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Surviving Spouses | Deployments
RETURNING FROM THE WAR ZONE
Created by experts at the National Center for PTSD, 2006
A Guide for Families of Military Members
HOMECOMING
The days and weeks after a homecoming from war can be filled with
excitement, relief, and Many other feelings. This guide is for military
family members, like you. This guide is also Helpful for friends and
returning veterans themselves. Following the veterans return from Overseas
duty, the entire family will go through a transition. This guide will help
each of you Understand readjustment during homecoming.
Reintegration following homecoming involves taking time for the veteran,
family and friends to Become reacquainted. Talk and listen to one another to
restore trust, support and closeness. There may be times when you and your
returning veteran feel stress, uncertainty, concern, and Distance from one
another. It may feel as if the service member is still fighting a war,
rather than Truly being home. All of these emotions are a normal part of
readjustment following deployment To a war zone. At first, these reactions
may be difficult to deal with. Some service members have Real difficulties
and struggle during their transitions back home. Because many service
members Face redeployment back to overseas duty, it is especially important
to address these difficulties During this time back home. Learning more can
help your family cope. In this guide you will Learn about:
- How expectations about homecoming may not be the same for service
members and Family members
- Ways to talk and listen to one another in order
to re-establish trust, closeness and Openness
- Information about possible
problems to watch out for
- How to offer and find assistance for your loved
ones
- What help is available and what it involves
A common expectation is
that the family will be exactly the same as it was before the Deployment.
However, during deployment families naturally change. Children have grown
and Spouses have taken on new responsibilities. New friendships may have
formed. War zone Exposure is a life changing experience for those deployed.
Understanding what you might Expect will help with the transition back to
civilian life. In this guide you will learn ways to Cope better, and if
problems arise, ways to find assistance.
THIS GUIDE CONTAINS:
- WHAT IS A COMBAT STRESS REACTION?
- EXPERIENCES IN THE WAR ZONE
- EXPECTATIONS ABOUT HOMECOMING
- EFFECTS ON FAMILY LIFE
- WHAT ARE THE SYMPTOMS OF PTSD?
- HOW OFTEN IS PTSD DIAGNOSED IN VETERANS?
- WHAT CAUSES COMBAT STRESS REACTIONS OR PTSD?
- OTHER COMMON STRESS REACTIONS
- ROLE OF THE FAMILY IN PROBLEM SOLVING
- ENCOURAGING A VETERAN TO SEEK HELP
- HOW TREATMENT WORKS
- COMMON THERAPIES USED TO TREAT PTSD
- WHERE TO GO FOR HELP
WHAT IS A COMBAT STRESS REACTION?
Understand that service members respond to experiences in a war zone in
different ways. Some service members report feeling upset or “keyed up” even
after they return home. Some May continue to think about events that
occurred in combat, sometimes even acting as if back in A combat situation.
These are common “combat stress reactions” (also called acute stress
Reactions) that can last for days or weeks and are a normal reaction to
combat experiences. Below is a list of common reactions:
Behavioral Reactions Physical Reactions Emotional Reactions Trouble
concentrating Trouble sleeping, overly tired Feeling nervous, helpless, or
Fearful Jumpy & easily startled Stomach upset, trouble eating Sad, guilty,
rejected or Abandoned Being on guard, always alert Headaches and sweating
When thinking of the war Edginess, easily upset or Annoyed Bad dreams or
flashbacks Lack of exercise, poor diet or Health care Experiencing shock,
being Numb, unable to feel happy Avoiding people or places Related to the
trauma Rapid heartbeat or breathing Feeling hopeless about the Future Work
or school problems Too much drinking, smoking, Or drug use Irritable or
angry Loss of intimacy or feeling Withdrawn, detached and Disconnected Other
health problems Becoming worse Not trusting others, being over Controlling,
having lots of Conflicts
Most service members, who experience combat stress reactions like those
listed above, will Recover naturally over time.
Others continue to struggle with memories of their combat experiences and
their reactions. Research still does not tell us why some people struggle
while others do not. BUT it is NOT Because of any type of weakness. Combat
stress reactions may create problems in Relationships with partners, other
family members, or friends; troubles at work; or troubles Handling money. If
the service member continues to experience these reactions and if it begins
To cause problems for them or their family, it may become post-traumatic
stress disorder or PTSD. Other operational stress injuries can also develop
and are discussed later in this guide.
