Tag: ptsd

Healing the Invisible Wounds: Understanding and Treating PTSD Among Military Veterans

Post-traumatic stress disorder (PTSD) has become one of the most pressing mental health issues among military veterans, particularly in the wake of modern conflicts in Iraq and Afghanistan. Years of exposure to intense combat, guerrilla warfare, and constant danger have left many veterans struggling with lasting psychological trauma. Despite increased public awareness and advances in treatment, PTSD continues to impose severe emotional, social, and economic burdens, both on individuals and on the healthcare system (Reisman, 2016).

PTSD among veterans is not a new phenomenon – it is a modern understanding of a condition that has existed as long as warfare itself. Historical records describe symptoms akin to PTSD as far back as ancient Greece, and over the centuries it has been labeled by many names, from “shell shock” during World War I to “battle fatigue” in World War II. The diagnosis of PTSD became formalized only in 1980, after the Vietnam War made clear the long-term psychological cost of combat. Contemporary studies estimate that between 13% and 30% of Iraq and Afghanistan veterans have experienced PTSD, with as many as half a million diagnosed cases over the past two decades (Reisman, 2016).

The condition rarely exists in isolation. Many veterans with PTSD also suffer from depression, anxiety, substance use disorders, and chronic pain, which together complicate both diagnosis and treatment. Depression is the most common comorbidity, and substance use is widespread among those attempting to cope with symptoms of trauma. Such overlapping conditions lead to higher rates of suicide, social isolation, and medical complications, making recovery a complex process requiring integrated care. Women veterans are particularly vulnerable, not only because of combat exposure but also due to the high prevalence of military sexual trauma, which can heighten the risk of developing PTSD (Reisman, 2016).

Diagnosis of PTSD involves both clinical interviews and self-report tools. Instruments such as the Clinician-Administered PTSD Scale (CAPS-5) and the PTSD Checklist (PCL-5) help determine symptom severity and functional impairment. The DSM-5 defines PTSD through four main symptom clusters—intrusion, avoidance, negative mood and cognition, and arousal—which reflect the range of ways trauma manifests in the mind and body. These diagnostic criteria guide clinicians toward evidence-based treatment approaches.

Cognitive-behavioral therapy (CBT) remains the most effective psychological treatment for PTSD. In particular, cognitive processing therapy (CPT) and prolonged exposure (PE) therapy are strongly supported by clinical evidence and widely used in veteran care. CPT focuses on identifying and restructuring distorted thoughts about the traumatic event, while PE encourages controlled and repeated engagement with trauma memories to reduce fear responses. Another therapy, eye-movement desensitization and reprocessing (EMDR), once met with skepticism, is now recognized internationally as an effective intervention that helps patients process trauma through guided eye movements and attention refocusing (Reisman, 2016).

While psychotherapy is the preferred first-line approach, pharmacological treatments are also important, particularly for those who do not respond fully to therapy. Selective serotonin reuptake inhibitors (SSRIs) such as sertraline and paroxetine are the only FDA-approved drugs for PTSD, although others like fluoxetine and venlafaxine are used off-label. These medications help regulate mood and anxiety symptoms but rarely lead to full remission. Researchers are increasingly investigating alternative pharmacological pathways, such as those involving GABA and glutamate neurotransmission. New drugs like vortioxetine, vilazodone, and even certain anticonvulsants such as topiramate are under study for their potential to modulate fear and memory processes. Some veterans also report relief from cannabis use, though its medical application remains controversial and tightly regulated (Reisman, 2016).

Combined treatment approaches – using both medication and psychotherapy – are often the most effective, particularly for veterans with severe or treatment-resistant PTSD. However, benzodiazepines, once commonly prescribed to manage anxiety, are now discouraged due to their limited efficacy and potential for dependency. The Veterans Affairs (VA) system has begun implementing education and shared decision-making programs to reduce benzodiazepine use and encourage evidence-based alternatives.

Beyond treatment, systemic and social barriers continue to hinder recovery. Many veterans face long wait times at VA facilities, limited access to mental health providers- especially in rural areas – and the persistent stigma associated with seeking psychological help. Cultural attitudes within the military often equate mental illness with weakness, deterring individuals from pursuing care. The VA has responded through public awareness campaigns like “About Face,” which normalizes PTSD treatment, and through telehealth services that provide remote therapy options. Studies indicate that telemedicine not only increases accessibility but also improves engagement and treatment adherence among veterans living far from urban centers (Reisman, 2016).

As more veterans seek care outside the VA system, the preparedness of community-based mental health providers has become a growing concern. Many civilian clinicians lack the training to address combat-related trauma effectively. To bridge this gap, the VA established the PTSD Consultation Program for Community Providers and partnered with organizations such as the Center for Deployment Psychology and Star Behavioral Health Providers, which train professionals in veteran-specific mental health care.

