Вы находитесь на странице: 1из 34

qwertyuiopasdfghjklzxcvbnmqw

ertyuiopasdfghjklzxcvbnmqwert
yuiopasdfghjklzxcvbnmqwertyui
opasdfghjklzxcvbnmqwertyuiopa
PTSD Final Proposal
Todd Switzer
sdfghjklzxcvbnmqwertyuiopasdf
ghjklzxcvbnmqwertyuiopasdfghj
klzxcvbnmqwertyuiopasdfghjklzx
cvbnmqwertyuiopasdfghjklzxcvb
nmqwertyuiopasdfghjklzxcvbnm
qwertyuiopasdfghjklzxcvbnmqw
ertyuiopasdfghjklzxcvbnmqwert
yuiopasdfghjklzxcvbnmqwertyui
opasdfghjklzxcvbnmqwertyuiopa
sdfghjklzxcvbnmqwertyuiopasdf
ghjklzxcvbnmqwertyuiopasdfghj
klzxcvbnmqwertyuiopasdfghjklzx

Chapter 1- Outline

Todd Switzer

Introduction:
My topic is on Post Traumatic Stress Disorder (PTSD) and the effects it has on Veterans.
My biggest concern is wondering if veterans are receiving the care they need, and the effects of
these treatments on them to treat PTSD. Also, PTSD is defined as a mental health condition that's
triggered by a terrifying event (Chamberlin, Sheena, 2012). Symptoms may include flashbacks,
nightmares and severe anxiety, as well as uncontrollable thoughts about the event (Chamberlin,
Sheena, 2012). I chose to focus on Veterans because I have several in my family and I was raised
to respect and honor our heroes. Overall the number one mental health concern for Veterans is
PTSD based on the multiple stress accumulated on veterans during their time overseas.
Additionally, PTSD has been around as long as humans have been around, traumatic and
terrifying events happen every day to someone in the world. I was curious as to how medical
professionals treat such a broad and big mental health issue in todays society.
Furthermore, my research will be conducted on Veterans in the Northeastern
Pennsylvania area who receive treatment at Wilkes-Barre VA Hospital. I plan to do a survey that
will focus on the veterans age, gender, wars fought in , branch of military, time in the military
when first PTSD symptoms occurred, treatment being received, symptoms, and if there is
something missing you wish to be added in your treatment plan. PTSD was not diagnosed as a
mental health concern until after the Vietnam War (Chamberlin, Sheena, 2012). Before the war
many Veterans suffered from PTSD but were simply told it was a side effect of war. They
referred to this as Shell Shock before PTSD was diagnosed. World War I & II Veterans never
received treatment for PTSD because it was not considered a medical issue during this era.

PTSD can lead to many negative health issues and if not diagnosed the Veteran will be unable to
receive the care needed. Among the highest outcomes of PTSD would be sleep deprivation,
alcohol or substance abuse, depression, nightmares, social discomfort, uncontrollable stress,
aggressive outbursts, and sometimes suicide. PTSD not only affects the entire family but also
society as well.
Furthermore, this research is very important because many Veterans commit suicide each
year and could be prevented if they received help. The military rate of suicide is 22 per 100,000
and now exceeds the general population of the United States which is 18 per 100,000 (Lee,
2012). In my opinion every Veteran returning home from overseas should be screened for
PTSD. The treatment for PTSD is very broad and treatment is very different for each individual.
We see PTSD in movies and on television shows with war heroes returning home to their
families, having a hard time returning back to society. After a traumatic event has happened it
scars the individual, and healing that scare is something we need to do a better job at here in the
United States.
Also creating more awareness and how you can assist a loved one who is seeking medical
assistance may save his/her life. Suicide prevention hotlines are a big part of VA hospitals
protocol and are handled very professionally. They also offer many social groups where Veterans
meet and talk about their issues when returning to society and the scars suffered overseas. I want
to gather research from Veterans first hand to help access the care they are being offered, and
look at what they feel would benefit them further if it was offered to them.
Statement of the Problem

Research is very important in this area because PTSD is a newer medical illness. There
are many people who suffer from PTSD who receive little to no help. The side effects for
someone who has PTSD are never good and in most cases cause more damage than already has
been done. Awareness and social groups should be given to any Veteran returning home in need
of anything for physical, emotional, or social injury. Treatment may be different for every patient
so more research and possible treatment options should be the primary goal for this illness.
Purpose of the Study:
The purpose of this research is to gather first-hand information on the care being
provided to Veterans who suffer from PTSD. I plan to do a survey and distribute to as many
Veterans as I can at the Wilkes-Barre VA Hospital to get their perspective regarding the care
being provided to them. I would like to see if age plays a factor as well. It is apparent to me that
PTSD was not diagnosed until after the Vietnam War. If you have Veterans from that war and
young Veterans coming home from Iraq, I wander if they receive the same care. The older
generation of Veterans who have PTSD never received care until much later, while Veterans
today are receiving care a lot quicker due to all the awareness.
Research Question:
What are the effects of PTSD on veterans, and the attendant care required?
Sub Question 1: What is Post-Traumatic Stress Disorder?
Sub Question 2: What symptoms are associated with PTSD?
Sub Question 3: What are the advantages of receiving care for PTSD?
Sub Question 4: What funding is being done on research for PTSD/ quality
of care?

Sub Question 5: What are the changes observed in patients who receive care?

Null Hypothesis:
There is no difference between early treatment, attendant care, and symptom
improvement in veterans
Hypothesis:
Are there enough veterans being treated early enough when symptoms first occur and do
their symptoms improve after care is given? Are health professionals observing the signs early
enough when caring for veterans with PTSD? Are the symptoms broadcasted well enough as to
anyone can access them? Are there examples of veterans who received care posted for others to
observe? Are there increases in funding for PTSD now that awareness is so high?
Definition of Terms:
Post-Traumatic Stress Disorder- Post-traumatic stress disorder (PTSD) is a debilitating anxiety
disorder that occurs after experiencing or witnessing a traumatic event that involves either a real
or perceived threat of injury or death. This can include a natural disaster, combat, an assault,
physical or sexual abuse, or other trauma ("Dictionary,).
Flash Backs
-recurrent and abnormally vivid recollection of a traumatic experience, as a battle, sometimes
accompanied by hallucinations ("Dictionary,).

Shell ShockAlso called: combat neurosis, loss of sight, memory, etc, resulting from psychological strain dur
ing prolonged engagement in warfare ("Dictionary,).
Stress- the physical pressure, pull, or other force exerted on one thing by another; strain
("Dictionary,)

Sleep Deprivationthe condition of being robbed of sleep, in real life or in experiment, as opposed to being
unable to sleep ("Dictionary,).
Substance AbuseLongterm, pathological use of alcohol or drugs, characterized by daily intoxication, inability to r
educeconsumption, and impairment in social or occupational functioning; broadly, alcohol or dru
g addiction ("Dictionary," ).
Depression-A condition of general emotional dejection and withdrawal; sadness greater and mor
e prolonged than that warranted by any objective reason ("Dictionary,).
DelimitationsResearch will be conducted on Veterans who receive care through the Wilkes-Barre VA
hospital only. Male or Female Veterans are both welcome. Veterans must be diagnosed with
PTSD to take the survey. The more age fluctuations the better so I get data from Veterans from
many different wars and time periods. They must be eighteen years or older, and they are
required to be eighteen before being able to join the military. Any branch of the military is
welcome.

