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OIF/OEF Women

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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 – PowerPoint PPT presentation

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Title: OIF/OEF Women


1
OIF/OEF Women
  • Darrah Westrup, Ph.D.
  • Womens Mental Health Center
  • Womens Trauma Recovery Program
  • National Center for PTSD
  • VA Palo Alto Health Care System
  • womenvetsPTSD.va.gov
  • darrah.westrup_at_va.gov

2
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?

3
Women Veterans
  • Women are one of the fastest growing segments of
    the veteran population. They comprise
  • 15 of active military
  • 20 of new recruits
  • 17 of reserve and National Guard
  • 13 of 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

4
Specific Needs of OIF/OEF Women
  • Less in-service social support
  • Different determinants of social support
  • Role transition
  • Intimate partner violence
  • Behavioral health
  • 29 of OEF/OIF women veterans who use VA are
  • diagnosed with mental health disorders
  • PTSD SUD comorbidity

5
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

6
OIF/OEF Women Presenting Problems
  • Comorbid Difficulties
  • Depression
  • Anxiety/panic
  • Substance use
  • Personality disorders
  • Somatization
  • Sexual dysfunction
  • Eating disorders
  • Self-injurious behavior

7
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.

8
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

9
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

10
Service Model
  • Designated womens 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

11
VA Services for Women
Only 19 of VA facilities provide any MH services
in a Womens Health Center Space Only 7 of
facilities provide any services by a specialized
womens MH team
These services will be especially important for
the younger, less chronic, women OEF/OIF veterans
12
Response to Treatment
Cason, et al., 2002
13
Evidence-Based PTSD Treatments
  • Clinical Practice Guidelines (ISTSS)
  • Cognitive behavioral therapy
  • Pharmacotherapy
  • Group therapy
  • Cochrane Review (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

14
Empirically-Supported Treatments for Women with
PTSD
  • Seeking Safety (Najavitz et al., 1996)
  • For women with PTSD and substance disorders
  • Fits Hermans first stage of treatment
  • No exposure work
  • 24 weekly sessions for 90 minutes
  • Group format
  • Manualized
  • Easily transferable

15
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, self-
  • esteem, and intimacy

16
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

17
Clinical Presentation
  • Interpersonal problems
  • Social isolation
  • Identity disturbance
  • Impulsivity
  • Emotion dysregulation
  • Numbing/dissociation
  • Problematic thinking

18
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

19
Clinical Factors that Affect Treatment
  • Difficulty establishing the therapeutic alliance
  • Approach based on relationship history
  • Blended with familial and military dynamics
  • Situation evokes vulnerability
  • Evokes issues with control

20
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

21
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

22
Program Planning Resources
  • Women Veterans Health Program Handbook
  • Women Veterans Health Program Plan of Care
  • VA Directives
  • Mental Health Strategic Plan
  • Womens Mental Health Committee

23
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 Womens Health
    Special issue. Journal of General Internal
    Medicine, 21 (3).
  • http//siadapp.dior.whs.mil/index.html (DoD
    Personnel and Procurement Statistics)
  • http//www.defenselink.mil/news/Mar2006/d20060316S
    exualAssaultReport.pdf (DoD Sexual Assault Report
    for 2005 with 06 Summary)
  • http//www1.va.gov/VHI/page.cfm?pg32 --
    https//www.ees-learning.net/librix/loginhtml.asp?
    vlibrix (Military Sexual Trauma Veterans Health
    Initiative)
  • http//www.ncptsd.va.gov/index.html (National
    Center for PTSD).
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