Article

A Scheme for Categorizing Traumatic Military Events

1VA Boston Healthcare System, MA, USA.
Behavior modification (Impact Factor: 2.23). 06/2012; 36(6):787-807. DOI: 10.1177/0145445512446945
Source: PubMed

ABSTRACT A common assumption among clinicians and researchers is that war trauma primarily involves fear-based reactions to life-threatening situations. However, the authors believe that there are multiple types of trauma in the military context, each with unique perievent and postevent response patterns. To test this hypothesis, they reviewed structured clinical interviews of 122 active duty service members and assigned the reported index (principal, most currently distressing) events to one or more of the following categories: Life Threat to Self, Life Threat to Others, Aftermath of Violence, Traumatic Loss, Moral Injury by Self, and Moral Injury by Others. They found high interrater reliability for the coding scheme and support for the construct validity of the categorizations. In addition, they discovered that certain categories were related to psychiatric symptoms (e.g., reexperiencing of the traumatic event, guilt, anger) and negative thoughts about the world. Their study provides tentative support for use of these event categories.

0 Followers
 · 
109 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Despite its prevalence, killing in war is an experience that may not fit neatly into existing models of posttraumatic stress disorder (PTSD) and its treatment. The context in which killing occurred may be complex. Furthermore, while killing may certainly be fear based, an individual may have also killed in response to losing someone close and experiencing sadness and anger, as opposed to fear. While evidence-based treatments for PTSD may be a good starting point for killing-related trauma, we argue that existing treatments need to be expanded. Complex killing-related cognitions that may not be anticipated or identified, moral injury, self-forgiveness, and loss are all important issues that arise that may need to be addressed in greater detail. Consequently, we have developed a 6- to 8-session individual treatment module for those impacted by killing in war, expressly designed for use with existing evidence-based treatments for PTSD, currently being validated for use in clinical practice. We see this module as supplementary, rather than as a replacement, building on the skills that veterans have already learned within these treatments. By expanding the types of treatments we offer those who have killed in war, we can ensure that we are providing veterans with comprehensive treatment that takes the complexities of war and its aftermath into account.
    Cognitive and Behavioral Practice 11/2013; 20(4):476–479. DOI:10.1016/j.cbpra.2013.05.003 · 1.33 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Guilt related to combat trauma is highly prevalent among veterans returning from Iraq and Afghanistan. Trauma-related guilt has been associated with increased risk for posttraumatic psychopathology and poorer response to treatment. Trauma Informed Guilt Reduction (TrIGR) therapy is a 4-module cognitive-behavioral psychotherapy designed to reduce guilt related to combat trauma. The goals of this study were to describe the key elements of TrIGR and report results of a pilot study with 10 recently deployed combat veterans. Ten combat veterans referred from a VA Posttraumatic Stress Disorder (PTSD) or mental health clinic completed TrIGR over 4 to 7 sessions. Nine veterans completed the posttreatment assessment. This initial pilot suggests that TrIGR may help to reduce trauma-related guilt severity and associated distress. Changes in trauma-related guilt were highly correlated with reductions in PTSD and depression symptoms over the course of treatment, suggesting a possible mechanistic link with severity of posttraumatic psychopathology. TrIGR warrants further evaluation as an intervention for reducing guilt related to traumatic experiences in combat.
    Cognitive and Behavioral Practice 01/2013; DOI:10.1016/j.cbpra.2013.08.001 · 1.33 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: This study examined whether exposure to morally injurious experiences (MIEs) contribute to mental health problems among returning Veterans via meaning made of possible traumas. Method: 131 Iraq and/or Afghanistan Veterans completed assessments of exposure to possible war-zone traumas, meaning made of a salient stressor from their lives, and mental health symptomatology (e.g., posttraumatic stress, depression, suicidality). Results: Structural equation modeling findings revealed that MIEs were indirectly linked with mental health outcomes via the extent to which Veterans were able to make meaning of their identified stressors. However, we also found that the direct path from MIEs to mental health problems was statistically significant. Conclusion: These findings provide preliminary evidence that difficulties with meaning making could serve as a mediating pathway for how MIEs increase the risk for adjustment problems following war-zone service, but that other factors associated with moral injury also have a bearing on psychological functioning among Veterans.
    Journal of Clinical Psychology 10/2014; 71(3). DOI:10.1002/jclp.22134 · 2.12 Impact Factor