Limitations
Only give survey to Veterans who are in the VA hospital receiving care so not just anyone
on the street is filling out the survey which could jeopardize the data. Veterans are usually
respectable so lying about answers is usually not the case but some may not list all the symptoms
they are suffering from out of toughness. Patients may not take the survey seriously and just
write down random responses.
AssumptionsI assume the Veterans who take this survey to fill it out with honesty and show genuine
care for the data I am collecting, and dont try to hide certain symptoms or treatments that may
be false. I expect every Veteran to list one thing they believe should be added into their care to
help treat PTSD. This may spread the awareness of each Veterans opinion to share with many in
the hope to help hopefully some Veterans needing assistance.
Significance of StudyThe research will help generate knowledge and awareness: Knowledge in the sense that
we should always be adding possible care outcomes to patients. Each patients care is different
for PTSD, so providing numerous treatment options will help provide the highest level of care
for all veterans. I anticipate this research also helps Veterans get tested for PTSD when
symptoms are low before they escalate quickly. The research will also allow me to assess and
view events from a Veterans point of view rather than a medical professionals point of view.
This will also help structure PTSD in several different eras through several different branches of
the military.

References
1. Chamberlin, E., & Sheena, M. (2012). Emasculated by trauma: A social history of

Post-traumatic stress disorder, stigma, and masculinity. Journal of American

Culture, 35(4), 358-365. Retrieved from

http://search.ebscohost.com

2.

Lee, E. A. (2012). Complex contribution of combat-related post-traumatic stress disorder


to veteran suicide: Facing an increasing challenge. Perspectives in Psychiatric
Care, 48(2), 108-115. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=73930131&site=ehost-live

Chapter 2
Research Question: What are the effects of PTSD on veterans, and the attendant care required?
Hypothesis: Is there enough veterans being treated early enough when symptoms first occur and
do their symptoms improve after care is given.

Prediction: A greater awareness for those coming home that require medical, social, and
financial support for their PTSD symptoms. With the numerous wars more men/women are
returning home with PTSD symptoms and are they receiving the care they need as well as follow
up care.

Introduction
Post-Traumatic Stress Disorder
History and the beginning of PTSD
3. Chamberlin, E., & Sheena, M. (2012). Emasculated by trauma: A social history of

Post-traumatic stress disorder, stigma, and masculinity. Journal of American

Culture, 35(4), 358-365. Retrieved from

http://search.ebscohost.com

The article discusses the history of post-traumatic stress disorder (PTSD) and similar traumainduced nervous disorders in the context of U.S. social history. It is said that military physicians
gradually changed their views of the masculinity of soldiers in light of the phenomenon
sometimes called shell shock and combat fatigue. The author notes the high incidence of PTSD
among U.S. soldiers deployed in Operation Enduring Freedom (OEF) and Operation Iraqi
Freedom (OIF). In this context, PTSD has purportedly been medicalized.

10

2. Kolk, B., &Najavits, L. M. (2013). Interview: What is PTSD really? Surprises, twists of
history, and the politics of diagnosis and treatment. Journal of Clinical Psychology, 69(5), 516522. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=86980700&site=ehost-live

The article presents a discussion about the psychological disorder post-traumatic stress disorder
(PTSD), particularly commenting on issues of diagnosis and treatment. It addresses the
diagnostic criteria of PTSD as recognized by the Diagnostic and Statistical Manual for Mental
Disorders (DSM), the political connotations of PTSD due to the frequency of veterans presenting
with symptoms, and the social aspects of PTSD.

3. Hayman, P. M., Sommers-Flanagan, R., & Parsons, J. P. (1987). Aftermath of violence:


Posttraumatic stress disorder among Vietnam veterans. Journal of Counseling &
Development, 65(7), 363. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=4979270&site=ehost-live

Posttraumatic stress disorder (PSTD) frequently occurs in the aftermath of violence. A


comprehensive four-phase treatment approach for Vietnam veterans with PTSD is presented.
Phase in the recovery process are assessment, stabilization of symptoms, working through the
trauma, and reintegration into the family and society. A second purpose of the article is to
describe the Vet Center Outreach Program. This program was established in 1979 by the Veterans
Administration to meet the mental health needs of the heretofore poorly served Vietnam veteran
population

Signs and Symptoms

11
1. Hart, R.H. (2003). A Face of War: PTSD. The Psychiatric times.Vol.06-Section: 01;
Pgs: 20:50. Retrieved from: http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=10054516&site=ehost-live

A Background story about a veteran who suffered from PTSD. Irish Tom" was the
first war veteran I knew who suffered from shell shock. I met him in December 1939
when I was 10 years old, and although I never saw him again after 1942, I can still
picture him in my mind. He was a tall, lean-fleshed man who appeared old in years
for someone in his 40s. His hands shook, his voice was tremulous, and there was a
distant look in his eyes as though he were somewhere else. "A casualty of the Great
War," was what adults said about him in whispering tones. One of the first to suffer
from shell shock, which was PTSD before its classification.

How it affects- Suicide/ family


1. Lee, E. A. (2012). Complex contribution of combat-related post-traumatic stress disorder to
veteran suicide: Facing an increasing challenge. Perspectives in Psychiatric Care, 48(2), 108115. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=73930131&site=ehost-live

The purpose of this case study is to present the complex contribution of combat-related posttraumatic stress disorder (PTSD) to suicide and international standards of treatment among
veterans deployed to the Middle East. CONCLUSIONS: PTSD carries increased physical and
psychological health risk in combat soldiers. Internationally, guidelines for PTSD promote
cognitive behavior therapies, specifically exposure therapy, as first line treatment; however,
implementation varies among countries. PRACTICE IMPLICATIONS: Evidence supports the
benefit of exposure-based psychotherapy for combat-related PTSD. Commonly prescribed
antidepressants and other psychotherapy treatments may not be as beneficial.

12

4. Haley, S. A. (1985). Some of my best friends are dead: Treatment of the posttraumatic
Stress disorder patient and his family. Family Systems Medicine, 3(1),
17-26. Retrieved from: http://search.ebscohost.com

Presents a brief historical review of combat psychiatry and argues the inadequacy of earlier
psychoanalytic theories to fully appreciate the deforming impact of combat on psychic
structures. The psychotherapy of Vietnam combat veterans poses unusual challenges because
major traumas occur at a developmentally vulnerable time and under conditions of minimal
social support. Difficulties are often triggered by the death of a close friend. The psychotherapist
may be drawn into this chaotic maelstrom and is necessarily at risk. A detailed case report of a
25-yr-old Black married ex-Marine combat veteran illustrates the difficulties of treating
posttraumatic stress disorder.

