the Department of Defense and the Veterans Administration look at both
PTSD and TBI as the unseen wounds of war and both conditions can share a
complex relationship. For example, an explosive device that causes a
TBI can also produce a trauma leading to PTSD. In addition, common
symptoms can make it even more difficult to diagnose each condition.
DOD’s initiatives to address the problem:
Center for Deployment Psychology (CDP) and the National Center for
Telehealth & Technology (T2) are component centers of the Defense
Center of Excellence for Psychological Health and TBI. CDP trains train
military, civilian psychologists, and other behavioral health
professionals while T2 develops communications and information
technologies to address psychological health and TBIs
and Veterans Brain Injury Center collaborates with organizations to
advance research on TBIs. A major focus is to evaluate the quality and
cost-effectiveness of treatments delivered to military personnel and
• Deployment Health Clinical Center (DHCC) provides a
gateway to information on deployment health and healthcare for
providers, service members, veterans, and families. RESPECT.Mil is a
treatment model designed by DHCC to screen, assess, and treat active
duty soldiers with depression and/or PTSD
• National Intrepid
Center of Excellence provides an interdisciplinary team assessment
approach combined with high technology diagnostics to follow
combat-related psychological health and TBI
TATRC has funded and
developed virtual reality programs that allow soldiers with PTSD to
revisit past wartime experiences and get past those events at their own
pace. The virtual reality program helps a war fighter recognize their
symptoms and find ways to obtain professional help.
TATRC product called “Mood Tracker” helps users monitor swings in moods,
emotions, and behaviors resulting from therapy, medications, or other
daily events. The application is designed for smart phone use and is
able to record emotions for up to several months so that patient mental
health can be documented over time.
TATRC developed and provides
“Neurocognitive Baseline Testing” for troops prior to deployment. More
than two million tests have been performed making it easier to detect
changes and identify mild TBI later on if necessary.
TriWest Healthcare Alliance takes care of all the active duty, retired
military, and their families in 21 western states and is a leader in
treating the unseen wounds of war. Stress related issues have increased
dramatically in the past three years with repeated deployments. As a
result, TriWest has increased their behavioral health professional staff
from 7,000 to 25,000. TriWest’s ten year old behavioral health hot line
is so successful that both the Army and Marine Corps asked TriWest to
help them set up their own hotlines.
The Veterans Administration
is also very active in serving the needs of veterans with PTSD through
their National Center for PTSD. The Center has developed
state-of-the-art assessment measures and treatments for clinicians to
use to diagnose and treat patients with PTSD. Information is
disseminated to clinicians through the Center’s web site, publications,
and treatment manuals, also through assessment tools, nationwide
training, and their in-person clinical training program.
adrenergic activation among veterans with PTSD has led to clinical
trials using anti-adrenergic medications. The Center is also working to
identify a biomarker for PTSD that would help identify true cases with
the disorder. This marker would be very useful for diagnostic purposes,
for monitoring treatment responses, and for evaluating veterans seeking
service-connected disability status for military-related PTSD.
Center established the “Published International Literature on Traumatic
Stress (PILOTS) electronic index to traumatic stress literature and
other mental health issues. The PILOTS index includes all relevant
publications regardless of their origin, linguistic, or geographic
A new initiative “Integrated Mental Health
Strategy” highlights the most resourceful psychological health services
available to assist the military and veterans available from not only
from DOD and VA but also from other Federal agencies such as SAMHSA,
Department of Labor, and HUD. All of these agencies have been involved
in developing ways to provide the best resources in the field to help
with psychological problems.
Preparing wounded warriors for life after the military -- that's what the FBI's
Wounded Warrior Program is doing. As they recover from injuries,
servicemen and women in the program can learn new skills and get
valuable work experience. SFC Eddie Lopez is one of them; He's been in
the program at the Norfolk Division of the FBI since March. He found
out about the program while recovering from injuries sustained in Iraq
in 2009. "I have orthopedic injuries, I have PTSD (post traumatic stress disorder) and I also have TBI (traumatic brain injury). Because of that, I also wind up getting severe migraine headaches, nightmares, can`t sleep, a lot of different things like that," said Lopez.