EXPERIENCES IN THE WAR ZONE
During deployment, service members may have taken part in missions and
operations that exposed them to very stressful or often life threatening
experiences. It is important for families to understand what they have been
through. Service members may have been shot at, seen the death or injury of
American personnel or of civilian and enemy combatants, or even witnessed
the death or injury of people they knew. IEDs (improvised explosive devices)
are common; many convoys deal with piles of garbage blowing up just as they
pass by. Many troops are on alert 24/7. Service members may have been
injured as a result of bombings, blasts, weapons or accidents, maybe even
surviving with very serious injuries. All of these experiences and others
occurred in a hot, dry desert environment without the normal comforts of
home.
Frequent Combat Experiences Reported by Members of the U.S. Army, 2003
Afghanistan Iraq Being attacked or ambushed 58% 89% Receiving incoming fire
84% 86% Being shot at 66% 93% Seeing dead bodies or remains 39% 95% Knowing
someone seriously injured or killed 43% 86%
The military teaches service members skills that help them to survive and
succeed in war. These same skills can cause problems at home. For example,
secretiveness and control are very important in the war zone; however,
communication and sharing the decision-making are necessary for good family
relations.
EXPECTATIONS ABOUT HOMECOMING
Families often want to hold barbecues and big welcome home parties for
their loved one when they return. The service member often has mixed
feelings about returning home because they now face a completely different
day-to-day life than they have grown used to. Relaxing may be what they
want, not a big party. Reworking “who does what”, who handles the money now,
who takes the kids to school, who mows the lawn; these issues will need to
be dealt with. Make sure
that all family members talk to each other about what they want and
expect, even before returning home. EFFECTS ON FAMILY LIFE
One challenge everyone faces is adjusting to changes in the family; both
the person returning from war and the family left behind have changed. War
experiences have changed the person who was deployed. Children have grown
and developed new skills in school. Spouses or other family members may have
taken on more responsibilities and control in the family. Everyone needs to
work and get used to a new family pattern that works for all involved. Be
aware that problems in relationships that were already there before
deployment may return.
Returning service members need to relearn how to feel safe, comfortable
and trusting again with family members. This involves getting reacquainted
and communicating with spouses, children, parents, friends, coworkers and
others.
Veterans: Remember that family members also need your understanding.
While you were deployed they might have had to take on extra
responsibilities, had to deal with problems without your help, or felt
lonely. It also takes time for them to readjust.
The service member should not feel forced to talk about his or her combat
experiences. They should be given opportunities to talk about the war and
their reactions and feelings with people who will not be judgmental or
negative. You should join in these discussions if you are invited to do so.
Service members may be more comfortable talking with their buddies about
their time at war. It may be helpful for the service member to speak with a
counselor about his or her experiences, or about any concerns about sharing
the details of war experiences with family members. Family and friends need
to remember not to take signs of withdrawal personally and to remember to be
patient. Recovery takes time.
Sometimes the everyday stress of family life can feel overwhelming for
the service member. He or she may become more irritated or react more
strongly to common family issues. Anger and aggression are common combat
stress reactions but these reactions may scare spouses and children, and
even the service member. Continued angry outbursts or over-reacting to
everyday situations might mean that you should get help.
NOTE FOR VETERANS: Getting into arguments and fights with family members
and others, often for minor reasons, can happen because of the angry or
aggressive feelings that are common after a trauma. In addition to having
more family conflict, those who return home from a war zone often feel
disconnected or detached from others. Sometimes this has to do with not
feeling able to tell other family members about what happened, not wanting
to intrude on them by speaking about the war, or just thinking that no one
will be able to understand. Sometimes this is related to having difficulty
in feeling or showing positive feelings. Sometimes wanting to be alone or
avoiding family gatherings creates isolation from family and friends. Yet
the support of these people is needed for a healthy recovery. Even though
you might feel like you want to withdraw, try to reconnect with family and
friends. Because the symptoms of PTSD change how you feel and act, traumatic
experiences that happened to you can affect everyone else in the family.
Family members react to the fact that their loved one has gone through a
trauma. At the same time, trauma symptoms can make you difficult to get
along with or cause withdrawal. It can be very hurtful and confusing for
everyone in the family when these changes occur.
