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Beyond PTSD: Exploring the stresses of veterans’ transition back to civilian life

The new Teachers College Resilience Center for Veterans and Families, which celebrated its formal launch this past week, is unique in focusing both its research and treatment on the transition of veterans from military to civilian life. 

Read about Resilience Center founding supporter David O'Connor in the WSJ's "Donor of the Day." (paywall) or view a PDF.

On the research side, the Center builds on the ground-breaking studies of George Bonanno, Professor of Clinical Psychology, whose work over the past 25 years, has helped overturn conventional understanding of human resilience to loss and trauma. In studies of events such as the 9/11 terrorist attacks, Bonanno has consistently shown that even after the most traumatic experiences, most people very quickly return to baseline resilience, while a much smaller percentage require longer time to recover. Those who do not recover at all constitute the smallest group, by far.

More recently, Bonanno has shown that these same trajectories hold for veterans of military combat – even those who have undergone multiple deployments.

Surprising Numbers

Using data on 140,000 soldiers from the Department of Defense’s Millennium Cohort Study – the largest long-term study ever to track soldiers from before they enter the service through to discharge – Bonanno collaborated with a team of researchers to show that no fewer than 83 percent of soldiers in the study experienced little change in trauma levels from before their deployment until the time they returned. Only about 7 percent (a much lower figure than is typically assumed) showed a noticeable increase in symptoms of trauma at a level similar to the diagnosis of post-traumatic stress disorder (PTSD). Perhaps even more striking, the number exhibiting resilience was even higher (85 percent) for those who served more than one military deployment.

 
 
Read about the launch of TC's new Resilience Center for Veterans and Families >>

“There’s no question that PTSD is a serious affliction, with a great deal of suffering involved,” Bonanno said at the TC Resilience Center launch event on November 5th.  “It’s only during the past few decades that society fully recognized this devastating consequence of exposure to combat, and we have since made a great deal of progress in treating it.

“But here’s the thing: If you’re seeing the challenges that veterans face only through the lens of PTSD, you’re missing a huge part of the picture. Why? Because most human beings who experience severe trauma or loss -- and that includes veterans – are profoundly resilient.”

Understanding Veterans' Experience

Focusing on that missing piece of the picture is the main goal of the Center. Bonanno is confident that a better understanding of exactly how resilience works will lead to more effective services and, ultimately, happier and more productive lives for veterans as they navigate the transition from military to civilian life.

 

“There’s so little understanding of the rest of what veterans go through, other than PTSD – and that’s what we’re interested in,” Bonanno says. “Not being a veteran myself, when I started doing this work and meeting soldiers and veterans it had an profound impact on me. I’ve been so impressed with what they go through, how dedicated they are, how much courage it requires, how much stamina and camaraderie, how they have to give of themselves entirely on behalf of the mission. Sometimes that involves intense trauma, but even when it doesn’t, the act of simply being in a danger situation and being in combat requires an adaptation. And then, when they leave, they have to switch out of that hyper-vigilant mode, because it just doesn’t work in civilian life. As soldiers, they give over to discipline and readiness, and when they come back they have to turn it off. And that’s a challenging and often stressful transition.

 

Much of Bonanno’s research, conducted in his Loss, Emotion & Trauma Lab at TC, has focused on “flexibility” – the ability to adapt emotionally to changing circumstances, whether the shift is from fighting in the wilderness to conducting house-to-house combat or returning from combat readiness to the everyday challenges of looking for a job, paying bills and raising children. A main goal of the Center is to develop additional research that will further investigate the specific mechanisms and strategies of flexibility.

Bonanno has already begun conducting additional research for the Center with  data from the Millennium Cohort Study, the results of which have not yet been made public. Such studies will provide more refined data about the effects of combat on soldiers, looking at such variables as the duration of their service and the branch of the service in which they served. Bonanno and TC doctoral student Meaghan Mobbs, a U.S. Army captain, are also working on measurement of all aspects of the transition and social adjustment from military to civilian life in newly-returning soldiers.