Now, the FBI's Wounded Warrior Program, is helping to prepare him for life after 24 years in the Army
by allowing him to develop new skills while also getting valuable work
experience as he recovers. "It's opened my eyes to a lot of new things,
you can see the things on TV, as far as the FBI, but when you get into
the support side, it's very interesting," said Lopez. Melanie Hayes,
who does recruiting and staffing for the FBI, says "This is a way of
giving back, it's a way of ensuring we are helping them have that easy
transition into civilian workforce once they do leave the military."
program can last anywhere from a few months up to two years. Lopez will
be completing the program in early October and will retire from the
military about a week later. "It's sad because I love the military,
and I wanted to continue on, but unfortunately I can't, so I'm seeking
somewhere that I can be a part of something more than me and that I can
also continue serving my country with something like the FBI," said
Lopez. To qualify, you must be a U.S. citizen, an active duty service
member, have at least six months remaining on the WW status, be able to
attain a Top Secret clearance, be cleared by DOD to participate, be able
to get to and from the assigned work site and be in compliance with
FBI's Employment Drug policy. For information on applying, visit the
Department of Defense's website Homefront Connections.
Caring for Those with Posttraumatic Stress Disorder
Last Updated: August 20, 2011
Does your wounded warrior…
·Have difficulty sleeping or suffer from nightmares?
·Have unwanted memories or thoughts?
·Suffer from anxiety and panic attacks?
·Become irritable or angry or express violent behavior?
·Use alcohol or drugs to cope with stress?
·Feel scared or confused?
·Have trouble managing daily activities?
so, he or she may be experiencing symptoms of posttraumatic
stress disorder (PTSD). Many survivors of a traumatic event return
to normal with time, whereas others take longer to
heal—these individuals may develop PTSD.
Causes and symptoms of PTSD
is an anxiety disorder or condition that is common in wounded warriors
who have been exposed to traumatic events while performing their
According to Journal of Rehabilitation Research & Development, service members
serving in Afghanistan and Iraq are involved in a variety of situations
that can have an impact on the mental state and emotional well-being of
an individual. They endure long periods of extreme stress,
experience intense battlefield activity that poses personal harm and
involves the taking of life, experience their own injuries, and witness
the injuries and deaths of others.
PTSD is a silent, invisible injury that may be characterized by three main clusters of symptoms. According to the journal Aggression and Violent Behavior, the three clusters are re-experiencing symptoms, avoidance symptoms, and hyperarousal symptoms.
Re-experiencing symptoms may be characterized by nightmares, flashbacks, and intrusive memories.
Avoidance symptoms center on avoidance of thoughts associated with traumatic experiences.
symptoms include sleep disturbance, anger/irritability, difficulty
concentrating, and an exaggerated startle response.
Strategies for helping and coping
with a wounded warrior who suffers from PTSD can place a heavy burden
on the caregiver. PTSD patients may experience difficulties in social,
professional, and family life, along with their own internal struggles.
It's important to learn how to help your wounded warrior and yourself
respond to your situation.
your wounded warrior’s symptoms in a diary by paying special attention
to how mood, feelings, and stress impact his or her daily activities.
the stress you and your wounded warrior experience by trying behavioral
therapy and relaxation techniques, such as meditation.
your wounded warrior’s triggers. Triggers are things that brings about a
symptom of PTSD, such as sounds, smells, words, or even certain people.
To avoid setting off triggers, develop a good communication system with
your wounded warrior.
contact with family and friends. A support system may help your wounded
warrior get through difficult changes and stressful times.
Check with doctors about antidepressant medications that may help your wounded warrior feel less sad.
Recognize that your wounded warrior might not want your help all the time.
walks, go for bike rides, or do other physical activities together.
Exercise is important for keeping brain activity in balance.
a support group for caregivers who are experiencing similar wounded
warrior situations. Locate such groups by contacting your local Army
installation's Soldier and Family Assistance Center (SFAC).
as much about PTSD as possible. Knowing how PTSD affects people may
help you understand what your wounded warrior is experiencing.
Emotional impact of Care-giving
an individual who has PTSD can be hard on the caregiver. As a
caregiver, you may have your own feelings of fear and anger about what
is happening to your wounded warrior, or you may wonder whether life
will ever return to the way it was. These emotions can begin to affect
your ability to serve.
not feel guilty or feel that you have to know it all. Remind yourself
that nobody has all the answers and that it's normal to feel helpless at
Do not feel bad if change is minimal. You cannot change anyone; people have to change themselves.
Take care of your physical and mental health.
Make time for activities and hobbies that you normally enjoy.
Take time to be alone. Find a quiet place to gather your thoughts.
Exercise regularly; exercise offers a healthful way to deal with stress.
Eat healthful foods to have the energy you need to carry you through the day.
your local Army installation’s SFAC for information about support
groups and caregiver support services. For additional information on
caregiving, visit the VA Caregiver Support website.
