Veteran Experiences of Trauma, Readjustment, & Recovery Flashcards
What is a Trauma?
daily hassles
major life events
serious traumatic events
Traumatic stressors
events in which someone feels that their life or the lives of others are being threatened
can be witnessed or experienced directly
These include events such as warzone exposure, physical or sexual assault, serious accidents, child sexual or physical abuse, disasters and torture.
DSM-V Criterion A of PTSD
A : “Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
Directly experiencing the traumatic event(s)
Witnessing, in person, the event(s) as it occurred to others
Learning that the traumatic event(s) occurred to a close family member or close friend.
Experiencing repeated or extreme exposure to aversive details of the traumatic event
Symptom Clusters
Intrusion
Avoidance
Negative alterations in cognitions and mood
Alterations in arousal and reactivity
Intrusion (or re-experiencing, “flashbacks”)
Recurrent distressing dreams of the event or acting/feeling as if the event is happening again
Avoidance
Avoiding memories, thoughts, feelings, people, places or activities that are reminders of the event
Negative alterations in cognitions and mood
Diminished interest in activities, feeling detached, inability to feel positive emotions, negative emotions, distorted blame of self or others
Alterations in arousal and reactivity
Irritable behavior, outbursts of anger, reckless or self destructive behavior, problems concentrating, hypervigilance, exaggerated startle, sleep disturbance
Suicide Risk
Mental health providers must conduct thorough evaluations for suicide risk in veterans, as veterans are at higher risk of suicide than the general population
Current suicidal behavior should be comprehensively assessed; in war veterans, having a history of PTSD is associated with an increased risk for suicidal behavior
How common is PTSD?
Of those who experience trauma, most do not develop PTSD
Only about 7% of all people develop PTSD in their lifetime.
So why do some people develop PTSD and others don’t? There are several factors that have an impact on whether someone develops PTSD.
personal factors, the traumatic event, and the recovery environment
Personal Factors
Personal factors such as prior trauma exposure and demographic characteristics have some effect on who develops PTSD
Several variables that are consistently found to be related to PTSD include: > female gender
> some genetic factors
> adverse childhood experiences
> previous psychiatric problems
> lower levels of education
> lower socioeconomic status
> minority race
Traumatic Event
Characteristics of the trauma exposure show a larger contribution to the development of PTSD than the personal factors
One of the most consistent findings is that the greater the severity of exposure, the greater the likelihood you’re going to develop PTSD
Greater perceived life threat, feelings of helplessness, and unpredictability or uncontrollability of the trauma are also significant risk factors.
Recovery Environment
The recovery environment risk factors are the ones that are the most interesting and important, because they are the ones we can do something about
Among those is social support following the event
Another factor that’s proving really important is subsequent life stress
Basically, the more life stress, the more likely someone is to develop PTSD
Military Sexual Trauma
“Psychological trauma, which in the judgment of a mental health professional, resulted from a physical nature, battery of a sexual nature, or sexual harassment which occurred while the Veteran was serving on active duty, active duty for training, or inactive duty training”
Often underreported
Barriers to disclosure unique to military
Associated with adverse mental health outcomes including PTSD, depression, and substance use disorders
Suicidal ideation and attempts are higher among individuals with a history of MST
LGBTQ+ Veterans
Increased risk of suicide for LGBTQ+ veterans
Higher risk for victimization and barriers to reporting
Health providers caring for LGBTQ+ veterans should take care to prevent perpetuation of the harmful consequences of sexual minority-based stigmatization and discrimination
Moral Injury
damage done to an individual’s core morality or moral worldview as a result of a stressful or traumatic life event, has been shown to significantly impact mental and physical health outcomes
Service members are frequently challenged with moral and ethical dilemmas during war and may perpetuate or fail to prevent acts that go beyond the bounds of deeply held beliefs
They may witness or learn about such acts and experience conflict about the unethical behaviors of others.
Service members unable to contextualize or justify their actions or the actions of others may experience long-lasting impairment due to moral injury.