3. Bullman, T. A. & Kang, H. K. (1996). The risk of suicide among wounded Vietnam
veterans. American Journal of Public Health, 86(5), 662-662... Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=afh&AN=9606201935&site=ehost-live

This study was undertaken to determine whether an association exists between combat trauma
and risk of post service suicide among Vietnam veterans. Methods: Risk of suicide for 34534
veterans who were wounded in Vietnam was evaluated for severity of wound and number of
times wounded. Results: There was a trend of increasing risk of suicide with increased
occurrence of combat trauma, the highest relative risk (1.82, 95% confidence interval [CI] =
1.12, 196) being observed for those veterans who were wounded more than once and
hospitalized for a wound. In comparison with the US male general population, veterans
hospitalized because of a combat wound or wounded more than once had a significantly
increased risk of suicide (standardized mortality ratios [SMRs] of 1.22 [95% CI = 1.00, 1.46] and
1.58 [95% Cl = 1.06, 2.26], respectively). Those wounded more than once and hospitalized had

13

the highest increased risk of suicide (SMR = 1.73, 95% CI = 1.10, 2.60). Conclusions: This study
suggests that, among wounded Vietnam veterans, there is an increased risk for suicide associated
with increased occurrence of combat trauma.

Dates and treatments


1. Gibson, C. (2012). Review of posttraumatic stress disorder and chronic pain: The path to
integrated care. Journal of Rehabilitation Research & Development, 49(6), 753-776. Retrieved
from http://search.ebscohost.com/login.aspx?direct=true&db=afh&AN=79730536&site=ehostlive

With the large number of Veterans experiencing posttraumatic stress disorder (PTSD) and
chronic pain, the purpose of this article is to review the prevalence of PTSD and chronic pain,
the theoretical models that explain the maintenance of both conditions, and the challenges faced
by providers and families who care for these patients. The Department of Veterans Affairs
(VA)/Department of Defense (DOD) VA/DOD Clinical Practice Guideline for Management of
Post-Traumatic Stress with special attention to chronic pain are presented. Limited scientific
evidence supports specific care and treatment of PTSD and chronic pain, and this challenges
providers to investigate and research potential treatment options. Integrated care models
designed for working with these patients are reviewed, including a focus on the techniques and
strategies to address not only PTSD and chronic pain, but other conditions, including substance
dependence and depression. A specific focus on headaches, back pain, and neuropathic pain
follows, including treatment recommendations such as pharmacological, psychotherapeutic, and
complementary approaches, given the high rates of these pain complaints for Veterans in PTSD
clinical programs. Integrated care is presented as a viable solution and approach that challenges
clinicians and researchers to develop innovative, scientifically based therapeutics and treatments
to enhance the recovery and quality of life for Veterans with PTSD and chronic pain.

14

Wars
1. Cifu, D. X., Taylor, B. C., Carne, W. F., Bidelspach, D., Sayer, N. A., Scholten, J., & Hagel
Campbell, E. (2013). Traumatic brain injury, posttraumatic stress disorder, and pain diagnoses in
oif/oef/ondveterans.Journal of Rehabilitation Research & Development, 50(9), 1169-1176.
Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=93923241&site=ehost-live

To identify the prevalence of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD),
and pain in Veterans from Operation Iraqi Freedom/Operation Enduring Freedom/Operation New
Dawn (OIF/OEF/OND), Veterans who received any inpatient or outpatient care from Veterans
Health Administration (VHA) facilities from 2009 to 2011 were studied. A subset of Veterans
was identified who were diagnosed with TBI, PTSD, and/or pain (head, neck, or back) as
determined by their International Classification of Diseases-9th Revision-Clinical Modification
codes. Between fiscal years 2009 and 2011, 613,391 Veterans accessed VHA services at least
once (age: 31.9 +/- 9.6 yr). TBI diagnosis in any 1 year was slightly less than 7%. When data
from 3 years were pooled, 9.6% were diagnosed with TBI, 29.3% were diagnosed with PTSD,
and 40.2% were diagnosed with pain. The full polytrauma triad expression (TBI, PTSD, and
pain) was diagnosed in 6.0%. Results show that increasing numbers of Veterans from
OIF/OEF/OND accessed VHA over a 3 year period. Among those with a TBI diagnosis, the
majority also had a mental health disorder, with approximately half having both PTSD and pain.
While the absolute number of Veterans increased by over 40% from 2009 to 2011, the proportion
of Veterans diagnosed with TBI and the high rate of co morbid PTSD and pain in this population
remained relatively stable.

2. Resnick, H. S., Foy, D. W., Donahoe, C. P., & Miller, E. N. (1989). Antisocial behavior and
post-traumatic stress disorder in Vietnam veterans. Journal of Clinical Psychology, 45(6), 860-

15

866. Retrieved from http://search.ebscohost.com/login.aspx?


direct=true&db=afh&AN=11975774&site=ehost-live

Assessment data from 118 Vietnam-era veterans seeking psychological services at two Los
Angeles Veterans Administration Medical Centers were analyzed to examine the potential
relationships between number of pre-adult and adult antisocial behaviors, as defined in the
Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric
Association, 1980) criteria for antisocial personality disorder, level of combat exposure, and
development of combat-related post-traumatic stress disorder (PTSD). Results of hierarchical
regression analyses indicated that combat exposure level was related significantly to PTSD
symptomatology, whereas number of pre-adult antisocial behaviors was not. However, both
combat exposure level and pre-adult behaviors, which were not correlated significantly, were
related significantly to number of adult antisocial behaviors. There were no significant
interaction effects. Results were consistent with a theoretical model of PTSD development that
emphasizes the role of trauma vs. premorbid character logical factors. In addition, the significant
association between combat exposure and adult antisocial behavior indicates that trauma may
play a role in the development and/or maintenance of adult antisocial behaviors observed in
some Vietnam veterans.

First Veterans diagnosed with PTSD


1. Hyer, L., Woods, M. G., &Boudewyns, P. A. (1989). Early recollections of Vietnam veterans
with PTSD...Individual Psychology: The Journal of Adlerian Theory, Research &
Practice, 45(3), 300. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=9099601&site=ehost-live

16

Investigates the early memories of Vietnam War veterans with posttraumatic stress syndrome in
the U.S. Reflection of less social interest; Pursuance of more negative outcomes and themes;
Victims of excessive or incorrect school discipline. Looks at early memories of veterans with
PTSD and their experiences with PTSD. The first Veterans with PTSD struggled simply because
PTSD was considered just a symptom of war.

Treatment for PTSD


1. Staples, J. K., Hamilton, M. F., &Uddo, M. (2013). A yoga program for the
symptoms of post-traumatic stress disorder in veterans. Military Medicine,
178(8), 854-860. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=89768620&site=ehost-live
The purpose of this pilot study was to evaluate the feasibility and effectiveness of a
yoga program as an adjunctive therapy for improving post-traumatic stress disorder
(PTSD) symptoms in Veterans with military-related PTSD. Veterans (n = 12)
participated in a 6 week yoga intervention held twice a week. There was significant
improvement in PTSD hyper arousal symptoms and overall sleep quality as well as
daytime dysfunction related to sleep. There were no significant improvements in the
total PTSD, anger, or quality of life outcome scores. These results suggest that this
yoga program may be an effective adjunctive therapy for improving hyper arousal
symptoms of PTSD including sleep quality. This study demonstrates that the yoga
program is acceptable, feasible, and that there is good adherence in a Veteran
population.