SEX DIFFERENCES
Men and women may have different ways of integrating back into the
family. To cope with stress, men may isolate more and leave the home to be
with friends or buddies. Women may need to talk about more of their
experiences with their partners. Some male partners experience resentment or
misunderstanding towards their returning woman veteran, and are reluctant to
sympathize both with her accomplishments and difficulties during war. In a
war zone, both women and men often have camaraderie with their buddies that
may be difficult to recreate in civilian life.
KIDS
Men and women both may face challenges coming home to their children and
kids can need time to reconnect. Children may feel resentment, abandonment,
sorrow or anger when a parent leaves. During deployment, a child may have
learned to rely more on the parent who remained at home. Homecoming may
bring back the child’s normal fears of separation. It’s important for the
veteran not to take these reactions personally, but instead to reassure the
child. Communication within the family, or in counseling, is very important
in helping the family as a whole.
PARENTS
Parents are also very important in the readjustment process yet they are
often overlooked. Most of the information in this guide also applies to you.
Even if your child is deployed from another state, every US state has Family
Assistance Centers that assist ALL military family members in need.
EFFECTS ON WORK FUNCTIONING
For some veterans, going back to work is hard because changes have
happened at their job during deployment. He or she also might be getting
their first civilian job and may have difficulty finding a job or a career
to get started in. Following the excitement of deployment, he or she may
find their old job boring. Combat stress reactions, such as feeling
irritable or “on edge”, having trouble sleeping, or problems relating to
people, make going back to work very difficult or even seem like an
impossible undertaking. The veteran may also worry that an employer (or
future employer) might not want to work with somebody who is dealing with
symptoms of PTSD or other combat stress reactions.
EFFECTS ON OTHER FUNCTIONING
Some other areas where problems can occur: Money issues can add to stress
at work or home, and finances are often complicated by deployment; Veteran’s
sleep is often disrupted and getting a full night of sleep is important to
maintaining a healthy and happy life; Aggressive driving is common, and
although adaptive in the war zone, causes problems at home. A veteran
experiencing combat stress may also have trouble concentrating, which can
affect many regular activities.
Effects of PTSD on Relationships •Vietnam veterans with PTSD are three to
six times as likely to divorce than Vietnam veterans without PTSD. •Veterans
diagnosed with PTSD, compared to those without PTSD, are more likely to be •
violent with partners and children, with rates as high as 63% for some type
of physical violence in the past year. Partners of Vietnam veterans with
PTSD reported markedly reduced satisfaction in their lives and greater
demoralization compared to partners of Vietnam veterans not diagnosed with
PTSD. Problems with family relationships, relationships with other people or
day-to-day life should not be overlooked. These difficulties can turn into
marital separation and divorce, family violence, and caregiver burden.
Communication is key to working through these problems. You may want to
consider talking to a counselor for support and assistance.
WHAT ARE THE SYMPTOMS OF PTSD?
You may have heard of PTSD, in relation to combat experiences or other
intense or traumatic situations, but have questions about what it really
means. Basically, the symptoms of PTSD include common reactions that
immediately follow a traumatic event such as combat. If these reactions
continue long after the combat or traumatic event has finished, it can
become PTSD. PTSD varies widely in how severe it can be, from mild and short
lasting to severe and chronic. These reactions can cause problems in getting
along with family and friends, functioning on the job or at school, or
adjusting to the transition back to civilian life.
Remember, immediately following a traumatic experience, most people
commonly experience symptoms. If these symptoms persist months after the
event, they may indicate the veteran has PTSD. Three types of reactions or
“symptoms” make up PTSD.
1. RE-EXPERIENCING. Sometimes after a service member has returned from
combat, they may continue to think about things that happened in the
war-zone. They may have nightmares about events they have witnessed or
actual combat situations. At times, they may feel as though they are
actually back in the war-zone. Others report that upsetting images of the
war-zone can flash into their mind making it difficult to think or
concentrate. Sometimes, these images are SYMPTOMS OF COMBAT STRESS REACTIONS
AND PTSD 1. RE-EXPERIENCING Continuing to think about combat or feeling as
if one is still in combat 2. AVOIDANCE AND NUMBING OF EMOTION Not wanting to
discuss the traumatic event, feeling detached from others, feeling shut down
emotionally 3. AROUSAL Having a hard time relaxing or feeling “on guard,”
feeling jumpy, unable to sleep, unable to concentrate, excessive concerns
about security, getting angry easily “triggered” by reminders, such as
sights or sounds or smells that remind them of their combat experience.
