Barriers to Seeking Treatment for PTSD in Returning Operation Iraqi Freedom and
Operation Enduring Freedom Airmen
Webster University, Albuquerque, New Mexico
TABLE OF CONTENTS
Proposal Summary3
Problem Statement and Literature Review5
Proposal Objectives8
Proposal Methodology9
Time Line12
Evaluation13
Implications for Future Research14
Proposal Budget15
References16
Appendix I (PTSD Questionnaire)17
Appendix II (Counseling Pre/ Post test)21
PROPOSAL SUMMARY
RESEARCH QUESTIONS:
What are the barriers to treatment for PTSD by returning Airmen at the three New Mexico Air Force bases? What type of program would be acceptable to Airmen to seek treatment for PTSD? Would providing counseling for returning Airmen change attitudes about seeking mental health treatment in the military?
RESEARCH GOALS:
To provide information to civilian/ military leaders about how to increase participation rates in counseling for Airmen returning from war.
RESEARCH FOCUS:
Identify factors that inhibit Airmen from seeking counseling for PTSD.
EXPECTED OUTCOME:
Information can be used to construct a program to enhance counseling participation rates among returning Airmen.
METHODOLOGY:
Phase 1- All members at Kirtland AFB, Cannon AFB and Holloman AFB (that have deployed to Iraq or Afghanistan since 2001 or are scheduled to deploy within the next year) will complete and return an electronic questionnaire about their perceptions of PTSD and their willingness to participate in counseling. Phase 2- members identified in the questionnaires showing signs of PTSD would be interviewed by research team to gain insight into their willingness to seek treatment. Phase 3- Airmen who showed signs of PTSD and sought treatment would be interviewed to provide insight into their experience and help evaluate why they chose to seek treatment and the outcome. Phase 4- Airmen who meet the criterion for PTSD will be provided counseling to let them experience counseling and to see if their mindsets about counseling change after completion of program.
COST AND DURATION:
This is a 24 month research project to take advantage of the bases’ deployment cycles. The proposed cost is $553,000 to cover the expenses of covering three bases in the New Mexico area. The cost includes researcher fees, data collection, travel expenses, hiring, and training four researchers for the project. Our plan is to hire two researchers at Cannon AFB and two researchers at Holloman AFB, however, if no qualified personnel can be found at these locations the project would require an additional $36,000 (at each location) to lodge and feed researchers. If base could provide meals and lodging for the part-time researchers then costs could be lower for the project.
PROBLEM STATEMENT AND LITERATURE REVIEW
The United States is engaging in a war that is predicted to outlast the length of the Vietnam War. The aftermath of Vietnam left 830,000 to deal with the consequences of PTSD (Schnurr P. et al, 2003) where it left its victims disturbed (broken homes, drug/alcohol abuse, depression and isolation). Although difficult to measure, it is predicted that more people died from in the aftermath of Vietnam from PTSD related suicide and behavior then the people listed on the Vietnam Nam Memorial (Coleman, 2006). The number of returning service members from Operation Enduring Freedom and Iraqi Freedom showing symptoms of PTSD in now over 300,000 and a recent study by the Rank Corp has found that only 53% of these individuals seek treatment for PTSD (Rand, 2008). Data from the National Vietnam Veterans Readjustment Study indicated that 38% of the 830,000 cases of PTSD did not show up in the veterans until 2-5 years after returning from combat (Schnurr P. et al, 2003). If the data from the Vietnam conflict holds true then The United States can expect this number to sore as theses conflicts continue and members experience delayed symptoms of PTSD from their experience.
Military forces of all four branches are facing a war within themselves, the war on PTSD and the stigma that goes along with seeking counseling or treatment with this mental diagnosis, as well as, any other mental issues. So why is there so much fear in seeking help for issues that come up either in war or in the home life? “Many service members fear that seeing a psychologist will sink their careers” says Navy. Cmdr. Anthony Arita, Ph.D. They worry – often needlessly- that their problems will get back to their bosses, endanger their security clearance and even result in their separation from the service (Dingfelder, 2009). Military leaders fear that these invisible war injuries could deplete a fighting force that’s already stretched thin (Dingfelder, 2009; Swaines, 2008; Schafer, 2006).
So is there a way to change the stigma on seeking help when it is needed? When speaking with veteran Staff Sergeant John G. Romero, USMC, about the stigma that goes along with counseling he said, “You just know that you don’t do it, they tell you it won’t hurt your career and then you see guys getting kicked out for not cleaning their room right, after they went and got help. It hurts your career, it really does. If you plan on staying in you suck it up and you get help once you’re out” (Romero, 2009). The military on the other hand has already starting making changes to try and provide better mental health services to its members. Higher up’s in the military such as Generals are coming forward and telling their stories and their struggles with PTSD, letting lower ranking individuals know that it is ok to feel this way, and ok to get the help you need. The Defense Department has changed its security clearance questionnaire so that people who seek mental health care for combat-related reasons do not have to report it. They also have launched a $2.7 million dollars service wide anti-stigma campaign. Senior Airman Christopher Jordan, USAF, who is on this third tour overseas (two tours in Iraq and currently serving a tour in Afghanistan) states that he does see more willingness to seek help of others or more soldiers saying that they are in need of help. “Much more than I saw two years ago in Iraq” (Jordan, 2009). This statement shows that more and more of our soldiers are being emotional affected from the traumatic experiences they are having in war.
