As the war in Afghanistan enters its 17^th year – it’s often labeled America’s longest war – an estimated have post-traumatic stress disorder.

But PTSD symptoms of anxiety, sleeplessness and anger aren’t, of course, relegated to those who served in the Middle East, or even in combat. Veterans have a than the general population, among which an estimated 7 percent will experience symptoms at some point during their lives. Research has shown, too, that service members have a than those without military experience.

Yet many service members don’t seek help, because they think it’s unlikely to work, they fear damage to their career, or they simply don’t know where to turn.

Now the 91̽»¨ is launching a study to identify soldiers experiencing post-traumatic stress symptoms and to determine whether free, confidential, over-the-phone counseling can help them navigate resources and spur them to seek further support.

is recruiting active-duty personnel to participate in the study, which involves three counseling sessions over two months, as well as four follow-up assessments within the first six months, all by phone.

“There are a lot of barriers to seeking care in the military,” said , a research associate professor in the 91̽»¨School of Social Work. “Soldiers are worried about it going on their record, losing their security clearance, or risking a promotion. But with PTSD, like substance abuse, if you seek treatment earlier, you can get your life back sooner.”

In recent years, Walker led a similar 91̽»¨study involving soldiers, known as the , which used a phone-counseling intervention to address excessive alcohol use. Participants in that study cut their drinking in half by the end of six months – an example of a “self-change,” in which a person can take action to adjust his or her own behavior.

“In this trial, the target is different. The ultimate outcome is for people to seek additional resources and to resolve their ambivalence about doing that. If they could just stop having PTSD, they would have done so,” explained Walker, who is leading the study with , a 91̽»¨professor of psychiatry and behavioral sciences.

“This is an opportunity for them to talk about the symptoms related to the traumatic event, how that experience has gotten in their way, or is getting in the way of relationships, work and school, in an effort to help them weigh the pros and cons of seeking help,” Walker said.

Soldiers receive up to $200 for their participation. The study is funded by the U.S. Department of Defense.

To participate, call 1-866-866-0137, email ucheckup@uw.edu or visit . For more information, contact Walker at ddwalker@uw.edu or 206-543-7511, or Kaysen at dkaysen@uw.edu or 206-221-4657.

But a randomized controlled study of 405 rape survivors in eastern Democratic Republic of Congo proves that short-term therapy delivered by paraprofessionals is effective at reducing mental health symptoms, according to a study released June 6 in the New England Journal of Medicine.

The study, “Controlled Trial of Psychotherapy for Congolese Survivors of Sexual Violence,” provided 154 women with cognitive processing therapy  (one individual session and 11 group sessions) and 248 women with individual supportive counseling. The therapy was conducted between April and July in 2011 by Johns Hopkins University and 91̽»¨ researchers working with the International Rescue Committee and local psychosocial workers.

Six months after treatment, just 9 percent of women in the therapy group met criteria for probable depression and anxiety, compared to 42 percent of women in the individual-support group, according to the study.

“We saw women, who once felt too stigmatized to be part of their community, re-engage after receiving cognitive processing therapy,” said Judith K. Bass, lead author of the study and assistant professor with the Department of Mental Health at Johns Hopkins Bloomberg School.

The great success of group therapy shows that a manual for  treatment — a step-by-step guide for therapists — helped both the therapists and the survivors, said Debra Kaysen, an associate professor of psychiatry and behavioral sciences at the 91̽»¨, and an author on the study.

Kaysen said cognitive processing therapy was developed in the mid-1980s by Patricia Resick, the director of the Women’s Health Sciences Division of the National Center for PTSD, part of the U.S. Department of Veterans Affairs and located in Boston.

Kaysen said the therapy has been used in six randomized trials – three among veterans suffering post-traumatic stress disorder and three among civilians who have experienced sexual or physical victimization – and is now being used widely throughout the Veterans Administration and the Department of Defense to treat post-traumatic stress disorder among active-duty military.

Kaysen said while there has been a great push for this therapy to be available to veterans, there are not the same mechanisms to get the therapy to survivors of sexual violence in community settings.

“I hope this study will make this therapy more available to survivors of sexual violence globally,” Kaysen said. “There is such a huge need out there.”

While most rapes are not reported and estimates vary widely, the U.S. Department of Justice in 2006 estimated that in the United States alone one in six women and one in 33 men have experienced a rape or attempted rape. Eastern Democratic Republic of Congo, where the trial was conducted, has experienced conflict for more than 20 years. In that country rape and sexual violence rates are described as among the worst in the world. A recent study showed that 40 percent of its women – two out of every five – had experienced rape.

Kaysen said researchers now have data five to 10 years out from people receiving this therapy.  Their symptoms of post-traumatic stress disorder, anxiety and depression have remained low. She said cognitive processing therapy goes after the root of symptoms. In the case of survivors of sexual violence, this form of mental health therapy deals with how the person’s outlook and sense of self was affected by the trauma in such areas as safety, trust, power, control, esteem and intimacy.

In the study in the Democratic Republic of Congo, women were chosen among villages being served by three Congolese non-governmental organizations. Qualitative studies in different languages were used to identify locally important psychosocial issues among sexual violence survivors. Abandonment and rejection by friends, concerns about providing for self and family, and fear and stigma were major issues.

The women were then evaluated for depression and anxiety by using the Hopkins Symptoms Checklist and for post-traumatic stress syndrome by using the PTSD Checklist-Civilian Version, both of which were adapted to the local culture. Women were also scored on their ability to perform important tasks of daily living. Participants were chosen for the study based on their scores.

The U.S. Agency for International Development Victims of Torture Fund and the World Bank sponsored the project.

In addition to Bass and Kaysen, the project researchers were Jeannie Annan, Sarah McIvor Murray, Shelly Griffith, Talita Cetinoghu, Karin Wachter, Laura K. Murray, and Paul Bolton.

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