Looking at the Brain

Another study that Bonanno and TC doctoral student Kan Long are planning to conduct through the new Resilience Center is to scan veterans’ brains to begin identifying “connectivity patterns” among different brain regions that reveal veterans’ flexibility levels. By combining the information from the scans with data collected on the same veterans’ behavior, Bonanno believes, it will be possible to begin pinpointing actual brain processes and mechanisms associated with flexibility. Bonanno’s going-in hunch: that the scans will reveal greater connectivity among key brain regions assumed to be crucial to flexibility among transitioning veterans.

 

Armed with that kind of information, Bonanno is confident such research can help guide the design of future interventions that can help veterans navigate those processes as they transition from active military life to civilian reality.

 

In the meantime, the Center will also incorporate the ongoing work of TC’s Dean Hope Center for Educational and Psychological Services, which provides quality care for local individuals and families. The Resilience Center is already helping guide a Dean Hope-based training program for graduate students who provide counseling and other services for veterans and their families. The training, led by Dean Hope Director Dinelia Rosa and doctoral student Joseph Geraci, himself a veteran who has served three tours of duty in Afghanistan, employs a “military cultural competence” model developed by Geraci. That model helps train practitioners about the unique culture of the military and the specific problems veterans face, so they can be more sensitive to their needs when they come for services. Bonanno gives the example of someone newly returned from deployment in the Middle East who has been trained to be vigilant for potential explosive devices or people who seem likely to attack at any given moment. When that person returns to civilian life and is in a crowded grocery store, he will need to relax that kind of vigilance and allow himself to become more open to casual interactions.

“Making that shift might not rise to the level of trauma,” Bonanno says, “but it is a palpably real problem for many veterans. Until now there haven’t been many services to help them face such day-to-day realities. But we’re going to learn how to do it better.” – Ellen Livingston

Read about Resilience Center founding supporter David O'Connor in the WSJ's "Donor of the Day." (paywall) or view a PDF.

Published Monday, Nov. 9, 2015

George Bonanno
George Bonanno speaking at the Resilience Center launch
Resilience Launch
At the Resilience Center launch event (left to right): founding supporter David O'Connor; Loree Sutton, Commissioner, NYC Mayor's Office of Veterans Affairs; Dinelia Rosa, Director of TC's Dean Hope Center for Educational & Psychological Services; George Bonanno, Director of the Resilience Center; TC President Susan Fuhrman; TC doctoral student Joseph Geraci
Dinelia Rosa
Dinelia Rosa, Director of TC's Dean Hope Center
Joseph Geraci
The Resilience Center will train graduate students to provide counseling and other services for veterans and their families through TC's Dean Hope Center for Educational and Psychological Services
George Bonanno
Much of Bonanno’s research focuses on “flexibility,” the ability to adapt emotionally to changing circumstances.
Resilience Logo

The new Teachers College Resilience Center for Veterans and Families, which celebrated its formal launch this past week, is unique in focusing both its research and treatment on the transition of veterans from military to civilian life. 

Read about Resilience Center founding supporter David O'Connor in the WSJ's "Donor of the Day." (paywall) or view a PDF.

On the research side, the Center builds on the ground-breaking studies of George Bonanno, Professor of Clinical Psychology, whose work over the past 25 years, has helped overturn conventional understanding of human resilience to loss and trauma. In studies of events such as the 9/11 terrorist attacks, Bonanno has consistently shown that even after the most traumatic experiences, most people very quickly return to baseline resilience, while a much smaller percentage require longer time to recover. Those who do not recover at all constitute the smallest group, by far.

More recently, Bonanno has shown that these same trajectories hold for veterans of military combat – even those who have undergone multiple deployments.

Surprising Numbers

Using data on 140,000 soldiers from the Department of Defense’s Millennium Cohort Study – the largest long-term study ever to track soldiers from before they enter the service through to discharge – Bonanno collaborated with a team of researchers to show that no fewer than 83 percent of soldiers in the study experienced little change in trauma levels from before their deployment until the time they returned. Only about 7 percent (a much lower figure than is typically assumed) showed a noticeable increase in symptoms of trauma at a level similar to the diagnosis of post-traumatic stress disorder (PTSD). Perhaps even more striking, the number exhibiting resilience was even higher (85 percent) for those who served more than one military deployment.

