A Meta-Analysis of the Effectiveness of Military and Veterans Affairs (VA) Combat-Related PTSD Programs

A meta-analysis was conducted to examine the effectiveness of 55 treatment outcomes reported by military and Veterans Affairs (VA) treatment centers for combat-related posttraumatic stress disorder (PTSD). The analysis includes 46 tested treatment outcomes derived from 21 psychotherapy studies, and nine tested treatment outcomes derived from seven pharmacotherapy studies, which were obtained through PsychINFO and PsychARTICLES database searches, as well as a reference search. Analysis of all treatment outcomes suggested a statistically significant, and meaningful, decrease in PTSD symptoms between baseline and post-treatment time points, t(54) = 9.27, p < .001, d = 0.35. Additionally, analysis of outcomes between psychotherapy and pharmacotherapy treatments resulted in statistically significant differences in PTSD assessment scores at post-test, indicating a greater degree of change for psychotherapy than for pharmacotherapy.

DUI program as OEF/OIF Veterans Outreach: Descriptive Data from Two Community-Based Outpatient Clinics

Although initially conceived as providing simply the preventive portion of an extended continuum of care for veterans, the Driving Under the Influence (DUI) program has turned out to be an important outreach service for active duty or recently discharged OEF/OIF (Operation Enduring Freedom/Operation Iraqi Freedom) veterans. Veterans receive empirically-based, state-mandated education and therapy under the only Department of Veterans Affairs (VA) - sponsored DUI program in the State of Colorado, with the advantage of having providers who are sensitive to symptoms of Post-Traumatic Stress Disorder (PTSD) and other relevant diagnoses specific to this population, including Traumatic Brain Injury (TBI). In this paper, the rapid growth of this program is described, as well as summary data regarding the completion, discontinuation, and augmentation of services from the original referral concern. Key results indicated that for nearly one third (31.9%) of the OEF/OIF veterans who were enrolled in the DUI program, this was their initial contact with the VA health care system. Furthermore, following their enrollment in the DUI program, more than one fourth (27.6%) were later referred to and attended other VA programs including PTSD rehabilitation and group therapy, anger management, and intensive inpatient or outpatient dual diagnosis programs. These and other findings from this study suggest that the DUI program may be an effective additional pathway for providing treatment that is particularly salient to the distinctive OEF/OIF population; one that may also result in earlier intervention for problem drinking and other problems related to combat. Relevant conclusions discussed herein primarily aim to improve providers' understanding of effective outreach, and to enhance the appropriate linkages between OEF/OIF veterans and existing VA services.

The Perpetration of Spousal Abuse by Male Combat Veterans: Recommendations for Individualized Group Domestic Violence Treatment for Veterans

Recent estimates suggest that spousal abuse is, in fact, on the rise in the U.S. military (The Miles Foundation, 2005). As research specific to the impact of posttraumatic stress disorder (PTSD) on U.S. soldiers has grown since the Vietnam War, clinicians and researchers have begun to investigate how combat-related trauma affects veterans in terms of aggression, hostility and social/emotional functioning. The training and stressors experienced by soldiers in the military are unique and affect all aspects of the veteran's functioning. This paper discusses questions related to why combat veterans may be at increased risk to commit spousal abuse (verbal, psychological, and physical), the relationship between PTSD, substance use, and violence, and the advantages to individualizing group domestic violence (DV) treatment programs for combat veterans. Recommendations will be made for a DV treatment program specifically for combat veterans who also suffer from PTSD.

I'm Not Who I Thought I Was: A Contextual Resolution to the Identity Loss of Combat PTSD.

Given the historical rates of combat post-traumatic stress disorder (PTSD), one can expect 30% of soldiers returning from current military conflicts to suffer from PTSD. For these individuals, various cognitive behavioral therapies (CBT) are the most commonly employed treatments. Unfortunately, however, symptom relapse can be expected with the various CBT approaches, as traumatic memories remain. Soldiers are imbued with a militarized identity, and the identity loss experienced by those soldiers who suffer from PTSD is particularly painful for this population, as the militarized identity effectively disavows personal suffering. For this reason, many combat veterans diagnosed with post-traumatic stress disorder experience undue, prolonged suffering as they struggle to make sense of the different person they fear they have become. This paper contrasts certain versions of Western philosophy, which view the self as a fixed and reified entity with certain versions of Eastern philosophy, which view the self as more contextual and fluid, in order to illuminate the value of employing third wave behavioral treatments, specifically Acceptance and Commitment Therapy (ACT), to treat the identity loss experienced by military veterans with PTSD. ACT echoes the Buddhist principle that attachment to verbally-constructed conceptual notions of self contribute to undue suffering, and that more vital living can be achieved by assuming a more contextual and experiential perspective on identity. Research and anecdotal accounts are cited to illustrate why treatment for identity loss associated with combat PTSD should be less focused on reconstructing a historically substance-oriented self and more focused on an epistemological reorientation to a deconstructed, contextual self.

