The deployment of a loved one can impact the entire family. Included will be the signs and symptoms of stress and PTSD within the family, changes in family dynamics, and the treatment for the resulting Post Traumatic Stress Disorder. Children going through a parent’s deployment often experience several of the similar effects as children of divorced families. They are concerned about what will happen to them and they also worry about the non-deployed parent leaving them as well. This paper will also introduce the effectiveness of three therapeutic approaches that can help assist a client and will provide pertinent information that can help develop good coping skills and manage the symptoms of PTSD. Most families are capable of overcoming adversities through family supports, friends, and community. While, others require supplementary assistance from their service providers to help them strengthen resilience, access to needed services, and readjustment to life post-deployment. Service members themselves recognize the need for such services and reducing the stigma of the diagnosis and its treatment is the focus of this review.
Let’s assume that most people are aware of the tribulations that can occur during a deployment of a loved one, but only a few people really know how deep the problem can go. According to Burns, Chandra, Jaycox and Scott (2008) “Caregivers from active component families may benefit the most from assistance in addressing child behavioral and mental health needs. On the other hand, reserve component caregivers may need support with respect to their own mental wellbeing, as they reported slightly more mental health difficulties. During deployment, reserve component caregivers cited more child disengagement, and more challenges with financial well-being. Active component caregivers often conferred more responsibilities on the child (e.g., care of siblings), and these caregivers described having more home responsibilities as well”, (Para 8). The mental and emotional stress that primary caregivers experience can often reach out to their children and the same for the children as they are also dealing with their own stressors of their parent that is caring for them.
One of the most common themes found in the articles selected was the complexity of the emotional and mental tribulations that families suffered during a parent’s deployment. Babies are known to have little difficulty with a parent’s deployment process because of their current age; babies are more concerned about their mechanical needs being met. Older children react in a more observable way when the deployment occurs and thus run into emotional and behavioral problems such as isolation and poor performance at work. The Department of Veteran Affairs states, “Especially for young children, the mental health of the at-home parent is often a key factor affecting the child's distress level. Parents reporting clinically significant stress are more likely to have children identified as "high risk" for psychological and behavioral problems”, (2010, Para 5). Children with pre-existing mental/emotional problems are at greater risk in the process of a parent deploying to have incidents surrounding both issues now.
Several factors are taken into consideration when attempting to research a topic like this for one most people would consider the situation complicated; however, what is not recognized is the inner workings of the change that can take place in the dynamics of the family and how all members of the family are gravely affected. Jerry Curtis a retired Navy Officer writes, “On the other hand…ask any former “Army brat,” to find out whether there is an upside to one-parent absence. Children of military families tend to mature earlier in the face of challenges not normally experienced by other children. They have to be, and are, more independent and resourceful and cope better with transitory friendships. They discover the true strength of family lifeand quickly learn how to tap into the resources of their larger military family”, (2009, Para 9). I was pleased to see that there is an upside to all of this and that when the children get older, they will appreciate what their deployed parent did for their country.
Duckworth (2009) a lieutenant in the US Army during the ongoing efforts in Afghanistan and Iraq reported that balancing a workload while in service and supporting a family is not easy. Most often individuals join the service to expand a brighter future for their country and consequently their families; but in most cases fail to realize the high deployment rates and end up feeling as if they may have gotten in over their heads, (Para 2). Soldiers need to be alert and focused on what they are doing and the strategy of knowing when they can relax and think about their families and write letters home is difficult at best.
Presently there are three counseling theories that are particularly effective in the treatment of PTSD in Veterans Cognitive Behavior Therapy, which includes techniques, designed to manage anxiety. Such as relaxation training, stress inoculation training, cognitive restructuring, breathing retraining, biofeedback, social skills training, and distraction techniques (Fairbank, De Good, & Jenkins, 1981; Foa, et al., 1995; Hyer, 1994; Muse, 1986)”, (Bayse, G. 1998 Para 5). Cohen describes problems associated with PTSD by stating, “From a Gestalt therapy perspective, PTSD characteristics may be viewed as indications of "unfinished business.” Specifically, because of the indicated symptoms of the trauma that seem to demonstrate the following:
An attempt to assimilate an experience that is not assailable. Repeated unsuccessful attempts in completion of the cycle of experience. Dissatisfaction with one's responses to the unusual circumstances. An existential reminder of one's mortality. This author continues to suggest that Gestalt therapy could be used to assist the client in coping with their disorder and how they can strive to achieve to have a better quality of life. “Therapy should focus, first, on enabling the client to turn away from the traumatic figure (perhaps the memory of a loved one, addiction, or the concept of invulnerability). In the second stage, therapy should guide the client gradually through the process of assimilation in which emotions could be discharged at a proper pace simultaneously with the development of a proper repertoire for energy draining. Working through the third stage, encountering the void, is most difficult, but when completed, leads to acknowledgement of the emergence of something new about the self. Thus, according to Mel nick and Nevis, after successful therapy, the client will not only be symptom free, but will also acknowledge a gain from the traumatic experience,” (Cohen, A. 2002). The focus of this therapy is to allow the client to go through the traumatic events in these stages so that he/she can learn to live life in the here and now without fear or isolation.
