“Healing takes courage, and we all have courage, even if we have to dig a little to find it.” — Tori Amos

Monday, November 11th was Veteran’s Day; a time to remember and commemorate those brave women and men who have fought for our country and freedoms. War can have serious effects on a country as a whole. I lost a dear friend to the Iraq war a few years back, and I remember the emotions that came along with the tragic loss: sadness, helplessness, and a bit of anger for the loss of such a young life. Many Americans have suffered emotionally from the deaths of war: Families, friends, and citizens. And then in the shining light of opposition, there are those that return home. Feelings of joy, relief, and pride are sure to be filled in not only the families and American citizens, but also the soldiers themselves. For many, returning home may be returning to normalcy and happiness, while for others it may be a different story. What about those veterans that are unable to leave their thoughts, feelings, and experiences of combat?

What about those veterans that experience PTSD?

There are over 2.3 million American veterans of the Iraq and Afghanistan wars (Veterans and PTSD, 2013). At least twenty percent of those veterans have developed PTSD and/or depression (Veterans and PTSD, 2013). In May of this year, CBS news and CBS Cares released a special radio hour dedicated to exploring the impact of PTSD on veterans. Listen to the show. What stood out for you? What did you learn?

The radio show describes harrowing effects of PTSD that seem to affect many veterans. Army Captain Shannon Mann, guest to the show, describes that many veterans leave the war with known, visible wounds, but often overlook their “invisible wounds” (CBS News, 2013).

Captain Mann suffered from a traumatic brain injury and combat stress. Mann describes his wounds manifesting through constant tension, violent nightmares, and an inability to leave bed (CBS News, 2013). These symptoms suffered by Captain Mann are symptoms that many other soldiers face and may face years after. In a study investigating PTSD among Vietnam War veterans, it was founded that of the 1.7 million veterans who ever experienced significant symptoms associated with PTSD, approximately 50% reported still experiencing distress from PTSD almost twenty years after (Weiss, Marmar, Schlenger, Fairbank, Jordan, Hough, & Kulka, 1992).

Why are there so many veterans still experiencing PTSD symptoms so long after? One answer may be the stigma that is unfortunately associated to it. Mental health has an associated stigma that affects those that are suffering, and war veterans may be a group that experiences its severity. In this clip, a war veteran describes the stigmas that PTSD symptoms may have on him and how others view him. According to researchers, self-stigma is a stigma in which an individual becomes aware of a stereotype associated with a stigmatized group, agrees with that stigma, and applies the stereotypes to one’s self (Mittal, Drummond, Blevins, Curran, Corrigan, & Sullivan, 2013). In a study exploring this self-stigmatized phenomenon, veterans with combat-related PTSD reported that they believed the public perceived them as

“dangerous”

“violent”

and “crazy.”

Similarly, it was found that the majority of veterans in this study believed that much of public held them responsible for causing their own illness due to their volunteering for military duty (Mittal, et al., 2013). These findings are disheartening especially due to the fact that there is no evidence to an increased aggression or danger among this group of individuals. It was shown from this study that many veterans who suffer from PTSD are avoiding treatment and are resistant to seeking treatment.

            Group therapy may be the answer. Group therapy allows for individuals to come together and discuss similar experiences, adversities, and emotions in a safe and accepting atmosphere. Group treatments provide social support and the opportunity for individuals to develop trusting relationships (Mott, Sutherland, Williams, Lanier, Ready, & Teng, 2013). Similarly, group therapy allows an individual to feel validated and understood by those peers that have had similar experiences (Mott, et al., 2013). The previously discussed study found that those veterans that interacted with other combat veterans who had PTSD helped empower them to collectively resist and dispute the stereotypes, which helped reduce their self-stigmization (Mittal, et al., 2013). Group-Based Exposure Therapy (GBET), a commonly used therapy for PTSD, has been shown to be effective in the reduction of PTSD symptoms and stigmatized attitudes. Group based exposure therapy allows individuals to be exposed to their feared object or context without any danger in a group setting, in order to overcome their fears and anxiety (Mittal, et al., 2013). A study conducted on twenty male veterans who received GBET founded that those veterans who completed the therapy showed a significant reduction in PTSD symptoms (Mittal, et al., 2013). Those participants in the study also reported that exposure to fellow members helped to normalize the experiences (Mittal, et al., 2013). In a similar study, GBET was found to show significant reductions in PTSD symptoms, reported depression symptoms, and cognitions related to PTSD (Ready, Vega, Worley, &Bradley, 2012). In a follow up of the study, it was founded that six months post treatment, participants reported having lasting benefits from sharing and hearing others’ military-related trauma (Ready, et al., 2013).

            GBET may be the answer to helping those veterans seeking and receiving the treatment they need, but it isn’t the only help veterans need. Stigma needs to be resolved and diminished for not only veterans, but for mental illness as a whole. Support our veterans this Monday as they helped and supported our country. Visit the National Center for PTSD  or Invisible Hero and take the step to make a difference!