2. AVOIDING REMINDERS AND NUMBING OF EMOTIONS. It seems normal to not
want to think about distressing thoughts and to avoid upsetting reminders.
However, individuals with combat stress reactions or PTSD often go to great
lengths to prevent recalling memories or discussing their past experiences.
They may also avoid reminders of their experience. They may appear to
withdraw emotionally or physically from family and friends and be numb and
detached. They may resist or even become angry when asked to talk about
their feelings or behaviors. They may use alcohol, drugs, or prescription
medications to avoid thinking or feeling. This avoidance is a reaction to
their combat experience and is not a sign that they are no longer committed
to their family and relationships. 3. AROUSAL. The service member may have
difficulty letting their “guard down.” Sometimes service members describe
feeling jumpy or easily startled. They may drive aggressively. They might
closely examine people or places to look for signs of danger or attack. They
may be overly protective of children and fear for the child’s safety.
Feeling keyed up can also make it harder for them to sleep and concentrate
and can cause irritability. Even if the person does not have PTSD, these
symptoms can cause problems. Acting early can prevent symptoms from becoming
worse and negatively influencing relationships, careers and the family’s
well-being.
HOW OFTEN IS PTSD DIAGNOSED IN VETERANS?
Among American Vietnam theater veterans, 31% of the men and 27% of the
women have had PTSD in their lifetime. Preliminary findings suggest that
PTSD will be present in at least 18% of those serving in Iraq and 11% of
those serving in Afghanistan. PTSD has been observed in all veteran
populations that have been studied, including World War II, Korean conflict,
Vietnam, Persian Gulf, Operation Enduring Freedom and Operation Iraqi
Freedom veterans. It also has been found in United Nations peacekeeping
forces deployed to other war zones around the
Although most veterans do not develop PTSD, a sizeable minority will have
PTSD for some period of their life. Preliminary findings suggest rates of
PTSD will be at least 18% for Iraq veterans and 11% for Afghanistan veterans
(2005).
world. PTSD is not only a problem for veterans, however. It occurs both
in adults and children who have been exposed to extremely stressful
situations (such as assault, rape, disasters or serious accidents), men and
women, Western and non-Western cultural groups, and at all socioeconomic
levels. A national study of American civilians conducted in 2005 estimated
that 7% of people have had PTSD in their lifetime.
WHAT CAUSES COMBAT STRESS REACTIONS OR PTSD?
Mental health professionals do not know why some people have PTSD
reactions to traumatic situations and other people don’t. We do know that it
does NOT say anything about the strength or character of the person
suffering. Again, there is no relationship between how strong a person is
and these symptoms; many people who are brave or strong end up with PTSD
symptoms after going through a traumatic experience.
PTSD is not a result of something the person wants or has chosen. In
fact, we know that most people would not choose to have PTSD. Life factors
that are related to PTSD include: greater exposure to life threatening
situations, prior trauma, and poor social support. Remember, these are
reactions that people sometimes experience after life-threatening situations
that can often be dealt with given help.
OTHER COMMON REACTIONS
DEPRESSION. Depression can vary from person to person, but generally,
depression involves feeling down or sad more days than not, and losing
interest in hobbies or activities that used to be enjoyable or fun. The
service member may feel low in energy and be overly tired. Depression also
involves a feeling of hopelessness or despair, or the feeling that things
are never going to get better. Depression may be especially likely when a
person has had personal losses connected with their deployment such as the
death of close friends. This sometimes leads a depressed person to think
about hurting or killing him or herself. Because of this, it is important
for your family member to get help for depression. If you notice that your
loved one seems to be feeling down most of the time or less interested in
things they used to enjoy.
