How psychologists in Ukraine are healing PTSD with learnings from US veterans

Post-traumatic stress disorder (PTSD) can come after any life-threatening event. A person may experience anxiety, sleep problems, mood changes, difficulty controlling emotions, or the feeling that they have to be alert all the time. They may have flashbacks or avoid anything that reminds them of the trauma. It's as if their body is back where the event happened.

Over the past three years of war in Ukraine, I've worked with MSF in its response to mental health needs in the northeast of the country, as well as and among displaced people and veterans. Everyone has been affected by the war somehow—witnessing violence, leaving behind homes and communities, or losing a loved one. Ukrainian veterans return home with the invisible wounds of war, such as traumatic brain injuries acquired in combat or PTSD.  

Most people find ways to cope and recover from traumatic events without specific treatment, but some do not. This can lead to a sense of hopelessness and helplessness, as if they have to live with PTSD for the rest of their lives. What everyone should know is that there are effective treatments, and people can recover learn to manage their symptoms when they have the tools.

Learning about PTSD from US veterans

I previously worked as a chaplain, a readjustment therapist, and a nurse care manager at the Veterans Administration Medical Center in Nashville, Tennessee. We learned a lot about treating PTSD after men and women in the military started coming home from the wars in Afghanistan and Iraq in the early 2000s. This led to publicly-funded research on the mental health effects of war—including PTSD, depression, and traumatic brain injury—and the development of evidence-based treatments that have proven to be effective for many people.

MSF is working to establish evidence-based treatments for PTSD in Ukraine through a specialized clinic called the PTSD Recovery Center. It is located in Vinnytsia and serves military veterans and displaced people in the surrounding region and beyond.

Processing traumatic memories with EMDR

One treatment we are helping to introduce is called Eye Movement Desensitization and Reprocessing (EMDR). It is a way of helping patients process their traumatic memories, so they are stored differently in their brains. Psychologists ask patients to recall and share the details of their traumatic experience while providing sensory input, like moving a finger for the patient to follow with their eyes. The aim is to form new neural connections that transform how the traumatic memory is stored, leading to a reduction of trauma-related symptoms. Those traumatic memories become more like typical memories, causing less emotional distress.

I remember when I first studied EMDR in 2005, it seemed strange that moving your eyes could have something to do with memories. But as research has continued, EMDR has proven to be very effective. Typically, people need around 12 EMDR sessions, but this can vary depending on the severity of the trauma.

In Ukraine, we also use the techniques of narrative exposure therapy and trauma-focused cognitive processing therapy, which help clients understand and change the way they experience their traumatic memories. They learn how their current emotional responses are related to past events, how to calm their nervous system, and how the body responds.

Something else that really makes a difference is the relationship between the therapist and the patient. I was privileged to supervise and mentor an amazing team of Ukrainian MSF psychologists. They put their hearts into this work and do an incredible job.

Continued success in treating PTSD

We regularly do assessments with each patient to monitor changes in PTSD symptoms and find steady improvement in such things as nightmares and sleep problems, to name a few. However, there are still many challenges. Alcohol dependence is widespread among people with PTSD in Ukraine. There is also a stigma around mental illness in Ukraine, as there is in the US and in other countries where I have worked.

What we found is that when one person has a positive experience with treatment, they go back and tell their family and acquaintances, and more people come forward to seek care. We see this with veterans too, spreading the word within members of their unit.

Today we have about 100 patients under treatment each month at the PTSD Recovery Center and we hope to continue this effort over the coming years, as well as provide training for similar programs across the country. As we exchange knowledge and improve care for people with PTSD, I am immensely proud of this work and of my MSF colleagues in Ukraine.

Laurel Cassidy has a PhD in global disaster nursing with a focus on mental health.