I appreciated Bonnie’s help so much in my life. My marriage was obviously in a very rough spot and [my wife] and I were able to work through it with her help…Thanks to Bonnie for taking the time to listen, to allow me to give lengthy answers and to not judge regardless of the topic. I can truly say that our marriage is stronger because of her and her dedication to my family. Thank you.
MajorUnited States Army

Post-Traumatic Stress Disorder
Approved Therapies for PTSD
Traumatic Brain Injury
Couples Counseling

PTSD

If you are on active duty, you don’t need research reports to tell you what you already know. Multiple deployments and a war in Afghanistan that has lasted over 10 years continue to affect the psychological health and well-being of military service members. The signature injuries of OEF/OIF/OND are post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI)‚ both of which can lead to depression, increased substance use, decreased sleep, and strained relationships. In many ways, these issues are even more critical for those who were recently released from active duty and therefore no longer have the support and structure of the military environment.

The 2008 Rand Report ‚ “Invisible Wounds of War, Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery‚” finds that about a third of service members who have deployed report ongoing symptoms of PTSD, TBI, or depression.

These conditions lead to a higher risk of unhealthy behaviors (smoking, drinking, physical health problems, and cyber addictions such as gaming, gambling, and pornography). Those behaviors affect marriage and other relationships and potentially weaken parenting abilities.

The report recommends that you have access to confidential, evidence-based treatment.

I offer Veterans Administration endorsed treatments for PTSD, TBI, and associated life problems. Appropriate treatment gives you, and your family, your lives back. You can return to being successful on the job and in your life.

Three clusters of symptoms characterize PTSD:

  • Re-experiencing
  • Avoidance
  • Arousal

Re-experiencing the trauma in dreams, flashbacks, and intrusive thoughts is the most commonly known symptom, but far from the most disruptive. Avoiding thoughts, feelings, activities, people, and places associated with the trauma can lead to isolation. Increased physiological arousal (heart racing, hyperventilating) impairs sleep and concentration, increases irritability and anger, and leads to hyper-vigilance and an increased startle response, all of which can lead to even more isolation, including from those who are closest. The cumulative effect is a destructive spiral of separation that neither creates or allows openings to change, much less cures.

Approved Therapies for PTSD

The Veterans Administration endorses two research-supported therapies: Prolonged Exposure Therapy (PE) and Cognitive Processing Therapy (CPT). Both are categorized as exposure therapies because they expose the individual to the events related to the trauma in different ways that help rewire reactions to them.

Prolonged Exposure Therapy helps trauma survivors emotionally process their trauma experiences to diminish PTSD and other trauma related symptoms. PE includes:

  • Education about common reactions to trauma
  • Breathing retraining
  • Repeated real-life exposure to situations that are avoided
  • Repeated imaginal (revisiting and recounting the trauma memory in imagery) exposure

Through repeated exposure and learning tools to manage physiological arousal, the individual learns that memories of the trauma and situations associated with the trauma are not the same as the trauma itself. Anxiety and distress decrease over time, allowing individuals to reclaim their lives. PE has been found to be particularly effective when the predominant PTSD symptom is fear.

Cognitive Processing Therapy views PTSD as a problem of recovery that occurs when individuals get “stuck” in habitual ways of thinking about the trauma and how it affects their lives. The way we think about events directly affects how we feel and act. CPT offers new ways to handle distressing thoughts and gain a new understanding of the events. There are four main components to CPT:

  • Education about PTSD symptoms and how treatment can help
  • Awareness of thoughts, feelings, and beliefs about the event
  • Learning how to question and challenge distressing thoughts and beliefs
  • Understanding trauma-related changes in beliefs about safety, trust, control, self-esteem, and intimacy


CPT has been found to be particularly effective when the predominant PTSD symptoms are guilt (e.g., survivor guilt) and shame (e.g., “If only I had”).

Traumatic Brain Injury

Traumatic brain injury (TBI) is a blow or jolt to the head that disrupts brain function in some way. Not all blows or jolts to the head result in a TBI. Common causes of TBI in the military are blast exposures, falls, motor vehicle accidents, blunt or penetrating force from bullets or blast fragments. TBI is classified as penetrating or non-penetrating, and its severity is determined at the time of injury as mild, moderate, severe.

