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  1. 1. Soldiers in Need
  2. 2. <ul><li>Through careful consideration and critical reading of over thirty-five different articles, ten articles were chosen for this review. The knowledge used in choosing these articles was developed from multiple tours in Iraq of the author, visits to mental stress tents in Iraq, and the use of assessment tools used to determine symptoms. All statistical knowledge was derived from the articles and shows the reliability of tools used for assessment. In the end it should be recognized that the main problem with assessment and treatment is the anger, hostility and aggressive nature of the new veterans. </li></ul>
  3. 3. <ul><li>Anger, aggression, and hostility are the signs of PTSD in veterans (Jakupac, Conybeare, Phelps, Hunt, Holmes, Felker, Klevins & McFall, 2007). Other signs include; sleeplessness, depression, traumatic stress, substance abuse, thrill seeking, and relationship problems (Bleise et al., 2007). From a veterans point of view, these things really do exist. I haven’t slept right since I have been home, my energy level is through the roof, I hear noises that aren’t there sometimes, and most of all, which isn’t included in the symptoms, it is hard to be a civilian again which I will assume is going to add to the relationship problems for most. </li></ul>
  4. 4. <ul><li>Some of the problems with early assessments are that soldiers are relieved to be coming home and may not feel any immediate symptoms, and they may not report symptoms for two reasons; first, they do not want treatment to interfere with leave time that has been granted and second, their command may look down on their reporting because these assessments are not confidential from the unit (Bleise et al., 2007). </li></ul>
  5. 5. <ul><li>According to Corrigan (2004) there are two factors that establish the stigma; the first is how these soldiers will be viewed when their fellow soldiers or command find out they have a mental illness and the second is the soldiers own belief and shame of having a mental illness because it will make them inadequate, inferior, weak and that asking for help is an admission of failure (Wright, Cabrera, Adler, Bleise, Hoge & Castro, 2009). </li></ul>
  6. 6. <ul><li>The classical DSM-IV version of PTSD is; “actual or threatened death or serious injury, or a threat to the physical integrity of self and others which evokes intense fear, horror, or helplessness” (Engelhard, Arntz, & Van Den Hout, 2007, p.2). However, there might be a flaw in using the DSM-IV as a guide for these assessments in that the A2 criteria, experiencing fear, horror, or helplessness, may not be an accurate factor when doing assessments for PTSD (Bleise, Wright, Adler, Cabrera, Castro & Hoge, 2008). </li></ul>
  7. 7. <ul><li>As Bleise (2004) found that these types of reactions were not endorsed by soldiers but anger and training were more accurate responses (Bleise, Wright, Adler, Cabrera, Castro & Hoge, 2008). Even though soldiers who are trained to fight, which is why A2 criterion may not apply, may not experience horror, fear, or helplessness it does not mean that they still do not experience significant levels of A1 criterion or exposure to traumatic events (Adler, Wright, Bleise, Eckford, & Hoge, 2008). </li></ul>
  8. 8. <ul><li>It is understandable that, as of March 2008, 347,750 veterans being seen across the nation at VA hospitals and roughly 43% of those veterans seeking mental health treatments that something needs to be done to address the rising number of Iraq and Afghanistan veterans returning home and seeking help (Erbes, Curry, & Leskela, 2009). Using the old treatments; anger management, cognitive processing therapies, substance abuse treatment, using questionnaires and surveys to establish modality and even PTSD was met with high rates of non-attendance and dropout rates (Erbes, Curry, & Leskela, 2009). </li></ul>
  9. 9. <ul><li>Virtual Reality Exposure (VRE) seems to be a promising type of treatment that is in line with the technology of the new soldier (Reger & Gahm, 2008). A new form of exposure therapy, this therapy recreates Iraq or Afghanistan convoys and while inducing the fear agent reduces the danger involved in order to engineer a new response to the stimuli (Reger & Gahm, 2008). </li></ul>
  10. 10. <ul><li>There might be another style of treatment that can offer some relief to PTSD and it is called Heart Centered Hypnotherapy. This type of therapy combines Hypno-behavioral therapy, Neuro-linguistic programming with the Gestalt theories and Erickson techniques to provide relief to soldiers with PTSD (Yarvis, 2008). Finally, cognitive behavioral conjoint therapy is a good treatment alternative (Monson, Fredman, & Adair, 2008). </li></ul>
