Strategic Retreat: ‘Post-traumatic growth’ helps vets find their futures

By Jennifer Miller - The Washington Post

Last fall, Shaun Durfey and five other veterans sat in a circle and drew their family trees.

Durfey, a 29-year-old former Marine, had served three tours in the Middle East. Upon his return to the States, he'd been given a host of medications for insomnia, depression and post-traumatic stress disorder, or PTSD, and he had spent hours at a Veterans Affairs hospital talking about the wartime deaths of friends. But his doctors had never probed his family history, which included painful memories of childhood neglect. Now, Durfey was being asked to speak openly about these experiences.

"'There's no shame in the bad parts of your life,'" Durfey recalled members of the group telling him. "'Just lay it out.' So I did."

Then the vets gathered around a bonfire and burned their family trees.

"It was a symbolic pledge to stop the trauma," Durfey said. "I felt like I was starting my life anew."

Therapy without meds

Durfey had left his wife and four children in Michigan to attend the Warrior PATHH (Progressive and Alternative Training for Healing Heroes) at Boulder Crest Retreat, a 37-acre private facility in the Blue Ridge Mountains of Virginia. Since it opened in 2013, more than 112 combat vets have participated in the free, week-long Warrior program. Another 2,400 veterans, spouses and caregivers have visited the center for family stays and workshops.

Boulder Crest is not the only post-deployment retreat, but its founders say they believe they have hit upon a unique approach for addressing combat trauma: It's a program aimed at encouraging personal growth that eschews medication. And they say they believe it is superior to classical psychological interventions by the Department of Veterans Affairs.

In many ways, the Boulder Crest approach is designed as a contrast to VA. Instead of visiting a doctor's office, participants spend a week outdoors - kayaking, hiking, riding horses and shooting arrows. Activities and discussions are led not by clinicians but by other combat veterans. Instead of medication, exposure therapy and cognitive processing therapy, vets explore their family histories, examining why they enlisted in the first place.

These methods are meant to facilitate post-traumatic growth, or PTG -based on the idea that with the right tools, survivors can emerge as people who are stronger, happier and healthier than before the traumatic event occurred.

PTG is not a clinical approach, but rather an outcome.

"It's the direct result of struggling with the aftermath of trauma," said Richard Tedeschi, a professor of psychology at the University of North Carolina at Charlotte who has studied PTG for more than 30 years.

Research suggests that PTG is a real phenomenon, but it's unclear why some people experience it and some do not. There's also no proven method for making PTG happen, which has created some skepticism about how much it really helps. Tedeschi said he believes Boulder Crest may have found a way, and he has designed a study to test it.

Standard interventions for PTSD have "understandably focused on reducing distress symptoms," Tedeschi said. "Now we're trying to focus on trauma survivorship."

A search for alternatives

The man behind Boulder Crest is Ken Falke, a former Navy explosive ordnance-disposal technician and master chief petty officer, who served in Bosnia in 1998 and made several trips to Afghanistan and Iraq as a civilian contractor.

Falke visited wounded EOD veterans at VA facilities through a nonprofit he and his wife founded in 2007. He was dismayed by how many of them were struggling.

"The current treatments for PTSD aren't working for combat veterans," he said.

According to the Department of Veterans Affairs, between 11 and 20 percent of veterans who served in Iraq and Afghanistan have PTSD in a given year. But a 2015 study reported that while "robust evidence" supports the effectiveness of exposure therapy and cognitive processing therapy, 60 percent of Iraq and Afghanistan veterans seen in routine clinical care "failed to begin or dropped out" of PTSD treatments. And up to 50 percent of those who did follow through "fail to show clinically significant improvements."

Falke is especially critical of reliance on medication for depression. That, he maintains, prevents veterans from confronting "the underlying issues of PTSD demons head on" -- demons that, he says, "are often from childhood and combat."

Falke's doubts come from his own experience after a traumatic brain injury and broken back from a 1989 parachute jump.

"My relief came from holistic treatments, especially chiropractic," he said. "I value alternatives to Western medicine because of this."When Shaun Durfey arrived at Boulder Crest, he says, he was taking high dosages of five medications but still "was shut down, isolated from family and friends."

Exposure therapy - which asks trauma survivors to talk about an event over and over, thereby lessening its emotional power - had only "mild success," he said, in reducing his PTSD symptoms.

"Everything from the VA was about my service," he said. At Boulder Crest, "they dug down into what was hurting you, brought that out and complemented it with activities that bring you down from being so wound up."

A year later, Durfey is off four of the drugs and takes the fifth, for knee pain, only as needed. He sees his VA therapist intermittently.

"I'm closer with my wife," he said. "I'm feeling emotions - joy, sadness, good and bad."

Tedeschi said many of the veterans he has worked with come from families where there's "not a lot of affection, or there's abuse or instability." Such individuals, he said, are more likely to suffer from PTSD.

Tedeschi said these vets are also more likely to re-enter civilian life "without confidence or connection or feeling understood." The Boulder Crest emphasis on exploring one's past, he said, lets them "see the whole picture of this and make sense of the struggle." Once they do, "it's easier for them to see what to do next."

Of combat vets who have participated in the Warrior PATHH program, 95 percent continue to participate in monthly video chats. Durfey has joined these sessions since the retreat. In addition, the vets from his PATHH group have a more informal online forum.

"If someone's in trouble, we'll talk about it," he said.

Not for everyone

Still, the PTG philosophy has its critics. Some people worry that the emphasis on growth creates unreasonable expectations. What if people don't feel healthier, more optimistic or closer to their families after a week at Boulder Crest?

A 2015 study in the journal Clinical Psychological Science found that in a sample of soldiers who spent time in Iraq, the "more perceived growth five months postdeployment was associated with more post-traumatic stress 15 months postdeployment."

Iris M. Engelhard, the study's lead author and a professor of clinical psychology at Utrecht University in the Netherlands, said some scientists argue that self-perceived growth "may involve illusory and self-deceptive aspects and represent avoidant or defensive coping, which may impede recovery."

Falke agreed that PATHH isn't for everyone - including veterans with drug addictions.

"We've had people come through who needed a lot more work, and we recommended they go to an inpatient facility or rehab," he said. About half of those who come to Boulder Crest are enrolled at VA, he said, and they seek out his program because their care isn't working.

Tedeschi's study of the Boulder Crest approach won't conclude until June 2018. It will track participants' mental health using both traditional measures of symptom reduction and measures of PTG, such as whether vets say they have seen their relationships improve, have set new priorities and feel more appreciation for life.

To Durfey, the results are already clear.

"What the VA was trying to do with all their meds and their therapy, I did in five days at Boulder Crest," he said.