Complementary and integrative medicine modalities such as acupuncture, chiropractic, massage therapy, and clinical hypnosis are increasingly available in the US Department of Veterans Affairs, and Caitlin Hildebrand, NP, is helping to initiate their introduction.
“It may sound surprising, but mindful awareness has become the cornerstone of most self-care groups within the VA,” says Hildebrand, clinical director of integrative health at the San Francisco VA Health Care System.
Although she lives in the Bay Area, Hildebrand found an academic home for her highly specialized interests at the University of Colorado College of Nursing. In September 2022, she began PhD studies at the CU College of Nursing’s Veterans and Military Health Program with a focus on biological behavior.
As part of her role in San Francisco, Hildebrand also leads a virtual mindful and intuitive eating group for veterans. The model developed by Hildebrand was selected as a semi-finalist in the VHA Shark Tank Competition, which identifies field-tested practices that promote positive outcomes for veterans.
about the program
Aligned with VA’s Whole Health model, the six-week virtual course is designed to transform veterans’ relationship with food and body image. According to Hildebrand, the curriculum has its roots in the work of Jon Kabat-Zinn, PhD, the founder of mindfulness-based stress reduction (MBSR) — an approach that blends Buddhist teachings with scientific evidence.
“We emphasize listening to hunger and satiety and paying attention to the present moment without judgment and with loving kindness,” she says. “Ultimately, this approach can change negative thought patterns around body image and food that lead to blame and shame and poor outcomes.”
According to a 2015 study, 78% of veterans are overweight and nearly a quarter live with type 2 diabetes. Hildebrand says these statistics directly correlate to post-traumatic stress disorder (PTSD) and depression, which veterans experience all too often.
“As you know, stress often changes our diet,” she says. “Veterans are more likely to become overweight and obese because they use food as a self-calming strategy or because they have other less than healthy coping mechanisms, such as excessive drinking or not exercising.”
Hildebrand says it can lead to diabetes, heart disease, and other weight-related conditions that the VA wants to prevent, and ideally stop, from happening.
“[Veterans] can really benefit from changing their coping strategies and stress management skills,” says Hildebrand. “Plus, military culture sets strict standards for what your body should be like. We discuss how to eat healthily and sustainably and leave room for joy and flexibility.”
The program brings together a group of veterans from the Northern California coast in a supportive, trauma-informed, patient-centered approach that Hildebrand says is designed to help participants develop new coping skills and listen to their bodies.
While many veterans strive to lose weight, the group is inherently body-positive and weight-inclusive, and teaches veterans how to value their bodies rather than perpetuate negative thoughts rooted in “nutrition culture.” Hildebrand usually moderates the sessions with a co-moderator, e.g. B. a nutritionist or psychologist.
The results of the program were encouraging: 100% of respondents said the group helped them listen better to hunger and fullness while developing a less judgmental and kinder approach to eating habits and body image.
“A veteran in his late 30s understood that a lot of his problems stemmed from issues with his body image,” she says. “He has post-traumatic stress disorder and traumatic brain injury – two conditions that can be closely linked to persistent obesity. As he worked his way through the group, he began to eat much more sustainably. He lost over 35 pounds and his pain has been reduced dramatically.”
Given these positive results, Hildebrand says there is interest in expanding the concept to VA systems nationwide.
A passion for veteran health
As a nurse, Hildebrand says she has always wanted to work with underserved communities. While her father served in the Air Force and her brother in the Army, she did not hear the call to military service but was drawn to the health of a veteran.
“Caring for veterans is especially rewarding because they have given so much themselves,” she says. “Veterans cared for by the VA typically have the most complex psychosocial needs. The VA is the perfect place to serve people who really need you.”
After completing her BSN and MSN from the University of Pennsylvania, a master’s degree in health administration and interprofessional leadership from UC San Francisco, and a fellowship in integrative medicine from the University of Arizona, Hildebrand took three advanced studies courses at the CU College of Nursing. and decided that CU was the perfect place for her PhD.
She is a recipient of CU Nursing’s Dean’s PhD Early Scholar Award program, which provides $10,000 for the first year of the doctoral program. Dean Elias Provencio-Vasquez, PhD, RN, announced the honor in early September during an event at the college’s fall graduate intensives. In April 2022, Hildebrand presented at the CU Nursing’s Partnerships for Veteran and Military Health Conference.
Caitlin Hildebrand, NP – PhD student in nursing at CU
Why she chose CU Nursing
Hildebrand says CU Nursing was the obvious choice for her unique interests.
“It’s the only PhD program with a focus on veteran and military studies,” she says. “It makes sense because veterans have unique needs.”
Another factor that pleased Hildebrand was that she didn’t have to quit her job at the VA to enroll. Like other CU Nursing students, she takes classes virtually—except during intensive courses when she visits the CU Anschutz Medical Campus to connect face-to-face with instructors and fellow graduate students.
“Most PhD programs require you to stop working. This program is the opposite of that,” she says. “Actually, you are encouraged to work. I just feel like it’s a lot more real and practical because you can hopefully relate the things you learn in class to your work and vice versa. I feel like I can really improve my practice with what I’m learning.”
What’s in the future?
During her time at CU Nursing, Hildebrand hopes to develop a dissertation based on qualitative and quantitative data from the mindful and intuitive eating groups to examine their impact on mental and metabolic health.
“I hope that the PhD will help me guide other studies within the VA related to complementary and integrative healthcare,” she says. Hildebrand says she also hopes to work on more regional and national policies for veterans’ health.
While she expects to have less free time during the PhD program, Hildebrand teaches yoga, volunteers, cooking, and hiking as part of her own holistic well-being. She plans to find ways to fit these activities into sustainable wellbeing.