychologist Scott Lilienfeld, who studies pseudo-science and mental illness.

Lilienfeld said the best, evidence-based treatment for PTSD is cognitive behavioral therapy, meant to help people develop coping strategies, and prolonged exposure therapy, to desensitize people to traumatic memories.

He suspects the standard treatment fails to work for many people because their therapist does it wrong.

“That, I think, leaves a big gap, a big vacuum, whereby people who are peddling, hawking treatments that are rather faddish, in some cases even pseudoscientific, can quickly fill in that gap,” Lilienfeld said.

In its practice guidelines, the Department of Veterans Affairs recommends treatments that have the most rigorous scientific evidence. But at the same time, the VA does recognize a growing demand for alternative healthcare.

Paula Schnurr, who heads the National Center for PTSD, which is part of the VA, said she’s “not concerned about veterans seeking alternative strategies in addition to effective strategies,” as long as the alternative doesn’t replace a method with more evidence behind it.

Schnurr said 90 percent of VA centers across the country do offer some sort of alternative treatment for PTSD. And many have been studied through clinical trials — some, like meditation and yoga, with promising results.

The National Center on PTSD is now looking into the benefits of Tai Chi, Schnurr said, “because as a martial art, it is something that might be appealing to veterans. It’s certainly a practice that can enhance health. And part of recovering from PTSD or other mental disorders isn’t only about treating the symptoms. It’s about treating the whole person.”

Schnurr also points out one approach to trauma, once approached with broad skepticism, is now on the VA’s list of approved treatments. EMDR — devised in the late 1980s — uses bilateral eye movement, looking side to side, during cognitive behavioral therapy. Only after about a dozen clinical studies did Schnurr feel comfortable recommending it.

“I’m convinced the treatment works; I’m not sure why,” she said.

But as long as the treatment is based on rigorous science, she said, that’s evidence enough.

This report was originally published by New England Public Radio.