August 5, 2011
In the two decades since Daniel Nieto served in the Gulf War, anxiety has dogged him nearly every day. He has trouble sleeping. Noises make him jump. He has panic attacks, an inability to concentrate and a social phobia that makes it difficult for him to be around people.
And this, he says, is just a “mild” case of Post-Traumatic Stress Disorder.
“I talk to guys who have it far worse than me,” the 42-year-old Army vet says.
Nieto is convinced that if active-duty military and vets with PTSD and other stress-related problems could spend time at Antione Johnson’s Warrior Relaxation Response Center in Colorado Springs, they’d find the same relief from anxiety that he has in just the few times he’s been there.
“Every day of your life, the problems follow you. Coming here to a place like this is tranquility,” says Nieto, who claims to be sleeping better and has greater control of his panic attacks.
Johnson would be delighted if more members of the military, past and present, availed themselves of his spa-like facility, tucked away in a nondescript strip mall near Circle Drive and Airport Road. A Gulf War vet himself, Johnson invested his and his wife’s savings to start the center in 2010, specifically to help people with PTSD, and he had high hopes that Fort Carson would send over the many “wounded warriors” who have suffered the emotional fallout from multiple deployments Iraq and Afghanistan.
But the support has been slow in coming. Johnson says he’s been rebuffed by a number of Fort Carson officials for reasons not clear to him, and TriCare, the health plan for active-duty and retired military, won’t cover programs based solely on relaxation techniques.
So Johnson recently brought in two part-time licensed behavioral specialists to satisfy TriCare’s requirements for coverage, and the center joined its network on July 1. It means Fort Carson health providers now can refer soldiers to the center for behavioral health treatment, but not for relaxation-response therapy alone. And the center will have to share the stage with about 600 other behavioral health providers in the Pikes Peak area who are in TriCare’s network and can provide approved psychotherapy treatments.
“The reality is, we have a large number of professional counselors who can do that (psychotherapy),” said Dr. Frank Maguire, senior vice president of health care services and chief medical officer for TriWest, one of TriCare’s three regional arms. “There is no real reason that Fort Carson would preferentially send active-duty members to this one center.”
'I feel my healing'
With its low lights, subdued colors, soft music, burbling fountains, comfy seating areas and pleasant aromas, the Warrior Relaxation Response Center could pass for an upscale spa. Visitors can spend quiet time in one of two cozy, small rooms, or head into a larger room where they can relax in one of three oversized massage chairs that even get the feet and calves.
But that’s just one component of the program. Johnson incorporates a soothing ambience with a blend of therapies designed to change negative thought patterns, reinforce positive ones and produce a “relaxation response.” It uses deep breathing techniques, visualization, a calm environment and repetitive affirmations — spiritual or secular, depending on a person’s preference — to achieve its goals.
“It’s all about retraining the thought processes,” says Melissa Petrone, a licensed clinical counselor with a practice in Fountain who has joined Johnson’s staff part-time. “You notice a difference in their demeanor. There are more smiles. They’re more relaxed.”
Johnson, a 20-year Army vet and former teacher, was compelled to start the center after reading a series of stories in The Gazette about soldiers coming back from overseas combat with a bucket full of emotional problems and anger issues.
“I wanted to do something to give back to the soldiers,” he says.
He spent 18 months researching what a therapeutic center for people suffering from PTSD might look like. He read more than a dozen books, including one on Relaxation Response, a concept developed by Dr. Herbert Benson, a cardiologist, Harvard medical professor and director emeritus at the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital. In the 1960s, his research led him to determine that doing a series of daily, repetitive activities — repeating a certain word, praying or doing yoga, for example — counterbalances the “fight or flight” response in someone who is anxious. Every time a person finds himself thinking negative thoughts or going into fight-or-flight mode, he’s supposed to turn to his repetitive activity to “break the train of everyday thinking,” Benson says.