  11. 11. <ul><li>This type of therapy combines PTSD therapies with relationship therapies that consists of 15 sessions based on psychoeducation on PTSD, relationship building, safety concerns and session orientation, behavioral interventions that promote communication, understanding and conflict resolution, and cognitive intervention to address maladaptive thinking patterns in PTSD and Relationship (Monson, Fredman, & Adair, 2008). </li></ul>
  12. 12. <ul><li>Overall the strengths of this study were to bring to add some stability to the areas of help that a soldier needs. Being in that system it is a rat race by individuals looking to further themselves first. It is my hopes that the strength of this paper and the studies chosen for this paper will show others where to start when trying to establish a cycle of assessment and treatment for the soldier that will not cause them fear or anxiety which will lead to more soldiers seeking help before the symptoms are life long. </li></ul>
  13. 13. <ul><li>Throughout he slide show I have put various notes in place. I would like to state that the statistical data provided in the studies researched were not of use in this study as I was only trying to form a pattern for assessment and treatment. The stats in these articles were only to help them make their treatment options useable the participants were to limited to be of any real validity until further testing can be done. That is the overall weakness of any treatment option right now is that they are too new with the guidelines given which are themselves too new. For instance, at one point it was said that exposure therapy was detrimental to recovery, but they still use it and modify it as well to suit the times. </li></ul>
  14. 14. <ul><li>Adler, A., & Hoge, C. (2008, June). A2 diagnostic criterion for combat-related posttraumatic stress disorder. Journal of Traumatic Stress , 21 (3), 301-308. Retrieved September 14, 2009, doi:10.1002/jts.20336 </li></ul><ul><li>Bliese, P., Wright, K., Adler, A., Thomas, J., & Hoge, C. (2007, August). Timing of postcombat mental health assessments. Psychological Services , 4 (3), 141-148. Retrieved September 14, 2009, doi:10.1037/1541-1559.4.3.141 </li></ul><ul><li>Bliese, P., Wright, K., Adler, A., Cabrera, O., Castro, C., & Hoge, C. (2008, April). Validating the Primary Care Posttraumatic Stress Disorder Screen and the Posttraumatic Stress Disorder Checklist with soldiers returning from combat. Journal of Consulting and Clinical Psychology , 76 (2), 272-281. Retrieved September 14, 2009, doi:10.1037/0022-006X.76.2.272 </li></ul><ul><li>Erbes, C., Curry, K., & Leskela, J. (2009, August). Treatment presentation and adherence of Iraq/Afghanistan era veterans in outpatient care for posttraumatic stress disorder. Psychological Services , 6 (3), 175-183. Retrieved September 14, 2009, doi:10.1037/a0016662 </li></ul><ul><li>Gerardi, M., Rothbaum, B., Ressler, K., Heekin, M., & Rizzo, A. (2008, April). Virtual reality exposure therapy using a virtual Iraq: Case report. Journal of Traumatic Stress , 21 (2), 209-213. Retrieved September 14, 2009, doi:10.1002/jts.20331 </li></ul>
  15. 15. <ul><li>Jakupcak, M., Conybeare, D., Phelps, L., Hunt, S., Holmes, H., Felker, B., et al. (2007, December). Anger, hostility, and aggression among Iraq and Afghanistan war veterans reporting PTSD and subthreshold PTSD. Journal of Traumatic Stress , 20 (6), 945-954. Retrieved September 14, 2009, doi:10.1002/jts.20258 </li></ul><ul><li>Monson, C., Fredman, S., & Adair, K. (2008, August). Cognitive–behavioral conjoint therapy for posttraumatic stress disorder: application to operation enduring and Iraqi Freedom veterans. Journal of Clinical Psychology , 64 (8), 958-971. Retrieved September 14, 2009, doi:10.1002/jclp.20511 </li></ul><ul><li>Reger, G., & Gahm, G. (2008, August). Virtual reality exposure therapy for active duty soldiers. Journal of Clinical Psychology , 64 (8), 940-946. Retrieved September 14, 2009, doi:10.1002/jclp.20512 </li></ul><ul><li>Yarvis, J. S. (Spring 2008). Hypnotherapy under fire: efficacy of heart-centered hypnotherapy in the treatment of Iraq war veterans with posttraumatic stress.   Journal of Heart Centered Therapies , 11, 1. p.3(16). Retrieved September 14, 2009, from PowerSearch Psychology Guide via Gale: </li></ul><ul><li>Wright, K., Cabrera, O., Bliese, P., Adler, A., Hoge, C., & Castro, C. (2009, May). Stigma and barriers to care in soldiers postcombat. Psychological Services , 6 (2), 108-116. Retrieved September 14, 2009, doi:10.1037/a0012620 </li></ul>