SUICIDAL THOUGHTS. War experiences and combat stress reactions,
especially personal loss, can lead a depressed person to think about hurting
or killing themselves. If you think your family member may be feeling
suicidal, you should directly ask them. You will NOT be putting the idea in
their head. If anyone you know has a plan to hurt themselves and the means
to do it (e.g., I have a gun and will shoot myself), and cannot make a
contract with you to stay safe, you should call 911 immediately. For more
information, contact the National Suicide Prevention Lifeline at
1-800-273-TALK (8255) or www.suicidepreventionlifeline.org/
ANGER OR AGGRESSIVE BEHAVIOR. Anger and irritability are symptoms of PTSD
and often associated with fear or loss of control; someone who is physically
tense tends to be angry as well. A typical example is over-reacting with
anger to a slight provocation. Frustration over the inability to control
PTSD symptoms (feeling that PTSD symptoms "run their life") can make a
person angry. Thinking about things that happened at the time of trauma (the
unfairness of the situation) can also lead to anger.
Although anger is a natural and healthy emotion, it can be expressed in
healthy or unhealthy ways. Intense feelings of anger and aggressive behavior
can cause marital, relationship, and family problems, job problems, and loss
of friendships. Because angry feelings keep people away, they also stop a
person from having positive connections and getting help. Some service
members may be especially over-protective of kids, or have angry reactions
to normal child behaviors. These types of reactions may actually be the
service member’s own fears about possible dangers the children could be
exposed to.
If anger or aggressive behavior is related to threatened or actual
violence against members of the family or others, it is especially important
to seek care from the police, or professional counselors (chaplains,
behavioral health, primary care, nursing, family assistance program) to
address the anger and combat stress reactions.
ALCOHOL AND/OR DRUG ABUSE. “Self-medicating” by drinking or abusing drugs
is a common way many cope with upsetting traumatic stress reactions. Usually
this is related to other readjustment concerns, as a person tries to deal
with the difficult thoughts, feelings, and memories related to their war
zone experiences by using drugs or alcohol to numb themselves. When a person
wants to avoid the memories or feelings related to combat, alcohol or drugs
may seem to offer a quick solution, but they actually lead to more problems.
If you or your family member begin to lose control of drinking or drug use,
it is important to get appropriate care.
SELF-BLAME, GUILT, AND SHAME. Sometimes service members, in trying to
make sense of their war experiences, take too much responsibility for bad
things that happened, for what they did or did not do or for surviving when
others didn’t (sometimes referred to as survivor guilt). Guilt and
self-blame are common for those who have been through difficult combat
situations, as the individual tries to make meaning of what happened.
Understand that the individual may even feel as if they have committed a
moral or religious wrongdoing, even if they were following orders.
ROLE OF THE FAMILY IN PROBLEM SOLVING
Adult family members can help the returning veteran by learning and
understanding some of the stressors and emotions a veteran may experience
after being away from home for a period of time, especially when he or she
has served in a war zone. Family members’ most important role is to be
genuine, loving, and supportive. You should be forward about expressing your
own needs and expectations, rather than hiding them in an effort to protect
the veteran.
At the same time, adult family members need to be supportive and
respectful of the veteran’s need for time to adjust. Spouses or partners
need to be prepared for change, and be ready to get used to to sharing
control of the family and important tasks and goals. It is important that
partners and spouses show their trust in the service member’s role as parent
and support joint decisions.
Family members should be ready to learn and accept new skills or tools
for coping used by the service member. For example, talking about likely
“triggers” will allow both partners to understand what might cause an
upsetting reaction. A positive attitude towards treatment and readjustment
can go a long way to making homecoming an easier transition.
It is also important to remember that all individuals in the family
count. The spouse or partner at home should be prepared to seek counseling
for themselves and children if needed. Oftentimes couples counseling can
help make the needs of individual family members clearer. Parents and
extended family also need to be taken into consideration.
ENCOURAGING A VETERAN TO SEEK HELP
Family members are often the first to notice problems in a veteran’s
readjustment. You also need to watch for any negative impact on children and
teens. While a veteran needs some practical time to readjust, problems that
continue over months may be on the way to becoming negative habits and
family patterns. If the veteran is using harmful strategies to cope with
stress, such as drinking, drugs, withdrawal and isolation, or showing strong
emotions that seem wrong in front of the family, consider encouraging the
veteran to seek assistance. Try to communicate your concerns to the veteran
with understanding and not blame.