Using a Psychopharmacology approach to treatment is also very useful and according to Korn, M (2002) “Numerous psychopharmacological treatment interventions have been tried in patients with PTSD, including tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, and mood stabilizers. Although all have been effective to some degree, the SSRIs may be particularly effective and only paroxetine and sertraline are FDA approved for the use in this disorder. Frank and colleagues demonstrated that both imipramine and phenelzine decreased symptoms of PTSD; however, the difficulties in utilizing these agents as well as their inferior safety profile limit their utility. Connor and colleagues demonstrated that fluoxetine was superior to placebo in a civilian population. Fluoxetine was helpful in alleviating many symptoms associated with PTSD, including emotional numbing, intrusive thoughts, hyper arousal, and avoidance. This indicates that this medication is going beyond the alleviation of one’s anxiety and depression; which are associated symptoms frequently present in this disorder”, (P 7 Para 1&2).
Module 7 Assignment 2 Psy492
The Effects of Military Deployments in Children and Families and the Development <br />Of Post Traumatic Stress Disorder<br />Module 7 Assignment 2PSY 492 Advanced General PsychologyBy Diane Garcia-BeckerAugust 14, 2011<br />
Children and Separation during Deployment<br />Even with the greatest laid plans and a cheerful demeanor, parents cannot always prevent their children from experiencing stress when they are called to duty. The following are signs of separation anxiety that children may exhibit when their parent is away. <br />Preschool or Kindergarten Age Children <br /><ul><li>“Clinging to people or favorite toy or blanket.
Loss of interest in usual interests and hobbies”.</li></ul>Military News, 2011<br /><ul><li>Children going through deployment may experience many of the same effects as children of divorce. Children can also feel a sense of loss or abandonment when a parent leaves them during a deployment.
They may not fully understand why Dad or Mom is gone and they may worry about their safety.
They can also be very perceptive to what the parent at home is feeling. These fears may consciously or subconsciously trouble children.
Helping any child emotionally prior to a deployment or any extended separation during service can help them cope. </li></li></ul><li>Coping with Military Deployment<br /><ul><li>Coping with the stresses and trauma of separation is something that all military families must learn to deal with. However, when there is a deployment to a combat situation, fears and concerns become heightened. Social support is extremely important and is highly recommended.
The effects of war can extend far beyond the deployed service member. Children and families can struggle with changes resulting from an absent parent or spouse. Families can also face problems when the absent service member returns.
It is also important for adults to learn to cope as well as helping kids to cope during a loved one’s deployment. A positive attitude is good. Keeping busy is good. Children end up picking that positive energy up, and they will recognize that they do not have to hold back on joy just because their parent is away.</li></ul> How Adults Can Manage Their Anxiety<br />There are things adults can do to manage their own fears and anxiety about their loved one’s deployment. <br />Suggested activities include: <br /><ul><li>“exercise (to “burn off” some of that anxiety and get your endorphins flowing.)
talk to at least one other adult face-to-face every day. involve yourself in the Family Resource Group if you are near a base.
be sure to make at least one friend who also has a deployed loved one – those not in the military may not understand.
try to remember other times that were tough, but that you got through.
information is important for most people; know whom to contact in the military if you do not hear from your loved one for a much longer than usual period of time” (A place of your own, 2007). </li></li></ul><li>Seeking support when needed<br /><ul><li>When stress becomes overwhelming, don't be afraid to seek professional help. Ongoing difficulties such as exhaustion, apathy, worry, sleeplessness, bad dreams, irritability, or anger-outbursts need the attention of a professional counselor.
