It turns out that military veterans are willing to talk about stress. They just haven't been getting access to the right confidantes and a comfortable setting.
Ellie is an example. Her ability to press veteran interview subjects to reveal information about their feelings and mental state worked better than the primary method used by the Department of Veteran Affairs.
Her secret? Ellie isn't a bland questionnaire. She isn't a human, either.
Developed by the University of Southern California's Institute for Creative Technologies, Ellie is a virtual PTSD screening and diagnostic tool that provides patients with an anonymous, unrecorded interview session. A recent study of Ellie's interactions with veterans showed that they are more willing to report symptoms of post-traumatic stress disorder to the program than using a traditional assessment method.
Ellie isn't alone. She is one of a few emerging technologies that are proving pivotal in supporting PTSD treatment. These therapy innovations are still in experimental stages, but for Gale Lucas, a senior researcher at USC's Institute for Creative Technologies, Ellie is a breakthrough in the most critical step of therapy — getting veterans to talk.
"If veterans or service members don't admit that they have a problem, even to themselves, then they won't be seeking treatment," Lucas said.
The National Center for PTSD estimates that between 11 percent and 20 percent of veterans who served in Iraq and Afghanistan have PTSD. Among Vietnam War veterans, they estimate that 30 percent have had PTSD in their lifetime.
When veterans return from deployment, they are required to complete a Post-Deployment Health Assessment, or PDHA, which contains 25 questions, including a checklist of symptoms. Veterans must self-disclose their symptoms to the document, and the information goes on their record.
Lucas said veterans and service members filling out the survey might feel pressure not to disclose all of their symptoms. The checklist is impersonal and, because the information from the PDHA is recorded, it might affect future deployment opportunities for still-serving members and job opportunities for veterans. "The culture of the military is to say, 'No, I'm fine,'" Lucas said.
Ellie offers anonymity to patients — the interview is not recorded. Instead, she reads expressions by tracking 66 points on a patient's face, and she also registers speech patterns. Analyzing this data in real time, she responds to patients with active affirmations, like nodding or even saying "mhmm" when patients appear to need it.
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The new study, published in Frontiers, shows that by building rapport with patients and keeping the interview anonymous, Ellie outperformed the PDHA in getting veterans to disclose symptoms. Ellie even topped an anonymous PDHA to show that a conversation, even with a virtual therapist, is effective in assessing PTSD.
"It's a humanlike interaction," Lucas said. "It makes people feel more comfortable sharing personal things, like symptoms of PTSD."
In the future, Lucas hopes that Ellie will be able to report the likelihood of a veteran having PTSD immediately following the interview. That will allow the veterans to make a more informed decision about seeking treatment through therapy.
About an hour north of Orlando, Florida, at 5PALMS Ormond Beach, a 24-bed residential facility that specializes in treating PTSD for women survivors of substance and sexual abuse in the military, chief clinical officer Laurie Deckard has overseen the implementation of NeuroFlow, which measures neurological movements in the brain and heart-rate levels to monitor PTSD symptoms in real-time.
"The patient is able to see how they're reacting to the material that's being told to them," Deckard said. "In therapy, you don't always know that you're making progress, but this way you can visibly see that you're making progress."
NeuroFlow operates by using the measurements from the brain and heart rate to generate readings of a patient's stress, relaxation and engagement levels. Because a patient might be unaware of what triggers their PTSD, a therapist can monitor these while the patient talks, taking note of what causes the patient to become uncomfortable.
Because it often takes weeks for patients to notice a significant difference in their mental health during therapy, NeuroFlow can also prove if patients are learning to cope with the disorder by showing incremental improvements in their levels.
The system was created by Adam Pardes and Chris Molaro, a former veteran, when Molaro saw alarming rates of veteran suicide. In 2014, 20 veterans died by suicide every day.
"How do you survive a year in combat and you come home, and the health care back home is inefficient to the point that you lose a battle like that?" Molaro said.
Molaro has implemented NeuroFlow in several clinics around the country — 5PALMS Ormond Beach has been using the software for about one month.
Already, Deckard has noticed a change. Because the software is designed to be read by anyone — not just neurologists or psychologists — patients have been able to track their progress.
"It's been a short time, but I do project that it's going to be something that our patients really love," Deckard said.
While researchers focus on the cutting-edge of new PTSD technology, the VA has been working on the technological blocking and tackling of PTSD treatment, moving as much information and public access as possible to the internet and onto mobile apps.
The National Center for PTSD's website hosts informational videos and guides that anyone can access from a computer. Josef Ruzek, director of the Center's Dissemination and Training Division in Palo Alto, California, said that 14 phone apps have been created across platforms for veterans to use.
"Phone apps are wonderful because they're with a person 24/7," Ruzek said.
The idea behind all of this technology is not to replace human therapists. In one app, Prolonged Exposure Coach, or PE Coach, a patient can remotely submit assignments for their therapist to look over. Anyone can download the app, but Ruzek said that the app is most effective with patients in therapy because they need human support.
David Cooper, the lead psychologist in the mobile applications department of the Center for Telehealth & Technology — which created PE Coach and a number of other phone apps — said placing treatment on phones is important because it can give veterans a lower stress way to deal with their larger stress issues. For example, a veteran with PTSD symptoms might be in public and feeling anxious or overwhelmed. They can learn about how to deal with these issues just by looking on their mobile device.
In addition, not everyone has time or can afford to go to a clinic, Cooper said. There are gaps in access to VA centers based on distance, and also based on lack of access to health coverage for many veterans.
Having the information public and easily accessible helps veterans and others with PTSD make treatment decisions. "Just like we use tech right now to make our work lives better, it can be used to make our personal lives better," Cooper said.
— By Trey Strange, special to CNBC.com