Monthly Archives: December, 2016

Soul Care Conversation (PTSD, and Guilt and Shame)

December 21st, 2016 Posted by Blog 4 comments

 

(The purpose of Soul Care Conversation is to create a place to generate dialogue, initiate thoughtful consideration for the challenges our veterans face each day, share ideas of veteran and family well-being and healing, and spark within all of us a call to be engaged with the veteran and caregiver community. Click here to visit the forum and join the conversation!)

Last week I concluded the outline for the Soul Care Conversation that we began over one year ago. We discussed networking with community agencies and governmental organizations regarding veteran care. As we look to future conversations please consider topics that we have discussed that you desire to go deeper, or offer suggestions on a particular topic that you desire to discuss. For this week, I received a suggestion from a colleague that desired to be in conversation about guilt and shame as it pertains to Post Traumatic Stress Disorder (PTSD).

BACKGROUND  

Recently, I read an article in the News and Observer that discusses a Duke study suggesting that Cognitive Process Therapy (CPT) significantly reduced Post Traumatic Stress Symptoms.

The study, in the journal JAMA Psychiatry, is the largest randomized clinical trial to date to apply cognitive processing therapy, or CPT, which has been used among civilians for decades, to active-military patients who are suffering from PTSD. It found that while using the treatment in both group and individual sessions significantly reduced PTSD symptoms, individual treatment was nearly twice as effective. (“Duke study shows therapy effective for military sufferers of PTSD,” News and Observer, written by Gavin Stone, 28 November 2016)

CPT is one of numerous forms of psychotherapy being used with our veterans diagnosed with PTSD. Therapies that have exhibited a track record of success include;

  • cognitive behavior therapy (CBT)
  • cognitive process therapy (CPT)
  • eye movement desensitization and reprocessing
  • exposure therapy

The VA and DoD also have used additional therapies as reported by the Washington Post to include;

  • equine therapy
  • alpha stimulation
  • guided imagery
  • yoga
  • hypnosis
  • aqua therapy
  • Botox

To understand CPT, let’s briefly review two factors; methodology and outcome.

CPT’s method;

  • face the trauma through a detailed written account
  • share the account with a therapist
  • work within a group process

CPT’s goal;

  • break the pattern of avoidance
  • enable emotional processing

Emotional processing allows for the clarification and modification of cognitive distortions. In other words, CPT provides the trauma survivor the opportunity to begin to look at the cause of the trauma and its effects in a different way. The bottom line is that the trauma survivor can choose to move beyond being a victim into being a stronger person by living into the possibilities of growth from the trauma experience.

The article continues to flush out the thought process of a trauma survivor, especially a combat warrior. The trauma survivor see themselves as a victim, but they also blame themselves for the event.

CPT is a method of treatment that involves evaluating the thoughts and beliefs associated with a patient’s traumatic experience, which for many in the military involves blaming themselves for events in combat that are out of their control, according to Patricia Resick, a professor of psychiatry and behavioral sciences at the Duke University School of Medicine and lead author of the study. Resick said that this tendency comes from the belief that in a “just world” good things happen to good people, which for some could also mean that if something bad happens it’s because you’re a bad person. “Instead of looking to the perpetrator of the trauma, they look to themselves to assign blame,” Resick said. “What we do is we systematically lead them through a series of steps to teach them to ask themselves questions so they can make more balanced statements about themselves.”  (“Duke study shows therapy effective for military sufferers of PTSD,” News and Observer, written by Gavin Stone, 28 November 2016)

People experience guilt for various reasons. Many find it difficult to move past guilt which can lead to chronic psychological issues, such as depression and anxiety. I have read research, surveys, periodicals, and books that all look at treatment from a psychotherapy model.

However, guilt and shame have implications beyond the psychological component.  From the perspective of a chaplain or a pastoral counselor, trauma and trauma care must also reflect a spiritual dimension.

LIVING LESSONS 

For one year I took part in a trial program, PTSD Pathways, at Fort Belvoir 2013-2014. The program included psycho-education, CPT, CBT, relaxation techniques, coping skills, and the understanding of relationships.

I learned that the primary focus of CPT was to help me re-conceptualize my traumatic event in order to reduce its ongoing negative effects. The Pathways program using CPT proved somewhat beneficial in my initial healing. However, the psycho-therapy did not go far enough. CPT lacked the spiritual component.