Concussion is another word for mild TBI and is the most common form of TBI in the military. Concussion results from a head injury that briefly “knocks you out” or makes you feel confused or “see stars.” It is not necessary to lose consciousness to have a concussion. Any alteration in consciousness as a result of a blow or jolt to the head is a concussion, even though it may not be obvious at the time. Mild TBI may affect physical, emotional, and cognitive abilities including:

  • Physical: headache, sleep disruption, fatigue, dizziness, nausea, light sensitivity
  • Cognitive: slow thinking, poor attention and concentration, memory problems
  • Emotional: anxiety, depression, irritability

Recovery is different for every person and injury. The key point is that recovery is not only possible, with honest participation in the right program, it’s a near certainty. Most people can expect to recover fully and return to duty or full participation in civilian life. Symptoms typically improve within hours to days and resolve completely within weeks.

Couples Counseling

Couples counseling is an important component in recovery from PTSD, TBI, and the prolonged periods of separation during deployments. When spouses understand the symptoms and what to expect during recovery, they can participate fully in creating a healing environment. Even in the most successful marriages, 70% of the ongoing areas of disagreement are never fully resolved. Happy and successful couples learn how to have ongoing conversations about their disagreements. Using research and evidence-based treatment endorsed by the Veterans Administration, I help military service members and their partners develop relationships that survive and thrive. Integrative Behavioral Couple Therapy (IBCT) has been shown to be particularly effective for OEF/OIF/OND veterans and their partners. Using the DEEP (Differences, Emotional sensitivities, External stressors, Patterns of interaction) formulation we analyze relationship problems like trust, money, depression to achieve the goals of ICBT:

  • Acceptance for differences and emotional sensitivities of each person
  • Acceptance and change for external stressors affecting the relationship
  • Change in patterns of problematic interaction between the partners

The outcome of this approach to working with couples is a more accepting and adaptive relationship based on each person’s “psychological reality.” Seeking help early can prevent patterns of communication from becoming entrenched. For those already “in the trenches,” counseling can improve communication with spouse, children, family, and friends.

Military Information and Resources

Center for Deployment Psychology  training for military and civilian behavioral health providers as well as education on a range of deployment related issues including depression, post traumatic stress disorder (PTSD), mild traumatic brain injury (mTBI), suicide in the military, and sexual assault in the military.

Defense and Veterans Brain Injury Center  educational materials on TBI and resources for service members, veterans, and the family members and caregivers of those who have sustained a TBI.

Deployment Health Clinical Center  offers information for veterans and their families on VA benefits, TRICARE, military service members making the transition to civilian life, and employment assistance.

National Center for Post Traumatic Stress Disorder

 

National Center for Telehealth & Technology (T2) leads the development of telehealth and technology solutions for psychological health and TBI. Their goal is to identify, treat, and minimize or eliminate the adverse effects of TBI and mental health conditions associated with military service. They have developed some great smart phone mobile apps including: PTSD Coach for individuals experiencing symptoms of PTSD, Breathe2Relax which is a portable stress management tool, and T2 Mood Tracker which allows users to self-monitor and track their emotional experiences over days, weeks, and months.

Veterans Administration web site offers information about benefits and services available to veterans including health care information. There is also information for caregivers of veterans who are unable to fully care for themselves.

TRICARE is the health care program for uniformed service members, their families, retirees and their families, and service members and veterans in the Wounded Warriors program.

Wounded Warriors Project . Each branch of the military has its own Wounded Warrior Program for individuals who have been injured in service to their country and who are transitioning out of active duty military. The Wounded Warrior Project is a non-profit organization whose purpose is to help injured service members to aid and assist one another through direct programs and services to meet their needs.

Links for Counseling and Support Services

Military One Source offers a range of information, resources, and services for active duty military and their families including no cost counseling.

Give an Hour offers free mental health services to U.S. military personnel and families affected by the current conflicts in Afghanistan and Iraq. 

Coming Home Project offers no cost support, education, and stress management to OEF/OIF/OND veterans, service members, and their families.