EL CENTRO, Calif. — Ruben Moreno Garcia, who served three combat tours in Iraq, now lives with his family in this Imperial Valley community and works as a mechanic in Yuma, Ariz.
Kathryn Williams, a clinical psychologist for the Department of Veterans Affairs, has an office in La Jolla, more than 100 miles away.
Williams and Moreno Garcia meet once a week for an hour or so to discuss his progress in coping with post-traumatic stress disorder, the condition common to U.S. military personnel who served in Iraq and Afghanistan.
Their sessions are over the Internet, using a firewall-protected connection and a different password for each session.
"Being in your own living room for sessions, that's comfortable," said Moreno Garcia, 31, who studied computers before enlisting in the Army.
Williams concedes she was somewhat suspect of the therapy-by-Internet method.
"I've been doing therapy face-to-face for 10 years, so I was skeptical," Williams said. "But after one or two sessions, you forget about the camera."
Dr. Nilesh Shah, director of telemedicine for the VA San Diego, is blunt about his assessment of the method, particularly in helping the growing number of VA patients that need long-term management for conditions like PTSD, diabetes or obesity.
"It's the future," he said.
In the past nine months, 240 veterans served by the VA San Diego have had nearly 900 therapy sessions for PTSD using videoconferencing.
In most cases, the patient came to a VA clinic where the technology was already in place to meet with a therapist located elsewhere. For a few patients, like Moreno Garcia, sessions were done in their homes using Cisco Jabber or Skype.
The veterans are spread throughout California. The program is being extended to veterans in Nevada, Oregon and Alaska.
Initial studies about the effectiveness of the videoconferencing approach have been positive, according to Steven Thorp, a clinical psychologist for the VA San Diego. He was the lead researcher in a recent study of 207 veterans enrolled in a 12-week course of PTSD therapy.
Veterans receiving the traditional approach to therapy — patient and therapist in the same room — showed progress more quickly in dealing with hyper-vigilance, mood swings and other aspects of PTSD.
But in the longer-term, videoconferencing patients progressed at a rate such that at the end of the 12 weeks, there was no difference between the two groups, according to the study published last year in Psychological Services, a journal of the American Psychological Assn.
"The face-to-face method is never going away — it's been around a long time," Thorp said. "But this is only going to get bigger."
There are occasional technical problems in using the Internet for live transmission: pixelation, choppiness and freezing. In one case, a therapist did not notice for three sessions that the patient was in a wheelchair, according to the study.
A decrease in empathy is also a possibility. "Physical contact, like shaking hands and handing tissues to a sobbing client, is not possible" with videoconferencing, the study noted.
Still, the approach is seen as a boon for veterans who do not live near a VA hospital or clinic. There is a VA clinic in El Centro, but Moreno Garcia, who makes a 100-mile round trip each day to his job as a mechanic with the Border Patrol in Yuma, decided that making appointments was dicey.
Born in Mexicali, Moreno Garcia spent six years on active duty in the Army, during which he became a U.S. citizen.
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