When her Humvee was hit by a roadside bomb in Iraq in 2008, former Army Sgt. First Class Elana Duffy was tossed around the front seat like a football, which resulted in a brain injury. For years afterward, she couldn’t shake the raw, negative emotions that slowly ate away at her. It simply never occurred to her that the impact to her brain would eventually erode her mental well-being too.
“I realized that I was kinda angry, but I wasn’t acknowledging it,” Duffy, 37, says. “I just thought I was processing things differently.”
Until 2012, Duffy worked in military intelligence. As an interrogator in Iraq, she extracted information from her subjects — some of whom were directly responsible for the deaths of her fellow soldiers — and often had to befriend them. Doing so was emotionally challenging, and after her head injury the stress of it all soon engulfed her.
“Everything, I thought, was ultimately related to a physical problem, and I didn’t really want to confront it,” she says.
She’s not unique in this situation. A recent report concluded that nearly half of post-9/11 veterans aren’t accessing the mental care they need. And women, who make up about 15 percent of the active-duty force, are suffering from post-traumatic stress disorder at a higher rate than in previous conflicts. Current estimates put the number of female veterans experiencing some form of depression or anxiety at one-half to one-third. What’s more, another one in five report being the victims of military sexual trauma (MST).
There are a host of methods to treat such veterans, like cognitive processing therapy and exposure therapy. These psychotherapies, while medically sound, can require a patient be in treatment for months, if not years. Contrast that with the use of a technique called eye movement desensitization and reprocessing, or EMDR, whose adherents say can rehabilitate combat veterans with PTSD in fewer sessions.
Duffy, who suffered from apoplexy, or cerebral hemorrhaging, was introduced to the practice at Headstrong, a treatment program in New York City dedicated to serving post-9/11 vets. Headstrong specializes in EMDR, which uses eye movements to alleviate the stress of a traumatic event. While closely tracking the rapid back-and-forth finger movements of a therapist (or other side-to-side stimulation), the patient holds in his or her mind the disturbing event and the negative memories associated with it.
No one knows exactly how EMDR works, but it seems to affect the way the brain processes information, including the source of a patient’s PTSD. After successful treatment, the patient can still recall the event, of course, but she’s able to recognize it in a less debilitating way.
The theory behind EMDR, which has been around since the late 1980s but only gained acceptance as a treatment for veterans in the past 15 years, comes from what we know about sleeping. During deep sleep, our eyes move quickly from left to right in a process called rapid eye movement. REM helps our brains metabolize information gathered throughout the day and lets go of whatever it doesn’t need.
Though the treatment has been widely supported by multiple studies, it’s not without criticism. A 2013 meta-analysis of prior EMDR studies, published in the journal Military Behavioral Health, concluded that it “[failed] to support the effectiveness of EMDR in treating PTSD in the military population.” The Department of Veterans Affairs — which, along with the Department of Defense, recommends the treatment — takes a more balanced approach, stating, “Although EMDR is an effective treatment for PTSD, there is disagreement about [if] it works. Some research shows that the back and forth movement is an important part of treatment, but other research shows the opposite.”
For Duffy, EMDR was the lifesaver she almost turned down.
“‘I don’t like psyches,’” she remembers saying of psychiatrists, after a clinician recommended she try EMDR at Headstrong. “I flat out told him, ‘I don’t trust them, I don’t like them. So I can’t promise you that I’m going to follow through with this.’”
But she did. And three years later, she swears by the clinic’s EMDR therapy in helping her manage her stress and anger.
Keeping all veterans, both women and men, in treatment is its own battle. A report by the RAND Institute found that the number of follow-up appointments given to veterans is insufficient to help manage PTSD, which leads many to give up on medical care altogether.
“The military sets up a therapy structure that’s so dysfunctional,” says Dr. Laurie Deckard, chief clinical officer for the all-female veteran treatment center 5Palms in Ormond Beach, Florida. She knows this firsthand: When she worked at Fort Stewart in Georgia, she routinely saw 10 service members in the morning alone, each getting only 20 minutes of therapy. “There is no way to do PTSD treatment in 20-minute sessions.”
But as more mental health professionals embrace EMDR for treating veterans, the calculation of how long it takes to rehabilitate them is changing.
Duffy, who once balked at the idea of psychotherapy, now says, “I don’t have to be a tough guy anymore. I don’t have to be this miserable.”
Editors’ note: Headstrong was co-founded by Zach Iscol, who is also a member of the NationSwell Council. This was brought to our attention after publication. Neither Headstrong nor the NationSwell Council paid for this article.
Correction: A previous version of this article identified Headstrong as a clinic. NationSwell apologizes for the error.