Transcript Soldiers and Veterans of War The Cultural and Personal Tragedy of

 http://www.youtube.com/watch?v=QAa3FjKxxOE&fea
ture=related
 3:52……………0:10-3:35
Rachael Dolan
Wendy Seiber
 Social and ethnocultural responses to trauma are
diverse
 Process involves:
 Helping the client understand the stress responses
 Process the traumatic event
 Develop adaptive coping mechanisms
 Integrating sociocultural influences in to treatment
strategies promotes restoration of homeostasis and
optimal functioning
 Civil War
› Soldier’s Heart
 WW1
› Shell Shock
 WW2
› Battle Fatigue
 Korean War
› Gross Stress Reaction
 Formally diagnosed as a disorder (PTSD) in 1980
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http://www.military.com/NewContent/0,13190,NCO_050510_PTSD,00.html
 Anxiety disorder that can occur after a person
experiences or witnesses a violent or frightening
event.
 Not everyone who experiences trauma develops
PTSD.
 The essential feature of PTSD is the development of
characteristic symptoms following exposure to
traumatic events that arouse “intense fear,
helplessness, or horror” (APA).
 May occur soon after trauma or can be delayed for
more than 6 months after
› When occurs right after trauma, usually gets better
after 3 months
› Some may have long term PTSD which can last for
many years
› Approximately 50% of cases remit within 1 year
 Psychological, genetic, physical and social factors
involved but no exact cause
› Changes the body’s response to stress
› There may be a personal predisposition necessary for
symptoms to develop after trauma
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Being female
Having learning disability
Physical and/or sexual abuse
Existence of mental disorder prior to event
Low education levels and poor SES
Some ethnic differences due to how pain and anxiety are
expressed (Hispanics, African Americans, Native Americans)
Duration of traumatic event*
Traumatic events inflicted by a person*
Violence associated with trauma*
Negative life events*
› *most likely to effect soldiers*
 Disaster Preparedness training
› Firefighters, police and paramedics receive this
 Strong support systems
› Positive paternal relationship
› Social support
 Positive life events
 Stress management training
 Psychological preparedness
 Older age at entry to war
 Higher level of education
 Higher SES
 Repeatedly “reliving” of the event, which disturbs day-to-day
activities
› Flashbacks, recurring distressing memories
› Repeated dreams
› Physical reactions to situations that remind of event
 Avoidance
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Emotional numbing, feelings of detachment
Inability to remember important parts of trauma
Lack of interest in normal activities
Less expression of moods
Staying away from anything that is a reminder
Sense of having no future
 Arousal
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Difficulty concentrating, sleeping difficulties
Exaggerated response when startled
Hyper vigilance
Irritability or outbursts of anger
 Webster Definition
 A soldier is loyal to his or her country, willing to fight and die.
 B.R. Burg
 “The complete officer must be the complete man, they
believed, and to measure up each had to possess an amalgam
of qualities that included patriotism, courage, honor, loyalty,
absolute honesty, and elevated standards of morality”
 Class?
 How would YOU define a soldier in the 21st century?
 War Machine?????
 Webster:
 An old soldier of long service, a former member of the
armed services, a person of long experience usually in
some occupation or skill (political or arts usually)
 From former Marine, Thomas D. Segel
 “A veteran is someone, who at some point has written a
check to Uncle Sam that reads: “Payable in full up to the
amount of my life, if necessary, to defend our way of
life.”
 2009 movie “Brothers”
 NPR
 http://www.npr.org/search/index.php?searchinput=ptsd
Common Concerns
•“Perceived as weak”
•“being treated differently by
unit leadership
•“A member of my unit
having less confidence of
me”
•In one study, soldiers felt
stigmatized and abandoned
after seeking help, and many
had not sought help for fear
of being ostracized.
 Recent study by the APA
showed:
 60% feared that seeking
out mental health care
could have negative
consequence on their
career
 More than 50% reported
they believe others would
think less of them if they
sought out counseling
 Most said they have rarely
or never spoken even to
family and friends about
mental health issues
 12% reported their spouse
would resent them if they
sought help
 NPR:
http://www.npr.org/templates/story/story.php?storyId=1284897
06
 “Reducing the stigma
associated with PTSD is
the first step”—Ron
Capps
 CBS news story: need to
reduce stigma in the
military
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http://www.cbsnews.com/video/watch/?id=7049763n&tag
=related;photovideo
 A policy shift in 2008 that no longer requires military
personnel applying for security clearance to disclose
psychiatric counseling.