Helping a Family Member Who Has PTSD
someone has PTSD, it can change family life. The person with PTSD may
act differently and get angry easily. He or she may not want to do
things you used to enjoy together.
may feel scared and frustrated about the changes you see in your loved
one. You also may feel angry about what's happening to your family, or
wonder if things will ever go back to the way they were. These feelings
and worries are common in people who have a family member with PTSD.
is important to learn about PTSD so you can understand why it happened,
how it is treated, and what you can do to help. But you also need to
take care of yourself. Changes in family life are stressful, and taking
care of yourself will make it easier to cope.
How can I help?
You may feel helpless, but there are many things you can do. Nobody expects you to have all the answers.
Here are ways you can help:
as much as you can about PTSD. Knowing how PTSD affects people may help
you understand what your family member is going through. The more you
know, the better you and your family can handle PTSD.
to go to doctor visits with your family member. You can help keep track
of medicine and therapy, and you can be there for support.
Tell your loved one you want to listen and that you also understand if he or she doesn't feel like talking.
Plan family activities together, like having dinner or going to a movie.
a walk, go for a bike ride, or do some other physical activity
together. Exercise is important for health and helps clear your mind.
contact with family and close friends. A support system will help your
family member get through difficult changes and stressful times.
family member may not want your help. If this happens, keep in mind
that withdrawal can be a symptom of PTSD. A person who withdraws may not
feel like talking, taking part in group activities, or being around
other people. Give your loved one space, but tell him or her that you
will always be ready to help.
How can I deal with anger or violent behavior?
family member may feel angry about many things. Anger is a normal
reaction to trauma, but it can hurt relationships and make it hard to
think clearly. Anger also can be frightening.
anger leads to violent behavior or abuse, it's dangerous. Go to a safe
place and call for help right away. Make sure children are in a safe
place as well.
hard to talk to someone who is angry. One thing you can do is set up a
time-out system. This helps you find a way to talk even while angry.
Here's one way to do this.
Agree that either of you can call a time-out at any time.
Agree that when someone calls a time-out, the discussion must stop right then.
Decide on a signal you will use to call a time-out. The signal can be a word that you say or a hand signal.
to tell each other where you will be and what you will be doing during
the time-out. Tell each other what time you will come back.
you are taking a time-out, don't focus on how angry you feel. Instead,
think calmly about how you will talk things over and solve the problem.
After you come back
Take turns talking about solutions to the problem. Listen without interrupting.
Use statements starting with "I," such as "I think" or "I feel." Using "you" statements can sound accusing.
Be open to each other's ideas. Don't criticize each other.
Focus on things you both think will work. It's likely you will both have good ideas.
Together, agree which solutions you will use.
How can I communicate better?
and your family may have trouble talking about feelings, worries, and
everyday problems. Here are some ways to communicate better:
Be clear and to the point.
Be positive. Blame and negative talk won't help the situation.
a good listener. Don't argue or interrupt. Repeat what you hear to make
sure you understand, and ask questions if you need to know more.
Put your feelings into words. Your loved one may not know you are sad or frustrated unless you are clear about your feelings.
Help your family member put feelings into words. Ask, "Are you feeling angry? Sad? Worried?"
Ask how you can help.
Don't give advice unless you are asked.
your family is having a lot of trouble talking things over, consider
trying family therapy. Family therapy is a type of counseling that
involves your whole family. A therapist helps you and your family
communicate, maintain good relationships, and cope with tough emotions.
therapy, each person can talk about how a problem is affecting the
family. Family therapy can help family members understand and cope with
health professional or a religious or social services organization can
help you find a family therapist who specializes in PTSD.
How can I take care of myself?
a person with PTSD can be hard on you. You may have your own feelings
of fear and anger about the trauma. You may feel guilty because you wish
your family member would just forget his or her problems and get on
with life. You may feel confused or frustrated because your loved one
has changed, and you may worry that your family life will never get back
of this can drain you. It can affect your health and make it hard for
you to help your loved one. If you're not careful, you may get sick
yourself, become depressed, or burn out and stop helping your loved one.
To help yourself, you need to take care of yourself and have other people help you.
Care for yourself
feel guilty or feel that you have to know it all. Remind yourself that
nobody has all the answers. It's normal to feel helpless at times.
Don't feel bad if things change slowly. You cannot change anyone. People have to change themselves.
care of your physical and mental health. If you feel yourself getting
sick or often feel sad and hopeless, see your doctor.
Don't give up your outside life. Make time for activities and hobbies you enjoy. Continue to see your friends.
Take time to be by yourself. Find a quiet place to gather your thoughts and "recharge."
