The military family system deserves to be given easy access to the most outstanding clinical treatments that we now have to offer. We are in the process of developing novel psychotherapeutic interventions for the heroes that have taken on the duty of defending our country with honor, commitment and exposure to trauma. Everyone in the system is impacted. Veterans and their families deserve to be able to make informed treatment choices that provide them with the opportunity to have hope filled, and normal lives going forward.
Innovative treatment needs to be inclusive. As clinicians we are not only caring for veterans. When we work from a systems perspective it is abundantly clear that the availability of mental health treatment choices for spouses, children, parents and siblings must always be available.
Resiliency
Veteran resiliency is interwoven with the love, support, encouragement, faith, courage and strength of the social-emotional system. This is a relational model that is driven by our psychological expertise in developmental theory, attachment, biology, technology, ongoing empirical research and exceptional, efficacious clinical care.
Optimal multimodal treatment will frequently require and include psychoeducation, individual psychotherapy, psychopharmacologic treatment, group therapy, family therapy, couples’ therapy, as well as specific clinical services for children and teens. We need to support healthy individual and family functioning.
Deployment
Deployment is a major life stressor that affects the entire family system. The past decade of wars in Iraq and Afghanistan have had more frequent and longer deployments than any other time in history and we have found that Non-Deployed Spouses (NDSs) are at increased risk for clinically significant psychiatric distress during and after the spouse is deployed (Bjornestad, et al.,2014). When focusing on the uniformity of evidence-based treatments in practice and the psychological consequences of engaging in combat, (Laska, 2013; Sammons, 2008) it is clear that this is the first time in history when psychological morbidity is likely to far outstrip physical injuries associated with combat. The current literature on Post-Traumatic Stress Disorder is extensive. Researchers and clinicians argue that the epidemic of Post-Traumatic Stress and brain injuries has been significant. According to the August Pentagon Report (2012), we are given the news that as two of our longest wars are ending, suicide is now the leading cause of death in the army. The literature on post deployment psychiatric health in Operation Enduring Freedom/Operation Iraqi Freedom have identified high rates of PTSD (21.8% ) depression (17.4%). There are estimates that 1900 veterans from Afghanistan and Iraq in the year 2014 have sadly taken their own lives).
Clearly children and families are impacted in profound ways when a parent goes to war (Boberiene, et al., 2014). Children of Service Members are 2.5 times more likely to develop psychiatric problems; there is evidence that 2 million children have been affected by deployment and 30,000 children have had to come to terms with parental death or injury (Lemon, et al., 2009; Gorman et al., 2010; Chandra, 2010).
When focusing on the uniformity of evidence-based treatments in practice we find that men are overrepresented within the American Armed Forces, comprising 85% of the population of those returning home. Male veterans are expected to function as husbands, partners, fathers, sons, and workers. In addition, they must separate from the military while reconnecting with family and friends and embracing the now unfamiliar civilian lifestyle (Chan, 2014; Cohen et al; 2010; Wells et al; 2010, Defife, 2012).
Innovative Treatment
Innovative treatment and psychoeducation go hand in hand. First and foremost, we must be sophisticated diagnosticians who understand the complexity of a wide range of symptomatology and psychopathology. Not being thorough and working in the dark is far too risky with this population. When the process of transitioning to civilian life is occurring, denial, hopelessness, loneliness, self-medication with alcohol and drugs, domestic violence, overcontrol of children and anxiety about their safety can be quite evident (DeAngelis, 2008). In addition, we have become much more skilled, in working with survivors’ guilt, and the veterans feelings that the whole purpose of life is now gone (Reeder, 2013). We must first decrease the ongoing factors that lead to treatment resistance and the low mental health utilization in military families. A 2008 VA study found that only 41% from the Iraq and Afghanistan wars do not enroll in any treatment. In order to provide essential, compassionate therapeutic care we must first overcome the obstacles that interfere with pursuing and maintaining treatment.
Although we know that there have been significant treatment advances, we still have found that nearly ½ of patients who enroll in treatment either drop out or remain symptomatic (Defife, 2012).
Treatment Resistance
There is a fear that medical records will ruin careers, there is a low perceived need for treatment and a lack of confidence in the efficacy of mental health treatment due to such factors as cost, embarrassment, and being stigmatized by members of one’s unit (Esposito, et al., 2011; Gorman, 2010; and Hoge, 2004). Utility and safety are essential in building the treatment frame. There has already been too much trauma, loss, anxiety, dysphoria, pain and hopelessness that interferes with the risk associated with trusting clinical provider.
Treatment must be easily accessible and inviting so that the barriers to seeking therapy are extinguished. Time is of the essence, long waiting lists for initial evaluations, treatment programs and research will undermine the therapeutic mission. Knowledge about emergency medical services must be transmitted, safety is paramount. The National Suicide Prevention Lifeline (1-800-273-TALK) is commonly used.
Excellent pharmacological treatment is beneficial. The FDA, for example, has already approved Sertraline (Zoloft) and Paroxetine (Paxil) for PTSD (Defife, 2012).
Resick (2012) has done some important research on impressive long-term outcomes of Cognitive Behavioral Treatment and the benefits of prolonged exposure therapy. Mastering stressful situations through breathing exercises that have been learned in session and Cognitive Processing Therapy and Cognitive Restructuring are frequently used as well as prolonged exposure therapy (Tomasulo, 2012) and EMDR (Eye Movement Desensitization and Response) in individual treatment (Grbesa, 2010). Dialectical Behavior Therapy (Linehan, 2009), Mindfulness (Kabat-Zinn, 2003) and Mindfulness Based Stress Reduction (Kearney et al., 2011) have been effective in the treatment of adolescents as well as adults. The innovative treatment strategies of self-acceptance, commitment, awareness, willingness to experience emotional distress and attention to the present can be extremely useful therapeutic tools (Chodron, 2013). It is our privilege and obligation to pursue our ongoing work in strengthening our military families (Petzel et al., 2014). Continuing to fulfill this clinical and research mission will enhance the functioning of our nation.
