3. WWII
1941-1945
16 Million +
Served
1,711,000
Survivors
Hiroshima &
Nagasaki, Japan
Atomic Veterans
and POW’s
Heroes / Patriotic
Nearing end of
life.
Korean
War
1950-1953
5.7 Million +
Served
2,275,000
Survivors
Exposed to
extreme cold
Skin Cancer in
scars, arthritis
High risk late life
health problems
Late Life
Vietnam
1964-1975
8.7 Million +
Served
7,391,000
Survivors
Agent Orange
herbicide
Teenage War
Hostile
Homecoming
Aging (60+)
Gulf
War
1990-1991
2.3 Million +
Served
2,244,583
Survivors
Gulf War
Syndrome
ALS or LOU
GEHRIG’S DISEASE
Patriotic
Middle Age
War on
Terror
2001 – present
More than 1.5
Million deployed
Multiple
Deployments
High Divorce &
Suicide Rates
Child behavioral
risks
Families = long-
term caregivers
18 – Middle Age
Wars
4. Classification Systems
WWII –
Red Scare
1941-
1945
Korean
War -
Communis
m
1950-
1953
Vietnam
1964-
1975
Gulf War
1990-
1991
War on Terror
2011 –
present
DSM II
1968
DSM I
1952
DSM III
1980
DSM IV
1994
DSM V
2013
Oct. 1943
War Dept.
Technical
Bulletin,
Medical 203
1959
Erwin Stengel
classification system
1980 - DSMIII
PTSD is recognized
as a symptom of war
rather than
character defect.
1982
Army Psychiatrist James
Titchener suggests veterans
entering treatment for PTSD
getting worse not better.
1944
Manual for coding
causes of Illness
according to a
diagnosis code for
tabulating morbidity
statistics
1945
ICD 6
1955
ICD 7
1965
ICD 8
1975
ICD 9
1992
ICD 10
2010
ICD 11 proposed for
use in 2014
5. WWII –
Red Scare
1941-
1945
Korean
War -
Communism
1950-
1953
Vietnam
1964-
1975
Gulf War
1990-
1991
War on Terror
2011 –
present
DSM II
1968
DSM I
1952
DSM III
1980
DSM IV
1994
DSM V
2013
Socio-
Political
2013 Women
in Combat
1993 Clinton:
DADT
2010-2011
DADT repeal
1950 Truman:
LGB banned
1941
Army =
AA air
combat
units
SRA 1944
GI Bill
1945-75 2nd reconstruction & civil rights movements
1947 Air Force
established
Truman ends
military segregation
Women in
workforce
1970’s – present Quiet Revolution – Women = college & work
2009 Recession
1996 Clinton:
DOMA
2013 Supreme
Court repeals
DOMA
1981 Agent
Orange Act
1988
Radiation
Exposed Vet.
Comp. Act
6. Prolonged Exposure
Therapy
» PE is a branch of Cognitive Behavior Therapy
» Research indicates that prolonged exposure therapy
is the leading treatment for Iraq and Afghanistan
Veterans who return from combat with PTSD,
anxiety, depression and guilt (Rauch, Defever,
Favorite, Duroe, Garrity, Martis & Liberzon, 2009)
» Prolonged Exposure Therapy can reduce symptoms
of PTSD from 42% (Goodson, Lefkowitz, Helstrom
& Gawrysiak, 2013) to 86% (Abou & Goldwaser,
2009).
7. Prolonged Exposure Therapy Strategies
• Psychoeducation
– Therapist provides an overview of the client’s current trauma responses;
– Therapist describes how prolonged exposure therapy will reduce symptoms.
• Imaginal Exposure
– Client provides detailed account of the experience provided by the client in first
person narrative;
– Client relives the emotional and physiological stress that the trauma created.
• In Vivo Exposure
– A technique that desensitizes the client’s trauma response and reduces anxiety by
exposing the client to situations and/or places that are triggers;
– Can also record/replay imaginal exposure session(s) to use as homework.
• Relaxation Skills
– Teach strategies for how to reduce anxiety (i.e. diaphragmic breathing, progressive
muscle relaxation).
• Relapse Prevention
Editor's Notes
More than ½ million Americans have been captured and interned as POW’s since the American Revolution. Not included in this figure are nearly 93,000 Americans who were listed as lost and never recovered. POW’s are veterans who were forcibly detained by an enemy government or its agents or a hostile force, whether during war or peace. (U.S. Dept. Veterans Affairs)
KOREAN: Examples of cold-related medical conditions include skin cancer in frost-bite scars, arthritis, fallen arches, stiff toes, and cold sensitization. Cold-related problems may worsen as Veterans grow older and develop complicating conditions such as diabetes and peripheral vascular disease, placing them at higher risk for late amputations.
Vietnam – Home within days was new due to better extraction methods in field and technology improvements.
GULF WAR = DESERT SHIELD/DESERT STORM – Kuwait & Saudi Arabian borders
WAR ON TERROR = Operation Enduring Freedom (OEF) Afghan and Operation Iraqi Freedom (OIF) Iraq
Gulf War Syndrome is the term used for these veterans who suffer from medically unexplained illnesses as a result of their service.
Amyotrophic Lateral Sclerosis (ALS) often referred to as "Lou Gehrig's Disease,"
Brigadier General William C. Menninger authored Medical 203, in 1943. Moving away from Freud’s ideology. This was the first time environmental factors were recognized to have impact on soldier’s psyche in U.S. Later adopted by all armed forces. (Picture from http://en.wikipedia.org/wiki/William_C._Menninger)
Prior classification systems under ICD (International Classification of Diseases) nomenclature were used to research morbidity and focused on inpatient mental wards. WWII brought new ideas about psychiatric care and needs for enhanced classification.
ICD 9 still did not include diagnostic criteria or a multiaxial system because primary function of system was to outline categories for collection of basic health statistics. (History of DSM, American Psychiatric Association)
Titchener was called for active duty in the Army during WWII, again for Korean War in 1950. Duke University Medical degree in psychiatry – focused on long term impact of psychic trauma. Died at age of 80 in 2003. (Cincinnati Enquirer, March 4, 2003).
SRA = Servicemen’s Readjustment Act
DOMA 1996 – Defense of Marriage Act – Marriage is reserved for heterosexual couples.
Repeal of DOMA 2013 – Supreme Court ruling allows for recognition homosexual marriages. Military personnel benefited from this because the federal government has moved quickly to make sure same sex couples are able to share benefits such as insurance and pensions the way heterosexual couples would be able to.
