Traumatic Stress and Affect Management in Military Families

The war-time deployment of a service member creates significant stress for the family system that supports that person’s transition into combat, combat duty, and readjustment into civilian and family life upon return. The stressors associated with the deployment cycle are significant and can lead to depression, anxiety, and behavioral concerns for all family members including the children and partners. A family’s adaptation to these stressors can also impact the functioning of the service member during the phases of mobilization, deployment, sustainment, and reintegration. Social work interventions that offer support to the military family can reduce levels of distress within and between the members and improve overall family functioning. A case vignette will be presented that highlights some of the salient interpersonal challenges that can develop in a military family when a veteran returns home with posttraumatic stress that is left untreated. Recommendations for interventions will be considered through the application of psychoeducational approaches for managing traumatic stress in families.     

Mothers and deployment: Understanding the experiences and support needs of deploying mothers of children birth to five

ABSTRACT

Military deployments can demand long separations of service members and their families. The strain of separation is particularly acute for mothers of very young children. This study aimed to better understand the deployment and reintegration experiences of service members who are mothers of young children. Focus groups and interviews were conducted with 12 service member mothers who deployed to Iraq and/or Afghanistan when one or more of their children was younger than age 6. Discussions explored experiences before, during, and after deployment; needs and challenges at each stage; available support resources and gaps in support. Thematic data analysis was conducted, drawing on principles of grounded theory. Disruption and continuity were central themes as participants illuminated the challenges they faced and their profound dedication to sustaining strong family relationships across the deployment cycle. Relinquishing, reassuming, and balancing multiple roles and responsibilities are additional themes that were frequently evoked. Participants noted a lack of formal resources responsive to their needs and circumstances and highlighted a need for services tailored to mothers who are deploying. Military mothers, particularly mothers of young children, face distinct challenges surrounding deployment. Better understanding their experiences and support needs can inform tailored services to meet their needs.     

“This will help your children”: Service providers’ experiences with military families during cycles of deployment

ABSTRACT

Military families face not only the same challenges as other families, but also unique issues due to their military involvement. Parenting programs for civilian families can be helpful, but they do not generally cover the specific issues faced by military families. The purpose of this qualitative study was to gather information from a focus group of eight service providers about the types of issues that affect military families, such that content and delivery of workshops at a social service agency could be formed to specifically cater to military families. This study utilized a phenomenological approach, and analyses revealed areas for social service involvement around the cycle of deployment. Specifically, social services could be helpful by using psychoeducational and normalization techniques around the five major themes that resulted from this study: (1) the issues of servicemembers psychologically withdrawing before deployment, (2) family cohesion and connectedness during and after deployment, (3) family stability during reintegration of the service member, (4) military families experience many of the same challenges that nonmilitary families do (such as domestic violence and financial issues), and (5) utilizing a military culture framework for all military family programs.     

Communicative Experiences of Military Youth During a Parent’s Return Home from Deployment

The return home of a service member from tour of duty can be stressful for military families (Bowling & Sherman, 2008), but surprisingly little is known about how military youth communicatively experience a parent’s homecoming (MacDermid Wadsworth, 2010). This study draws on the emotional cycle of deployment model (Pincus, House, Christenson, & Adler, 2001) to examine the reunion period in military youth’s own words. Individual interviews were conducted with 31 military youth (age range = 10 to 13 years old). Participants identified four changes to family life (RQ1), including spending time together, experiencing emotional tranquility, returning to patterns in place before deployment, and having difficulty reintegrating the service member into everyday routines. Some military youth reported that the reunion matched their expectations (RQ2), but others noted that the reunion fell short of their expectations or that they did not expect the returning service member to be so tired or so irritable. Participants also described four issues of uncertainty (RQ3), including questions about the service member’s activities during deployment, reasons for joining and deploying, family life, and the possibility of future deployments. The article concludes by examining the theoretical and pragmatic implications of the findings.     

Associations Between Prior Deployments and Marital Satisfaction Among Army Couples

Although the experience of deployments has been described as devastating to married life, evidence linking deployments directly to poorer marital functioning has been sparse. The analyses described in this article compare associations between prior deployments and current marital satisfaction across four different ways of measuring prior deployment within a large and representative sample of married Army service members and their spouses. Results indicate that the experience of prior deployments is associated with significantly lower current marital satisfaction among military couples. The association is disproportionately strong for first deployments and first cumulative months of deployment and weakens over subsequent deployment experiences. Most of these associations, but not all, can be accounted for by the fact that service members who have been deployed are more likely to have experienced traumatic events and to experience posttraumatic stress disorder symptoms, both of which are independently associated with lower levels of marital satisfaction.     