References

CBS News. (2013). Post-traumatic stress disorder’s effect on U.S. veterans explored on CBS radio news. Retrieved November 9, 2013, from http://www.cbsnews.com/8301-35277_162-57585903/post-traumatic-stress-disorders-effect-on-u.s-veterans-explored-on-cbs-radio-news/

Mittal, D., Drummond, K.L., Blevins, D., Curran, G., Corrigan, P., & Sullivan, G. (2013). Stigma associated with PTSD: Perceptions of treatment seeking combat veterans. Psychiatric Rehabilitation Journal, 36(2), 86-92.

Mott, J.M., Sutherland, R.J., Williams, W., Lanier, S.H., Ready, D.J., & Teng, E.J. (2013). Patient perspectives on the effectiveness and tolerability of group-based exposure therapy for posttraumatic stress disorder: Preliminary self-report findings from 20 veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 5(5), 453-461.

Ready, D.J., Vega, E.M., Worley, V., & Bradley, B. (2012). Combining group-based exposure therapy with prolonged exposure to treat U.S. vietnam veterans with PTSD: A case study. Journal of Traumatic Stress, 25, 574-577.

Veterans statistics: PTSD, depression, TBI, suicide. (2013). Retrieved, 2013, from http://www.veteransandptsd.com/PTSD-statistics.html

Weiss, D.S., Marmar, C.R., Schlenger, W.E., Fairbank, J.A., Jordan, B.K., Hough, R.L., & Kulka, R.A. (1992). The prevalence of lifetime and partial post-traumatic stress disorder in vietnam theater veterans. Journal of Traumatic Stress, 5(3), 365-376.

1)

Watch this short clip .

What feelings did you experience watching this?

Disgust? Sadness? Now, notice the feelings and attitudes that the women express. Shame. Unable to express and feel the terror they have experienced.

The women of the Eastern Democratic Republic of Congo have experienced trauma. Almost 40% of the women in the Congo have experienced some sort of sexual violence. The violent abuse these women face result in mental health problems, such as depression, fear, anxiety, and PTSD. Many of these women feel shame, unable to tell anyone of their experiences for fear of abandonment and rejection from family and friends (Bass, Annan, Murray, Kaysen, Griffiths, Cetinoglu, Wachter, Murray, & Bolton, 2013). They are not the only ones affect. Many children of these women are subjective to these brutalities forced upon their mothers. Similarly, many of these women are left pregnant, increasing their concern about how to provide for themselves and their family.

Imagine the detrimental toll not only the experiences have on the women, but also the fact that these women feel unable to express themselves safely. What is the answer? According to the New York Times (2013), group therapy may be helping these women survivors overcome their shame in order to regain their lives.

Researchers sought to determine the advantages of group therapy practices for women of the Congo that had experienced sexual violence. The researchers provided the subjects of this study with cognitive processing therapy for treating the depression, anxiety, and PTSD of the survivors (Bass, et al., 2013). The results of this study showed that the group therapy in comparison to individual support alone was more effective in reducing the symptoms associated with PTSD and depression. In a follow-up, it was assessed that even six-months after the treatment, only nine percent of women who had received group therapy were still experiencing anxiety, depression or PTSD. However, forty-two percent of women who received individual support were still experiencing these problems (Bass, et al., 2013). Similarly, the therapy helped in improving the daily functioning of the survivors in the study (Bass, et al., 2013).

What was helpful?

According to the New York Times article (2013), one benefit of the group therapy was that women were able to face their emotions and experiences head on. The women were asked to question their beliefs of blaming themselves. Women were taught to think rationally about the feelings there were experiencing as well as the beliefs that ensued after the attack. After reading this I thought, that is amazing, but can’t individual therapy help in that exploration as well? So WHAT about group therapy created such a drastic improvement?

SUPPORT.

Although, it was not mentioned in the article, or the study, I believe that the universality of the experiences that these women faced created cohesion that a group needs in order to strive. This universality creates strong support. Each of the women in the groups feels the emotions that others are feeling; know the risks of expressing the experiences to family and friends, but also understand what these emotions and experiences have done to them and their lives. The commonality in experiences may give women the encouragement they need in order to make a positive change.

Although this therapy helped those women, many women of the study (and myself) were left with several questions. For one, why has this treatment not reached those of distress sooner? Perhaps due to culture, finance, or lack of resources. However, it is apparent that there is some gratifying result of group therapy for women who have experienced trauma. Another question that came up is the cultural connotations that this study has and needs to be considered. Do the communal aspects of group therapy resonate to a culturally communal environment, such as the Congo? What are the cultural differences from Congo women and those women in the United States or elsewhere? Regardless of these questions, it is apparent that this study not only shows the advantages group therapy has for the women of the Congo, but also that group therapy may be beneficial in many settings for women who are experiencing PTSD or are victims of sexual violence. As the lead researcher of the study stated, “If you can do this in Congo, you can do it anywhere” (New York Times, 2013).

By following this link you can learn more about the travesties that are happening in the Congo, donate, and get involved. You too can help end these travesties.

