Evolution Program

Evolution Trauma Intensive Outpatient Program (TRIOP) - Treating Post-Traumatic Stress

Mission:

The Evolution Trauma Intensive Outpatient Treatment Program (TRIOP) for Post-Traumatic Stress (PTS) at Landstuhl Regional Medical Center (LRMC) is an evidence-based, six-week therapeutic program designed to help Service Members in all branches deal with the lasting effects of traumatic events. We also provide these services to retirees and eligible dependents.

What We Treat:

Evolution offers two tracks: (1) combat and deployment-related trauma (also various other traumas) and (2) sexual trauma; the sexual trauma track addresses sexual trauma from any time of life—not just military sexual trauma.

Who We Treat:

Evolution treats active duty Service Members assigned to EUCOM, AFRICOM, and CENTCOM. Activated Reservists and National Guard who are deployed to these areas also are eligible. We also provide these services to retirees and eligible dependents.

What is Post-Traumatic Stress?

PTS is the aftermath of exposure to traumatic events, experiences and situations. These traumas can be things you have experienced yourself, things that happened to someone you care about, or events you have witnessed. People can also report symptoms of PTS after incidents that violate their moral code or that represent a deep betrayal of trust.

PTS is characterized by:

• Re-experiencing (intrusive memories and images, nightmares, flashbacks, strong reactivity to reminders of the trauma)
• Hyperarousal (irritable, hypervigilant, on edge, trouble sleeping, jumpy)
• Avoidance (trying to avoid thinking or talking about events, avoiding places and activities, isolation, self-medicating with alcohol)
• Negative thoughts and emotional states (often feeling anxiety, horror, guilt, shame; self-blame; negative beliefs about self and others; feeling detached from others; unable to feel love or happiness)

Program Description:

Treatment is provided in group and individual therapy sessions. Each participant receives about 30 hours of face-to-face treatment per week, and also does daily homework. Treatment is provided by multiple clinical disciplines. The primary evidence-based treatment model used in the program is Cognitive Processing Therapy (CPT). Other types of evidence-based treatment are used on a case-by-case basis, including Prolonged Exposure (PE) and Eye Movement Desensitization and Reprocessing (EMDR).

One aspect of treatment involves learning to challenge beliefs that cause anxiety, painful emotions, self-doubt, and avoidance. Another piece of the program helps strengthen basic coping skills, such as learning how to reduce the fight-flight response (severe anxiety and hypervigilance) using a variety of relaxation techniques, yoga, and meditation. Yet another part of the program works on overcoming avoidance (reluctance to go places, and avoidance of thinking/talking about the trauma).

Evolution treats the full spectrum of symptoms associated with PTS—as described above—and also develops skills for dealing with grief and loss, relationship issues, communication, and the struggle many have with their own sense of self. In addition, consultation regarding medications used to treat PTS and other behavioral health problems is available.

The program, which began in March 2009, is designed from research into the effects of traumatic experience and mirrors successful programs at the former Walter Reed Army Medical Center and the Department of Veterans Affairs, as well as various programs run by psychologists in the U.S. Evolution is a joint military and civilian effort.

Results:

There is no simple, quick fix for PTS. The problems usually have been present for a number of years before someone enters treatment, and changing habitual patterns is difficult. Despite these hurdles, Evolution has seen good results with a large number of patients, who have reported a significant decrease in the distressing symptoms of post-traumatic stress. We have seen family relationships improve, patients re-engage with the world around them, and improved ability to handle the triggers that have been so troublesome. Additionally, overall anxiety and depression symptom measures have decreased for many participants by the end of treatment.

Summary:

The Evolution Trauma Intensive Outpatient Program is the only program of its kind in the European theater, and is designed to successfully return participants with PTS symptoms to a higher level of functioning in their work, family life, and personal well-being. The curriculum is a six-week, therapeutically intensive program for those who want relief from the heavy burden of PTS.

Contact us by phone or email usarmy.lrmc.evolution@mail.mil.