Despite ongoing research and program development, PTSD remains one of the most significant public health challenges facing veterans. Its economic cost exceeds billions of dollars annually, and its human cost is measured in the thousands of suicides that occur each year among former service members. Continued investment in both psychological and pharmacological research, alongside improved access to culturally competent care, is essential. Addressing PTSD requires not only medical intervention but also systemic reform and societal understanding to ensure that those who have endured the traumas of war receive the comprehensive care and dignity they deserve (Reisman, 2016).

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Trauma informed Social Work Practice

Trauma-informed social work practice is an approach to social work that takes into account the impact of trauma on the lives of individuals, families, and communities. This approach recognizes that trauma can have long-term effects on a person’s mental health, physical health, and well-being, and that individuals who have experienced trauma require specialized care and support.

The goal of trauma-informed social work practice is to create a safe and supportive environment for individuals who have experienced trauma. This approach emphasizes the importance of building trust and collaboration with clients, as well as empowering clients to make decisions about their own care. Trauma-informed social work practice also recognizes the role that societal and institutional trauma can play in the lives of individuals, and seeks to create change at a systemic level.

One of the key principles of trauma-informed social work practice is understanding the prevalence of trauma. Research has shown that a significant percentage of the population has experienced some form of trauma in their lives. This trauma can range from individual experiences, such as physical or sexual abuse, to collective experiences, such as discrimination or systemic oppression. Understanding the prevalence of trauma is essential in creating an environment that is sensitive to the needs of individuals who have experienced trauma.

Another principle of trauma-informed social work practice is the importance of safety. Trauma can create feelings of fear, anxiety, and vulnerability, which can make it difficult for individuals to engage in social work services. Trauma-informed social work practice emphasizes the importance of creating a safe environment for clients, both physically and emotionally. This may involve providing privacy and confidentiality, ensuring that clients have control over their own care, and creating a space that is calm and welcoming.

Trauma-informed social work practice also emphasizes the importance of empowerment. Clients who have experienced trauma often feel disempowered and may have difficulty trusting others. Trauma-informed social work practice seeks to empower clients by providing them with information, support, and tools to help them make decisions about their own care. This may involve working collaboratively with clients, recognizing their strengths and resources, and supporting them in setting goals that are meaningful to them.

Cultural humility is also a key aspect of trauma-informed social work practice. Social workers must recognize the ways in which cultural differences can impact the experience of trauma, as well as the ways in which cultural beliefs and practices can be a source of strength and resilience. Cultural humility involves recognizing one’s own cultural biases and limitations, and working to create a culturally responsive and inclusive environment for clients.

Finally, trauma-informed social work practice recognizes the importance of collaboration and partnership. Addressing the impact of trauma requires a multidisciplinary approach, and social workers must work collaboratively with other professionals, such as mental health providers, medical professionals, and educators. Trauma-informed social work practice also recognizes the importance of community partnerships, and seeks to create partnerships with community organizations and leaders to create a more supportive and responsive environment for individuals who have experienced trauma.

In conclusion, trauma-informed social work practice is an approach to social work that recognizes the impact of trauma on the lives of individuals, families, and communities. It emphasizes the importance of understanding the prevalence of trauma, creating a safe and empowering environment for clients, practicing cultural humility, and collaborating with other professionals and community partners. By adopting a trauma-informed approach, social workers can provide more effective care and support to individuals who have experienced trauma, and contribute to creating a more just and equitable society.

Adverse Childhood Experiences (ACEs)

What are ACEs

Adverse Childhood Experiences (ACEs) are stressful or traumatic experiences that can have a huge impact on children and young people throughout their lives.

The ten widely recognised ACEs, as identified in a US study from the 1990s, are:

Abuse:

  • physical
  • sexual
  • verbal

Neglect:

  • emotional
  • physical

Growing up in a household where:

  • there are adults with alcohol and drug use problems
  • there are adults with mental health problems
  • there is domestic violence
  • there are adults who have spent time in prison
  • parents have separated

As well as these 10 ACEs there are a range of other types of childhood adversity that can have similar negative long term effects. These include bereavement, bullying, poverty and community adversities such as living in a deprived area, neighbourhood violence etc.

We are committed to addressing all types of childhood adversity, and this is anchored in our long-standing, national approach of Getting it right for every child.

Why ACEs matter

Childhood adversity can create harmful levels of stress which impact healthy brain development. This can result in long-term effects on learning, behaviour and health.

Evidence from ACE surveys in the US, UK and elsewhere demonstrates that ACEs can exert a significant influence throughout people’s life.