 Department of Defense
 Seeking to reduce the psychological toll of deployment
and stigma of seeking mental health treatment
 Resiliency Training
 Peer support programs
 Integrated mental health and primary providers
Real Warriors Campaign:
 Encourages use of mental health services and stigma
reduction via community outreach, partnership with
military organizations and NGOs, printed material, media
outlets, interactive website and social networking.
“Reaching out is a sign of strength”
 Difficulty fitting into the society they went to war to
defend
 Hard to turn off some of the reactions that saved life in
combat
 May lead to grief in bar
 No drug addictions, alcoholism, or criminal behavior
until after war
 War assignments basically 14months of testosterone
build-up
 Common risk factors
 Male gender, older age, diminished SES (homelessness
and unmarried status especially), availability and
knowledge of firearms, and the prevalence of medical
and psychiatric conditions associated with suicide
 Efforts under way to emphasize ambulatory care and
decrease the VA culture of reliance on impatient
treatment heightens the need for accurate suicide
assessment
 Data released by Army
 September
 Active Duty: 19 potential: 6 confirmed, 13 under investigation
 Reserves: 10 total: 4 confirmed, 6 pending investigation
 October
 Active Duty: 9 potential: 2 confirmed, 7 under investigation
 Reserves: 16 potential
 Suicide Prevention Lifeline
 1-800-273-TALK
 Wounded Soldiers and Family Hotline
 1-800-984-8523
 Abuse
 Tension
 Marital strain
 Violence
 Secondary PTSD for wives
 Spouses married to husbands with PTSD
 Higher levels of burden ad distress
 Suffered more somatization symptoms ,obsessive-compulsive
problems, depression, anxiety, paranoid ideation, and
psychoticism
 Reported more anger, suspicion, anxiety and blame towards
their spouse
 Interpersonal problems:
 Coping with the veteran’s ptsd symptoms, unmet needs,
violence, and emotional cutoff
 Effective types of treatment:
 Family psychoeducation, support groups for both partners
and veterans, concurrent individual treatment, and couple or
family therapy
 Michelle D. Sherman (2006)
 Veterans with PTSD have higher rates than the general
population of abuse
 17 couples seeking therapy were studied
 PTSD and depression diagnosed Veterans perpetrated
more violence
 Much higher than found in previous research
 81% engaged in at least one act of violence toward their
partner in a year
 > than 6x the general population
 Increased crime rates
 Lost lives
› Risk of suicide and/or homicide
 High medical costs
› Costs of untreated trauma, related alcohol/drug abuse about
$160 Billion/yr
 Legal woes
› Criminal Behavior
 Poor work performance
› Lost jobs-US loses $3 Billion every year due to work place
problems caused by PTSD
 Family troubles
 Growing need to facilitate their reintegration into
communities, families and jobs
 3 factors
 Tour of duty, level of danger, and lack of linkage to the civilian
culture will compound the adjustment difficulties
experienced by returning veterans
 Strategies for reintegration include:
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Identification of effective strategies
National communication initiatives
Screening and strategic service plans
Local veteran support collaborative
Internet communication
Addressing disability
Coping with the loss of a veteran
 1918
 Established to respond to the mental health needs of
“shell shocked veterans”
 2008
 Sponsored a 3-day conference aimed at preparing social
workers to respond to the new and complex needs of
veterans returning from the Iraq and Afghanistan Wars
 A joint planning process effectively developed a program
that helped military and civilian social workers gain
insight into the impact of multiple deployment,
traumatic brain disorder, PTSD, and other factors
present in today’s new military culture
 Exposure Therapy (ET)
 Foster emotional and cognitive processing of trauma by
helping patients systematically overcome their
avoidance of trauma-related stimuli and memories.
 Veterans Health Administration: Virtual Reality
Exposure Therapy
 http://www.youtube.com/watch?v=z4rnpmJeN5Q
 The most effective treatments involve understanding
and overcoming avoidance behavior
The Response of the VA
•Funded a nationwide effort to spread the use of evidence-based exposureoriented treatments for PTSD. Mandated that such treatments be available in
each VA medical center
•Has placed evidence based psychotherapy coordinators at every VAMC to
help promote the use of effective treatments, created a PTSD mentoring
program
•Incorporated the use of “Telehealth”
“
 Pet Therapy
 http://www.time.com/time/vide
o/player/0,32068,671301612001_2
030797,00.html
 P2V http://p2v.org/
 Paws for Purple Hearts: Veterans
Helping Veterans
 Combat veterans with PTSD
train dogs
 In dozens of interviews, veterans
and their therapists reported
drastic reductions in P.T.S.D.