2. Taft, C. T., Creech, S. K., &Kachadourian, L. (2012). Assessment and treatment


of posttraumatic anger and aggression: A review. Journal of Rehabilitation
Research & Development, 49(6), 777-788. Retrieved from
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=79731022&site=ehost-live
The Department of Veterans Affairs (VA) and Department of Defense's (DOD)
recently published and updated Department of Veterans Affairs/Department of

17
Defense VA/DOD Clinical Practice Guideline for Management of Posttraumatic Stress
includes irritability, severe agitation, and anger as specific symptoms that
frequently co-occur with PTSD. For the first time, the guideline includes nine specific
recommendations for the assessment and treatment of PTSD-related anger,
irritability, and agitation. This article will review the literature on PTSD and its
association with anger and aggression. We highlight explanatory models for these
associations, factors that contribute to the occurrence of anger and aggression in
PTSD, assessment of anger and aggression, and effective anger management
interventions and strategies.

3. Wilk, J. E., West, J. C., Duffy, F. F., Rae, D. S., Hoge, C. W., &Herrell, R. K. (2013).
Use of evidence-based treatment for posttraumatic stress disorder in army
behavioral healthcare. Psychiatry: Interpersonal & Biological Processes, 76(4),
336-348. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=92692412&site=ehost-live
To identify the extent to which evidence-based psychotherapy (EBP) and
psychopharmacologic treatments for posttraumatic stress disorder (PTSD) are
provided to U.S. service members in routine practice, and the degree to which they
are consistent with evidence-based treatment guidelines. Method: We surveyed the
majority of Army behavioral health providers (n = 2,310); surveys were obtained
from 543 (26%). These clinicians reported clinical data on a total sample of 399
service member patients. Of these patients, 110 (28%) had a reported PTSD
diagnosis. Data were weighted to account for sampling design and no responses.
Results: Army providers reported 86% of patients with PTSD received evidencebased psychotherapy (EBP) for PTSD. As formal training hours in EBPs increased,
reported use of EBPs significantly increased. Although EBPs for PTSD were reported
to be widely used, clinicians who deliver EBP frequently reported not adhering to all
core procedures recommended in treatment manuals; less than half reported using
all the manualized core EBP techniques. Conclusions: Further research is necessary
to understand why clinicians modify EBP treatments, and what impact this has on
treatment outcomes. More data regarding the implications for treatment
effectiveness and the role of clinical context, patient preferences, and clinical
decision-making in adapting EBPs could help inform training efforts and the ways
that these treatments may be better adapted for the military.

4. Hyler, L., Woods, M. G., Bruno, R., &Boudewyns, P. (1989). Treatment


outcomes of Vietnam veterans with PTSD and the consistency of the
mcmi. Journal of Clinical Psychology, 45(4), 547-552. Retrieved from
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=11966916&site=ehost-live

18
This study addresses two issues: treatment changes on the MCMI of Vietnam
veterans with PTSD and test-retest reliability of the Million Clinical Multiaxial
Inventory (MCMI). Fifty Vietnam veterans carefully were identified for the diagnosis
Post-Traumatic Stress Disorder (PTSD). They were admitted to a Special PTSD
Treatment Unit that consisted of an intense S-week period with the focus on the
revivified Vietnam experience. They also were given the MCMI at two points in time,
treatment inception and 35 days later at discharge. Results show that 17 of 20
scales on the MCMI changed in the negative direction as a result of treatment. Also,
the MCMI has adequate test-retest reliability, and the personality scales (with the
exception of Borderline) have higher reliability coefficients than do symptom scales.
The use of the MCMI is encouraged both as a monitor of treatment for these
veterans and for its stability.

5. Degun-Mather, M. (2001). The value of hypnosis in the treatment of chronic


PTSD with dissociative fugues in a war veteran. Contemporary
Hypnosis, 18(1), 4-13. Retrieved from :
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=6148789&site=ehost-live
This report describes the successful treatment of a British war veteran who had
chronic post-traumatic stress disorder (PTSD) of 40 years' duration. He had also
developed dissociative fugues during this time. He was finally admitted to a
psychiatric hospital with severe depression and PTSD. After discharge he was
treated by three-phase oriented treatment as follows: Stage 1 stabilization with
psycho-education and a cognitive-behavioral approach with hypnosis; Stage 2 reprocessing of traumatic material by use of a safe-remembering hypnotic method
with cognitive reevaluation of traumatic events to resolve the negative feelings.
Hypnotic dreams also facilitated re-processing. During therapy, the veteran
recovered the memory of one event which was crucial to his therapeutic progress.
Stage 3 included further memory integration and rehabilitation. This was aided by
dream elaboration, both with and without hypnosis. At the end of therapy, the
veteran was virtually symptom-free and was able to regain emotional and social
contact with his family and friends.

6. Marshall, R. P. (1995). A general model for the treatment of post-traumatic


stress disorder in war veterans. Psychotherapy: Theory, Research, Practice,
Training, 32(3), 389-396. Retrieved from:
http://search.ebscohost.com/login.aspx?direct=true&db=pdh&AN=199600405-003&site=ehost-live
Presents a general conceptual model of the recovery processes required for a
successful therapeutic resolution of war-related PTSD. These processes involve

19
relationship building, the development of emotional and cognitive connections with
the trauma, recognition of the divergence between pre- and post-trauma values,
modifying one's sense of self, establishing meaning for the trauma, and
reestablishing appropriate self-management and social skills. The authors
emphasize the importance of the therapistveteran relationship to client
engagement in the recovery process. Case vignettes are included to illustrate
model dynamics.

Associated with PTSD

Flash Backs
1. Russell, S. S. (2013). Veterans' stories: What they may have to tell us - a
personal reflection. Urologic Nursing, 33(2), 92-96. Retrieved from:
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=86861350&site=ehost-live
It has been said that we learn much from war. Not only how to conduct it and to
be successful, but we learn how the body works and how to assist in regaining
function. Without our veterans, much of today's medical knowledge would not be
nearly as complete. We have learned how to care for and celebrate our veterans
when they return from the war. Vietnam veterans can share what it is like to
come home to a country that is not only entirely different, but even antagonistic,
to the veteran as a person. This article will consider the types of homecoming
experiences veterans have encountered while also introducing examples of the
medical knowledge that has been gained from the struggles of those who have
fought, and often died, for our country.

20
Stress
1. Nash, W. P., & Watson, P. J. (2012). Review of VA/DOD clinical practice
guideline on management of acute stress and interventions to prevent
posttraumatic stress disorder. Journal of Rehabilitation Research &
Development., 49(6), 637-648. Retrieved
from:http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=79731016&site=ehost-live
This article summarizes the recommendations of the Department of Veterans
Affairs (VA)/Department of Defense (DOD) VA/DOD Clinical Practice Guideline
for Management of Post-Traumatic Stress that pertain to acute stress and the
prevention of posttraumatic stress disorder, including screening and early
interventions for acute stress states in various settings. Recommended
interventions during the first 4 days after a potentially traumatic event
include attending to safety and basic needs and providing access to physical,
emotional, and social resources. Psychological first aid is recommended for
management of acute stress, while psychological debriefing is discouraged.
Further medical and psychiatric assessment and provision of brief, traumafocused cognitive-behavioral therapy are warranted if clinically significant
distress or functional impairment persists or worsens after 2 days or if the
criteria for a diagnosis of acute stress disorder are met. Follow-up monitoring
and rescreening are endorsed for at least 6 months for everyone who
experiences significant acute posttraumatic stress. Four interventions that
illustrate early intervention principles contained in the VA/DOD Clinical
Practice Guideline are described.