Currently, the United States Department of Veterans Affairs (VA) and the Department of Defense are using the “A” treatments and guidelines recommended by The International Society for Traumatic Stress Studies (ISTSS). These treatments include Prolonged-exposure therapy (PET), Eye-movement desensitization and reprocessing (EMDR) andcognitive behavioral treatments. A research team from Emory University is currently working with Iraqi war veterans to research the effects of virtual reality that exposes the veterans to simulated combat conditions in Iraq, the team then randomizes the conditionsand administersthe drugs D-cycoserine (DCS), a placebo, or the anti-anxiety drug alprazolam (Xanax) to analyze the effects on the participants (DeAngelis, 2008).
Even with all different types of studies going on with current military members and veterans it still begs that question of, why is there so much stigma with getting mental help when needed? We believe that until this question is answered neither the military nor the general public will fully understand why only 53% of soldiers seek help for PTSD. The first step towards a more empirical assessment of the effectiveness of counseling with military members and veterans of the military is to gather more information from soldiers themselves as to why they fear seeking treatment. It is clear that more studies need to be done to fully understand the stigma, and more services for mental health with no consequences need to be offered to service members since the number of individuals returning home from war with PTSD is continually growing. Through our study, we intend to indentify why soldiers have a stigma with seeking mental health and what can be done to change the attitude or stigma that goes along with seeking counseling in military service members of the United States.
PROPOSAL OBJECTIVES
1.Identify Airmen with signs of PTSD criterion as defined by DSM-IV-TR using PTSD Questionnaire developed by the Anxiety Disorder Research Center.
2.Identify Airmen’s current feelings about the military and seeking counseling.
3.Identify obstacles for Airmen seeking counseling and identify any positive factors that may lead to more Airmen seeking counseling for PTSD.
4.Provide group counseling to members returning who exhibit criterion for PTSD and evaluate members’ attitudes toward counseling after completing the group therapy sessions.
PROPOSAL METHODOLOGY
Why is there such a stigma with seeking help for PTSD in the military?
How can we encourage more of our returning service members to seek counseling treatment for PTSD so that they can deal with it effectively in their daily lives?
The United States Government and The United States Air Force are trying to better understand why so many of their soldiers are not dealing with their war induced mental issues, i.e. PTSD. We have chosen to conduct a small population evaluation and experiment with the Air Force in New Mexico. New Mexico offers a diverse Air Force population. Kirtland AFB has approximately 4200 active duty and reserve personnel who represent all major Air Force Commands. Kirtland is engaged in the regions of Iraq and Afghanistan providing members to assist the United States Army in rebuilding and training Iraqi forces and engage in combat operations in Afghanistan. Cannon AFB has approximately 2600 Airmen from the Air Force Special Operations Command sending aircraft and personnel to support special operations forces in both theaters, as well as, piloting unmanned aerial vehicles. Holloman AFB has approximately 2600 active duty personnel assigned to the Air Combat Command- pilots there are transitioning from the F-117A Nighthawks to the F-22A Raptor and have combat experience in both theaters. All bases combined provide our research with a cross section that is representative of the entire Air Force.
Squadrons from each base will be chosen to take a series of electronic pre-tests prior to their deployment, as well as,Airmen who are returning from deployment. Each Airman will be screened by this pre-test as to how much they might be suffering from PTSD. We will train four research assistances (two for each base) to administer the pre-test and to compile data to show the effects of the before and after thoughts of war deployments.
We will have two experimental groups; returning soldiers from two bases (Kirtland and Canon). Kirtland soldiers will receivemandatory group counseling (18 sessions) conducted by lead researchers. These group counseling sessions will focus on the stigma of receiving counseling as well as teaching Airmen that they are not alone in this fight and that together they can help each other deal with the effects of war and PTSD. At Canon, group counseling with be voluntary to all returning soldiers. The two lead researchers will conduct intensive interviews with soldiers who show signs of PTSD based off of pre-test, but who do not volunteer for group therapy. Once Airmen have returned from war, volunteer group therapy will be offered. To those at Cannon who choose group therapy and at Kirtland who have been mandated to participate in counseling, 18 sessions will be conducted and the groupmembers will be given a post-test that will be compared with their pre-test to evaluate if there is a change in mindset to seeking treatment. Airmen who do not choose group therapy will be administered the post-tests. Intensive interviews will also be conducted with this round of soldiers returning from war. Holloman Air Force Base will be our control group. These Airmen will not receive any counseling sessions; they will just be given the pre and post-tests.