ACEs have been found to be associated with a range of poorer health and social outcomes in adulthood and that these risks increase as the number of ACEs increase.

Research from Wales found that people who reported experiencing four or more ACES are:

  • 4x more likely to be a high-risk drinker
  • 16x more likely to have used crack cocaine or heroin
  • 6x increased risk of never or rarely feeling optimistic
  • 3x increased risk of heart disease, respiratory disease and type 2 diabetes
  • 15x more likely to have committed violence
  • 14x more likely to have been victim of violence in the last 12 months
  • 20x more likely to have been in prison at any point in their life

Consideration of ACEs is therefore crucial to thinking about how to improve the lives of children and young people, to support better transitions into adulthood, and achieve good outcomes for all adults.

What are we doing to address ACEs

As set out in the Programme for Government 2018 to 2019, we are committed to preventing ACEs and helping to reduce the negative impacts of ACEs where they occur and supporting the resilience of children, families and adults in overcoming adversity.

We are take forward action in four key areas:

1. Providing inter-generational support for parents, families and children to prevent ACEs

2. Reducing the negative impact of ACEs for children and young people

3. Developing adversity and trauma-informed workforce and services

4. Increasing societal awareness and supporting action across communities 

We held an ACEs ministerial event in March 2018 in Glasgow involving people working across a wide-range of related sectors and Year of Young People Ambassadors. This explored what was working well, where further action is needed and opportunities for collaboration.

Through our Getting it right for every child approach, families and children can be supported by services to prevent and reduce adversity and the negative outcomes associated with it.

We will build on our existing policies, including:

Our policies in the following areas are also relevant:

Addressing ACEs is also about better supporting adults who have been through adversity and trauma.

We are working with NHS Education for Scotland and have announced £1.35 million funding to deliver a national trauma training programme. This will help Scotland’s current and future workforce develop skills and services that respond appropriately to people’s adverse childhood experiences and other traumatic experiences.

Consideration of ACEs is increasingly informing the development of national policy. For example, the Justice in Scotland: Vision and Priorities 2017 to 2020 identified ACEs as a key issue. A range of actions are being taken to reduce their impact e.g. measures to reduce parental incarceration by moving to a presumption against short prison sentences.

We are also working with the Scottish ACEs Hub (co-ordinated by NHS Health Scotland) which aims to raise awareness and understanding about ACEs and progress national action. For example, the Scottish ACEs Hub, in conjunction with Education Scotland, held a conference in March 2018 on addressing childhood adversity to support children’s learning and wellbeing.

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Read more: NHS Health Scotland

CBT in Social Work

Cognitive Behavioral Therapy (CBT) is a well-established psychotherapeutic approach that has been shown to be effective in treating a range of mental health disorders. CBT is based on the idea that our thoughts, feelings, and behaviors are interconnected, and that changing our thoughts and behaviors can lead to a positive change in our emotions and overall well-being. As a social worker, CBT can be an effective tool in helping clients manage their mental health concerns and achieve their goals.

CBT is a highly structured and goal-oriented therapy that typically involves a specific number of sessions. A social worker using CBT would first work with the client to identify the negative thoughts and behaviors that are causing distress. This may involve conducting a thorough assessment of the client’s mental health history, as well as their current thoughts and behaviors. Once these negative thoughts and behaviors are identified, the social worker would work with the client to challenge and reframe them in a more positive and constructive way.

CBT is also highly collaborative, and the social worker would work closely with the client to develop specific strategies and techniques to manage their thoughts and behaviors. This may involve teaching the client relaxation techniques such as deep breathing or progressive muscle relaxation, as well as problem-solving skills to help them cope with difficult situations. The social worker may also use homework assignments and other exercises to help the client practice these techniques outside of therapy sessions.

CBT is highly effective in treating a range of mental health concerns, including depression, anxiety, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). As a social worker, CBT can be an effective tool in helping clients overcome these issues and achieve their goals. For example, a client struggling with depression may benefit from CBT techniques that help them challenge their negative thoughts and behaviors, develop coping strategies, and improve their overall mood and sense of well-being.

In addition to its effectiveness in treating mental health concerns, CBT is also highly adaptable and can be tailored to meet the specific needs of individual clients. This may involve modifying the therapy to address cultural or linguistic barriers, as well as addressing any co-occurring mental health or substance use issues that the client may be experiencing.

In conclusion, CBT can be a highly effective tool for social workers in helping clients manage their mental health concerns and achieve their goals. By identifying negative thoughts and behaviors, challenging and reframing them, and developing specific strategies and techniques to manage them, social workers can help their clients overcome a range of mental health concerns and improve their overall well-being.