Women Warriors - Treatment
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Transcript Women Warriors - Treatment
OIF/OEF Women
Darrah Westrup, Ph.D.
Women’s Mental Health Center
Women’s Trauma Recovery Program
National Center for PTSD
VA Palo Alto Health Care System
womenvetsPTSD.va.gov
[email protected]
OIF/OEF Women
What do we need to know about OIF/OEF
women?
How are they different?
What are their particular treatment needs?
How can we best serve OIF/OEF women?
What services are needed?
What are the effective treatments?
Women Veterans
Women are one of the fastest growing segments of the
veteran population. They comprise:
15%
20%
17%
13%
of
of
of
of
active military
new recruits
reserve and National Guard
OIF/OEF troops (59 casualties as of April ’06)
5% of 27 million veterans are women and this number
is expected to increase to 10% by 2010
Women veterans have greater health problems than
their nonveteran female counterparts
87% of women veterans do not use VA care
Specific Needs of OIF/OEF Women
Less
in-service social support
Different
Role
determinants of social support
transition
Intimate
partner violence
Behavioral
health
29%
of OEF/OIF women veterans who use VA are
diagnosed with mental health disorders
PTSD
– SUD comorbidity
OIF/OEF and Family
Family issues are paramount
Often in caregiver role
Partner conflict
Parenting skills
Domestic violence
Young children
Individuation from family of origin
OIF/OEF Women: Presenting Problems
Comorbid Difficulties
Depression
Anxiety/panic
Substance use
Personality disorders
Somatization
Sexual dysfunction
Eating disorders
Self-injurious behavior
Military Sexual Assault
Higher rates of Military Sexual Trauma
Physical attacks and sexual assaults of
women by comrades exceed casualties by
enemy actions.
As many as 25% of military women have
been sexually assaulted.
Sexual assaults and harassment that occur
in military may be more damaging than
other work settings.
MST is associated with
Increased suicide risk
Major depression
PTSD
Alcohol/drug abuse
Long-term sexual dysfunction
Disrupted social networks
Occupational difficulties
Asthma
Breast cancer
Heart attacks
Obesity
Combat-related Exposure
Problems similar to those for sexual assault
Drug-related disorders
Accidental deaths
Higher level of general psychiatric distress
More frequent somatic complaints
Anxiety/panic
PTSD
Service Model
Designated women’s clinic
Gender specific services
Prevention and educational services
Mental health presence in primary care
Couples and parent-child therapies
Drop-in groups with childcare
Evening hours
Evidence-based treatments
VA Services for Women
Only 19% of VA facilities provide any MH services in a
Women’s Health Center Space
Only 7% of facilities provide any services by a
specialized women’s MH team
These services will be
especially important for
the younger, less
chronic, women
OEF/OIF veterans
Response to Treatment
1.6
Effect Size
1.4
1.2
1
Men
Women
0.8
0.6
0.4
0.2
0
Pretreatment
PostFollow-up
treatment
Cason, et al., 2002
Evidence-Based PTSD Treatments
Clinical Practice Guidelines
Cognitive behavioral therapy
Pharmacotherapy
Group therapy
Cochrane Review
(ISTSS)
(Bisson & Andrew, 2005)
Trauma focused cognitive behavioral (TFCBT) group and
individual therapy, and stress management are effective
treatments for PTSD
TFCBT is superior to stress management between 2 and 5
months following treatment
TFCBT is more effective than other therapies
Empirically-Supported Treatments
for Women with PTSD
Seeking Safety (Najavitz et al., 1996)
For women with PTSD and substance disorders
Fits Herman’s “first stage” of treatment
No exposure work
24 weekly sessions for 90 minutes
Group format
Manualized
Easily transferable
Empirically-Supported Treatments
for Women with PTSD (cont.)
Cognitive-Processing Therapy (Resick &
Schnicke, 1992, 1993)
Based on Information Processing Theory
12 sessions
Education about trauma meaning
Cognitive therapy – challenging beliefs
Disclosure about the trauma (written)
Skills building – safety, trust, power, selfesteem, and intimacy
Empirically-Supported
Treatments
Acceptance and Commitment Therapy
(Hayes, Strosahl, & Wilson, 1999)
12 sessions in “building block” format
Control of private events as the problem
Self as context rather than content
Letting go of the struggle
Commitment and behavior change
Clinical Presentation
Interpersonal problems
Social isolation
Identity disturbance
Impulsivity
Emotion dysregulation
Numbing/dissociation
Problematic thinking
Clinical Presentation (cont.)
They are in despair
They want better lives
They deserve our best effort
“Coping” strategies impede therapeutic growth
Difficulties can be longstanding and
entrenched
Providers are necessarily impacted by the work
Clinical Factors that Affect Treatment
Difficulty establishing the therapeutic
alliance
Approach
based on relationship history
Blended
with familial and military
dynamics
Situation
Evokes
evokes vulnerability
issues with “control”
Providers’ Challenge Maintaining a Therapeutic Stance
Caring for those who can make it
difficult
Managing the negative impact
On
oneself
On
the patient or client
On
other patients/clients
Strategies to Help Maintain a
Therapeutic Stance
Protect your compassion
Language matters
No need to be “above it all”, get support
Expect to fall from grace
Be rigorous
Be intentional vs. reactive
Be aware of your limits
Human behavior is purposeful
Even illogical behavior has a function
Focus on the behaviors vs. labeling
Never forget people can and do get better
Program Planning Resources
Women Veterans Health Program
Handbook
Women Veterans Health Program Plan
of Care
VA Directives
Mental Health Strategic Plan
Women’s Mental Health Committee
Suggested References
Kimerling, R., Ouimette, P., Wolfe, J. (2002). Gender and PTSD. New York: Guilford
Press.
Washington, D. L., Yano, E. M., & Horner, R. D. (Eds.). (2006). VA Research on
http://siadapp.dior.whs.mil/index.html (DoD Personnel and Procurement Statistics)
http://www.defenselink.mil/news/Mar2006/d20060316SexualAssaultReport.pdf
(DoD Sexual Assault Report for 2005 with 06 Summary)
Women’s Health [Special issue]. Journal of General Internal Medicine, 21 (3).
http://www1.va.gov/VHI/page.cfm?pg=32 -- https://www.eeslearning.net/librix/loginhtml.asp?v=librix (Military Sexual Trauma Veterans
Health Initiative)
http://www.ncptsd.va.gov/index.html (National Center for PTSD).