The body responds with a slower heart rate, relaxed muscles and a drop in blood pressure.
“You change yourself right down to the genes,” says Benson, who has written extensively on the Relaxation Response.
Through a little bit of networking and word of mouth, Johnson’s center has attracted about 150 people — both active duty and retired — and the comment cards are filled with praise.
“Can’t wait until I get my referral from my doctor so I can attend on a regular basis. I feel my healing coming on,” wrote one participant.
“This is a much-needed tool for soldiers with PTSD. I am against the use of drugs to induse (sic) relaxation,” wrote another.
Although Johnson is heartened by the response, he’s essentially been offering the services pro bono. The only money he’s collected so far is from sales of books related to relaxation and mind-body topics. Otherwise, he’s kept it running with the $300,000 he used from his family’s savings.
So it’s critical for him to get more people with TriCare or Veterans Administration coverage in the door, which will allow him to be reimbursed for visits. Because TriCare covers only traditional psychotherapy services, however, Johnson won’t get reimbursed for visits from people who come in just for the relaxation side of the operation. But TriCare might cover some of the relaxation offerings as long as they’re in conjunction with treatment by the psychotherapist.
“It comes down to, you can only pay for those services that are specifically listed as a TriCare covered benefit,” Macguire says. “Massage therapy is not. Certainly, relaxation therapies by themselves are not TriCare covered. But if they’re using them as an adjunct to covered services, in some cases it could be covered.”
The hardest part: Gaining acceptance
For TriCare clients who aren’t active duty, getting an appointment with the psychotherapist at Johnson’s center is relatively easy. Depending on which plan they have, they can self-refer to a TriCare provider or take advantage of an “initial eight” benefit, which allows them to see a provider eight times without referral, Macguire said.
Active-duty military, however, need a referral, and Johnson has been trying to raise the center’s profile at Fort Carson. So far, it’s been a losing battle, he says. In a fact sheet about the center, he chronicles a number of encounters with several of Fort Carson’s leaders, saying they canceled meetings or never returned phone calls. They could not be reached for comment.
Now, Johnson is working with ombudsmen at Fort Carson to see if the center can be part of the post’s reintegration program for soldiers returning from combat, and he says they seem receptive to what he’s doing.
He also hopes that one day soon, TriCare will recognize the Relaxation Response and relaxation therapies used to get there as a viable -- even preferred — treatment for PTSD. Benson says TriCare is behind the curve in that regard, and hasn’t paid attention to the science proving its effectiveness.
“It’s a lag — they don’t know the new data,” Benson says. “I’ve presented at multiple military bases; after that, it starts getting accepted. To be able to treat PTSD, which has no other effective therapy — people are paying attention to it.”
Macguire and Dr. Blake Chaffee, vice president of integrated health care services for TriWest, say a group within TriCare that writes its policy manuals is constantly reviewing the science and determining what the agency will pay for.
“With all the concern that PTSD has been for the military, there has been a lot of development of alternative-type programs and therapies to help them deal with the effect of PTSD,” Chaffee said. “And various branches of the service and TriCare Management Activity are looking at those as to what appears to be useful and what doesn’t. I can tell you that the people who run those programs are equally as passionate that their programs are efficacious and is THE program that would be useful for service members to be part of.”
So until, or if, some of those uncovered components of Johnson’s center win TriCare approval, he’ll have to rely on reimbursements that come from approved visits to staff who provide more traditional psychotherapy services. He’s also working on getting the center established as a nonprofit, and plans to seek grants to keep it going. Active-duty military and veterans also can use the facilities by paying a sliding-scale fee of $15 to $60.
“Profit is not our main goal,” Johnson says. “We can’t deny people mental health. That’s so important. We want to stay open.”
Nieto, the Gulf War vet, believes the time has come for the program to be embraced by the VA and the military.
“There are guys out there who are 100 times worse than me who need to be in here,” he says. “I’d almost make it mandatory for them to be here.”