Relearning peace after war

Relearning peace after war

ECU lab uses biofeedback to help Marines manage stress disorder

Lance Cpl. David Hoover, 21, tries to concentrate on playing a video game by using only his brain waves, as recreational therapist Tami Maes, 28, of Raleigh gives feedback. Hoover was injured by a bomb in Iraq.
Staff Photos by Chuck Liddy

By Jay Price, Staff Writer
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GREENVILLE - A year and a half after he left Iraq, Sgt. Terrell McClain is still fighting the sniper who shot him in the arm and the mortar shells and rockets that rattled his brain. His weapon: biofeedback.
About once a week, McClain, 24, and a handful of other Marines travel from Camp Lejeune's Wounded Warrior Barracks to a lab at East Carolina University, where they are strapped with sensors that measure stress via perspiration, body temperature and heart and brain rhythms. They are taught methods of controlling anxiety, such as breathing techniques or thinking of pleasant topics. Computer screens let them see the effects in simple terms such as a computer-generated roller coaster that starts moving when they reduce anxiety and stops when it rises again.

The idea is to train the wounded Marines to control outbursts of anger and anxiety and other symptoms of post-traumatic stress disorder and traumatic brain injury.

"There's nothing abnormal about these guys," said Carmen Russoniello, director of ECU's psyschophysiology and biofeedback lab. "They are having normal responses to the situations they were in, and we're just training them to have better responses."

McClain said he was skeptical when he started the program in March but is now a believer, because it has helped him control his hair-trigger temper, a typical PTSD symptom.

"I still express my emotions, but I don't act wild," he said. "It's helping a lot, and I mean a whole lot."

Biofeedback is only one part of Russoniello's program, which is designed to reduce anxiety and stress through relaxation, recreation and social interaction.

Meet the civilians

Therapists also are using activities such as kayaking, Frisbee golf and wheelchair basketball, and more traditional forms of therapy, such as group counseling. Even getting off the base and interacting with college students is part of the therapy, since many of the wounded Marines will soon be moving back into the civilian world, Russoniello said.

"We do serious training, but life isn't just serious," Russoniello said. "It's also about having fun, and it's about things like checking out who you are in relationship to others. Whatever we do, it has to make sense as far as real life."

Russoniello served with the Marines in Vietnam and said for years afterward he struggled to cope with the things he had seen and done. He wanted the nation's latest generation of combat veterans to have it better.

Many will need help: This spring, the Pentagon released data showing that more than 40,000 troops who served in Iraq and Afghanistan had been diagnosed with PTSD, and military leaders say that more have gone undiagnosed. Thousands more have traumatic brain injuries, typically from the blast of the improvised bombs used so often by insurgents in Iraq.

Russoniello's lab is working with the Marines assigned to Camp Lejeune's Wounded Warrior Barracks while they recover. Many in the barracks have PTSD, brain injuries or both. They also often have physical problems, and the recreational therapy in the ECU program helps them improve things such as balance and coordination.

The program started in February. It's operating on a shoestring, Russoniello said, but last month it opened an office next to the barracks. That will make it easier for Marines to get therapy more than once a week.

The program is weeks from adding a new therapy even closer to the cutting edge than biofeedback: Marines will be immersed in a highly detailed "Virtual Iraq" where they will assume a digital form and encounter the very things that caused their problems -- bombs, ambushes, snipers.

The idea, which has been under limited use in several places around the country in the past couple of years, is to desensitize those who have experienced trauma and give them more control over their memories of combat. Therapists will control the number and type of "surprises," stopping the sessions periodically when the Marines' stress levels spike, to work with them on controlling their responses.

Boosting the chaos

The wounded Marines will use the techniques learned from the simpler biofeedback equipment to control their stress levels. From session to session, therapists will gradually boost the level of chaos, allowing the Marines to come to terms with tougher and tougher experiences.

The "Virtual Iraq" program is being donated by a treatment center on the West Coast that is working with Marines there. The program has been in use elsewhere for a few years.

Therapies based in virtual worlds have several advantages, Russoniello said, including the ability of Marines who deploy again or who leave the service and move to a distant state to continue working with the same therapist.

McClain, the sergeant who was shot by a sniper, said more wounded troops should try the innovative therapy and the techniques like "going to a happy place" in your mind.

"To be able to calm down, that's a big thing," he said.

Of course, those who aren't familiar with the Marine Corps' band-of-brothers camaraderie might be startled at the happy place McClain goes to in his mind: Iraq, 2006. With his Marine buddies.


jay.price@newsobserver.com or (919) 829

PTSD: a short historyPost-traumatic stress disorder has been an official diagnosis for less than three decades, but people have noted for centuries war's toll on the mind and emotions. Some experts have pointed to what they see as a portrayal of PTSD symptoms in the characters of classic works, such as Achilles in Homer's "The Iliad," which dates to as early as the late 9th century B.C., or to England's warrior-king in Shakespeare's "Henry V."
The modern history of PTSD dates to the Civil War:
* 1861-65: The "soldier's heart," also known as Da Costa's Syndrome, is an anxiety disorder that surgeon Jacob Da Costa observed in Civil War soldiers. The symptoms mimic heart disease: shortness of breath, sweating and chest pains, but no physical problem is detected.
* 1914-18: British physicians during World War I coin the term "shell shock" to describe suspected nerve injury during combat. Top officers on both sides, however, see it as cowardice and malingering. The British government executes 306 soldiers for cowardice. Court-martial records, unsealed 80 years later, show that most suffered from PTSD brought on by trench warfare experiences. In November 2006, the British government pardons them.
* 1939-45: British and American military physicians during World War II begin using the terms "battle fatigue" and "exhaustion" to describe soldiers suffering combat stress. In August 1943, Maj. Gen. George Patton curses out and slaps a soldier in a field hospital in Sicily who is being treated for "nerves." News of the incident reaches the United States, nearly ending Patton's military career.
* 1946: The U.S. Army conducts its first study of the effects of combat on frontline troops during World War II. The study's authors report that 98 percent of soldiers who had faced 60 days or more of continuous combat developed severe psychiatric disorders.
* 1955: Audie Murphy, America's most famous World War II hero and the most decorated soldier in U.S. history, surprises many by publicly confessing that he suffers from depression, insomnia and nightmares because of his wartime experiences. He reveals he can sleep only with a loaded pistol under his bed and repeatedly urges Congress to take better care of veterans suffering mental health wounds.
* 1980: The U.S. government accepts post-traumatic stress disorder as an official diagnosis after the Veterans Administration conducts a nationwide study of post-war adjustment problems reported by Vietnam War veterans. The designation later allows veterans of Vietnam and other wars diagnosed with this condition to receive disability benefits.

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