Military‐Related Posttraumatic Stress Disorder and Intimate Relationship Behaviors: A Developing Dyadic Relationship Model

The protracted conflict in Iraq and Afghanistan and an all‐volunteer military has resulted in multiple war zone deployments for many service members. While quick redeployment turnaround has left little time for readjustment for either the service member or family, dealing with the long‐term sequelae of combat exposure often leaves families and intimate partners ill‐prepared for years after deployments. Using a modified grounded theory approach, digitally recorded couple interviews of 23 couples were purposefully selected from a larger sample of 441 couples to better understand the impact of war zone deployment on the couple. The veteran sample was recruited from a randomly selected cohort of men in treatment for posttraumatic stress disorder (PTSD). Overall, it was found when veterans experiencing deployment‐related PTSD reenter or start new intimate relationships they may bring with them a unique cluster of interrelated issues which include PTSD symptoms, physical impairment, high rates of alcohol and/or drug abuse, and psychological and physical aggression. These factors contributed to a dynamic of exacerbating conflict. How these couples approached relationship qualities of mutuality, balanced locus of control and weakness tolerance across six axes of caregiving, disability, responsibility, trauma, communication, and community impacted the couple's capacity to communicate and resolve conflict. This dyadic relationship model is used to help inform implications for clinical practice.     

Common Challenges in Conducting Prolonged Exposure Therapy With Active Duty Service Members: Case Discussion and Strategies for Intervention

Prolonged Exposure (PE) Therapy receives most of its empirical support from trials conducted with civilian posttraumatic stress disorder (PTSD) populations. There has been only limited research on its use with military personnel with combat-related PTSD, and as a consequence, there has been less clinical discussion detailing its application with active duty service members. The purpose of this paper is to highlight two challenges that commonly arise when conducting PE with active duty service members: 1) selecting the most appropriate index event to focus on in imaginal exposure out of the numerous traumas an active duty patient is likely to have experienced, and 2) patients’ tendency to engage in “safety behaviors,” which undermine the effectiveness of in vivo exposure. The nature of these challenges is explored from a theoretical perspective, along with two case examples to illustrate their presentation in treatment. Specific strategies for addressing them are reviewed.     

Communication of Military Couples During Deployment and Reunion: Changes,Challenges, Benefits,and Advice

The emotional cycle of deployment model proposes that military couples face both obstacles and opportunities across the trajectory of deployment. Guided by the model, we seek to address gaps in the literature by investigating how 236 recently reunited service members and at-home partners (N = 118 couples) describe their experiences during deployment and reunion. Results of content analyses revealed a variety of changes to communication during deployment (RQ1), challenges of reunion (RQ2), benefits of deployment (RQ3), and advice for reintegration (RQ4). These findings bolster and extend the emotional cycle of deployment model; they also have practical utility for helping military couples navigate deployment and reunion.     

Intimate Partner Communication From the War Zone: A Prospective Study of Relationship Functioning,Communication Frequency,and Combat Effectiveness

This study examined (a) the association between relationship functioning prior to and during deployment, and the frequency of communication during deployment; and (b) the association between relationship functioning and depression during deployment and their influence on service members’ ratings of duty performance. Participants were 144 partnered Airmen assessed immediately before and during a one‐year high‐risk deployment to Iraq. Results showed an overall high frequency of partner communication during deployment. High relationship distress at predeployment predicted lower frequency of communication during deployment. Changes in relationship distress from before deployment to during deployment independently predicted frequency of communication, above and beyond predeployment distress levels. Level of relationship distress and depression during deployment independently predicted service members’ ratings of impact on duty performance.     

The experiences of adolescents and young adults residing with their families in emergency shelters in Canada

Emergency homeless shelters can be stressful environments for families. They can be associated with emotional distress and feelings of restriction for parents, and with behavioural, social, and developmental challenges for children. However, little is known about the experiences of accompanied youth residing in shelter with their families, as the literature about this age group's experiences of homelessness has mainly focused on unaccompanied youth. Findings from the current study are drawn from qualitative interviews with 16 adolescents and young adults (aged 16–21) who were homeless and living with their families in family homeless shelters in Ottawa, Ontario, Canada. Youth described family homeless shelters as stressful environments but also found that the shelters provided support to them and their families. Youth discussed the various strategies they used to cope in facing the challenges of shelter life. These findings add to our understanding of youth who are homeless and highlight the ways in which they adapt to the challenges of living in a family homeless shelter with their families. Recommendations are included for ways that shelter staff and policymakers can enact operational and systemic changes that could potentially improve the experiences of such youth and their families.     

Continuity of Mental Health Care Across Military Transitions

Multiple deployments, a prominent characteristic of operations Enduring Freedom, Iraqi Freedom, and New Dawn, have been linked to increased risk for various mental health conditions. It is also well known that military transitions, such as a change of duty station or discharge, are an inevitable part of military life. While military transitions can be stressful for any service member or veteran, those with mental health conditions face additional challenges. Transition stress can exacerbate a mental health condition that in turn hinders ability to manage the transition, resulting in a cycle of stress. As a result, those receiving mental health care while transitioning often experience difficulty continuing treatment post-transition. This article describes a unique and innovative transition coaching program designed to address this emerging issue.     

