Brett Litz, Ph.D.; VA Boston Healthcare System, PTSD Multidisciplinary Research Consortium Award

For warriors, the impact of war is, can be, profound psychologically and spiritually and socially. And the label we give to the problems that arise over the life course about participation in war for warriors is Post Traumatic Stress Disorder. Most Service members are remarkably resilient to the demands of their deployment, and the demands are huge. There is life threat, there is loss of life, there is loss of peers, and the traumatic loss and the grief that comes from that. And there is also something we call moral injury that the participation and acts that cause-that are morally and ethically challenging.

But most Service members are remarkably resilient to those demands in war. But some, about 10 to 20% will suffer this psychiatric condition called PTSD that affects their ability to do their jobs and to stay in the military, and it affects their families, and most of all it makes them suffer a great deal with basically their memories of what happened to them in war that they are having a hard time coping with and living with.

I'm the Assessment Core Director of the Strong Star Consortium which is a series of clinical studies on the treatment of PTSD for Service members in Garrison. In that capacity, we're ensuring that the assessments occur in a reliable and valid way and that we're covering all the right variables to evaluate the impact of these treatments on Service members. Our role is to evaluate which treatments are best for certain Service members with certain characteristics. In other words, what works and why for Service members.

And that's really important because the treatments that are known to help with PTSD, it's based on a science that comes chiefly from the civilian literature, and these treatments called cognitive behavioral therapies have not really been studied sufficiently with Service members in the military culture in the military environment in Garrison. And that's the Strong Star's mandate.

So some therapies will not help Service members; some will help them very well. There may be some characteristics of the deployments of some Service members or their social context, their family context, that predict whether a particular type of therapy is going to help them. That's our job is to use all the data in the Strong Star study and do-make some predictions about what these therapies do and how they help Service members.

The Strong Star Consortium is a 5-year project and we're in year two. Thus far what we've done is to create a uniformity of assessments, we've trained people in the assessments, and now we're waiting to collect the data for all the treatment studies.

We have military partners who are collaborators and co-investigators in the study, and that helps us with inroads at Fort Hood, and other sites in the San Antonio area, to collect data on active duty military personnel.

The CDMRP program really ensures that the partnerships are in place so that the scientific community and the military community can synergistically combine their efforts so that the questions that get answered have military relevance and that the research can happen in an Active Duty culture and that requires a lot of integration and support and collaboration between Active Duty military partners and the academic community. And I think that's fully in place in the Strong Star Consortium.

To get Service members to volunteer-they're volunteering for treatment studies-it's hard to do. The one thing that's in our favor however is that already we have come to appreciate that, for example, at Fort Hood there are wait lists. There are a lot of Service members, thanks to the efforts in the Army and in other Service cultures to reduce stigma and to make care more available, there's a lot of care-seeking Service members. And again, this is a very unique world. We're not treating people in the private sector or in the VA; these are people who have jobs. They go back to their jobs. And performance is a big deal. Service members are very proud and they gain a lot of satisfaction from performing their duties well. And they have the opportunity to rise and to get promotions and what have.

So we're looking at that and trying to measure that as well; trying to improve the functioning and to reduce the suffering of Service members while they're in Garrison.

So it is an enormous undertaking. And it requires a lot of cooperation and collegiality and communication and I think it's been done very well, certainly to my satisfaction, and it's a really good team.