Trauma effects not only the body and mind, but also the spirit. From my foxhole, the behavioral health community has been reluctant to recognize the relevancy of the spiritual component in our veteran care.

However, recently the conversation about PTSD now includes another dimension, moral injury. (We discussed in detail in an earlier conversation.) Some behavioral health experts describe moral injury as a psychological scar of war.

Moral injury is unlike PTSD, which is based on fear from feeling one’s life threatened. Moral injury produces guilt and shame from something done, or not done, or witnessed that goes against one’s values. Men and women have returned from war broken and their diagnosis is wrongly labeled PTSD because their wound was not recognized as a moral injury. Often PTSD and moral injury overlap. But, it is imperative that the therapists/counselors differentiate the two.

I believe one of the reasons I continued to struggle after completing the Pathways program was the absence of the spiritual component in my work toward healing. I worked with diligence attempting to overcome my fear from my trauma, however, I had yet to work on the damage left by decisions made in war.

Moral injury has taken on life within the behavioral health community. Should not the faith community become involved in the discussion, offer ideas for healing, and partner with the behavioral health community for our veterans?

IMPLICATIONS FOR THE FAITH COMMUNITY 

For the purpose of this conversation, let’s look at a possible spiritual therapeutic model. What should be some of the critical components? For me, a model may include;

  1. Acknowledge – take an honest assessment of thoughts and behavior, then acknowledge guilt and shame, and anger
  2. Forgiveness – choose forgiveness of self in the trauma experience as well as others who may have had responsibility
  3. Self-acceptance – renounce self lies like; I’m no good, I’m nothing, I’m worthless, I can’t be loved, and accept the reality of being a child of God
  4. Renewal – begin to retrain mind
  5. Amends – restoration involves a direct way to repair what has been damaged or broken (for the veteran, maybe difficult to go back to place of injury, however, there are other ways; contribute to refugee or orphan fund in the area of the war, volunteer at a shelter or soup kitchen, etc)
  6. Accountability – be in a community that offers accountability and support

Do you have a model? What would you include? What components should we include that are missing from the model here? Have you included a spiritual dimension in the care of a veteran diagnosed with PTSD? What does that look like?

I hope this sparks a conversation among us. This is an important aspect of caring for those affected by trauma.

I pray that you have a very blessed Holyday season and a Happy New Year. Until next year….thank you for the conversation.

 

Soul Care Conversation (Network with Community Resources)

December 3rd, 2016 Posted by Blog No Comment yet

(The purpose of Soul Care Conversation is to create a place to generate dialogue, initiate thoughtful consideration for the challenges our veterans face each day, share ideas of veteran and family well-being and healing, and spark within all of us a call to be engaged with the veteran and caregiver community. Click here to visit the forum and join the conversation!)

Last week I hope you enjoyed the blessings of celebrating Thanksgiving with family and friends. Due to celebrating Thanksgiving with my family, I did not write our weekly blog. This week, we will discuss the importance of networking with faith partners and other community resources in order to care for veterans and their families.

BACKGROUND 

From a geopolitical perspective, war is about national defense and strategy, often linked to patriotism. However, the personal factor of war is about courage, sacrifice, pain, sorrow, and tragedy. There often is disagreement among our national leaders and among our citizens as to the geopolitical importance or legitimacy for a particular war. However, only a few will argue about the personal cost of war for those who were asked by their nation to fight in them.

Regardless of the purpose of war or the conditions of combat, fighting is intensely personal to the warrior. To the individual Soldier, Sailor, Airmen, Marine, or Guardian, war is about staying alive and providing support and protection to his/her battle buddy. Daily survival takes precedence over national strategy.

This factor is often forgotten when the realities of war are put behind us. This is an important distinction, when our nation is ready to move on after war has ended or even in the midst of our current war, the individual veteran can not put the war behind him/her.

All wars since the American Revolution have been described in terms of the length, cost, and casualties. But each war had its unique aspects that posed challenges to public support and the military/veteran care system. These factors affected the veteran.

