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The Lingering Effects of Military Service

This Veterans Day, pay attention to mental health concerns.

For decades, many veterans and active-duty military personnel have been left to wage their own personal battles against mental health disorders long after their return home. Unfortunately, many veterans hesitate to seek professional assistance due to the social stigma surrounding mental illness. According to the Substance Abuse and Mental Health Services Administration, approximately 50% of returning service members who need mental health treatments pursue them, and only slightly more than half who receive treatment obtain adequate care.

As awareness of mental health conditions continues to grow, the stigma has lessened and more cases of post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI), the two most common mental health concerns facing today's veterans, are receiving greater attention.

PTSD

PTSD results from experiencing or witnessing a traumatic event. Symptoms of this disorder may consist of flashbacks, nightmares and severe anxiety or uncontrollable thoughts about the event. The symptoms can last for months to years.

According to the Wounded Warrior Project 2015 Annual Alumni Survey, more than 3 in 4 wounded veterans report PTSD. The Wounded Warrior Project estimates that at least 400,000 service members are dealing with this disorder.

"While stateside, every [service person] experiences depression and anxiety to a certain degree because of the occupational stress that accompanies the profession," explained Cpl. Phillip Sheldon, a Marine Corps machine gunner who served from 2011 to 2015. "Once home, the symptoms of PTSD manifest in different ways, but all too often we write the symptoms off as occupational stress and don't realize the magnitude of a veteran's suffering until the symptoms grow more severe."

A veteran's ability to identify his or her need for effective treatment can be critical to reducing PTSD symptoms and improving overall mental function. Without treatment, this condition can lead to intrusive memories, methods of avoidance, negative changes in thinking and mood, changes in emotional reactions, symptom intensification or even thoughts of suicide, the Mayo Clinic reports.

Although several types of medication can help improve PTSD symptoms, psychotherapy is an important component of care. Three subtypes of psychotherapy are used in PTSD: cognitive behavioral therapy, interpersonal therapy and exposure therapy. Cognitive behavioral therapy helps veterans recognize patterned ways of thinking which can be disruptive.

"We now have several empirically supported psychotherapies, such as cognitive behavioral therapy and interpersonal psychotherapy, for specific disorders, as well as the medications," said Michael Friedman, PhD, a clinical psychologist in Manhattan and a member of EHE International's Medical Advisory Board. "The key is making sure that both you and your providers are familiar with these treatments and that your treatment plan reflects a science-based approach to optimize likelihood of success."

Interpersonal psychotherapy involves a time-limited treatment plan that encourages a patient to regain control of his or her mental state through a 12- to 16-week program. In this program, the relationship among communication methods, interactions with others and resulting mental health conditions are stressed.

Exposure therapy assists veterans in safely facing their traumatic experience, teaching them how to effectively cope with the event. Eye movement desensitization and reprocessing are also used. These combine exposure therapies with a series of guided eye movements, helping a veteran to process traumatic memories while attempting to alter his or her standard reaction to the disturbance.

TBI

A TBI can result from a blow or jolt to the head; It is classified as mild, moderate severe or penetrating. The most common form of this injury in the military is a mild TBI or concussion, an event that disrupts the normal function of the brain. TBIs can be produced by blasts, bullets, fragments, falls, motor vehicle crashes, sports or assaults, according to the Defense and Veterans Brain Injury Center.

Pentagon figures published in an August 2015 Congressional Research Service report show that more than 300,000 service members experienced a TBI from 2001 through the first quarter of 2015; nearly 8,000 were severe or penetrating in nature.

"With mild TBI, one of the most common symptoms is problems with prospective memory-remembering to do things," explained Elizabeth Twamley, a neuropsychologist with the VA San Diego Healthcare System, in a press release.

These injuries can also cause other cognitive, physical and emotional symptoms. Cognitive symptoms may include concentration problems, attention problems, slowed thinking and difficulty finding words. Veterans who have experienced a TBI may physically notice headaches, sleep disturbances, dizziness, balance problems, nausea/vomiting, fatigue, visual disturbances, sensitivity to light, and tinnitus. 

Veterans who experience emotional responses to a TBI typically report irritability, anxiety, depression and mood swings. Although recovery is different for each person, symptoms usually begin to lessen within hours, but full recovery can take days or weeks. Nevertheless, every time an additional concussion is sustained, a TBI's healing time may increase, according to the Defense and Veterans Brain Injury Center (http://dvbic.dcoe.mil/about-traumatic-brain-injury/article/tbi-basics).

Veterans who have experienced a TBI can assist in the healing process by drinking plenty of water, eating a healthy diet, resting during the day, getting adequate sleep and by avoiding caffeine and alcohol, the center reports (http://dvbic.dcoe.mil/about-traumatic-brain-injury/article/tbi-basics).

Other Disorders

Other common diagnoses seen in some veterans include attention deficit hyperactivity disorder, bipolar disorder, major depressive disorder, sleep disorders, memory and cognition problems and substance dependence, the Veterans' Families United Foundation reports (http://veteransfamiliesunited.org/2011/06/06/common-diagnosis-medications-and-side-effects-of-veteran-readjustment-problems/). In some cases, symptoms of these conditions mask underlying PTSD.

"A friend of mine began drinking copious amounts of alcohol after his deployment from Afghanistan and blacked out in the company office, waking up in a fit of rage and confusion. He often remarked that the symptoms [of PTSD] were there all along had he listened to them and asked for help sooner," Sheldon told ADVANCE.

Seeking support for all mental health concerns helps ensure that veterans regain the highest quality of life and degree of normalcy. If you are a veteran in need of mental health services, or you know someone who is, healthcare is available at the closest Veterans Affairs Medical Center. Visit http://www.va.gov/ to locate the closest to your zip code. In case of a mental health crisis, call the Veterans Crisis Line at 1-800-273-8255.

Lindsey Nolen is a staff writer. Contact: lnolen@advanceweb.com.

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