Researchers from all sites will compile data from questionnaires, pre and post tests, interviews and group therapy session. Our units of analysis included both returning and deploying Airmen from war. The preparation and research of this study will take 24 months. 22 of those months will be used to conduct research and the last two months will be used to compile data. Upon completion of this study, data will show the thoughts of seeking treatment from active duty service members, and if counseling (i.e. group therapy) was helpful in helping service members deal effectively with their PTSD symptoms. Researchers will then determine core stigmas of seeking counseling and effective ways of encouraging service members to seek treatment.
The pre and posttest questionnaires will be mandatory for personnel that meet the project requirements (deployed to Iraq or Afghanistan since 2001). The part time researchers will be trained and guidance for the intensive interviews will be standardized so each research group is gaining the appropriate information for the study. The data collection methods will be identical at each base to ensure research is standardized. Researchers must collect post deployment questionnaires within two weeks of the members return from combat- to measure results of both the pre and post deployment mindset of the individuals.
Summary of Methods
1.Survey Airmen at Kirtland AFB, Cannon AFB and Holloman AFB who have deployed to Iraq or Afghanistan (since 2001) and returned or those who are about to deploy to these regions using an electronic survey.
2.Use appendix I and appendix II as a pre test for deploying Airmen and have members’ complete questionnaires (posttest) after they return from combat to see if members meet criterion for PTSD and determine thoughts about seeking help for PTSD.
3.Airmen that displayed criterion for PTSD will be given intensive interviews to determine attitudes Airmen have for seeking or reasons for not seeking counseling for PTSD.
4.Evaluate data for factors that affect Airmen from seeking treatment for PTSD and evaluate information gained through intensive interviews to determine positive and negative influences on members’ willingness to seek treatment.
5.Provide Group Therapy and evaluate effectiveness.
TIME LINE
(Total time 24 months)
Months 1-2: Meet with Government Officials of the United States Air Force who hired us to do their study on PTSD. Develop questionnaire for military service members. Visit bases and squadrons where questionnaire will be given and meet with squadron leaders. Locate and secure an office for workers. Obtain computer equipment. Hire research observers and counselors.
Months 3-12: Conduct Research. Work with squadron leaders and military staff to select squadrons and decide which rotation of Airmen will receive treatment. Give pre-test to first rotation of Airmen getting ready for deployment, as well as, the last rotation of Airmen who just returned from deployment. Give volunteer group therapy to Airmenwho meet the criterion for PTSD who just returned from war. Conduct intensive interviews with Airmenthat do not choose group therapy. Locate and secure office place for testing.
Months 13-21: Conduct second round of research with returning Airmen who took pre-test. Give volunteer group therapy to Airmen. Give post-test. Conduct intensive interviews with soldiers who show signs of PTSD and who refuse to get treatment or help with PTSD. Provide counseling to volunteers of first rotation of Airmen after returning from war.
Months 22-24: Compile data gathered by research assistance and counselors. Compare pre-test and post-test data. Evaluate effectiveness of therapy. Identify counseling issues with significant improvement of counseling participation before and after war. Evaluate program and issue final report.
EVALUATION
Success in this project will be:1. For the researchers to be able to identify barriers to counseling in Airmen stationed at New Mexico Air Force bases. Questionnaires will give researchers a good indication of the current mindset towards seeking help for PTSD. Airmen identified through testing that meet the PTSD criterion will give researchers insight on the reasons to why or why not some Airmen seek help and others do not.
A Target group from Kirtland and Cannon AFB (individuals with seven or more criterion for PTSD) will be provided counseling; 2.) if there are positive changes in attitude towards counseling from group members after the 18 sessions it would provide great insight for the research team.Research from the three bases will be compiled and analyzed to determine if there are common factors among the bases.
3.) The research will include counseling of individuals that meet PTSD criterion and if Canon Airforce base can get at least 20 individuals to voluntarily participate in counseling we would consider that successful for our research.
IMPLICATIONS FOR FUTURE RESEARCH
Research has already shown that 300,000 members of the military are experiencing symptoms of PTSD and only half are seeking treatment. There has been a stigma on mental illness in the military and findings from this research may be a step in the right direction for the development of new programs that will encourage more military people to get help for their PTSD before they return to civilian life and deal with this burden themselves. Airmen are being exposed to situations they have never before encountered (filling ground duty positions in combat to support the Army- i.e. convoy duty, preparing dead service member for shipment back to the states, killing people from remote locations (UAVs) interrogating and guarding prisoners) and are witnessing the harsh realities of war. The results of this research will give Air Force leaders a snapshot of members of all Air Force commands and provide vital information to help its Airmen before they medicate themselves with alcohol, turn to drugs, isolate themselves from family and friends and possibly commit suicide. The research conducted in New Mexico could be continued in other states and overseas to assess different environments to determine variables that have an effect on a member’s willingness to seek treatment for PTSD (leadership, PTSD education, family support and awareness programs).