Sleep Depravation
1. Lewis, V., Creamer, M., &Failla, S. (2009). Is poor sleep in veterans a function
of post-traumatic stress disorder? Military Medicine, 174(9), 948-951.
Retrieved from:http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=44204038&site=ehost-live
Substantial research has demonstrated an association between posttraumatic stress disorder (PTSD) and quality of sleep, particularly in veteran
populations. The exact nature of this relationship, however, is not clear. The
possibility that poor sleep is a more general experience among veterans has
not been explored to date, with most studies focusing only on veteran

21
populations with PTSD. This pilot study aimed to explore whether sleep
disturbance is common to veterans generally or simply those with PTSD. Data
were collected from a community sample of 152 Australian Vietnam war
veterans, 87 of whom did not meet criteria for PTSD. All those with PTSD and
90% of those without PTSD reported clinically significant sleep disturbance,
indicating that serious sleep problems are common across the veteran
population. Despite the limitations of this initial study, these results highlight
the importance of ensuring that research into sleep disorders in veterans with
PTSD pays attention to the potential etiological role of other military factors,
including deployments.

Substance Abuse
1. Seidel, R. W., Gusman, F. D., &Abueg, F. R. (1994). Theoretical and practical
foundations of an inpatient post-traumatic stress disorder and alcoholism
treatment program. Psychotherapy: Theory, Research, Practice,
Training, 31(1), 67-78. Retrieved from:
http://search.ebscohost.com/login.aspx?direct=true&db=pdh&AN=199446047-001&site=ehost-live
Describes the structure and process of an inpatient program for the
treatment of posttraumatic stress disorder (PTSD) and alcoholism. The
therapeutic community setting uses lifespan developmental and social
learning models to provide patients with (1) a framework for understanding
what has happened to them, (2) tools for more effective coping, (3) an arena
to experience the discomfort of previous coping mechanisms, and (4) the
anxiety/pleasure of creating and practicing a new and more effective
repertoire of skills. The program is divided into 3 phases. Phase 1 focuses on
solidifying motivation for change through assessment, education, and
interpersonal work. Phase 2 represents the action stage, and incorporates
exposure-based therapy in a developmental framework to address trauma
issues. Phase 3 emphasizes maintenance and generalization of patients'
learning via modified relapse prevention training.

Advantages of receiving care for PTSD


1. Rosen, R. C., Marx, B. P., Maserejian, N. N., Holowka, D. W., Gates, M. A.,
Sleeper, L. A., & Kang, H. K. (2012). Project valor: Design and methods of a
longitudinal registry of posttraumatic stress disorder (PTSD) in combat

22
exposed veterans in the Afghanistan and Iraqi military theaters of
operations. International Journal of Methods in Psychiatric Research, 21(1), 516. Retrieved from: http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=73176897&site=ehost-live
Few studies have investigated the natural history of post-traumatic stress
disorder (PTSD). Project VALOR (Veterans' After-discharge Longitudinal
Registry) was designed as a longitudinal patient registry assessing the course
of combat-related PTSD among 1600 male and female Veterans who served
in Operation Enduring Freedom (OEF) in Afghanistan or Operation Iraqi
Freedom (OIF). Aims of the study include investigating patterns and
predictors of progression or remission of PTSD and treatment utilization. The
study design was based on recommendations from the Agency for Healthcare
Quality and Research for longitudinal disease registries and used a prespecified theoretical model to select the measurement domains for data
collection and interpretation of forthcoming results. The registry will include
1200 male and female Veterans with a recent diagnosis of PTSD in the
Department of Veteran Affairs (VA) electronic medical record and a
comparison group of 400 Veterans without a medical record-based PTSD
diagnosis, to also allow for case-control analyses. Data are collected from
administrative databases, electronic medical records, a self-administered
questionnaire, and a semi-structured diagnostic telephone interview. Project
VALOR is a unique and timely registry study that will evaluate the clinical
course of PTSD, psychosocial correlates, and health outcomes in a carefully
selected cohort of returning OEF/OIF Veterans.

Funding on research for PTSD/ quality of care


1. Copeland, L. A., Fletcher, C. E., & Patterson, J. E. (2005). Veterans' health and
access to care in the year after September 11, 2001. Military Medicine, 170(7), 602606. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=17734113&site=ehost-live
The goal was to explore veterans' perceptions of their health care in the year after
September 11, 2001. Methods: A random sample of outpatients seen at a
Manhattan (New York City) or Midwestern Veterans Affairs facility between
September 12, 2001, and September 30, 2002, received a mailed questionnaire.
Regression assessed the effects of site, demographic features, military service, and
symptoms of post-traumatic stress disorder (PTSD) on health status, care-seeking,

23
and satisfaction with health care among 490 patients. Results: Veterans from New
York City reported better health and more satisfaction that their providers listened
to them. Patients with more PTSD symptoms reported poorer health, more
September 11-related symptoms, and less satisfaction with care and were more
likely to seek care outside the Veterans Affairs system. Conclusions: Proximity to the
September 11 terrorist attacks had little relationship to patients' perceptions of their
health and health care, whereas PTSD symptoms had a pervasive effect. Patients
with PTSD symptoms may require outreach programs to assist them in dealing with
catastrophic events, regardless of their proximity to the events.

2. Twamley, E. W., Baker, D. G., Norman, S. B., Pittman, J. O. E., Lohr, J. B., &Resnick,
S. G. (2013). Veterans health administration vocational services for operation Iraqi
freedom/operation enduring freedom veterans with mental health conditions.
Journal of Rehabilitation Research & Development, 50(5), 663-670. Retrieved from:
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=90133101&site=ehost-live
High rates of mental health conditions and unemployment are significant problems
facing Veterans of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF).
We examined two national Veterans Health Administration (VHA) databases from
fiscal years 2008-2009: a larger database (n = 75,607) of OIF/OEF Veterans with
posttraumatic stress disorder, depression, substance use disorder, or traumatic
brain injury (TBI) and a smaller subset (n = 1,010) of those Veterans whose
employment was tracked during their participation in VHA vocational services. Only
8.4% of Veterans in the larger database accessed any vocational services and
retention was low, with most Veterans attending one or two appointments. Veterans
with TBI and with more mental health conditions overall were more likely to access
vocational services. Only 2.2% of Veterans received evidence-based supported
employment. However, supported employment was effective, with 51% of those
Veterans receiving it obtaining competitive work. Effect sizes quantifying the effect
of supported employment provision on competitive work attainment, number of
jobs, job tenure, and retention in vocational services were large. Given the high
success rate of supported employment for these Veterans, additional supported
employment specialists for this population would be expected to improve work
outcomes for post-9/11 Veterans who want assistance returning to work.

