Post Deployment Readjustment Issues for Military Personnel By
Post Deployment Readjustment Issues for Military Personnel By: Greg Quenneville, LCSW
Objectives • To learn about the range of post deployment challenges faced by returning combat veterans and their families. • To learn about PTSD and how this can exacerbate post deployment readjustment difficulties. • To learn about PTSD interventions.
Posttraumatic Stress Disorder and the DSM 5 • • A. Directly experiencing a traumatic event. Witnessing, in person, the event as it occurred to others. Learning that the traumatic event occurred to a close family member or friend. In these cases the event must have been accidental or violent. Experiencing repeated or extreme exposure to aversive details of the traumatic events.
Posttraumatic Stress Disorder and the DSM 5 • • Criterion B. Presence of one or more of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: Recurrent, intrusive distressing memories of the event. Recurrent distressing dreams in which content is related to the traumatic event. Flashbacks, in which he individual feels as if the event is happening again. Prolonged psychological distress at exposure to cues that symbolize a reminder of the traumatic event. Criterion C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following: Avoidance of or efforts to avoid distressing memories, thoughts, or feeling that serve as reminders of the traumatic event. Avoidance of or efforts to avoid people, places, activities, objects, or conversations associated with the traumatic event.
Posttraumatic Stress Disorder and the DSM 5 • • • Criterion D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two or more of the following: Inability to remember an important aspect of the traumatic event. Exaggerated negative beliefs about oneself. Persistent, distorted cognitions about the cause or consequences of the traumatic event that leads the individual to blame themselves or others. Persistent negative emotional state Diminished interest in or participation in significant activities. Feelings of detachment from others. Persistent inability to experience positive emotions. Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by 2 or more of the following: Irritability, self destructive behavior, hyper vigilance, exaggerated startle response, problems concentrating, sleep disturbance. Symptoms must continue longer than one month and must cause significant distress or impairment in social, occupational, or other form of functioning.
PTSD Stats • Recent studies reveal: – 11. 8% of active duty men and women reported PTSD immediately post-deployment in Iraq – 16. 7% reported PTSD 3– 6 months later – About ¼ Iraq and Afghanistan veterans treated by VHA have received a PTSD diagnosis – Among all veterans served by VHA, the proportion diagnosed with PTSD increased by 60% between 2001 and 2007
Physiological Responses • When a traumatic event occurs, the inner agency of the mind loses it’s ability to control the disorganizing effects of the experience, and disequilibrium occurs • The mind attempts to reorganize, classify, make sense out of and cope with the event • Neurotransmitters, neuromodulators, hormones, endogenous opioids, specific cortical functions designed to deal with emergency are activated. After the person is no longer in danger, the nervous system continues to function in an elevated state • Intense continuous stress can cause permanent physical changes in the brain, such as decreases in the hippocampal area of the brain, where memory encoding, consolidation and organization take place
Military Sexual Trauma • “sexual harassment that is threatening in character or physical assault of a sexual nature that occurred while the victim was in the military, regardless of geographic location of the trauma, gender of the victim, or relationship to the perpetrator” National sample: – Women w/MST 5 x more likely to meet PTSD criteria • Effects approximately 20% women and 1% men
Protective Factors • • Social support Genetic factors Strong unit leadership and high unit morale Limited life stressors following the event
Readjustment and Family Functioning • Reorganization of roles following return home from a deployment. • Avoidance symptoms are highly correlated with marital problems. • Emotional numbing • Anger towards “trivial matters”
Combat Exposure and Intent to Divorce • PTSD and depression have been found to be negatively associated with marital quality. • Lack of connection to those who haven’t experienced combat. • Combat exposure alone is not sufficient to predict marital dissatisfaction. • Marital distress and high combat exposure are risk factors for reporting intent to divorce or separate.
Divorce Rates in Military personnel Vs Civilians • When compared to comparable civilians, military men and women are more likely to marry than civilians. • Military men are less likely to get divorced while in the military. • Females are 3 times more likely to get divorced while in the military than men. • Upon exiting the military men and women have higher rates of divorce than civilians.
Traumatic Brain Injury (TBI) • May result from IEDs, bullets, mortars, vehicular accidents. • Majority of TBIs today are caused by concussions and go unnoticed as a result. • In 2011, 32, 591 service members sustained TBI. • Classified as focal (localized to small area) or diffuse (covering a large area) open or closed or mild, moderate, severe.
m. TBI
Treatment • Psychopharmacological: SSRIs. • Zoloft, paxil, prazosin.
Psychotherapy • Narration- the act of verbalizing an experience to someone else without judgment. • Prolonged Exposure- discussing details of a traumatic experience on a recurrent basis. • Cognitive Behavioral Therapy- identifying thoughts that contribute to feelings and behaviors and correcting these if they’re unrealistic. • Cognitive Processing Therapy- 12 sessions, discussing and correcting beliefs regarding safety, trust, esteem, intimacy power/control.
Psychotherapy Continued: • Coping skills- anger management, breathing exercises, implementing leisure activities. • Mindfulness- turning attention to present moment in an objective manner without judgment. • Group Therapy
References • • • Alvarez, J. , Mc. Lean, C. , Harris, A. H. S. , Rosen, C. S. , Ruzek, J. I. , & Kimerling, R. (2011). The comparative effectiveness of cognitive processing therapy for male veterans treated in a VHA posttraumatic stress disorder residential rehabilitation program. Journal of Consulting and Clinical Psychology, 79(5), 590 -599. doi: 10. 1037/a 0024466 American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. (5 th ed. , Text Revision). Washington, DC: Author. Benson, H. (1975). The Relaxation Response. New York, NY: Harportorch Bliese, P. D. , Wright, K. M. , Adler, A. B. , Cabrera, O. , Castrol, C. A. , & Hoge, C. W. (2008). Validating the primary care posttraumatic stress disorder screen and the posttraumatic stress disorder checklist with soldiers returning from combat. Journal of Consulting and Clinical Psychology, 76, 272 -281. Carlson, J. G. , Chemtob, C. M. , Rusnak, K. , Hedlund, N. L. , & Muraoka, M. Y. (1998). Eye Movement Desensitization and Reprocessing (EDMR) Treatment for Combat-Related Posttraumatic Stress Disorder. Journal Of Traumatic Stress, 11(1), 3 -24. Greyson, B. (2005). Posttraumatic stress symptoms following near-death experiences. In Turner, F. , Social work diagnosis in contemporary practice (pp. 353 -359). New York, NY: Oxford University Press, Inc. Hagenaars, M. A. , Van Minnen, A. , De Rooij, M. (2010). Cognitions in Prolonged Exposure Therapy for Posttraumatic Stress Disorder. International Journal of Clinical and Health Psychology. 10 (3). 421 -434. James, R. K. , (2008). Crisis Intervention Strategies, Sixth Edition. Brooks Cole, Belmont, CA Johnston, B. Grasso & Maslowski, J. (2010). Conflicts between ethics and law for military mental health providers. Military Medicine, 175(8), 49 -62. Jovanovic, T. , Popovic, S. , Kozaric, K. D. (2006). Psychophysiological Responses to Trauma-Related Stimuli in PTSD: Potential for Scenario Adaptation in Exposure Therapy. Novel Approaches to the Diagnosis and Treatment of Posttraumatic Stress Disorder. 6 (1). 87 -98.
- Slides: 18