Getting your loved one to seek help is not always as easy as you may
hope. A study of soldiers returning from Iraq found that only 40% of those
that were having mental health problems said they were interested in
receiving help. Many returnees hesitate to receive mental health treatment
for fear that it will hurt their image or even ruin their military careers.
Family members’ most important job may be to encourage the veteran to seek
counseling and treatment, for everyone’s’ benefit. Effective treatments
exist and early treatment can prevent worse problems from happening.
Encouraging the veteran to seek help is a benefit for all concerned.
HOW TREATMENT WORKS
Combat stress reactions usually go away over time. But, if they don’t, a
person might develop PTSD. The good news is that there are effective
treatments for PTSD and the other problems mentioned above. Counseling for
combat stress reactions or PTSD is really very practical and involves common
sense steps.
- The person in treatment has regular conversations with a trained
professional.
- They are helped to think about their current situation and how they
want to change it.
- They learn more about PTSD and how it is affecting them and those
around them. In addition they may speak with other service members who
served in combat operations, to give and receive support.
Many veterans receive treatment for PTSD in Veterans Affairs (VA) PTSD
treatment programs and Readjustment Counseling Service Vet Centers. In the
usual type of outpatient treatment the veteran comes into a clinic for
individual appointments and maybe group sessions. For the most severe cases
of PTSD, residential treatment, where the veteran lives in the treatment
program for several weeks, is often recommended.
Treatment usually focuses on the following activities:
- Assessment. Treatment typically begins with a discussion with a
counselor about problems the service member has faced since returning.
- Setting goals. The vet and counselor decide on goals to improve
their life and what changes are needed to help achieve those things.
- Learning about PTSD. Through talking with the counselor and classes
with other service members or vets, the person will learn about combat
stress reactions and PTSD and how it affects them and their loved ones.
- Learning coping skills or “tools.” There are a lot of skills that
can help in recovery, including skills for lowering physical tension,
skills for communicating better with family and friends, and skills for
handling anger and conflict. Treatment involves learning new ways of
dealing with the things that make the person frightened, depressed,
angry, or sad.
- Looking at yourself. Treatment often involves the person in
treatment learning to notice what he or she is thinking and feeling, how
they act with other people, and what situations or thoughts trigger
distressing emotions. In addition, the service member or veteran may be
offered additional treatment options:
- Medications. Treatment may involve talking with a psychiatrist or
primary care doctor about possible medication. Medications can relieve
anxiety, depression, irritability, and the nightmares or sleeplessness
that often comes with PTSD. They can also make it easier to participate
in other counseling activities.
- Telling the trauma story. Discussing traumatic combat situations and
sharing feelings can be painful. There may be a concern that this pain
may overwhelm the veteran with sadness, pain, grief, or anger. But
talking about traumatic experiences can be very helpful for recovery if
the person is able to talk to someone they learn to trust. It can make
the service member take a fresh look at their experiences and their
opinions about them. Often, this kind of therapeutic talking takes place
over many meetings, and gradually veterans find that the memories become
more controllable, and less painful or frightening. Treatment may last a
few weeks or months or for several years. Usually, contact with a
counselor is more frequent at first, and gradually becomes less often as
the service member learns different strategies for dealing with
thoughts, feelings, memories, and relationships.
COMMON THERAPIES USED TO TREAT PTSD
COGNITIVE-BEHAVIORAL THERAPY (CBT) has been shown to be the most
effective treatment for PTSD. CBT involves working with cognitions, or
thoughts, to change emotions, thoughts, and behaviors. There are several
types of CBT:
- Exposure therapy uses careful, repeated, detailed imagining of the
trauma (exposure) in a safe, controlled environment, to help the person
face and gain control of the fear and distress that was overwhelming in
the trauma.
- Cognitive Restructuring is an approach in which veterans identify
and examine upsetting thoughts about their trauma, challenge those
thoughts, and replace them with more balanced and accurate ones.
- EMDR (Eye Movement Desensitization and Reprocessing) involves
elements from both treatments above; having people move their eyes back
and forth while re-imagining the source of their trauma. Although
research suggests that the eye movements are not necessary, EMDR is an
effective treatment.
- Stress Inoculation Training reduces symptoms through anxiety
reduction techniques, teaching coping skills, and correcting inaccurate
thoughts related to the trauma. MEDICATION can reduce PTSD symptoms as
well as the anxiety, depression, and sleeplessness often experienced
with PTSD. Several kinds of medication have been tested and shown to
cause improvement in symptoms, and some others have shown promise.
