Doctors from the Fort Hood Intrepid Spirit Center in Killeen, Texas presented a multidisciplinary treatment approach for service members coping with the effects of traumatic brain injury (TBI) at the 2016 Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury Summit Sept. 13-15.

Dr. Scot Engel, a clinical psychologist and site director of the Intrepid Spirit Center, and Dr. John Dieter, a neuropsychologist and director of research, explained the Fort Hood Intensive Outpatient Program (IOP), which helps service members who have deployed to combat zones or experienced sexual assault in the military. Candidates are eligible to participate with commander approval if they have not responded positively to lower-level treatments and have at least two of the following:

• A history of TBI
• Current experience with significant emotional distress
• Chronic pain

The program combines multiple disciplines to also treat service members with posttraumatic stress disorder (PTSD). This is because PTSD symptoms can negatively influence other symptoms. For example, head injuries coupled with the stress of deployment often lead to insomnia, which can impair a service member’s reasoning and problem-solving skills. In addition, service members commonly experience chronic pain and other medical conditions, as well as depression and anxiety.

“The goal is to reduce the service member’s number of self-reported symptoms,” Dieter said.

The doctors reported that evaluations immediately following the program, and one month later, show a consistent and statistically significant decrease in symptoms of PTSD and TBI, as well as improved sleep and reduction in chronic. In addition, soldiers showed significant improvements in cognitive functioning on neuropsychological tests.

“We don’t pretend that these are problems with permanent solutions,” Engel said. “But they are problems that can be managed.”

Service members in the program take a “360-degree assessment” to evaluate different aspects of their TBI:

• Behavioral Health
• Neuropsychology
• Occupational Therapy
• Pharmacy
• Physical Therapy
• Speech/Language

Over six weeks, participants address different aspects of their TBI. These can include:

• Cognitive Rehabilitation. Teaches problem-solving skills by addressing issues with memory, attention and forming strategies to avoid procrastination and accomplish tasks.
• Stress Management. Teaches how to identify situations and triggers that cause stress, and skills to address those situations in an effective and healthy manner.
• Cognitive Processing Therapy. During eight sessions, service members work in a group to analyze and normalize their traumatic experiences, and learn to address the emotions evoked by those memories.
• Sleep Therapy. Gives service members techniques and information to regulate sleep cycles and avoid insomnia post-deployment.
• Occupational Therapy and Leisure. Educates patients on the importance of maintaining a balance between professional and leisure activities, and explores healthy ways to expand personal satisfaction.
• Cognitive Rehab Tablet. Through handheld games and applications, service members and veterans hone reasoning and deductive skills.
• Physical Training and Yoga. Helps service members and veterans overcome heightened levels of stress and physical aspects of TBI through intensive exercises. Teaches service members skills for stress management and physical wellness post-treatment.
• Master Resiliency Training. Teaches patients to increase overall resilience.

Beginning Oct. 31, DCoE will offer all of the summit sessions online. At that time, those who were unable to view the live sessions can still receive continuing education credit for them by signing up and watching the recorded sessions. The 2017 DCoE Summit is tentatively scheduled for Sept. 19-21, 2017.

To learn more about the Fort Hood Intrepid Spirit Center’s Intensive Outpatient Program at the Carl R. Darnall Army Medical Center, call (254) 287-8179.  For more information about the IOP program specific to the National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, visit the NICoE Intensive Outpatient Program.