3. Sayer, N. A., Rettmann, N. A., Carlson, K. F., Bernardy, N., Sigford, B. J., Hamblen ,
J. L., & Friedman, M. J. (2009). Veterans with history of mild traumatic brain injury
and posttraumatic stress disorder: Challenges from provider perspective. Journal of
Rehabilitation Research & Development, 46(6), 703-715. Retrieved from

24
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=48075779&site=ehost-live
The Department of Veterans Affairs (VA) has separate clinical structures and care
processes for traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD).
However, because veterans are returning from the wars in Iraq and Afghanistan with
TBI (most frequently mild TBI [mTBI]) and PTSD, the VA needs to evaluate current
service delivery systems. We conducted key informant interviews with 40 providers
from across the United States who represented separate clinical teams providing
specialized TBI or PTSD services. We identified challenges providers perceive in
scheduling and engaging patients with co-occurring mTBI and PTSD (mTBI/ PTSD) in
treatment, determining the etiology of patients' presenting problems, coordinating
services, and knowing whether or how to alter standard treatments. We found
consensus that patients with mTBI/PTSD often have other morbidities requiring
specialized treatment, including pain and sleep disturbance. Another important
theme we found was the need for patient and family educational material on
mTBI/PTSD or pain and mTBI/PTSD and provider education tailored to provider
specialty. Together, findings point to the need for guidance for providers on best
practices to assess and treat mTBI/PTSD given available information, a systematic
approach toward patient and provider education, and research to build the evidence
base for practice.

4. Magruder, K. M., & Yeager, D. E. (2008). Patient factors relating to detection of


posttraumatic stress disorder in department of veterans affairs primary care
settings. Journal of Rehabilitation Research & Development, 45(3), 371-381.
Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=33993779&site=ehost-live
They examined the impact of patient-level factors on provider recognition of
posttraumatic stress disorder (PTSD). Analyses were based on a random sample of
1,079 consenting patients who had an outpatient visit at any of four southeastern
Department of Veterans Affairs hospitals in 1999. We collected data on PTSD
symptoms, social demographics, functional status, medical record diagnoses, and
independent PTSD diagnostic assessments for 888 patients. Complete and usable
data were available for 819 patients. A total of 98 patients (12%) met criteria for
PTSD, and of these, 42 (43%) were correctly classified as such by their provider.
Results indicate that age (50-64), war-zone service, worse functioning on the 36Item Short Form Health Survey role emotional subscale, a diagnosis of
musculoskeletal pain, a greater percentage of persistent re-experiencing or
avoidance/numbing symptoms, and a previously diagnosed substance use disorder
were all independently related to provider recognition of PTSD. Knowledge of these
factors may help inform providers and direct improved screening and case finding.

25

Changes in patients who receive care


1. Blake, D. D., Cook, J. D., & Keane, T. M. (1992). Post-traumatic stress disorder and
coping in veterans who are seeking medical treatment. Journal of Clinical
Psychology, 48(6), 695-704. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=9302070996&site=ehost-live

The present study examined psychological coping styles and mental health
treatment histories in veterans with PTSD. This study also served as a replication
and extension of an earlier investigation that assessed the prevalence of PTSD in
World War 11, Korea, and Vietnam combat veterans who were seeking medical
treatment. Thirty-six combat veteran medical patients were compared to 38 war-era
controls. Nearly a third of the combat veterans met psychometric criteria for PTSD;
none of the controls met these criteria. Both PTSD-positive subjects and mental
health treatment seekers showed a significantly greater use of emotion-focused
coping. Results also showed that Vietnam combatants were more likely to have
received individual mental health treatment. These findings and their treatment
implications are discussed.

2. Bormann, J. E., Hurst, S., & Kelly, A. (2013). Responses to mantram repetition
program from veterans with posttraumatic stress disorder: A qualitative
analysis. Journal of Rehabilitation Research & Development., 50(6), 769-784.
Retrieved from:
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=90169700&site=ehost-live
This study describes ways in which a Mantram Repetition Program (MRP) was used
for managing posttraumatic stress disorder (PTSD) symptoms in 65 outpatient
Veterans with PTSD. The MRP consisted of six weekly group sessions (90 min/wk.)
on how to (1) choose and use a Mantram, (2) slow down thoughts and behaviors,
and (3) develop one-pointed attention for emotional self-regulation. Critical incident
research technique interviews were conducted at 3 mo.post intervention as part of a
larger randomized clinical trial. The setting was an academic-affiliated Department
of Veterans Affairs hospital in southern California. Categorization and comparison of
the types and frequency of incidents (i.e., triggering events) were collected.
Participants reported a total of 268 triggering events. Content analysis of the
outcomes resulted in 12 discreet categories, including relaxing and calming down,

26
letting go of negative feelings, thinking clearly and rationally, diverting attention
away from triggering events, focusing attention, refining Mantram skills, dealing
with sleep disturbances, coming back from flashbacks, slowing down,
communicating thoughts and feelings more effectively, feeling in touch spiritually,
and letting go of physical pain. The study shows that the MRP was helpful in
managing a wide range of emotional reactions in Veterans with PTSD.

3. Burke, H. S., Degeneffe, C. E., & Olney, M. F. (2009). A new disability for
rehabilitation counselors: Iraq war veterans with traumatic brain injury and posttraumatic stress disorder. Journal of Rehabilitation, 75(3), 5-14. Retrieved from
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=45463593&site=ehost-live
Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are
considered the "signature" injuries of military personnel serving in the Iraq war. An
alarming number of returning veterans are incurring a combination of these two
disabilities. TBI and PTSD combined presents an array of challenges for injured
persons that are experienced differently by those separately affected by TBI or
PTSD. Hence, the combination of TBI and PTSD presents a new disability
classification for the rehabilitation counseling profession. There is an acute need to
develop and facilitate specialized care and rehabilitative services for veterans
impacted by this nascent disability. We highlight neurobiological, behavioral, and
physiological characteristics associated with combat-incurred TBI/PTSD injuries.
Additionally, we offer recommendations for rehabilitation counseling professionals
and researchers to consider in response to our review of the current system of
veteran care, common barriers to rehabilitation and societal re-integration, and
available resources for military personnel impacted by TBI and PTSD.

4. Cook, J. M., Dinnen, S., O'Donnell, C., Bernardy, N., Rosenhack, R., & Hoff, R.
(2013). Iraq and Afghanistan veterans: National findings from VA residential
treatment programs. Psychiatry: Interpersonal & Biological Processes, 76(1),
retrieved from: http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=85872953&site=ehost-live
A quality improvement effort was undertaken in Department of Veterans Affairs'
(VA) residential treatment programs for Posttraumatic Stress Disorder (PTSD) across
the United States. Qualitative interviews were conducted with over 250 directors,
providers, and staff during site visits of 38 programs. The aims of this report are to
describe clinical issues and distinctive challenges in working with veterans from Iraq
and Afghanistan and approaches to addressing their needs. Providers indicated that
the most commonly reported problems were: acute PTSD symptomatology; other
complex mental health symptom presentations; broad readjustment problems; and

27
difficulty with time demands of and readiness for intensive treatment. Additional
concerns included working with active duty personnel and mixing different eras in
therapy. Programmatic solutions address structure (e.g., blended versus era-specific
therapy), content (e.g., physical activity), and adaptations (e.g., inclusion of family;
shortened length of stay). Clinical implications for VA managers and policy makers
as well as non-VA health care systems and individual health care providers are
noted.

