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Write an 8- to 10-page paper in which you do the following:
- Define the problem (Military PTSD). Provide prevalence, incidence, and relevance to the military population as background information.
- Describe evidence-based treatments (EBTs) identified for the problem or psychosocial or rehabilitation treatments. Provide information about the relevance of these approaches with a military population.
- Identify agency resources that would be needed to address the problem and treat the military members and their families.
- Identify training and education that would be needed for treatment providers. Provide a rationale for additional training and education.
- Identify Department of Defense, Veteran’s Administration, and community resources to assist treatment providers with referrals for additional services.
There are many psychological, emotional, physical, and societal issues which affect the overall well-being of our nations service members, veterans, and their families. Of these issues, post-traumatic stress disorder (PTSD) is arguably the most detrimental as it can cause service members and veterans to begin a downward spiral. Correlation exists between PTSD and increased rates of substance use disorder (SUD). Individuals diagnosed with PTSD are also at an increased risk of developing suicidal ideation.
Most disturbingly, one can suffer from many of the symptoms of PTSD without realizing it. This means, many service members and veterans go undiagnosed or misdiagnosed and are never treated for their symptoms. There also exists a stigma in the armed forces surrounding PTSD. As a result, many service members fail to report the symptoms they are experiencing following a traumatic event. The military is now making efforts to combat this stigma, though there is still much work to be done in this area (APA, 2018b).
The United States Department of Veterans Affairs (2017b) posits, individuals now being diagnosed with PTSD fills a long-time gap in psychological and psychiatric services in that the causes of symptoms are events experienced by the individual, as opposed to the service member’s personal weakness. Research conducted on veterans returning from combat was integral in the development of the diagnosis. Combat takes a significant physical, psychological, and emotional toll on the war fighter. Hence, the history of what we now know as PTSD is closely related to the history of war (para. 2).
History of PTSD
The first attempts to make a medical diagnosis of psychological symptoms following combat exposure date back to the American Civil War (1861-1865) (VA, 2017b). Half a century later, President Wilson announced the end of World War I. At that time, the symptoms of PTSD were described as “shell shock” as they were thought to be a reaction to the sounds of enemy artillery shell explosions. Treatments focused on daily activities to increase function and productivity. Treatments included hydrotherapy, electrotherapy, and hypnosis (VA, 20147b, Shell Shock).
The Department of Veterans Affairs (2017b) explains, during World War II, the diagnosis of shell shock was replaced with combat stress reaction (CSR). The condition was also referred to as “battle fatigue.” Many military leaders, including Gen. Gorge S. Patton were in disbelief of the validity of CSR. The condition was treated immediately ensuring the sufferer could return to combat expeditiously. The benefits of military relationships and support were the primary focus of treatment to decrease stress and promote recovery (Battle Fatigue or Combat Stress Reaction). The treatment for CSR is related to what we now know to be the strengths perspective.
The Department of Veterans Affairs (2017b) also posits, the American Psychiatric Association developed the first Diagnostic and Statistical Manual of Mental Disorders (DSM-I) in 1952. DSM-I included a diagnosis of gross stress reaction (GSR) proposed for individuals who were not abnormal but suffered symptoms following traumatic events such as a car accident or combat exposure. There was a problem, though. If the symptoms of GSR lasted longer than six months, clients had to be diagnosed with another condition. In 1890, the association added PTSD to DSM-III after extensive research with Vietnam veterans and survivors of other traumatic events. This diagnosis was updated in 2013 in DSM-5 to include current research (Development of the PTSD Diagnosis).
PTSD and Military and Veteran Populations
Research conducted by The Committee on the Assessment of Ongoing Efforts in the Treatment of PTSD (2014) indicates, there were around 22 million veterans as of September 2013. Of said veterans, about 2.2 million served deployment tours in Iraq and or Afghanistan. This number is projected to increase to nearly 4 million by the year 2040. 54% of Iraq and Afghanistan veterans report using VA healthcare benefits. In 2011, nearly 100,000 Iraq and Afghanistan veterans had a diagnosis of PTSD. This is almost one quarter of the number of individuals who actively seek care at VA facilities. These numbers are believed to be underrepresented as many veterans choose to receive treatment at facilities outside of VA medical centers (Prevalence and Incidence of PTSD in U.S. Veteran Populations).
Evidence-Based Treatment Options
The American Psychological Association (2018a) strongly recommends four evidence-based treatments which are variations of cognitive behavioral therapy (CBT). CBT is a very broad treatment encompassing many forms of treatment delivered by cognitive behavioral therapists. Cognitive Processing Therapy, Cognitive Therapy and Prolonged Exposure focus on specific aspects of CBT interventions (Strongly Recommended).
Cognitive Behavioral Therapy (CBT). CBT often focuses on the interrelationship between an individual’s thoughts, feelings and behaviors. Specific issues or behaviors are targeted and focus is turned toward altering said issue or behavior to improve overall function. Cognitive behavioral therapists believe altering one’s negative or hurtful thoughts can influence healthy behavior and improve feelings and emotions (APA, 2018a, Cognitive Behavioral Therapy).
Cognitive Processing Therapy (CPT). CPT is a specialized type of cognitive behavioral therapy. This form of therapy helps the client to challenge and change harmful beliefs and emotions associated with a traumatic event. Throughout the 12-session process, clients begin to develop a new understanding and concept of the even to positively affect his or her everyday life (APA, 2018a, Cognitive Processing Therapy).
