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WAR

Published On January 5, 2015

POLICY

Foreign Wars, Domestic Tragedies

Families of returning veterans sometimes develop mental health problems of their own. An MGH team studies the problem and looks for solutions.

The U.S. involvement in the Iraq and Afghanistan wars is winding down, and soldiers’ stories are disappearing from the news. Yet the wars have left an emotional aftermath. An estimated 10% to 18% of the veterans of those conflicts experience post traumatic stress disorder, and this “invisible wound” creates ripple effects that can extend to family members. A study by researchers at the Veterans Administration Puget Sound Health Care System and the University of Utah suggests that in some cases, the effects of PTSD can affect all family members.

The study examined 65 couples in which the husband or male partner was an Iraq or Afghanistan veteran. In 33 of these couples the veteran had PTSD. As couples discussed an issue they disagreed about, researchers found that the spouses of those with PTSD displayed greater anxiety and higher levels of dangerous cardiovascular activity than did their partners who had PTSD. The couples dealing with the condition also showed higher levels of distress in their relationships.

Treating PTSD and other invisible wounds of war is the mission of the Home Base Program, a collaboration between Massachusetts General Hospital and the Red Sox Foundation, which provides clinical care and support services to veterans and their families.

For couples dealing with PTSD, Home Base provides a therapy model using cognitive behavioral conjoint therapy (CBCT) — a type of treatment designed to address the symptoms of PTSD in one partner while also improving communication and relationship skills.

This communication-based approach takes aim at one of the hallmark symptoms of PTSD: emotional numbness. A spouse may feel frustrated and shut out from intimacy, according to Shiri Cohen, PhD, a clinical psychologist providing couples and family treatment with the Home Base program. “Couples will often say that they have communication issues, but that may be code for something more profound — a feeling of disconnect and isolation in the relationships,” Cohen says. “Spouses will tell me, ‘I’m in this partnership but he’s not really there.’”

The therapy begins by teaching the couple to recognize the ways that PTSD can affect the nervous system — for instance, by triggering an exaggerated startle response. The therapist helps the couple find the right techniques to negotiate tense moments. They also learn to brainstorm alternative ways of thinking about war experience that may linger, such as persistent thoughts of guilt or fear. This work that the spouses undertake together, says Cohen, capitalizes on a couple’s shared emotional resources while also building those resources further through an emotionally intimate recovery process.

Children, too, may experience ripple effects. When a parent seems different from when he or she left, kids may feel anxious and confused. “The emotional withdrawal, disengagement from shared activities, and irritability of a parent with PTSD can leave kids feeling like the parent doesn’t love them anymore,” says Bonnie Ohye, PhD, acting clinical director of the Family Team at Home Base. Some children may act out, withdraw, or develop a short fuse themselves.

Others can develop academic or social difficulties. A 2013 study of more than 14,000 California children in seventh, ninth and 11th grades found that those who’d had a parent or sibling deployed were 40% more likely to report feelings of sadness or hopelessness, 24% more apt to experience suicidal thoughts and 15% more likely to feel depressed than peers who didn’t have a family member in the military.

Home Base offers support, consultation, and connection with care providers to parents and children as they process a parent’s war injury, deployment or their own emotions. “Kids can worry that if they’re really honest with their parents it will damage their relationship,” Ohye says. The therapeutic process will ideally help children and parents learn how to re-connect with one another.

Since its inception, the Home Base program has served more than 7,500 veterans and military family members with clinical care and support.

To further extend its reach, Home Base has partnered with MGH’s Psychiatry Academy to develop “From the War Zone to the Home Front,” a free, online training program that helps train health care providers to recognize and address the mental health needs of veterans and their families.

The program trains community clinicians to recognize and treat problems that returning veterans and military families face. “Some of it is just raising awareness to ask — are you part of a military family? So many clinicians never ask,” says Naomi Simon, MD, MSc, Chief Medical Officer of the Home Base Program.

The online courses began in 2012, and since then, Home Base has trained over 14,000 providers nationwide to recognize and respond to invisible wounds of war in their clinical practices.

Participants hail from all over the U.S. and include social workers, psychologists, nurses and physicians.

One of the Home Base Program’s most important objectives is to spread the message that PTSD and other invisible wounds are highly treatable, says Paula K. Rauch, MD, program director for the Family Team at Home Base. “That’s an under-told story,” she says. “There is hope.”

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