Transcript Understanding the Needs of Returning Veterans Combat

Understanding the Needs of
Returning Veterans
Combat Stress, Trauma, & Readjustment
Rob Braese, Ph.D.
OEF/OIF/OND Readjustment Program
Oklahoma City VA Medical Center
Thank You
A Much Needed Topic
Goals & Overview
• Provide information on the
current wars
• Discuss the mental/emotional
impact of serving in a combat
theater
• Review common problems
experienced after combat
• Discuss how these problems
may present in an educational
setting, and provide some
suggestions for working with
veterans
• Opportunity for questions
A Unique Situation
• Ongoing war – all volunteer force
• Overall, troops have more experience
• High possibility of redeployment
• Men and women serving in all branches of the
military
• Older average age than in previous wars
• % of population on active duty is lower than in prior
wars
• Guard and Reservists are being used more
extensively than in prior wars
Differences with Guard &
Reservists
• Dual life – not steeped in military culture
• Do not live on military bases
• Did not volunteer for full-time service
• May not have expected to be deployed for long,
dangerous duty in a war zone
• Many have established families and careers
• Differential impact?
Risk Factors
in the Current Wars
• Extended and variable lengths of deployments
• Unclear enemy lines
• City and street warfare
• Unpredictability – IEDs, lack of control, friend/foe
• Surviving more serious injuries, especially traumatic
brain injuries (TBI)
Protective Factors
in the Current Wars
• Troops moving in and out in units
• More awareness of mental health treatment
• Forward stationed mental health providers
• Surviving more serious injuries, especially TBIs
(survivability 90% in Iraq vs. 76% in Vietnam)
• Early interventions and treatment (immediate
screening assessments and 3-6 month follow-ups)
Traumatic Events in OEF/OIF
• Multi-casualty incidents
• Friendly fire
• “Avoidable” casualties and
losses
• Death or maiming of
children and women
• Witnessed or committed
atrocities
• Screening gruesome scenes
of carnage
• Witnessed death/injury of a
close friend of leader
• Handling dead bodies and
body parts
• Killing unarmed or
defenseless enemies
• Injuries or near-misses
The Stress of Combat
Combat Stress
Typical Reactions to Combat Experiences
PTSD
Mild/Moderate/Severe
Readjustment
Readjustment Reactions
Soldiers are often happy to be home but may…
• Feel “wired” or “tired”
• Putter around the house, struggling to shift away from combat
operations schedules
• View themselves and the world differently
• Feel emotionally disconnected from family and friends
• Struggle with focus and staying on tasks
• Desire to go back because “life was easier over there”
• Struggle being in crowds
• Feel that others “just don’t get it”
• Appear irritable or “on edge” to family and friends
War Zones Require a Unique
Set of Skills & Behaviors (Dr. Jim Monroe)
War Zone Skills
Home Skills
Safety
Physically unsafe
Physically safe
Trust
Avoid closeness
Create intimacy
Mission Orientation
Single-task/highly
focused
Multitasking/room for
the “little things”
Decision Making
Chain of command
Cooperation
Response Tactics
Act, then think
Think, then act
Predictability &
Intelligence
Unpredictable
Predictability
Numb/over-control
Express emotions
Emotional Control
Stress Injuries & PTSD
What is PTSD?
(DSM-5)
• First there is a “Stressor”
• Exposed to death, threatened death, actual or
threatened serious injury, or actual or threatened
sexual violence by:
o Direct exposure
o Witnessing in person
o Learning that it happened to a close family member or close
friend (must have been violent or accidental)
o Repeated or extreme indirect exposure to aversive details of it
(usually in the course of professional duty - first responders, police)
4 Criteria of Symptoms
Intrusion
Avoidance
PTSD
Negative
Cognitions & Mood
Increased Arousal
Stress Injuries
When stress is too intense or too long
(Capt. W. Nash, USN)
Three Mechanism of Stress Injuries
Trauma
Fatigue
Grief
An impact injury
A wear-and-tear
injury
A loss injury
Due to events
involving terror,
horror, or
helplessness
Due to the
accumulation of
stress over time
Due to the loss of
people who are
cared about
Other Areas of Need
• Depression
• Substance Abuse
o Seal et al. (2011)
o Those with PTSD were 4x more likely to have a drug and alcohol problem
o About 1 in 10 had alcohol use disorder and about 1 in 20 had a drug use
disorder
• Marital and Family Problems
o
o
o
o
Sayers, Farrow, Ross & Olsin (2009)
40.7% feel like a guest in their own home
25.0% children are not warm toward them or are afraid of them
37.2% not sure of their role in the family
• Traumatic Brain Injury (TBI)
In the Classroom
Barriers for Student Veterans
Informational
• Education options, Transfer credits
• Financial aid policies, etc.
Financial
• Out of pocket expenses
• Certifying eligibility, new GI Bill
Cultural
• Bridging the gap between military and
collegiate cultures
Injury &
Trauma
• PTSD, depression, TBI, etc.
• Traditional disability services?
McBain (Summer 2008) AASCU Perspectives
Cognitive Changes from Deploying
• Cognitive changes just following deployment?
• 654 deploying Army soldiers examined before and
after war-zone deployment (compared with a nondeploying cohort)
• When compared to non-deployed, compromise in:
o
o
o
o
Sustained attention
Verbal learning
Visual-spatial memory
Increased negative state affect in confusion and tension
• Did see improvements in simple reaction time
Vasterling, et al. (2006) Neuropsychological outcomes of Army personnel following deployment to the
Iraq War. JAMA, 296, 519-529.
Difficulties in the Classroom
• PTSD
o
o
o
o
o
Each of the symptom clusters impacts the classroom
Intrusion
Avoidance
Negative Cognitions and Mood
Increased Arousal
• TBI
o
o
o
o
o
o
Variety of cognitive difficulties depending on the injury
Eyes – sensitivity to light, easily fatigued
Difficulties with organization
Frequent headaches
Concentration, short-term memory
Low frustration tolerance, irritability
Too Far
Balance
Too Far
Ignorant
Knowledgeable
Stereotyping
Giving In
Healthy Challenges
Unreal Expectations
Ignoring Problems
Open to Dialogue
Overly Intrusive
Warrior Ideal
Student with + & -
Damaged Vet
Denying Impact
Validate Impact
Overly Attribute
Pretending they are
any other student
Valuable Info and
Experiences
Asking to speak for
the military or war
Thank You!
If you have any questions or comments, please feel
free to contact me through the OEF/OIF/OND
Readjustment Program.
Rob Braese, Ph.D.
Clinical Psychologist
Oklahoma City VA Medical Center
(405) 456-2855
[email protected]
(Photos courtesy of www.army.mil)