Complementary and integrative medicine modalities such as acupuncture, chiropractic care, massage therapy, and clinical hypnosis are increasingly available within the U.S. Department of Veteran Affairs, and Caitlin Hildebrand, NP, is helping to lead their roll-out.
“It might 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.
Though she’s based in the Bay Area, Hildebrand found an academic home for her super-specialized interests at the University of Colorado College of Nursing. In September 2022, she began a PhD course of study at CU College of Nursing’s Veteran and Military Health Care program with a bio-behavioral emphasis.
As part of her role in San Francisco, Hildebrand also facilitates a virtual mindful and intuitive eating group for veterans. Developed by Hildebrand, the model was selected as a semifinalist in the VHA Shark Tank Competition, which identifies field-developed practices that promote positive outcomes for veterans.
About the program
Aligned with VA’s Whole Health model, the six-week virtual course is intended to transform veterans’ relationships with food and body image. Hildebrand says the curriculum has roots in the work of Jon Kabat-Zinn, PhD, founder of mindfulness-based stress reduction (MBSR) – an approach which blends Buddhist teachings with scientific findings.
“We emphasize listening to hunger and fullness, and paying attention to the present moment without judgment and with loving kindness,” she says. “Ultimately, this approach can change negative thinking patterns about 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 with the post-traumatic stress disorder (PTSD) and depression that veterans too commonly experience.
“As you know, stress often changes how we eat,” she says. “Veterans can be more likely to become overweight and obese because they are using food as a self-soothing strategy, or they have other less-healthy coping mechanisms such as overdrinking or not exercising.”
Hildebrand says this can lead to diabetes, heart disease, and other weight-related conditions that the VA aspires to prevent and ideally halt.
“[Veterans] can really benefit from shifting their coping strategies and stress-management skills” Hildebrand says. “Also, the military culture gives rigid standards on what your body is supposed to be like. We discuss how to eat in a way that improves health and that’s sustainable and has room for joy and flexibility.’”
The program gathers a group of veterans from coastal Northern California in a supportive, trauma-informed, patient-centered approach that Hildebrand says is intended to help participants develop new coping skills and listen to their bodies.
While many veterans aspire to lose weight, the group is inherently body-positive and weight-inclusive, and teaches veterans how to appreciate their bodies rather than continue negative thinking rooted in “diet culture.” Hildebrand usually facilitates the sessions with a co-facilitator, such as a dietician or a psychologist.
Results from the program have been encouraging with 100% of respondents surveyed reporting the group helped them better listen to hunger and fullness while developing a less judgmental and kinder approach to eating habits and body image.
“One veteran in his late 30s came to understand that many of his issues came from body-image challenges,” she says. “He has PTSD and traumatic brain injury -- two conditions that can be closely associated with persistent obesity. By working through the group, he started eating in a much more sustainable way. He lost over 35 pounds and his pain was dramatically reduced.”
With such positive results, Hildebrand says there is interest in spreading the concept to VA systems nationwide.
A passion for veterans’ health
A nurse practitioner, Hildebrand says she 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 found herself drawn to veteran’s health.
“Caring for veterans is particularly rewarding because they have given so much themselves,” she says. “Veterans cared for by the VA tend to have the most complex psycho-social needs. The VA is the perfect place to serve people who really need you.”
After completing her BSN and MSN at the University of Pennsylvania, a master’s degree in healthcare administration and interprofessional leadership at UC San Francisco, and a fellowship in integrative medicine at the University of Arizona, Hildebrand took three extended studies classes at CU College of Nursing, and decided CU was the perfect place to pursue her PhD.
She is the 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 during an event at the College's Fall Intensives for doctoral students in early September. In April of 2022, Hildebrand presented at CU Nursing’s Partnerships for Veteran and Military Health Conference.
Caitlin Hildebrand, NP - CU Nursing PhD Student
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 veteran and military studies concentration,” she says. “It makes sense because veterans have unique needs.”
Another factor that appealed to Hildebrand is that she didn’t have to stop working at the VA to enroll. Like other CU Nursing students, she participates in courses virtually – except during intensives when she will visit the CU Anschutz Medical Campus to interact with instructors and fellow doctoral students in person.
“Most PhD programs require you to stop working. This program is the opposite of that,” she says. “In fact, you are encouraged to work. I just feel like it’s a lot more real-world and practical because the things you learn in class you can hopefully relate to your work and vice versa. I feel like I can really enhance my practice through what I am learning.”
What’s ahead in the future?
During her time at CU Nursing, Hildebrand hopes to develop a dissertation drawing upon qualitative and quantitative data from the mindful and intuitive eating groups to study their effect on mental and metabolic health.
“I’m hoping the PhD will help me lead 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 policy for veterans’ health.
While she expects to have less spare time during the PhD program, Hildebrand teaches yoga, volunteers, cooks, and hikes, as part of her own holistic wellness. She plans to find ways to fit in these activities for sustainable well-being.