Long Road Home

“I never talked about it, my unit never talked about it, the guys who watched it happen never talked about it,” he says. Returning home, he went 12 years without talking about it. He tried to resume a normal life but couldn’t find his footing. By 2018, PTSD had him at a breaking point.

“I was having trouble at work, in my marriage,” he says. “I was isolating myself. I ended up divorced. That was a real eye-opener.” He tried to treat his symptoms on his own, but nothing worked. Finally, Burgess called Emory. That call, he says, changed everything.

“PTSD is a disorder of avoidance,” says Barbara Rothbaum, professor of psychiatry, Paul A. Janssen Chair in Neuropsychopharmacology and director of the Emory Healthcare Veterans Program. “Traditional treatments for veterans with PTSD have a dropout rate of around half. Our program has a 90% completion rate.”

What’s more, veterans are maintaining the gains they made even after they leave the program. Approximately 88% of veterans who participate in the program’s two-week Intensive Outpatient Program (IOP) say they have maintained their gains a full year after they graduate. And the 12% who did not maintain their gains say they still are better off than they were prior to enrolling.

“Veterans are learning how to apply the tools we taught them,” Rothbaum says. “They are building back their lives over time.”

Burgess went through the IOP for PTSD (the program has since expanded to offer an additional track for veterans with traumatic brain injury and one for substance use disorder). He remembers with gratitude the veterans and active service members he met and bonded with during those weeks and has stayed in contact with several of them.

Another highlight, he says, were the in vivo sessions, a form of prolonged exposure therapy where veterans are introduced to environmental stressors they otherwise might avoid.

“I don’t like having my back to the door,” he says. “And the first thing they did, they had us sit with our backs to the door. So I had to get used to that. I also don’t like crowds. So we went to Walmart. And I had to learn — okay, crowded, yes; bad situation, no. I had to train myself to see that there’s a difference.”

Now, a year-and-a-half later, Burgess has regained stability and recovered his confidence, though he says he’s still a work in progress. He works at a construction supply company in Alpharetta and is a proud father to an eighth-grade daughter.

As executive adviser to the Emory Healthcare Veterans Program, he brings nearly four decades of leadership experience to his role, which includes building new alliances and strengthening Emory’s existing relationships with the U.S. military, the Wounded Warrior Project and community and government partners.

Garrett also brings his love of the North Georgia mountains. He received his military training at the University of North Georgia in Dahlonega and spent summers working with the Youth Conservation Corps in the Chattahoochee National Forest and on the Appalachian Trail. He makes a point of spending time outdoors with those enrolled in the Emory program, and has offered guided hikes at Kennesaw Mountain National Battlefield Park for veterans.

While the program’s focus remains on delivering care, the research driving this care forward has inspired Garrett. The future of veterans’ health, he says, lies in personalized treatment.

“We are excited about the potential of biomarkers to dramatically improve the precision of diagnostics and the ability to personalize treatments for veterans with PTSD,” he says.

Emory serves as the PTSD biomarker repository for the Warrior Care Network. The collection of blood and saliva samples from veterans who elect to participate is potentially game-changing. Data from this repository could help researchers predict who is more likely to experience PTSD. It could help with the development of treatment and prevention strategies.

It also could help identify which treatment will work best for any given veteran or service member, because there is no one-size-fits-all therapy when it comes to PTSD and its shattering effects.

Listening to veterans means acknowledging that wounds of war do not come from combat alone, says Ursula Kelly, a nurse scientist at the Atlanta VA Health Care System.

“There are differences between PTSD caused by combat and PTSD caused by sexual trauma,” she says. “Both are life-altering, but military sexual trauma often involves a deeply personal betrayal. These are the people — fellow service members and superiors — who were supposed to have your back. With PTSD related to military sexual trauma, not only are veterans dealing with the stigma of having PTSD, but there is the added stigma and victim-blaming associated with women’s sexual assault.”

The VA defines military sexual trauma as sexual assault or ongoing threatening sexual harassment while serving in the military. It is now so common the VA routinely asks all veterans if they have experienced it. Between 20% and 40% of female service members report having experienced military sexual trauma, depending on what study is being cited, according to Kelly. Male service members also experience military sexual trauma, but their reporting rates are much lower — 3% to 4% — though experts believe their actual rates are actually similar to women’s.

In research funded by the VA, Kelly and her colleagues are comparing the effectiveness of trauma-sensitive yoga to evidence-based psychotherapy for PTSD. She believes yoga, as an embodied treatment, offers an important tool for healing over the long term.

How does yoga help? The answer might seem counterintuitive, she says. Yoga works precisely because it does not require the patient to retell their story, at least not right away. Kelly’s theory is yoga has the opposite effect of PTSD on the nervous and immune systems — and provides a non-cognitive pathway to healing.

“For some survivors,” she says, “exposure therapy just isn’t possible right away. They’ve usually experienced multiple traumas throughout their lives. The complexity is just too great. ‘Telling your story’ is exceedingly difficult for these women.”

The results of her research to date are promising. Trauma-sensitive yoga is proving to be as effective as evidence-based psychotherapy (specifically, cognitive processing therapy) for treating PTSD and co-occurring depression in women with PTSD and military sexual trauma. Kelly isn’t looking to replace psychotherapy. But she thinks yoga could provide an alternative or serve as an additional treatment. Yoga helps people learn to regulate their emotions through their bodies, rather than through their thoughts and memories.

At the Emory Healthcare Veterans Program, yoga is offered to participants as a valuable general practice, though not as a specific treatment for PTSD.

Virtual reality therapy also is among the treatments offered to veterans in the program for a wide range of combat-related issues, including military sexual trauma-related PTSD. According to research conducted by Rothbaum’s team, virtual reality therapy holds promise for providing relief for veterans grappling with this particularly difficult set of experiences.

Rothbaum has long been a pioneer in virtual reality therapy for patients with phobias, anxiety, addictions or PTSD. Virtual reality exposure therapy involves having patients describe aloud their most traumatic memories while the therapist matches those descriptions using a computer-generated 3D environment.

“The virtual reality exposure system provides an effective treatment and allows for controlled delivery of sensory stimulation by the therapist,” she says.

Meanwhile, Kelly’s work at the VA serves as a reminder of how important skilled nurses and nurse scientists are for veterans’ health care nationwide.

Emory is one of 18 U.S. nursing schools competitively chosen by the Department of Veterans Affairs to participate in the VA Nursing Academic Partnership for undergraduate nursing students and graduate nurse practitioner students.

Since its launch at Emory in 2013, the VA Nursing Academic Partnership program has graduated more than 100 nursing students. More than 20 graduate nurse practitioner students have graduated since 2015, the start of the graduate arm of the program.

The program trains nurses to understand the unique and often chronic issues within the veteran population. Lisa Muirhead, associate professor of nursing at the Nell Hodgson Woodruff School of Nursing, serves as principal investigator for both programs.

“I’ve been most inspired by the willingness that veterans have shown to share their stories with our nursing students,” she says. “I’m also inspired by the growing interest in caring for veterans that our students express as they are immersed in the provision of veteran-centered care.”

There’s a lot that being in the military can and does prepare you for, says Banik, the Marine veteran:

“But they can’t teach you how to deal with the outcomes of war or what you might see in wartime situations. I want my fellow veterans to know that help is possible. Mental health is possible.

By Stacia Pelletier. Leigh DeLozier contributed.