Conclusion
The goal of this research is to provide helpful information to the men and
women returning from war who show early signs of PTSD. Also the Veterans
research being done is to evaluate the level of care being provided to these brave
men and women who protect us and keep us safe. Providing knowledge and
awareness as well as early signs will help keep more veterans alive past their time
as soldiers. This work is also designed to provide knowledge of PTSD from the start
as well as the effects it takes on both the mental as well as the social health of an
individual. The evaluations are designed to show where individuals are receiving
care and what steps should be taken to provide improved care.

Chapter III
Methodology
Research Design
Across sectional research design will be utilized to assess the impact of quality of care on
veterans with PTSD. The survey will be given to veterans who are receiving care at the Wilkes

28

Barre VA Hospital. The survey will focus on the quality care they are receiving for PTSD. There
will be various questions asking age, branch, years served, wars fought in, education level, and
age when diagnosed with PTSD, symptoms, care being given for PTSD, improvements needed to
care, treatment trajectory, and several others to determine percentages regarding PTSD care for
veterans.
Participants
The design of this study will be a cross sectional design. Sample size for this study will
be determined using G*Power 3.1.7. An a priori power analysis will be computed to reach 80%
power using an alpha value set at .05. Recruitment will remain open until the minimum number
of participants are recruited.
Research will be conducted on Veterans who receive care through the Wilkes Barre VA
hospital only. Male and female Veterans will be recruited for this study. Veterans must be
diagnosed with PTSD to take participate. Participants must be over the age of 18. Any branch of
the military is eligible. All veterans taking the survey will be recruited from the VA Hospital in
Wilkes Barre Pennsylvania. The entire study should take approximately an hour to complete.
There will be only one survey and no follow ups with the veterans.
Materials
Demographics.
The primary researcher will be in charge of developing the demographic questionnaire and IRB
will be responsible for reviewing and accepting the questionnaire before it will be presented to
those taking part in the study. Any age is welcome as long as they are a veteran suffering from
PTSD and receiving care through WB VA hospital. Any race, military branch, gender, and age
are all accepted. Veterans will have to be receiving care at this facility for PTSD to be eligible for

29

the survey. Gender, Age, Race, County of residence, Branch(s) served, Tour dates & Areas
toured, M.O.S. in military, years served in military, rank earned before discharge.
Surveys
A researcher designed survey will be used to measure quality of care among Veterans. This
survey will be evaluated by a fellow Marywood faculty for validity purposes.
Questions will be developed to measure: year when PTSD first was diagnosed, age when noticed
PTSD, current age, PTSD symptoms, care receiving from PTSD, how would you rank your
PTSD care (scale), how you feel your care could be improved, military honors such as ribbons
and medals earned, how you were treated when first diagnosed with PTSD, has your treatment
improved, how could PTSD care be improved for veterans, health concerns in general, health
concerns from PTSD, and medication for PTSD.
Procedure
After obtaining my Marywood IRB approval, recruitment of participants will begin with
a convince sample where the primary researcher (PI) travel to the VA hospital and ask veterans to
participate. The PI will contact the suicide prevention coordinator at the Wilkes Barre VA and
request permission to be included when veterans have group for those suffering from PTSD.
Forms for informed consent will first be read to the veterans and those who wish to participate in
the study will sign them before receiving the survey. I plan to take surveys with me to a group
meeting and read them the request form followed by asking permission for those who would like
to help me with my graduate professional contribution. There will be no personal information
collected on the survey making it confidential and anonymous, and impossible to track back to
them. Once the survey is completed, participants will be given the opportunity to ask any
questions and will be thanked for their time.

30

Data Analysis
Data will be collected from all the surveys. All data will be entered into an excel
spreadsheet using SPSS. Analyzing the timeframe they were diagnosed with PTSD will help
calculate which generation they were in for example Vietnam, Gulf War, and Iraq etc. Analysis
will compare different generations of veterans to see if care varied depending on generation and
if care has improved for veterans today as opposed to the Vietnam era. This study seeks to
determine if age, generation, and time frame served in the military correlates to how care has
been provided to veterans.
Research Question.
What are the effects of PTSD on veterans, and the attendant care required?
Sub Question 1: Who suffers from Post-Traumatic Stress Disorder?
Sub Question 2: What symptoms do veterans with PTSD suffer from?
Sub Question 3: What are the advantages veterans receive when being treated
for PTSD?
Sub Question 4: What funding has been done that benefits veterans with
PTSD and the quality of care for veterans?
Sub Question 5: What observable changes in veterans who receive care are
observed and documented?
Summary
Overall this study will help develop awareness from generation to generation and help to
provide awareness as to changes in care for veterans suffering from PTSD. I hope the results of
this research show that care has improved since first being diagnosed during the Vietnam era
when medical assistance was extremely low. I plan to gather information from a range of

31

different veterans age wise to help get a broad understanding of the symptoms and care and see
if there is a correlation between the generation and the symptoms and care for each veteran. The
participants will hopefully take my survey seriously and provide me with information that will
help benefit other veterans suffering from similar mental illnesses. I plan to design the survey
myself and gather the data myself with no help in this professional contribution.
I plan to limit my region to the Northeast Pennsylvania territory focusing on veterans
who receive care at one specific location which is the Wilkes Barre VA Hospital. Participants will
have to have a medically diagnosed illness of PTSD and be receiving care for the symptoms at
the VA hospital. The survey will be some scale rankings as well as questions with space provided
for the participants to write their overall thoughts without being limited to a one word response.
PTSD has changed over the generations and I strongly believe we still struggle with providing
care for those who need it, especially those suffering from mental illness.
References
1. Blake, D. D., Cook, J. D., & Keane, T. M. (1992). Post-traumatic stress disorder
and coping in veterans who are seeking medical treatment. Journal of Clinical
Psychology, 48(6), 695-704. Retrieved from
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=9302070996&site=ehost-live
2. Bormann, J. E., Hurst, S., & Kelly, A. (2013). Responses to mantram repetition
program from veterans with posttraumatic stress disorder: A qualitative
analysis. Journal of Rehabilitation Research & Development., 50(6), 769-784.
Retrieved from:
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=90169700&site=ehost-live

3. Bullman, T. A., & Kang, H. K. (1996). The risk of suicide among wounded Vietnam
veterans. American Journal of Public Health, 86(5), 662-662. 6p.4charts. Retrieved from
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=9606201935&site=ehost-live
4. Burke, H. S., Degeneffe, C. E., & Olney, M. F. (2009). A new disability for
rehabilitation counselors: Iraq war veterans with traumatic brain injury and