 
 
Read about the launch of TC's new Resilience Center for Veterans and Families >>

“There’s no question that PTSD is a serious affliction, with a great deal of suffering involved,” Bonanno said at the TC Resilience Center launch event on November 5th.  “It’s only during the past few decades that society fully recognized this devastating consequence of exposure to combat, and we have since made a great deal of progress in treating it.

“But here’s the thing: If you’re seeing the challenges that veterans face only through the lens of PTSD, you’re missing a huge part of the picture. Why? Because most human beings who experience severe trauma or loss -- and that includes veterans – are profoundly resilient.”

Understanding Veterans' Experience

Focusing on that missing piece of the picture is the main goal of the Center. Bonanno is confident that a better understanding of exactly how resilience works will lead to more effective services and, ultimately, happier and more productive lives for veterans as they navigate the transition from military to civilian life.

 

“There’s so little understanding of the rest of what veterans go through, other than PTSD – and that’s what we’re interested in,” Bonanno says. “Not being a veteran myself, when I started doing this work and meeting soldiers and veterans it had an profound impact on me. I’ve been so impressed with what they go through, how dedicated they are, how much courage it requires, how much stamina and camaraderie, how they have to give of themselves entirely on behalf of the mission. Sometimes that involves intense trauma, but even when it doesn’t, the act of simply being in a danger situation and being in combat requires an adaptation. And then, when they leave, they have to switch out of that hyper-vigilant mode, because it just doesn’t work in civilian life. As soldiers, they give over to discipline and readiness, and when they come back they have to turn it off. And that’s a challenging and often stressful transition.

 

Much of Bonanno’s research, conducted in his Loss, Emotion & Trauma Lab at TC, has focused on “flexibility” – the ability to adapt emotionally to changing circumstances, whether the shift is from fighting in the wilderness to conducting house-to-house combat or returning from combat readiness to the everyday challenges of looking for a job, paying bills and raising children. A main goal of the Center is to develop additional research that will further investigate the specific mechanisms and strategies of flexibility.

Bonanno has already begun conducting additional research for the Center with  data from the Millennium Cohort Study, the results of which have not yet been made public. Such studies will provide more refined data about the effects of combat on soldiers, looking at such variables as the duration of their service and the branch of the service in which they served. Bonanno and TC doctoral student Meaghan Mobbs, a U.S. Army captain, are also working on measurement of all aspects of the transition and social adjustment from military to civilian life in newly-returning soldiers.

Looking at the Brain

Another study that Bonanno and TC doctoral student Kan Long are planning to conduct through the new Resilience Center is to scan veterans’ brains to begin identifying “connectivity patterns” among different brain regions that reveal veterans’ flexibility levels. By combining the information from the scans with data collected on the same veterans’ behavior, Bonanno believes, it will be possible to begin pinpointing actual brain processes and mechanisms associated with flexibility. Bonanno’s going-in hunch: that the scans will reveal greater connectivity among key brain regions assumed to be crucial to flexibility among transitioning veterans.

 

Armed with that kind of information, Bonanno is confident such research can help guide the design of future interventions that can help veterans navigate those processes as they transition from active military life to civilian reality.

 

In the meantime, the Center will also incorporate the ongoing work of TC’s Dean Hope Center for Educational and Psychological Services, which provides quality care for local individuals and families. The Resilience Center is already helping guide a Dean Hope-based training program for graduate students who provide counseling and other services for veterans and their families. The training, led by Dean Hope Director Dinelia Rosa and doctoral student Joseph Geraci, himself a veteran who has served three tours of duty in Afghanistan, employs a “military cultural competence” model developed by Geraci. That model helps train practitioners about the unique culture of the military and the specific problems veterans face, so they can be more sensitive to their needs when they come for services. Bonanno gives the example of someone newly returned from deployment in the Middle East who has been trained to be vigilant for potential explosive devices or people who seem likely to attack at any given moment. When that person returns to civilian life and is in a crowded grocery store, he will need to relax that kind of vigilance and allow himself to become more open to casual interactions.

“Making that shift might not rise to the level of trauma,” Bonanno says, “but it is a palpably real problem for many veterans. Until now there haven’t been many services to help them face such day-to-day realities. But we’re going to learn how to do it better.” – Ellen Livingston

Read about Resilience Center founding supporter David O'Connor in the WSJ's "Donor of the Day." (paywall) or view a PDF.

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