Medication can help relieve distressing symptoms and make it possible
for you to participate in other types of talk therapy that have been
shown to be effective.
WHERE TO GO FOR HELP
Service members and their families may receive treatment for war zone
related problems from a number of qualified sources. These include chaplain
services, mental or behavioral health services located with hospitals or
clinics, primary care physicians or nursing, and family assistance programs.
Many veterans, including National Guard and Reserve members, and active duty
service members will receive treatment for PTSD at the Department of
Veterans Affairs (VA) and Readjustment Counseling Service Vet Centers. Most
treatment is performed in an outpatient treatment setting in which the
service member continues to live at home and attends individual appointments
and groups.
VA SERVICES
Make sure all service members enroll, even if there is no plan to use VA
services. Once service members have returned from deployment, they are
eligible to receive cost-free health care and readjustment services through
the VA for any conditions related to combat service for two years following
active duty. After two years, services are still available for a co-pay
based on income. If a person served in the National Guard or Reserves and
was deployed to a war zone, they are eligible for the same benefits. They
must enroll to be eligible for these services. Fill out an application
online at: www1.va.gov/health_benefits/
VA HEALTH CENTERS. VA health care centers are located across the country,
and range from small, local clinics to large hospitals. At these facilities,
service members can receive help for any problem, both physical and mental
health problems. Many VA facilities have experts in PTSD and related
problems your family member can talk with.
VET CENTERS. Another great place for getting help after returning home,
Vet Centers are located throughout the country and are focused on helping
veterans readjust to life after deployment and providing outreach. Many of
the counselors are veterans themselves. They offer readjustment and mental
health counseling, providing vets and their families with resources to
handle post-deployment issues.
To access care at a VA or Vet Center, your family member will need to
establish their status as a combat veteran by showing the Enrollment
Coordinator at his or her local facility one of the following pieces of
evidence:
- A DD-214 indicating service in a designated combat theater of
operations; or
- Proof of receipt of the Afghanistan Campaign Medal; Iraq Campaign
Medal; Armed Forces Expeditionary Medal; Kosovo Campaign Medal; Global
War on Terrorism Expeditionary Medal (does not include Global War on
Terrorism Service Medal); or Southwest Asia Campaign Medal; or
- Proof of receipt of Hostile Fire or Imminent Danger Pay (commonly
referred to as “combat pay”) after November 11, 1998; or
- Proof of exemption of Federal tax status for Hostile Fire or
Imminent Danger Pay after November 11, 1998. To find out more
information about benefits, or to locate the VA nearest you, call
1-877-VETS or go to www.vba.va.gov/EFIF, Vet Center, 1-800-827-1000 or
www.va.gov/rcs.
VETERAN SERVICE ORGANIZATIONS (VSOS)
Another great resource for individuals returning from a war zone is
Veteran Service Organizations (VSOs). These organizations specialize in
providing resources and assistance to military servicemen and women
following deployment, and help bring individuals with similar experiences
together. They also provide help with paperwork for benefits. These groups
are often organized by branch of service, religion, ethnicity, war zone
theater, purpose, and many other categories. Large organizations, such as
the American Legion and Veterans of Foreign Wars (VFW) are focused on the
needs of veterans in general. To find out more or become involved with one
of these organizations, check out www.va.gov/vso.
IN CLOSING
We hope you have found this guide helpful. Learning about what to expect
when a loved one returns from a war zone, and about combat stress reactions
and PTSD is an important first step to being able to recognize when help is
needed. We want to emphasize that most combat related reactions are not
permanent. In many cases, they will go away on their own. With early proper
treatment, problems that impact your family and relationships may be
minimized. When problems do continue, effective treatments are available. In
most cases cognitive behavioral therapy (with or without medication) can
either eliminate or at least improve stress reactions and functional
problems, and help stop family disruption. Remember, combat stress reactions
are like any other physical injury from war. There is a range of how severe
these invisible injuries are, just like there is a range of how severe
physical injuries are. If problems do persist, treatment may help everyone
lead a happier, more well-adjusted life.
For more information about stress-related disorders and resources for
veterans and their families, see
www.ncptsd.va.gov
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