Get regular exercise, even just a few minutes a day. Exercise is a healthy way to deal with stress.
healthy foods. When you are busy, it may seem easier to eat fast food
than to prepare healthy meals. But healthy foods will give you more
energy to carry you through the day.
the good things. It's easy to get weighed down by worry and stress. But
don't forget to see and celebrate the good things that happen to you
and your family.
difficult times, it is important to have people in your life who you
can depend on. These people are your support network. They can help you
with everyday jobs, like taking a child to school, or by giving you love
You may get support from:
Friends, coworkers, and neighbors.
Members of your religious or spiritual group.
Doctors and other health professionals
PTSD Treatment Programs in the U.S. Department of Veterans Affairs
medical center within VA has PTSD specialists who provide treatment for
Veterans with PTSD. Plus, the VA provides nearly 200 specialized PTSD
treatment programs. A referral is usually needed to access the specialty
programs. You can use this VA PTSD Program Locator to see if there is a specialized program near you. (NOTE: If you are in crisis dial 911 or 1-800-273-TALK/8255.)
all VA's offer the same programs. Your doctor can help you decide which
program is best for you. This fact sheet describes the specialized PTSD
programs and also the other options within VA for getting PTSD
Who is covered for VA care?
VA services are provided to all Veterans who have the following:
completed active military service in the Army, Navy, Air Force, Marines, or Coast Guard (or Merchant Marines during WW II)
discharged under other than dishonorable conditions
includes National Guard members and Reservists who have completed a federal deployment to a combat zone
At times, the VA has special agreements to provide care to Active Duty service members and family.
What services are offered?
Each PTSD program offers education, evaluation, and treatment. Program services include:
One-to-one mental health assessment and testing
One-to-one psychotherapy and also family therapy
Group therapy (covers topics such as anger and stress, combat support, partners, or groups for Veterans of specific conflicts
are conducted by mental health care workers. For more information about
types of mental health care workers, see our fact sheet Finding and Choosing a Therapist.
VA Medical Center has providers that have been trained to offer PTSD
treatment. Please be aware that even if your VA Medical Center does not
have one of the special PTSD programs described below, you can still get
effective PTSD treatment. Ask your doctor to refer you to a mental
health provider who is a PTSD specialist. Below you will also find
information about other options for getting PTSD treatment within VA.
Specialized Outpatient PTSD Programs (SOPPs)
include three basic types of clinics. At these outpatient (not live-in)
clinics, you can meet with a provider on a regular basis.
PTSD Clinical Teams (PCTs) provide group and one-to-one treatment.
Substance Use PTSD Teams (SUPTs) treat the combined problems of PTSD and substance abuse.
Women's Stress Disorder Treatment Teams (WSDTTs) provide women Veterans both one-to-one and group treatment.
Specialized Intensive PTSD Programs (SIPPs)
provide PTSD treatment services within a "therapeutic community." Many
programs are residential (live-in). Activities offered are social,
recreational (relax), and vocational (work), as well as counseling.
PTSD Day Hospitals (DH)
are outpatient. They provide one-to-one and group treatment for 4-8
hours each visit. Patients come in daily or several times a week.
Evaluation and Brief Treatment of PTSD Units (EBTPUs) provide PTSD treatment for a brief time ranging from 14 to 28 days.
PTSD Residential Rehabilitation Programs (PRRPs)
provide PTSD treatment and case management. The goal is to help the
trauma survivor return to healthy living in the community. Stays at a
PRRP tend to be 28 to 90 days long.
Specialized Inpatient PTSD Units (SIPUs) provide trauma-focused treatment. Hospital stays last from 28 to 90 days.
PTSD Domiciliary (PTSD Dom)
provides live-in treatment for a set period of time. The goal is to
help the Veteran get better and move to outpatient mental health care.
Women's Trauma Recovery Program (WTRP)
was opened by the VA in Palo Alto, CA, in 1992. This live-in program
focuses on war zone-related stress as well as Military Sexual Trauma
(MST). In the program Veterans can work on skills needed to deal
comfortably with other people. The program is 60 days long.
VA medical centers are now offering walk-in clinics. By walking into
the primary care clinic, a Veteran can be seen that day by a mental
Other VA treatment locations where a Veteran can get PTSD treatment include:
Community Based Outpatient Clinics (CBOCs)
Primary care programs
Provide care in a local setting
Services include mental health care (some locations)
NOTE: The email and phone numbers provided for the PTSD Programs are for information inquiries and are not continuously monitored. VA Medical Centers without a specific PTSD Program do offer PTSD Treatment. Contact your local VA Medical Center and ask for the Mental Health clinic. Many Vet Centers and VA Community Based Outpatient Clinics also offer PTSD treatment.
If you need immediate assistance, contact 911 or 1-800-273-TALK/8255.