On the Edge of the World: Trauma and Twinship Selfobject Needs in Mrs. Dalloway

Alienation and aloneness appear as common themes in the experience of those impacted by trauma. Self psychology theorists, including contemporary proponents of intersubjectivity theory, have also discussed the ways in which alienation and disconnection from others permeate the experience of post-traumatic stress disorder. This discussion has highlighted the importance and centrality of twinship selfobject needs in providing a relational home for the emotional pain associated with trauma. These phenomena are especially apparent when one encounters the experiences of those combat veterans who have attempted to readjust to society upon returning home from military service. Using self psychology and intersubjectivity theory, this paper explores the ways that fiction, specifically Virginia Woolf's Mrs. Dalloway, can illuminate the ways that trauma negatively impacts twinship selfobject needs in combat veterans. In examining the character of Septimus Smith, this paper illustrates the estrangement, singularity, and alienation associated with post-traumatic stress, and how this state of being can collude with societal misunderstanding and repression to shatter the self's sense of belongingness with and connection to others.

The Experiences of American Indian Women Warriors

This article examines the unique experiences of American Indian (AI) female veterans through a generalized qualitative study. Revealed in this study were interesting cultural insights regarding a concentrated, yet largely misunderstood, population within the U.S. military. For this study, six participants were interviewed and data were analyzed to identify common experiences of AI female veterans. The analyses revealed unique roles assumed during military service, a strengthening of cultural values, identity development, and personal empowerment as a result of AI women having served in the military. Discussion, implications, and limitations of this study are also described.

A Qualitative Study of Potential Suicide Risk Factors Among Soldiers Transitioning From Operation Iraqi Freedom/Operation Enduring Freedom

Using qualitative methods, this study explored potential risk factors for suicide, as defined by Joiner's Interpersonal-Psychological Theory of Suicide (IPTS), in a population of Soldiers returning from deployment in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF). Sixty-eight Soldiers participated in semi-structured interviews during the period of transition from deployment to the garrison environment. These Soldiers were asked about changes in perception of pain, experiences of perceived burdensomeness, and lack of belonging. Interviews were transcribed and analyzed. A phenomenological methodology was employed (Creswell, 2006). In response to questions about perception of pain, Soldiers discussed both positive and negative changes in their experience of physical and emotional pain. When asked about experiences of perceived burdensomeness, Soldiers described changes related to deployment, such as injuries and combat related guilt, as well as changes related to transition from combat, including care seeking, reintegration into family and society, and emotional distancing. Regarding the experience of lack of belonging, Soldiers described difficulties related to the deployment, such as combat injuries, leadership roles, and individual differences, as well as difficulties related to reintegration such as symptoms of emotional numbing and distancing. Findings highlight the potential utility of IPTS in exploring both acute and chronic suicide risk factors associated with deployment and transition, as well as potential treatment strategies that may reduce suicide risk in the population of Soldiers during reintegration.

Back in Blue: The Successful Reintegration of Combat Veteran Law Enforcement Officers.

In the past ten plus years, several million national guard and reserve component military personnel have been deployed in support of the global war on terrorism. Tens of thousands of those personnel also serve as full-time law enforcement officers in police and sheriff's offices around the country. Life as a law enforcement officer is tough enough, but when combined with the psychological baggage brought on by months of war, reintegrating into civilian life and the role of a law enforcement officer can be extremely difficult. This article discusses a reintegration program specifically for law enforcement agencies that is designed to promote long-term psychological and social health in combat veteran officers. The program's costs are offset by the many assets (leadership, tactical training, etc.) these men and women bring to the department. By committing to the long-term successful reintegration of these individuals, departments enhance their own forces and improve community safety.