symptoms and in reliance on
medication after receiving a
service dog

http://content.usatoday.com/communities/pawprintpost/post/2010/01/dog-helps-iraq-vet-with-ptsd-my-littlemarine/1
 Chris Goehner from Wenatchee
Valley WA
 Suffers from PTSD since
serving 2 tours in Iraq with the
Marines
 Since receiving his dog, Pele, he
reports he has slept better than
he had in 3 years., that he can
go into a crowded place with
less fear that he is going to be
attacked or shot at. Not as
unnerved by loud noises that
remind him of shellfire, and he
isn’t constantly filled with anger
and ready for a fight
Dr. Craig Bryan: Assistant Professor of
Psychology at the University of Texas
Health Center
http://www.npr.org/templates/story/story
.php?storyId=131096642
“Unfortunately, in the vast majority of
cases, when a veteran comes forward for
help, it's usually when they're in extremely
bad shape.” --Dr. Craig Bryan
(4:30-7:45)
Techniques he uses:
Classic Talk Therapy: Relates to many
aspects of military life. Helps service
members understand that they do have a
choice and can exercise free will.
Obstacles to Intervention (Such
as Exposure Therapy)
 Lack of therapist training in
exposure techniques
 Myths about the tolerability and
safety of exposing their fears
 Therapist beliefs about the lack of
applicability of research outcome
trials to real-world settings
 Gap between science and practice
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Other Barriers to Treatment
Location of VA medical centers
Simply seeking treatment and talking
about the trauma are obstacles to care
Those who are most symptomatic are
also the least likely to seek help
Lack of access to empiricallysupported therapies and multiple
barriers to care have resulted in only a
minority of returning veterans with
PTSD receiving state-of-the-art
treatment
 Need to be aware of and understand the stigma and
barriers to treatment
 There is a big need to “train both military and civilian
psychologists and other mental health professionals to
provide high quality deployment-related behavioral
health services to military personnel and their families
(Teurk 2009)”
 Terrorism is a psychological warfare against society as
a whole so intervention must be approached from a
societal as well as individual clinical perspective.
Study (de Jong 2002) defines four levels of intervention:
1. Societal
2. Community
3. Family
4. Individual
Studies have shown that interventions to bolster
psychological resilience and post deployment social
support may help reduce the severity of traumatic
stress and depressive symptoms
 Cognitive Behavior
Therapy and EMDR
 Eye movement
desensitization and
reprocessing
 Exposure Therapy
 Medication
Management
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Increase research concerning neurobiological,
psychological and physical health implications
Clinical considerations
Examination on the impact of the family
Advocacy within criminal justice system
Screening improvements
Expanded treatment options
Networking among service providers
Increased community outreach
Ongoing learning
Client: Dan Jones
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28-year-old single Caucasian male who is a National guardsman with 4 years
reserve service
Presenting Problem:
 Was called to active duty in Baghdad. Describes his deployment as “high
intensity,” saying that he witnessed an explosion that killed three of his friends.
Witnessed dead and injured civilians and Iraqi soldiers on multiple occasions
Involved in an attack that left him with shrapnel in his neck, chronic pain, reports
feeling anger since the incident.
 Began to develop insomnia, hyper vigilance and a startle response
 Reports dreams which are intense and frequent, as well as intrusive thoughts and
flashbacks
 Since returning home, he has withdrawn from his peer group, reports feeling
detached from others. Avoids going out where there will be crowds or loud
noises, has a lack of interest in the things he enjoyed before deployment.
Current Functioning:
 Cl. demonstrates difficulty completing daily tasks, being in public, maintaining
relationships. Avoids conversations about past traumatic events with friends and
family.
 Cl. Would like to begin school again but wants to address these symptoms as he
readjusts to civilian life. No mental health history
Diagnosis:
 Post Traumatic Stress Disorder.
One-on-one talk
therapy, CBT
2. Virtual Reality Exposure
Therapy to help relieve
the traumatic
experiences, re-learn
panic responses
3. Connection with a social
network or support
group
1.
 Screening for mental health: military pathways
 http://www.mentalhealthscreening.org/military/index.a
spx
 National Center for PTSD
 http://www.ptsd.va.gov/
 PTSD Resources
 http://www.patss.com
 Iraq War Clinician Guide
 http://www.ptsd.va.gov/professional/manuals/iraq-warclinician-guide.asp
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