Cognitive Therapy. As its name implies, this form of therapy is meant to address one’s cognition. Cognitive therapy seeks to modify negative evaluations and associations with the memory of a traumatic even. This will change unwanted thoughts, emotions, and behaviors that have negatively affected the client’s everyday life. Cognitive therapy can be delivered individually or in a group setting (APA, 2018a, Cognitive Therapy).
Prolonged Exposure. Prolonged exposure is another specific form of CBT. Clients are coached to approach memories of traumatic events the client has chosen to avoid at their own pace. In facing what he or she has been avoiding for so long, he or she develops confidence and learns memories and reminders of the traumatic even are not dangerous and do not have to be avoided (APA, 2018a, Prolonged Exposure).
Conditionally recommended interventions are those with evidence indicated positive treatment outcomes; however, current evidence and research may not be as strong, or the balance of benefits and harm may be less favorable, or the intervention may not be easily applied across treatment settings or subpopulations. As additional research is conducted, the status of recommendation may change (APA, 2018a).
Brief Eclectic Psychotherapy. Brief eclectic psychotherapy pools many of the aspects psychodynamics and the cognitive behavioral approach. Treatment is focused on changing negative emotions associated with shame and guilt. The client-patient relationship is also emphasized and each weekly one-hour session has a specific objective. This type of intervention is most effective for one who has been exposed to a single traumatic event (APA, 2018a, Brief Eclectic Psychotherapy).
Eye Movement Desensitization and Reprocessing Therapy (EMDR). EMDR is a structured form of therapy which is meant to encourage the client to focus on the traumatic memory momentarily while experiencing bilateral stimuli simultaneously. The stimulation is typically eye movements, which are associated with reducing vividness and negative emotion associated with the client’s traumatic memory. This type of treatment is usually delivered on an individual basis once or twice weekly for a total of six weeks (APA, 2018a, Eye Movement Desensitization and Reprocessing Therapy).
Medications. The Department of Veterans Affairs (2017d) describes four medications generally used in the treatment of PTSD: Sertraline (Zoloft), Paroxetine (Paxil), Fluoxetine (Prozac), and Venlafaxine (Effexor). Each has been shown helpful in treating symptoms of anxiety and depression associated with the disorder. They affect the ways in which the brain processes chemicals which affects the way one feels and behaves (Antidepressants).
Agency Resources Needed to Treat PTSD
There are many resources necessary to effectively treat a veteran suffering from the symptoms of PTSD. Firstly, if the veteran is in a severe crisis or has suicidal ideation, the agency should ensure the veteran gets to the nearest emergency room. For non-life-threatening situations, the agency should maintain a list of trusted mental health providers servicing military and veteran populations. In addition, below are other helpful resources to have:
- Local VA Medical Center
- National Association of Social Workers Military & Veterans: Professional Development
- National Association of Social Workers Military & Veterans Practice Tools
- Suicide Prevention Lifeline: 1-800-273-8255
- Veterans Crisis Line: 1-800-273-8255
- Veteran Combat Call Center: 1-877-WAR-VETS (1-877-927-8387)
- Military OneSource: 1-800-342-9647
Training and Education Needed to Treat PTSD
The first thing workers in the agency should do is familiarize themselves with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This will help to recognize and identify the symptoms of PTSD. NASW (2012) provides the following guidance for working with service members, veterans, and their families:
- social workers must remain knowledgeable about the most effective practice models and changes to the systems in which they work;
- they should understand that health and behavioral health issues related to military evolve in ways specific to combat experience and exposure;
- workers should remain informed about research and EBP specific to military populations; and
- workers should continue to improve their practice through education and training specific to military and veteran populations and promote said knowledge with colleagues (Standard 7 Professional Development).
Department of Defense, VA, and Community Resources
The Department of defense offers guidance about psychological health and traumatic brain injury through the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE). According to DCoE (n.d.), the center’s mission is ”to improve the lives of our nation’s service members, families and veterans by advancing excellence in psychological health and traumatic brain injury prevention and care” (Mission). The Department of Veterans Affairs provides support and research through the National Center for PTSD.
Below are links to agency websites and or phone numbers for several federal and community resources available to providers, service members and veterans, and their families:
- Defense Centers of Excellence: 1-866-966-1020
- PTSD United
- PTSD Foundation of America: (877) 717-PTSD
- US Department of Veterans Affairs National Center for PTSD
- American Psychiatric Association
- National Institute of Mental Health
American Psychological Association. (2018a). PTSD treatments. Retrieved from http://www.apa.org/ptsd-guideline/treatments/index.aspx.
American Psychological Association. (2018b). The military’s war on stigma. Retrieved from http://www.apa.org/monitor/2009/06/stigma-war.aspx
Committee on the Assessment of Ongoing Efforts in the Treatment of Posttraumatic Stress Disorder. (2014). Treatment for posttraumatic stress disorder in military and veteran populations: Final assessment. Washington, DC: National Academies Press.
Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. (n.d.). About DCoE. Retrieved from https://web.archive.org/web/20130524193559/http://dcoe.health.mil/About_DCoE.aspx
National Association of Social Workers. (2012). NASW standards for social work practice with service members, veterans, & their families. Washington, DC: NASW Press.
U.S. Department of Veterans Affairs. (2017a). Cognitive processing therapy for PTSD. Retrieved from https://www.ptsd.va.gov/public/treatment/therapy-med/cognitive_processing_therapy.asp. U.S. Department of Veterans Affairs. (2017b) History of PTSD in veterans: Civil war to
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