OIF/OEF Women
Darrah Westrup, Ph.D.
Women’s Mental Health Center
Women’s Trauma Recovery Program
National Center for PTSD
VA Palo Alto Health Care System
womenvetsPTSD.va.gov
darrah.westrup@va.gov
OIF/OEF Women

What do we need to know about OIF/OEF
women?
How are they different?
What are their particular treatment needs?

How can we best serve OIF/OEF women?
What services are needed?
What are the effective treatments?
Women Veterans

Women are one of the fastest growing segments of the
veteran population. They comprise:







15%
20%
17%
13%
of
of
of
of
active military
new recruits
reserve and National Guard
OIF/OEF troops (59 casualties as of April ’06)
5% of 27 million veterans are women and this number
is expected to increase to 10% by 2010
Women veterans have greater health problems than
their nonveteran female counterparts
87% of women veterans do not use VA care
Specific Needs of OIF/OEF Women
Less
in-service social support
Different
Role
determinants of social support
transition
Intimate
partner violence
Behavioral
health
29%
of OEF/OIF women veterans who use VA are
diagnosed with mental health disorders
PTSD
– SUD comorbidity
OIF/OEF and Family

Family issues are paramount


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Often in caregiver role
Partner conflict
Parenting skills
Domestic violence
Young children
Individuation from family of origin
OIF/OEF Women: Presenting Problems
Comorbid Difficulties




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Depression
Anxiety/panic
Substance use
Personality disorders
Somatization
Sexual dysfunction
Eating disorders
Self-injurious behavior
Military Sexual Assault




Higher rates of Military Sexual Trauma
Physical attacks and sexual assaults of
women by comrades exceed casualties by
enemy actions.
As many as 25% of military women have
been sexually assaulted.
Sexual assaults and harassment that occur
in military may be more damaging than
other work settings.
MST is associated with

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Increased suicide risk
Major depression
PTSD
Alcohol/drug abuse
Long-term sexual dysfunction
Disrupted social networks
Occupational difficulties
Asthma
Breast cancer
Heart attacks
Obesity
Combat-related Exposure

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Problems similar to those for sexual assault
Drug-related disorders
Accidental deaths
Higher level of general psychiatric distress
More frequent somatic complaints
Anxiety/panic
PTSD
Service Model
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Designated women’s clinic
Gender specific services
Prevention and educational services
Mental health presence in primary care
Couples and parent-child therapies
Drop-in groups with childcare
Evening hours
Evidence-based treatments
VA Services for Women
Only 19% of VA facilities provide any MH services in a
Women’s Health Center Space
Only 7% of facilities provide any services by a
specialized women’s MH team
These services will be
especially important for
the younger, less
chronic, women
OEF/OIF veterans
Response to Treatment
1.6
Effect Size
1.4
1.2
1
Men
Women
0.8
0.6
0.4
0.2
0
Pretreatment
PostFollow-up
treatment
Cason, et al., 2002
Evidence-Based PTSD Treatments

Clinical Practice Guidelines

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Cognitive behavioral therapy
Pharmacotherapy
Group therapy
Cochrane Review

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(ISTSS)
(Bisson & Andrew, 2005)
Trauma focused cognitive behavioral (TFCBT) group and
individual therapy, and stress management are effective
treatments for PTSD
TFCBT is superior to stress management between 2 and 5
months following treatment
TFCBT is more effective than other therapies
Empirically-Supported Treatments
for Women with PTSD

Seeking Safety (Najavitz et al., 1996)
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For women with PTSD and substance disorders
Fits Herman’s “first stage” of treatment
No exposure work
24 weekly sessions for 90 minutes
Group format
Manualized
Easily transferable
Empirically-Supported Treatments
for Women with PTSD (cont.)

Cognitive-Processing Therapy (Resick &
Schnicke, 1992, 1993)

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Based on Information Processing Theory
12 sessions

Education about trauma meaning
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Cognitive therapy – challenging beliefs

Disclosure about the trauma (written)

Skills building – safety, trust, power, selfesteem, and intimacy
Empirically-Supported
Treatments

Acceptance and Commitment Therapy
(Hayes, Strosahl, & Wilson, 1999)

12 sessions in “building block” format
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Control of private events as the problem
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Self as context rather than content
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Letting go of the struggle
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Commitment and behavior change
Clinical Presentation
Interpersonal problems
 Social isolation
 Identity disturbance
 Impulsivity
 Emotion dysregulation
 Numbing/dissociation
 Problematic thinking

Clinical Presentation (cont.)

They are in despair

They want better lives

They deserve our best effort

“Coping” strategies impede therapeutic growth


Difficulties can be longstanding and
entrenched
Providers are necessarily impacted by the work
Clinical Factors that Affect Treatment

Difficulty establishing the therapeutic
alliance
 Approach
based on relationship history
 Blended
with familial and military
dynamics
 Situation
 Evokes
evokes vulnerability
issues with “control”
Providers’ Challenge Maintaining a Therapeutic Stance


Caring for those who can make it
difficult
Managing the negative impact
 On
oneself
 On
the patient or client
 On
other patients/clients
Strategies to Help Maintain a
Therapeutic Stance

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Protect your compassion
Language matters
No need to be “above it all”, get support
Expect to fall from grace
Be rigorous
Be intentional vs. reactive
Be aware of your limits
Human behavior is purposeful
Even illogical behavior has a function
Focus on the behaviors vs. labeling
Never forget people can and do get better
Program Planning Resources

Women Veterans Health Program
Handbook

Women Veterans Health Program Plan
of Care

VA Directives

Mental Health Strategic Plan

Women’s Mental Health Committee
Suggested References

Kimerling, R., Ouimette, P., Wolfe, J. (2002). Gender and PTSD. New York: Guilford
Press.

Washington, D. L., Yano, E. M., & Horner, R. D. (Eds.). (2006). VA Research on

http://siadapp.dior.whs.mil/index.html (DoD Personnel and Procurement Statistics)

http://www.defenselink.mil/news/Mar2006/d20060316SexualAssaultReport.pdf
(DoD Sexual Assault Report for 2005 with 06 Summary)

Women’s Health [Special issue]. Journal of General Internal Medicine, 21 (3).
http://www1.va.gov/VHI/page.cfm?pg=32 -- https://www.eeslearning.net/librix/loginhtml.asp?v=librix (Military Sexual Trauma Veterans
Health Initiative)

http://www.ncptsd.va.gov/index.html (National Center for PTSD).