You may have read our previous blog about the Navy’s residential posttraumatic stress disorder (PTSD) treatment program. The facility has recently opened its doors to more service members affected by PTSD and expanded its treatment offerings. Read on for an update.
Along San Diego’s beautiful coastline you will find an actual healing oasis for service members. This therapeutic refuge is the Overcoming Adversity and Stress Injury Support (OASIS) Program, which is located aboard Naval Base Point Loma and overlooks a serene cityscape beyond a picturesque bay. The OASIS Program was originally established in 2010 to better help our nation’s warriors who remain severely haunted by invisible war wounds and are experiencing combat-related PTSD. For almost eight years OASIS has successfully met its health care mission as the sole Department of Defense (DoD) intensive residential program for PTSD stemming from combat exposure. This pioneer program is now trailblazing a new era of DoD health care with its recent expansion of services to treat all manner of service-related PTSD, not just combat-related disorders. The broadened scope of care also provides a much-needed resource to address sexual trauma that occurred in the military and its pervasive consequences.
Trauma-focused treatment for PTSD may be found in DoD military treatment facilities (MTFs), Department of Veterans Affairs (VA) facilities and civilian treatment networks. Those treatment resources traditionally offer individual and/or group therapy, psychoeducational classes, crisis intervention services, pharmacotherapy and other treatment modalities across various outpatient settings. Some VA sites and certain private facilities offer residential PTSD treatment. However, VA programs typically do not afford treatment to active-duty service members and private civilian enterprise residential programs are costly, usually geographically remote from the service member’s duty station, and often unfamiliar with our military community, culture and unique needs.
These challenges associated with civilian care for active-duty service members can be frustrating for the patients and their commands. Negative health care experiences and suboptimal resources contribute to the stigma associated with PTSD. The military lifestyle is inherently chaotic and stressful, posing a rigid reality that makes the timely treatment of PTSD and protected recovery difficult to accomplish. Often, PTSD subsequently evolves into a more devastating condition that impacts the service member, as well as their friends, family, and command. This is arguably an avoidable toll that affects the overall military mission beyond patients’ own health and welfare.
OASIS has been designed to provide a comprehensive, time-limited treatment in a safe setting. As a residential program, patients receive treatment in a protective environment that obviates many of the common distractions and stressors that jeopardize overall therapeutic benefits in other typical settings. OASIS is free for active-duty service members; commands need only fund to-and-from transportation.
Length of treatment is based upon on service members’ needs and capabilities and case-specific determinations by the OASIS treatment team. OASIS utilizes a multi-phase program model and patients typically receive a minimum of two weeks, to a maximum of eight and a half weeks, of treatment. A multiphase model facilitates the OASIS treatment team a greater perspective on the individual’s current functioning status before committing to specific treatment courses. All phases aim towards skills consolidation and ultimate reintegration into the community.
At OASIS, multiple evidence-based group and individual therapy approaches are offered, including prolonged exposure (PE) therapy, cognitive processing therapy (CPT), eye movement desensitization and reprocessing (EMDR), dialectical behavioral therapy (DBT), seeking safety, and cognitive behavioral therapy for insomnia (CBT-I). The OASIS Program’s treatment interventions, policies and practices are aligned to the recently updated 2017 VA/DoD clinical practice guideline for PTSD. In conjunction with the recent expansion of services, several group sessions dedicated to sexual assault have been added. These include sexual assault-specific sessions for process group, moral injury group, mind body medicine group, and DBT group.
OASIS also offers in-house psychotropic medication management, as well as primary care medical services and comorbid substance abuse interventions in collaboration with the Point Loma Substance Abuse Rehabilitation Program (SARP). It must be noted though that OASIS is not a dedicated dual-diagnosis program. To be a candidate for OASIS treatment and receive optimal care, any potential patient with comorbid substance use issues must be clinically stable and commit to abstinence from any substance use throughout the entirety of the program.
OASIS also offers auricular acupuncture, a specialized moral injury program, recreation therapy, occupational therapy assessment and treatment, a “combat arts” program, yoga, a mind body medicine program, and unique in-vivo experiences to practice skills in groups and individually during outings in the local area. Equine therapy was recently introduced to the OASIS program, affording patients opportunities to work with horses to improve communication skills, assertiveness, and stress tolerance while decreasing social isolation and withdrawal. Other interactive animal-based therapeutic modalities include a semi-weekly dog training clinic to foster empathy and bonding, as well as sessions with the Navy Marine Mammal Program. This latter activity provides OASIS patients with exposure opportunities to interact with sea lions and bottle-nose dolphins, enhancing communication and coping skills in a novel setting.
The OASIS treatment model is founded on the premise that traumatic stress injuries are expected occurrences after particular negative experiences. Such injuries can, and should, be treated effectively with the ultimate aim of returning the service member to full duty whenever possible. OASIS honors military culture and tradition, reducing incongruities between the treatment setting and military life. The OASIS Program is a highly-intensive program and it is important that all patient candidates have demonstrated a willingness and ability to engage in individual and group therapy. Further, best results are achieved when the patient enters the program without prominent distractions (e.g., pending/ongoing legal or administrative problems like courts martial, civilian court proceedings, divorce, etc.) or serious physical conditions requiring frequent medical follow-up appointments. Matters such as these detract from the OASIS Program’s ability to achieve therapeutic momentum and provide actual recovery and restoration in a finite period of time.
The OASIS Program’s mix of civilian and military providers works to minimize the stress of transitioning from residential treatment back into a healthy lifestyle. OASIS providers and case managers provide continuity and coordination of care from more intense to less intense levels of care through warm clinical hand-offs, active communication, and collaborative planning.
The OASIS Program continues to evolve its treatment capabilities to help its broadened patient population in the best possible manner. Please consider OASIS as a resource for any active-duty PTSD patients who could benefit from the program.
If you have a patient who may benefit from OASIS, contact the OASIS Administration Office at 619-524-9605 for further information and referral assistance.
Cmdr. (Dr.) Chris Alfonzo is a Navy psychiatrist and currently serves as the division officer of the OASIS Program at Naval Medical Center San Diego.
The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.