$1.5 million DOD grant will open doors on relationships of soldiers with PTSD
January 22, 2009 – Newly minted First Lady Michelle Obama has pledged to turn up the volume on issues facing military families and find concrete ways to help home lives that are stressed by multiple deployments and symptoms of trauma in returning soldiers.
In fact, the Department of Defense has already started to step up efforts in this area, offering family-oriented counseling and support programs and funding research into deployment stress and the impact of post-traumatic stress disorder (PTSD) on families. Some of that funding, in the form of a $1.5 million grant, was recently awarded to Casey Taft, a School of Medicine associate professor of psychiatry, who is studying domestic violence among returning soldiers with PTSD. Taft’s research dovetails with his other veteran-related work – funded with a $2 million grant from the Centers for Disease Control – on preventing partner abuse and enhancing soldiers’ intimate relationships.
“People who are exposed to trauma, and in particular those who develop PTSD, are at very high risk for aggressive behavior,” says Taft, who also works at the Boston Veterans Affairs Medical Center and the National Center for PTSD. “In one Vietnam war study, they found that among vets with PTSD, one third had engaged in physical violence against their partner in the past year. This rate was almost three time the rates they found among vets without PTSD. Since we know that current vets in Iraq and Afghanistan have been exposed to significant trauma and many of them have been on multiple deployments and they’re coming back with high rates of PTSD and other mental health issues, it would stand to reason that they would also engage in high levels of aggression and partner violence, though we don’t have the specific data to back that up.”
Taft’s DOD project will unfold in two phases, starting with focus groups and the development of an intervention. The second phase involves controlled clinical trials in Boston and Arkansas. Program topics will include healthy relationships, understanding anger, stress, and coping, relaxation, and communication styles, among others.
BU Today talked with Taft about the impact of combat on personal relationships and the influence of personal relationships on the battlefield.
BU Today: How would you define intimate partner violence? Is it strictly physical?
Taft: There are different definitions. There’s physical, psychological, and sexual aggression. Some people also look at stalking as another form.
What role does military culture play in affecting intimate relationships?
Military training plays a significant role. When veterans go into a war zone, they need to be constantly vigilant to any kind of threat in their environment. They’ll see threats that others don’t, and they need to do that to stay alive and keep their buddies alive, to do their job. They don’t really know who the enemy is, and they have to respond quickly. So they are constantly ready to respond to potentially threatening situations with aggression. When they come home, they can’t just turn that off. They still see threatening situations where others don’t. They might misread facial clues or assume people are going to try and hurt them, and they might respond in an aggressive way. And seeing the kinds of horrific things they might see in a war zone can also change the way they think about the world. They may have difficulty trusting other people. They may feel the world is an unsafe place. These kinds of changes can carry over into their intimate relationships.
What symptoms of PTSD play into relationship problems?
Hyperarousal symptoms, where the veteran is on edge, where their fight-or-flight responses are always kicking in, might lead to difficulties with anger. There are also symptoms called emotional numbing, where individuals might have trouble experiencing love or happiness and might just have a general numbing of their emotions. They may be more likely to avoid anything that might remind them of their trauma. And those numbing and avoidance symptoms have been shown to be especially difficult for relationships. We want to help veterans communicate more and express feelings in positive ways rather avoiding their partners or important issues. A big part of both research projects is to help soldiers improve their communication skills and make sure they don’t avoid dealing with their partners or with anything that reminds them of traumas. We want to teach them to communicate in positive and assertive ways and let their partners know how they feel. A lot of veterans go from being aggressive to being overly passive.
Why has preventing abuse in relationships been so challenging in the military?
It’s not necessarily a DOD or VA issue. In the larger community, successful interventions for domestic violence have not been developed, either. There are a number of interventions out there, but the literature hasn’t shown them to be particularly effective. That may be, in part, because it’s difficult to conduct randomized control trials for interventions for relationship abuse. It’s hard to assign individuals to no-treatment control groups. But it also stems from the fact that the study of domestic violence has only been going on for the past 20 or 30 years. Prior to that, it was an understudied area, one that wasn’t on the forefront of the public consciousness. Abuser programs are a relatively new phenomenon.
In the military itself, they have family advocacy programs and a system for identifying and treating perpetrators of relationship abuse. There’s a lot of work going on, but these programs have rarely been empirically evaluated. The family advocacy programs deal with a range of different issues: child abuse, helping the partners make adjustments when the soldiers deploy, domestic violence. But I’m not aware of any programs that look at PTSD and its role in relationship abuse.
How do relationship problems back home manifest on the battlefield?
The family relationship is very important to how the soldier functions in the war zone. There is some data that suggest family problems are strong predictors of whether the soldier will stay in the military. It may affect the soldier’s performance and morale. How well the partner is doing and the partner’s perception of things also play a big role in how well the soldier does. And it affects health outcomes. If the intimate relationships are positive, the solider is likely to experience better physical and mental health. For these reasons and others, there has been an increased focus on dealing with domestic violence in military populations.