Title: OIF/OEF Women
1OIF/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
2OIF/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?
3Women 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
4Specific 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
5OIF/OEF and Family
- Family issues are paramount
- Often in caregiver role
- Partner conflict
- Parenting skills
- Domestic violence
- Young children
- Individuation from family of origin
6OIF/OEF Women Presenting Problems
- Comorbid Difficulties
- Depression
- Anxiety/panic
- Substance use
- Personality disorders
- Somatization
- Sexual dysfunction
- Eating disorders
- Self-injurious behavior
7Military 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.
8MST 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
9Combat-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
10Service 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
11VA 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
12Response to Treatment
Cason, et al., 2002
13Evidence-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
14Empirically-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
15Empirically-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
16Empirically-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
17Clinical Presentation
- Interpersonal problems
- Social isolation
- Identity disturbance
- Impulsivity
- Emotion dysregulation
- Numbing/dissociation
- Problematic thinking
18Clinical 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
19Clinical 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
20Providers 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
21Strategies 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
22Program Planning Resources
- Women Veterans Health Program Handbook
- Women Veterans Health Program Plan of Care
- VA Directives
- Mental Health Strategic Plan
- Womens Mental Health Committee
23Suggested 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).