Military outreach programs are resources that can help families prevent social isolation. Interventions for military families are especially important for younger families and those without a prior history of deployments. </li></ul>Tips for family members to cope with deployment<br />Remind yourself that even though you hear regularly about deaths in the military, the vast majority of deployed troops are not harmed. <br />Keep up routines. Try to stick to everyday routines. Familiar habits can be very comforting. <br />Take time out for fun. Don't forget to do things that feel good to you. Take a walk, spend time with your pets, or play a game you enjoy. <br />Take time to listen to each other. <br />Emotions such as fear, anger, and feeling "numb" are normal and common reactions to stress. Family members need to make sure these emotions aren't turned against one another in frustration. It will help you to manage tension if you share feelings, recognize that they are normal, and realize that most family members feel the same way. <br />Limit watching news media programs. Families should minimize TV, radio and web exposure related to the war. News often uses fearful content and images to create a "story." <br />
Deployed military women also undergo the same experiences of saying goodbye to their children and their spouse for extended periods of time.<br />Upon returning from serving, women can find themselves without the same support network that male soldiers rely on. While men returning from service may have wives to help them readjust to civilian life, women returning may find that they must immediately become responsible for the family once againand sometimes with limited help from friends and family……<br />In families where the mother is the primary caretaker of the children, it can be especially difficult to leave their children behind . A study conducted in female veterans of Operation Desert Storm, who had children reported higher rates of emotional problems and mental illness in their children. They also experienced a greater decrease in their quality of life after deployment than males or women serving without children. The children of these moms in service also showed higher levels of emotional disturbance during her absence(Women Veterans of America, 2011).<br />
State of Affairs of Female Veterans<br /><ul><li> Women make up 20% of today's military
11% of the combat force in Iraq and Afghanistan are female (roughly 212,000 troops)
30,000 Single Mothers have deployed to Iraq and Afghanistan as of March 2009
In 2008, 2,908 sexual assaults were reports involving service members (9% increase from 2007); Alarmingly, its estimated that more than half of the assaults go unreported
As of September 2009, the Department of Veteran Affairs estimated 13,100 homeless female veterans; Women Veterans are up to 4 times more likely to be homeless than non-veteran women
23% of female Veterans have children under 18 years old </li></ul>According to a 2008 study by the RAND Corporation, women develop Post Traumatic Stress Disorder (PTSD) and/or Depression as a result of traumatic experiences at more than twice the rate of men. <br />
Potential Research <br />Some of the questions I would ask, that might benefit the research, are:<br />How do we know that babies are not as effected as older children, is it because they can not verbalize their angst? When it is the mother that deploys would the baby be in danger of shutting down in a way because the first person they bonded with is suddenly not there? Could there be a chance for that baby to become a failure to thrive baby? I believe that when we say that babies are not as affected, we need to dig a little deeper on that part of the research, which would serve to give a better and more accurate report.<br />Asking researchers to describe in depth, the trouble that servicewomen have being separated from their families and what strategies they should use to cope and how they should apply those skills to continue to perform their tasks.<br />Are there support groups in the military for families of deployed soldiers? If so, why is this information not highly publicized? This gentle probing question might prompt the researchers to follow-up with providing information to families who are unaware of this resource.<br />
Post traumatic Stress Disorder <br />What is post-traumatic stress disorder?<br />Post-traumatic stress disorder (PTSD) is an anxiety disorder that can occur after someone experiences a traumatic event that caused intense fear, helplessness, or horror. PTSD can result from personally experienced traumas (e.g., rape, war, natural disasters, abuse, serious accidents, and captivity) or from the witnessing or learning of a violent or tragic event.<br />How common is post-traumatic stress disorder<br />“Veterans are perhaps the people most often associated with PTSD, or what was once referred to as "shell shock" or "battle fatigue." The Anxiety Disorders Association of America notes that an estimated 15 percent to 30 percent of the 3.5 million men and women who served in Vietnam have suffered from PTSD” (NAMI, 2003).<br />
Effects of PTSD<br /> “ What are the most common relationship problems for people with PTSD?<br />PTSD can affect how couples get along with each other. It can also affect the mental health of partners. In general, PTSD can have a negative effect on the whole family.<br />Male Veterans with PTSD are more likely to report the following problems than Veterans without PTSD:<br />marriage or relationship problems<br />parenting problems<br />poor family functioning”<br /> (US Department of Veteran Affairs, 2011)<br /><ul><li> PTSD can make somebody hard to be with. Living with someone who is easily startled, has nightmares, and often avoids social situations can take a toll on the most caring family. Early research on PTSD has shown the harmful impact of PTSD on families.