Similarly, you can also join a run for the Congo women. Get involved by joining a run near you, planning one, or increasing your awareness. Knowing is the first step!

 

References

Bass, J.K., Annan, J., Murray, S.M., Kaysen, D., Griffiths, S., Cetinoglu, T., Wachter, K., Murray, L.K., & Bolton, P.A. (2013). Controlled trial of psychotherapy for congolese survivors of sexual violence. The New England Journal of Medicine, 368(23), 2182-2191.

Grady, D. (2013). Therapy for rape victims of sexual violence shows promise in congo. Retrieved, 2013, from http://www.nytimes.com/2013/06/06/health/therapy-for-rape-victims-shows-promise.html?pagewanted=all&_r=0

“Our Sorrows & Wounds are Healed, Only When We Touch Them with Compassion.” – Buddha: A Look into Group Therapy and Trauma

Close your eyes. Now imagine that there’s an ominous black figure chasing you. No matter where you turn, that black figure is lurking around each corner. You may get away from this figure, but it always shows up; it is at your work, out with your friends, and even in your dreams at night. This figure terrifies you, and your fear affects your daily functioning. Open your eyes. How do you feel? Terrified? Overwhelmed? Don’t worry, you were just imagining. What if you were to feel like this all the time? For many who have experienced a terrible and traumatic event, this may be how they go about their daily lives.

            Trauma is a response an individual may have as an effect of an event such as rape, natural disaster, or death of a loved one. A victim of trauma commonly experiences a mixture of psychological, behavioral, and emotional problems that often affect their daily functioning. Posttraumatic stress disorder (PTSD) is a mentally diagnosed disorder that is seen through characteristics of survivors of prolonged trauma (Mendelsohn, Zachary, & Harney, 2007). While, not all those who experience a trauma will develop PTSD, there are those who will. Check out this clip…

Feelings of pain, experiences of flashback, and dissociating from the world are experiences this woman had due to her PTSD. And she’s not alone. According to the National Institute of Mental Health (2005), over a 12-month period about 3.5% of United States adults were diagnosed with PTSD. Of those 3.5%, 37% of the cases were considered severe. Given the problems that may arise for a person who experiences trauma, it is important for them to find resource that can create a sense of safety in the social world (Mendelsohn, et al., 2007)). Each of us has experienced even a small event that may have shaken us up, and altered our lives for even just one day. While I have not experienced trauma that has impacted my daily functioning, I know that it exists. I believe that it is important for more people to understand trauma, and furthermore the possibility that group therapy may give people that are inflicted their lives back.

Many people who experience trauma may walk through the world with feelings of mistrust, shame, and general fear (Mendelsohn, et al., 2007). Similarly, research has shown that many people who are experiencing post-traumatic stress disorder (PTSD) are more susceptible to developing symptoms related to anxiety disorders, depression, personality disorders, and substance abuse (Mendelsohn, et al., 2007). It is important for individuals to gain a sense of power and control back, but how do they go about doing that? Who can possibly understand what they are going through? Does exploring their fears open an exposure to the painful memories that they are trying to forget?

Group therapy allows individuals to connect with others who may have experienced similar incidents, and also help in developing trusting relationships. Group therapy is a form of therapy in which a number of people meet together under the guidance of a therapist in order to help themselves and others in their journey to change and help (AGPA, 2012).

Harold Cohen (2013) of Psychology Central further explains that confrontation and exposure to another fellow survivor of trauma may be easier than to someone who has never experienced trauma first-hand. According to Mendelsohn, et al., group therapy also engrains an understanding of the outside world that is in exact opposition of the adversity that they have been exposed to. The non-stigmatized support that group members offer each other creates resiliency and improved self-esteem while in turn repairing environmental discrepancies (Mendelsohn, et al., 2007).

My blogs will explore different facets of group therapy in regards to trauma. I am hoping to dive into specific traumatic experiences, and possible group therapy benefits. Also, I will explore several new and interesting group therapies for trauma survivors. My process will allow the opportunity for debate, and I hope and encourage that these blogs offer the opportunity for questions and issues either in favor or against my proposed topic. However, the main purpose of my blogs is for at least one reader to come away will a greater understanding and empathy for the challenges that trauma survivors face. It is my hopes to relay to everyone (trauma survivors and all) a sense of hope and understanding; you are NOT alone!

 References

American Group Psychotherapy Association. (2012). Group therapy. Retrieved, 2013, from http://www.agpa.org/group/consumersguide2000.html

Cohen, H. (2013). Psychotherapy treatments for PTSD. Retrieved September, 2013, from http://psychcentral.com/lib/treatment-of-ptsd/000665

Mendelsohn, M., Zachary, R.S., & Harney, P.A. (2007). Group therapy as an ecological bridge to new community for trauma survivors. Journal of Aggression, Maltreatment & Trauma, 14, 227-243.

Post-traumatic stress disorder among adults. (2005). Retrieved, 2013, from http://www.nimh.nih.gov/statistics/1ad_ptsd_adult.shtml