The needs in our veteran community are great. Whether a veteran has served 6 years stateside supporting the war effort or a 3 year enlistment of 2 years deployed, veterans have earned our nation’s care and service. They have served selflessly and have made great sacrifices. Veterans seek the following;

  • employment
  • medical care and mental health care
  • education and training
  • housing and home loans
  • disability compensation and pension
  • burial benefits

The Department of Veterans Affairs (VA) coordinates and manages the nation’s largest integrated health care system with more that 1,700 hospitals, clinics, counseling centers, community living centers, and other care facilities.

Additionally, there is a plethora of community and faith based organizations, and local and state government agencies partnering with the VA to complement care and services.

However, I believe there are two factors that can affect comprehensive and quality veteran care;

  • large number of veterans accessing the VA
  • network of care for veterans and their families is vast but disconnected

Lets look briefly at both of these factors.

First, we have 21.5 million veterans from World War II, Korea, Vietnam, Grenada, the Cold War, Panama, the Gulf War, Bosnia, Kosovo, and the Post 9/11 Wars. The Department of Veterans Affairs often becomes overwhelmed with the challenges of managing veteran needs. The problems at the VA are well documented; long waits, poor service, and delayed or at times denied health care and other benefits.

Second, our communities have an extensive network of veteran services; non-profit and charities as well as local and state government agencies. There are over 20,000 organizations designed to provide a specific aspect of care to our veterans and their families. The list is quite vast. However, there is a lack of integration within the network.

This week, google veteran care and you will see pages of services available to veterans and their families. A few examples are;

  • Veteran Service Organizations (VFW, American Legion, Disabled Veterans of America, Wounded Warrior Project, Red Cross, and hundreds more)
  • Operation We are Here and Veterans Families United Foundation (Resources for the military community and care providers for veterans with PTSD)
  • Citizen Soldier Support Program (Connects veterans and their families to primary health care and behavioral health providers)
  • Vet Jobs (Connects transitioning military men, women, and family members to the civilian work force)
  • Hidden Heroes Foundation (Provides awareness of the challenges experienced by military/veteran care-givers and a national registry)

Additionally, over the last decade, more and more organizations provide spiritual care resources. Some include;

  • We Honor Veterans (National Hospice and Palliative Care Organization provides care at the end of a veteran’s life)
  • Veterans Health Administration recognizes the importance of providing for the spiritual care of veterans
  • Coming Home Project (Provides care, support, education, and tools to veterans, families, and care-providers committed to the silent wounds of war)
  • Soul Repair Center (Provides workshops, conferences and resources to faith communities dealing with veteran moral injury)
  • Mighty Oaks Warrior Program (Mission is to provide veterans a new life purpose through hope in Christ)
  • Military Outreach (Connects faith communities with veteran needs)

FAITH COMMUNITY IMPLICATIONS

We recall the two factors that can affect comprehensive and quality veteran care; millions of veterans overwhelming the VA system, and a large disconnected network of agencies providing care. To meet these challenges, the faith community can provide three critical components;

  • partner with the various entities in the community offering veteran care
  • network with the organizations and charities providing mental, spiritual and physical care
  • provide a connection through spirituality

Partner with community organizations and governmental agencies – Because our congregations include persons who live and work within their respective communities, they have connections either through professional or personal relationships with veteran care organizations. Faith community leaders can cultivate these connections, develop relationships, and offer support through the volunteering of time, financial contributions, or establishing long term commitments in leadership. Through relationships, faith community leaders can ensure the spiritual dimensions of our veteran care will be addressed.

Network with organizations and charities –  The faith community can be the conduit for veteran care. There are several steps that can be taken that bring an integration of support; research those entities within the community offering veteran support, reach out to and develop a relationship with these organizations, design a “yellow pages” that delineates support agencies and distribute to community leaders, and collaborate within the network in order to discuss and meet veteran challenges by leveraging community resources. A practical step, call the VA Hospital Chaplain, or the VA Clinic Director in your community. Seek information on how to be supportive of the VA programs.

Provide a connection through spirituality – Each veteran’s journey is unique. Whether renewing their faith or finding a new spiritual path, veterans are exploring and discovering the role of spirituality to overcome their challenges. Through awareness, training, and sensitivity, the faith community can provide a role in healing, restoration, and well-being.

What has been your experience with charities and organizations supporting veterans? What good news stories do you have in networking with community resources?

So, I have exhausted my outline for the Soul Care Conversation. I would appreciate hearing from you as far as future topics to discuss. Let me know. In the mean time, thank you for these conversations…