PTSD keypoints
“startle” reflex
memory loss
fear
flashbacks
Moral Injury keypoints
anhedonia
grief
guilt
shame
social alienation
lack of trust
difficultly with forgiveness
PTSD and Moral Injury have in common:
anger
depression
anxiety
substance abuse
insomnia
nightmares
Psychology of forgiveness
Forgiveness (particularly self-forgiveness) is the cornerstone of the process of healing from moral injury
Posttraumatic growth
Some individuals experience subjectively traumatic events and experience positive psychological outcomes referred to as posttraumatic growth from the experience
Posttraumatic growth = related to higher satisfaction with life, and PTSD was negatively related to life satisfaction
Deliberate rumination (a type of cognitive work) was positively related to posttraumatic growth, while intrusive rumination was positively related to PTSD [1
These findings suggest an important role for treatment strategies that focus on promotion of deliberate rumination , or other meaning-making strategies .
Post-Deployment Stages
Honeymoon period
Readjustment and Renegotiation:
> Re-establish relationships
> Reexamine goals
> Renegotiate roles that may have changed
Reintegration and Stabilization
> Acceptance of change and “the new normal”
Behavioral Health Issues and percentages
Posttraumatic Stress Disorder: 12-25%
Depression: 3-25%
Mild Traumatic Brain Injury: 11-19%
Excessive drinking and tobacco use
Chronic Pain
“Any” mental health risk/concern: 18-35%
Psychosocial/Other Stressors
Unemployment or Underemployment
Feels out of place in the college classroom
May have attention, concentration or memory challenges that were not there before
May have physical challenges not present before; may feel swindled, taken advantage of, wronged
Feeling out of place – don’t fit in, feel misunderstood, incompetent, disrespected
May miss camaraderie of their unit
Strain in family or romantic relationship
Special Issues for Women
The largest group of women Veterans today served in post- 9/11 operations.
Women make up nearly 11.6 percent of post-9/11 Veterans.
About 1 in 5 women seen in VHA respond “yes” when screened for Military Sexual Trauma (MST)
Women often face particular stigma and guilt associated with leaving their children while deployed
Special Issues for Reservists
Reservists (National Guard and Military Reserves) comprise 50% of all deployed troops
May be assigned into units in which they know no other personnel
Deployment may result in the loss of their job and/or financial penalty
Deployment usually less anticipated
Reserve forces don’t live on military bases so they and their families are not surrounded by others in same situation
Reintegration may be especially difficult for Reservists
Deployment Stressors for Partners Who Stay Behind
Increased Family Responsibilities
Financial challenges
Isolation
Fear for spouse’s safety
Fears about fidelity
Loneliness, sadness, feeling of being overwhelmed
Common Reactions: Partner
Feeling helpless or guilty that they can’t help or understand
Trying to avoid triggering partner
Depression
Anger vacillating with Guilt
Discouraged, hurt or alienated by changes in partner
Drug or alcohol abuse
“He’s not the person he was before”
“She’s not present…not there for me
like she used to be…always distracted”
“He won’t talk to me”
“Why isn’t she over it by now?”
Healthy Coping: Sharing and Renegotiating Roles
Partner should be prepared for changing household roles (and new personality traits)
Partner and service member should discuss what skills they have, and what responsibilities they each prefer. (These may have changed)
Compromise if necessary. Both partner and service member need to feel understood and respected.
Things to Avoid
Pressuring service member into talking against their will
Stopping him or her from talking (the opposite)
Making judgmental statements, “You should be better by now; You’re acting crazy”
Telling service member what they “should” do
Using clichés or easy answers (e.g. “everything happens for a reason,” “now that you’re back, you can put this behind you,” “war is hell”)
Giving unsolicited advice
Rushing things. It will take time.
Warning signs that service member should seek help
Imminent concern that they may hurt themselves or someone else.
If any of the following persist beyond first few months:
Frequent and intense conflicts, poor communication, inability to meet responsibilities
Work, school or community issues; frequent absences, conflicts, inability to meet deadlines, poor performance
Frequent or severe depressed or angry moods
Frequent intrusive thoughts or images of war zone experiences. Being regularly hyperalert or on guard.
Mental Health Treatment
Cognitive Behavioral Therapy
> Cognitive Processing Therapy
> Prolonged Exposure
> Eye Movement Desensitization and Reprocessing (EMDR)
Psychopharmacologic Treatment
Group Treatment (supportive, psychoeducational, skills-based)
Increased availability of complementary and alternative medicine, (yoga, mindfulness meditation, iRest, acupuncture)
Self-help (e.g. apps)