A Model for Assessing the Impact of Combat-Related Deployments on U.S. Army Spouses

Cognitive appraisal and coping theory were used to examine parental stress, family stress, and personal stress among wives of deployed soldiers. A random sample of wives of U.S. Army personnel deployed to Iraq provided evidence that length of deployment, rank of deployed soldier, and number of previous deployments, impacted these wives during deployments. Results suggest that rank of deployed soldiers and number of deployments influenced the spouse's perception of family stress; whereas rank and length of the deployment influenced her experience of parental stress. All three factors served as indicators of the personal stress experienced during deployments by these wives.     

The unsilencing of military wives: wartime deployment experiences and citizen responsibility

One of therapists' contemporary moral imperatives is to support American service members and their families regardless of personal position on the Global War on Terrorism. One way therapists can respond to this imperative is by seeking to understand Army wives' experiences during their husbands' wartime deployments. Therefore, this study utilized a combination of individual interviews with Army wives and a reflecting team of military wives and civilians to explore military wives' experiences. Two main themes were identified: the wives' experience was an emotional roller coaster and they felt silenced--and could be unsilenced--in their interactions with civilians. Therapists working with Army wives should (a) normalize the roller-coaster experience; (b) encourage wives to recognize negative and positive influencers and explore their idiosyncratic coping skills; (c) support positive civilian-military connections; and (d) as a civilian and as a therapist, seek to be a positive civilian connection by proactively showing support.     

21st Century American Military Families: A Review in the Context of the Wars in Afghanistan and Iraq

This article has three interrelated objectives designed to highlight military family studies in the context of the wars in Afghanistan and Iraq. Often referred to collectively as “the war on terror,” Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom represent the most comprehensive wars fought with an all‐volunteer force since the nation's independence. I review the literature on American military families with an emphasis on the challenges facing military families during these operations. First I provide coverage of issues specific to military marriages and then address the research on children of military families. The article ends with an argument for scholars to take a more integrated approach to the study of military families that would help break down the current state of family scholarship and military family scholarship as parallel lines of inquiry.     

“A Fear Like I've Never Felt”: Experiences of Parents Whose Adult Children Deployed to Combat Zones

Despite the increase of research with military families, less is known about the experiences of those parents who have adult children deployed overseas for military operations. This article presents parents’ experiences of having adult children deployed to combat zones. Qualitative data were gathered through an Internet-based survey during 2010. Analyses revealed important themes within the parents’ portrayals expressing strong reactions of fear, worry and concern for their children's safety and well being throughout their experiences. Parents also described frustrations communicating with their deployed children. Support from formal and informal sources was important to their coping, as was assistance from religious and military organizations. Finally, parents reported varied impacts of the adult children's deployment on the parents’ marriages. Implications for future military family research and family life education are provided.     

Quality of life among U.S. Army spouses during the Iraq war

ABSTRACT

During the course of previous military conflicts, attention has been focused on separations experienced by service members and their loved ones. This study utilized the ABC-X model of Family Stress and Resiliency Theory to provide information about specific family and parental stressors, family coping, appraisal of stress and coping abilities, and quality of life for spouses at various stages of a recent military deployment. Three groups of spouses differed primarily for levels of family stress and quality of life. In addition to comparative analysis, path analyses were conducted for each group to determine the influence of stressors, coping, wellbeing, and sense of coherence on quality of life. The model for the group of spouses with service members deployed longest accounted for the greatest amount of variability in quality of life. Implications for family counseling, social work practice, and community policy have been provided.     

Childhood Autism and Proactive Family Coping: Intergenerational Perspectives

This article considers the value of intergenerational and specifically, grandparental support, in the management of adaptive tasks posed by raising a young child with autism. The tasks addressed range from accessing early intervention to enhancing family social functioning. We note unique social, financial, and health-related stressors faced by families of children with autism. We outline an innovative, stress theory-based framework, the Autism Proactive Intergenerational Adaptation (APIA) Model, which delineates the role of grandparents in contributing to family adaptation to the stresses of raising a child with autism. We focus on proactive family coping strategies in building resilience and ameliorating the adverse impact of stressors on quality of life (QOL) for individual family members and for the family unit. We discuss barriers and facilitators of intergenerational alliances involving grandparental participation and support.     

Psychological Flexibility as a Framework for Understanding and Improving Family Reintegration Following Military Deployment

Postdeployment reintegration may present an exceptional challenge to service members and their families; yet, overcoming this challenge seems to strengthen family relationships through a shared sense of purpose. Navigating family reintegration may be an important determinant of long‐term psychological well‐being. If the needs of military families are to be answered effectively, it is of critical importance to identify the skills that facilitate positive reintegration following deployment. This article proposes psychological flexibility as a group of interrelated skills that could be directly intervened on to facilitate not only resilience but also positive growth and development. This paper focuses on the conceptualization of family reintegration in terms of psychological flexibility, including common deficits observed in this population and potential goals of treatment. Video Abstract