PTSD has a negative effect on families of service members because those suffering with PTSD have a hard time feeling emotions. They may feel detached from others. This can cause problems in personal relationships, and may even lead to behavior problems in their children. The numbing and avoidance that occurs with PTSD is linked with lower satisfaction in parenting.</li></li></ul><li>PTSD and Brain Structures<br />
Medications<br />Selective Serotonin Reuptake Inhibitors (SSRI's)<br />The medications mentioned below are the only FDA approved medications for PTSD . <br />SSRIs primarily affect the neurotransmitter serotonin which is important in regulating mood, anxiety, appetite, and sleep and other bodily functions. <br />Examples of the SSRI's and some typical dosage ranges are: <br />sertraline (Zoloft) 50 mg to 200 mg daily<br />citalopram (Celexa) 20 mg to 60 mg daily<br />paroxetine (Paxil) 20 to 60 mg daily<br />fluoxetine (Prozac) 20 mg to 60 mg daily<br /> Other Newer Antidepressants for PTSD<br />ulmirtazapine (Remeron) 7.5 mg to 45 mg daily<br />venlafaxine (Effexor) 75 mg to 300 mg daily <br />nefazodone (Serzone) 200 mg to 600 mg daily<br /> Every patient varies in their response and ability to tolerate a specific medication and dosage, so medications must be tailored to individual needs. <br />Research has suggested that maximum benefit from SSRI treatment depends upon adequate dosages and duration of treatment. Treatment adherence is key to successful pharmacotherapy treatment for PTSD. <br />Mood Stabilizers for PTSD<br />Carbamazepine (Tegretol), Divalproex (Depakote), Lamotrigine (Lamictal).<br />Atypical Antipsychotics for PTSD<br />While originally developed for patients with a psychotic disorder, this class of medications is being applied to patients with many other psychiatric disorders including PTSD. They act primarily on the dopaminergic and serotonergic systems and are being used in PTSD for improving hyper arousal and re-experiencing symptoms. <br />Olanzapine (Zyprexa) <br />Risperidone (Risperdal) <br />Other Medications for PTSD<br />Prazosin (Minipress) <br />Tricyclic Antidepressants (such as Imipramine) <br />Monoamine Oxidase Inhibitors (MAOI's) (such as Phenelzine) <br />
References<br />Angeli, E., Wagner, J., Lawrick, E., Moore, K., Anderson, M., Soderland, L., & Brizee, A. (2011, April 19). General Format. Retrieved from http://owl.english.purdue.edu/owl/resource/560/01/<br />Bayse, Gregory (1998) Treatment of PTSD. This is a student produced page of the Department of Psychology at Houghton College, Retrieved August 6, 2011, from http://campus.houghton.edu/orgs/psychology/ptsd/treatment.htm.<br />Burns, Rachel M. Chandra, Anita. Jaycox, Lisa. Scott, Molly, (2008), Understanding the Impact of Deployment on Children and Families, Retrieved July 08, 2011 from http://www.rand.org/pubs/working_papers/2008. <br />Curtis, Jerry (2002-2010). The Effects of Deployment on Military Children, Retrieved July 092011, from http://www.helium.com/items/1731966-the-effects-of-deployment-on-military-children.<br />Cohen, A. (2002). Gestalt Therapy and Post Traumatic Stress Disorder: The Potential and its (lack of) Fulfillment. Gestalt vol.6 No.1, retrieved August 10, 2011, from http://www.g-gej.org/6-1/gestaltptsd.html.<br />Department of Veterans Affairs. (2009).How Deployment Stress Affects Children and Families: Research Findings, Retrieved July 09, 2011, from http://www.ptsd.va.gov/professional/pages/pro_deployment_stress_children.asp.<br />Duckworth, Darrel Colonel Lieutenant (2009), Affects of Multiple Deployments on Families, Retrieved July 09, 2011, from http://www.dtic.mil/cgi-bin/GetTRDoc?Location=U2&doc=GetTRDoc.pdf&AD=ADA498029.<br /> Fairbank, J.A., DeGood, D.E., & Jenkins, C.W. (1981). Behavioral treatment of a persistent post-traumatic startle response. Journal of Behavior Therapy and Experimental Psychology, 12, 321-324. http://www.nacbt.org/whatiscbt.htm<br />Frank JB, Kosten TR, Giller EL Jr, Dan E. A randomized clinical trial of phenelzine and imipramine for posttraumatic stress disorder. Am J Psychiatry. 1988; 145:1289-1291.<br />Korn, M. (2002) Recent Developments in the Science and Treatment of PTSD from Medscape .P 4 Para 1&2, retrieved August 10, 2011, from http://www.medscape.org/viewarticle/436398<br />Mel nick, J. & Nevis, S. M. (1992). Diagnosis: The struggle for a meaningful paradigm. In E. C. Nevis (Ed.), Gestalt Therapy. New York: Gardner Press<br />