By Eileen Rivers
Washington Post Staff Writer
Tuesday, May 6, 2008
Derrick Farley, a 29-year-old Army sergeant stationed at Fort Bragg, N.C., has seen many people die. He served in Iraq for three year-long tours of duty with only six-month breaks between them. He remembers driving trucks along the dirt roads of Tikrit, ever alert for telltale signs of a sniper or the sudden blast of a hidden roadside bomb. His vehicle, he said, was hit 13 times.
After he returned home from his last tour, it was often the less tense moments from Iraq that ran through his mind. For months, he had nightmares during which he screamed out in Arabic as he relived run-ins with detainees. At times, the sound of shots ringing out from the firing range at Fort Bragg would launch him right back onto the roads of Iraq.
Farley is far from alone: A Rand study released last month said 20 percent of the approximately 1.6 million U.S. military personnel who have served in Iraq or Afghanistan suffer from symptoms of post-traumatic stress disorder.
But recently Farley has found a way to quell the symptoms of PTSD. Instead of allowing his mind to flash back to the roadside carnage, the truck driver pictures himself sitting on a yoga mat at the District's Walter Reed Army Medical Center, taking deep, relaxing breaths.
The techniques Farley learned there from yoga teacher Robin Carnes help him to realize that he's "actually here on Fort Bragg and not in Iraq," he explained by phone from the base.'They're Not as Angry'
The Specialized Care Program at Walter Reed focuses on helping service members returning from Iraq and Afghanistan leave their wartime experiences behind.
Yoga, Carnes said, has become a large part of that effort.
In conjunction with a team of psychologists, a physical therapist, two nurses, a social worker and a general internist, Carnes has worked with hundreds of service members.
The program, which serves as many as 120 service members per year, 90 percent of whom suffer from PTSD, costs about $800,000 annually. That figure covers salaries for the program's specialists as well as travel and accommodations for the participants, such as Farley, who typically come for a three-week treatment session.
The yoga that Carnes teaches, a form of guided meditation known as yoga nidra, was added to the program in 2006 after she helped conduct a feasibility study at the medical center.
The results of the study were overwhelmingly positive, she said, adding that the service members appreciated learning skills that they could continue to use after they left.
However, it's difficult to document the program's impact. Participants, who evaluate their own progress, often say they feel better after sessions, Carnes said, but there's little scientific evidence to back their anecdotal reports.
"Students in class come up to me and say, 'I haven't felt this relaxed in a long time,' " Carnes said. "They say that they are more patient with their family. They're not as angry."Soothed by Ocean Sounds
Farley went through a three-week program earlier this year. On a Thursday afternoon, 11 days into it, he lay on the floor, covered in blankets, head propped up with pillows, along with his wife and five other participants.
A CD of soothing ocean sounds played in the background and, with his eyes closed, Farley listened as Carnes led them through a yoga nidra session.
Periodically, she gave specific instructions: "Bring attention to your eyelids. Feel the place where your eyelids touch. Bring attention to your inner resolve. Think about the things you want from yourself. Focus on your breathing."
Being specific, Carnes said, prevents their minds from re-creating disturbing moments.
"The first day, the first week, there was a lot of restlessness," Carnes said. But during this session Farley and his fellow soldiers fell fast asleep -- a sign of progress, Carnes said.
In addition to twice-weekly yoga nidra classes, soldiers in the program participate in yoga sessions that use physical postures to help alleviate pain and encourage concentration. The Specialized Care Program also includes individual and group therapy, physical therapy, classes that teach coping strategies, and daily seminars that cover topics such as the causes of stress, the primary function of sleep and ways to monitor and reduce depression.
Farley's wife, Jessica, participated in classes with her husband and learned what had been causing Derrick's symptoms. He had never felt comfortable, he said, talking to his wife about his problems before the Walter Reed program.
It was Jessica who originally encouraged her husband to get help. He didn't realize that he was screaming out during the night, but these episodes troubled her deeply.
At first "she kept [the night terrors] from me," Farley said, "because I already felt bad enough not being myself, and she didn't want to add any stress to it." But after an especially bad nightmare, "she said to me, 'You know we need to get you some help.' "
Farley initially sought that help from the 82nd Airborne Division's mental health services in North Carolina. The experts there prescribed medication, he said. He also spoke to a therapist once a week. But he felt as though the prescription was masking his problems rather than solving them, he said.
"You got four brigades at Fort Bragg, and everybody is coming back from their deployment," Farley said. "It's hard to get appointments. It's hard to get time with a therapist. It's hard to be seen every week now. The appointments get stretched out to once a week, once every two weeks, once a month."
His therapist recommended that he apply for the Walter Reed program.Individually Tailored Care
About 10 to 15 percent of service members in Operation Iraqi Freedom are at risk for PTSD, according to Cynthia Smith, a Department of Defense spokeswoman.
To meet this need for assistance, the Army Medical Command has contracted for 275 additional mental health workers nationwide, according to the Office of the Assistant Secretary of Defense for Health Affairs. The contractors have filled 112 positions, and there are about 137 applicants in various stages of hiring.
Walter Reed is attempting to start pilot programs at bases across the country that will use the medical center's three-week program as a model, said Col. Charles Engel, a psychologist whose department oversees the PTSD program.
What distinguishes Walter Reed's program, Engel said, is its multidisciplinary approach combined with care tailored to each participant.
"Nothing we do is by rote," said Roy Clymer, a psychologist and the program's director.
"We see yoga as a part of two important things," Clymer said. "One part of it is the physical aspect . . . that invites them to get in touch with the body to show them that the body doesn't have anything bad to compete against anymore. Another is that yoga is a part of mindfulness, bringing them back in the present moment."Not About Finding a Cure
Farley wishes he had been able to spend more time in the program. Perhaps "I could have gotten everything out of my system," he said.
He stays in touch with many of the soldiers he met at the program. And each night, he uses the yoga techniques he learned there.
He climbs into bed, closes his eyes and follows his instructor's directions on a CD, allowing his mind to shut down for a peaceful night's rest -- something that he has finally been able to master after six months out of Iraq.
"It's not about finding a cure for PTSD," Farley said. "It's about learning to cope."