32
post-traumatic stress disorder. Journal of Rehabilitation, 75(3), 5-14.
Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=45463593&site=ehost-live
5. Chamberlin, E., & Sheena, M. (2012). Emasculated by trauma: A social history
of post-traumatic stress disorder, stigma, and masculinity. Journal of
American Culture, 35(4), 358-365. Retrieved from
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=83711222&site=ehost-live
6. Cifu, D. X., Taylor, B. C., Carne, W. F., Bidelspach, D., Sayer, N. A., Scholten, J.,
& Hagel Campbell, E. (2013). Traumatic brain injury, posttraumatic stress
disorder, and pain diagnoses in oif/oef/ondveterans.Journal of Rehabilitation
Research & Development, 50(9), 1169-1176. Retrieved from
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=93923241&site=ehost-live
7. Cook, J. M., Dinnen, S., O'Donnell, C., Bernardy, N., Rosenhack, R., & Hoff, R.
(2013). Iraq and Afghanistan veterans: National findings from VA residential
treatment programs. Psychiatry: Interpersonal & Biological Processes, 76(1),
Retrieved from: http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=85872953&site=ehost-live
8. Copeland, L. A., Fletcher, C. E., & Patterson, J. E. (2005). Veterans' health and
access to care in the year after September 11, 2001. Military
Medicine, 170(7), 602-606. Retrieved from
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=17734113&site=ehost-live
9. Degun-Mather, M. (2001). The value of hypnosis in the treatment of chronic
PTSD with dissociative fugues in a war veteran. Contemporary
Hypnosis, 18(1), 4-13. Retrieved from :
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=6148789&site=ehost-live
10.Gibson, C. (2012). Review of posttraumatic stress disorder and chronic pain:
The path to integrated care. Journal of Rehabilitation Research &
Development, 49(6), 753-776. Retrieved from
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=79730536&site=ehost-live
11.Haley, S. A. (1985). Some of my best friends are dead: Treatment of the posttraumatic stress disorder patient and his family. Family Systems Medicine,
3(1), 17-26. Retrieved from: http://search.ebscohost.com/login.aspx?
direct=true&db=pdh&AN=1986-01768-001&site=ehost-live
12.Hart, RH. (2003). A Face of War: PTSD... The Psychiatric times. 06-01; 20:50.
Retrieved from: http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=10054516&site=ehost-live
13.Hayman, P. M., Sommers-Flanagan, R., & Parsons, J. P. (1987). Aftermath of
violence: Posttraumatic stress disorder among Vietnam veterans. Journal of
Counseling & Development, 65(7), 363. Retrieved from
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=4979270&site=ehost-live
14.Hyer, L., Woods, M. G., & Boudewyns, P. A. (1989). Early recollections of
Vietnam veterans with PTSD. Individual Psychology: The Journal of Adlerian

33
Theory, Research & Practice, 45(3), 300. Retrieved from
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=9099601&site=ehost-live
15.Hyler, L., Woods, M. G., Bruno, R., & Boudewyns, P. (1989). Treatment
outcomes of Vietnam veterans with PTSD and the consistency of the
mcmi. Journal of Clinical Psychology, 45(4), 547-552. Retrieved from
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=11966916&site=ehost-live
16.Kolk, B., & Najavits, L. M. (2013). Interview: What is PTSD really? Surprises,
twists of history, and the politics of diagnosis and treatment. Journal of
Clinical Psychology, 69(5), 516-522. Retrieved from
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=86980700&site=ehost-live
17.Lee, E. A. (2012). Complex contribution of combat-related post-traumatic
stress disorder to veteran suicide: Facing an increasing
challenge. Perspectives in Psychiatric Care, 48(2), 108-115. Retrieved from
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=73930131&site=ehost-live
18.Lewis, V., Creamer, M., & Failla, S. (2009). Is poor sleep in veterans a function
of post-traumatic stress disorder? Military Medicine, 174(9), 948-951.
Retrieved from: http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=44204038&site=ehost-live
19.Magruder, K. M., & Yeager, D. E. (2008). Patient factors relating to detection
of posttraumatic stress disorder in department of veterans affairs primary
care settings. Journal of Rehabilitation Research & Development, 45(3), 371381. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=33993779&site=ehost-live
20.Marshall, R. P. (1995). A general model for the treatment of post-traumatic
stress disorder in war veterans. Psychotherapy: Theory, Research, Practice,
Training, 32(3), 389-396. Retrieved from:
http://search.ebscohost.com/login.aspx?direct=true&db=pdh&AN=199600405-003&site=ehost-live
21.Nash, W. P., & Watson, P. J. (2012). Review of va/dod clinical practice guideline
on management of acute stress and interventions to prevent posttraumatic
stress disorder. Journal of Rehabilitation Research & Development., 49(6),
637-648. Retrieved from: http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=79731016&site=ehost-live

22. Resnick, H. S., Foy, D. W., Donahoe, C. P., & Miller, E. N. (1989). Antisocial behavior
and post-traumatic stress disorder in Vietnam veterans. Journal of Clinical
Psychology, 45(6), 860-866. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=11975774&site=ehost-live
23.Rosen, R. C., Marx, B. P., Maserejian, N. N., Holowka, D. W., Gates, M. A.,
Sleeper, L. A., Vasterling, J. J., & Kang, H. K. (2012). Project valor: Design
and methods of a longitudinal registry of posttraumatic stress disorder

34
(PTSD) in combatexposed veterans in the Afghanistan and Iraqi military
theaters of operations. International Journal of Methods in Psychiatric
Research, 21(1), 5-16. Retrieved from:
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=73176897&site=ehost-live
24.Russell, S. S. (2013). Veterans' stories: What they may have to tell us - a
personal reflection. Urologic Nursing, 33(2), 92-96. Retrieved from:
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=86861350&site=ehost-live
25.Sayer, N. A., Rettmann, N. A., Carlson, K. F., Bernardy, N., Sigford, B. J.,
Hamblen , J. L., & Friedman, M. J. (2009). Veterans with history of mild
traumatic brain injury and posttraumatic stress disorder: Challenges from
provider perspective. Journal of Rehabilitation Research &
Development, 46(6), 703-715. Retrieved from
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=48075779&site=ehost-live
26.Seidel, R. W., Gusman, F. D., & Abueg, F. R. (1994). Theoretical and practical
foundations of an inpatient post-traumatic stress disorder and alcoholism
treatment program. Psychotherapy: Theory, Research, Practice,
Training, 31(1), 67-78. Retrieved from:
http://search.ebscohost.com/login.aspx?direct=true&db=pdh&AN=199446047-001&site=ehost-live
27.Staples, J. K., Hamilton, M. F., & Uddo, M. (2013). A yoga program for the
symptoms of post-traumatic stress disorder in veterans. Military Medicine,
178(8), 854-860. Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=89768620&site=ehost-live
28.Taft, C. T., Creech, S. K., & Kachadourian, L. (2012). Assessment and
treatment of posttraumatic anger and aggression: A review. Journal of
Rehabilitation Research & Development, 49(6), 777-788. Retrieved from
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=79731022&site=ehost-live
29.Twamley, E. W., Baker, D. G., Norman, S. B., Pittman, J. O. E., Lohr, J. B., &
Resnick, S. G. (2013). Veterans health administration vocational services for
operation Iraqi freedom/operation enduring freedom veterans with mental
health conditions. Journal of Rehabilitation Research & Development, 50(5),
663-670. Retrieved from: http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=90133101&site=ehost-live
30.Wilk, J. E., West, J. C., Duffy, F. F., Rae, D. S., Hoge, C. W., & Herrell, R. K.
(2013). Use of evidence-based treatment for posttraumatic stress disorder in
army behavioral healthcare. Psychiatry: Interpersonal & Biological
Processes, 76(4), 336-348. Retrieved from
http://search.ebscohost.com/login.aspx?
direct=true&db=afh&AN=92692412&site=ehost-live