Since September 11th, 2001 over 110,000 United States military veterans have taken their own lives (Department of Veteran Affairs, 2018). Because of the lack of resources and a powerful stigma that still exists in this community, veterans are either turned away for care or are terrified to seek help. On June 1st, 2005 my dad who was an Air Force veteran and police officer became one of the 110,000, the moment I found out of his death, I almost became a part of the statistic as well. For the next thirteen years, I would struggle with post-traumatic stress and suicidal ideation while I served my country. I became stuck in a state that constantly blamed myself for my dad’s death, which in turn ended up with me being medically retired from the Air Force after thirteen years. I believed that no matter what I did or how hard I tried, my post-traumatic stress and suicidal thoughts would always be something I would battle. I lost hope and no longer had purpose in my life, I had become comfortable in my chaos which in turn was effecting every aspect of my life. It wasn’t until I found Dr. Craig Bryan at the University of Utah’s National Center for Veterans Studies, that I finally saw that I could rebound from my traumas and get my life back. Veteran mental health and suicide prevention is a big topic in todays society because of the epidemic it has become. At some point in our careers, a veteran is going to walk through our doors needing help. By understanding the scientifically proven methods used to treat veteran post-traumatic stress and suicidal ideation, we as a community can come together to give these heroes the best possible chance to recovery and maintain a overall state of well-being.
When I was a child, I struggled to trust anyone but my dad. He had been the only constant person in my life since my mom left when I was three. He taught me to be strong and how to be a leader. He allowed me to make my own mistakes and learn as much as I could from them. He was a great man that always put his family first, he was my hero. What I did not know was, on a daily basis he was fighting a war that no one could see. He was a veteran of the United States Air Force and a police officer in Upstate New York for 25 years. Each day he was seeing things that most people would not be able to handle. He put his life on the line because that is what he loved to do, he was a hero of the community and well known by all. His love for his country, community and family gave him purpose, a purpose that would eventually take his life and send me spiraling into chaos.
I had entered the Air Force on March 23rd, 2003. I joined after the invasion of Iraq and was ready to go to war. What I did not realize was, I was going into a career field that could only deploy if you volunteered, because we were already considered “deployed” since we worked on nuclear Intercontinental Ballistic Missiles. I got to my first base later that year in Cheyenne WY, I was eager to see what opportunities I had in front of me and was very excited to start a new life where I had purpose and a true identity in this world. It wasn’t long before I had a chance to deploy overseas to Kuwait. While there, my mission was to provide security for the troops coming in and out of Iraq as well as foreign delegates and government officials. One assignment I did not foresee during this time was something that really hit me hard. At the time, I had no clue what it was really doing to me, but it was something I wanted to do so those that were killed in action were able to go home to their families. During my time in Kuwait, I helped handle the human remains of those who were killed during combat in Iraq. I remember the number every day, 104.
After returning home in February of 2005, I was thrown straight back into work. There were no mental health assessments or evaluations and never a question of whether or not I needed to see a counselor for anything. Truthfully, I had no clue the Air Force had its own mental health program until it was too late. But I was excited to get home, my first daughter was due soon and without warning she came just 2 weeks after my return. I never realized it, but I didn’t have the chance to readjust back to life in the States, especially with what was about to come. While I was in the dessert, I got a chance to call home at Christmas and see how my dad, mom, and sister were doing. My dad had told me that he tore up his knee playing basketball and was going to have to have surgery and it had taken him out of work. He was hopeful it would be a quick fix and he would be back to work and playing basketball in no time. Sadly, that was not the case. After his surgery and a lot of physical therapy, his knee was stuck at an angle and he was unable to walk without using his crutches. This began a side of my dad that I had never seen before, but later learned it was something he had dealt with for a long time.
Just weeks after his initial surgery, my dad fell into a severe depression. He lost all hope that he was going to get better and would be able to return to his job as a Sergeant with the Ithaca College Police Department. I saw him slipping away each and every day as I talked to him on the phone. He no longer cared to talk and had the concentration of a 5 year old sitting in a room full of toys. His illness got so bad I needed to go home, I needed him to see just how much I cared and that things were going to get better as soon as we found a doctor that could fix his knee. When I got home to New York, it was like my dad was a shell of who he used to be. He had lost about forty pounds and had shaved the mustache he had my entire life. He paced around the house and spent a lot of time in his room away from me and his new granddaughter. This was also the first time I ever saw him cry, it broke my heart and I had no idea what to say. As he told me he was scared and hopeless, all I could say was “everything is going to be okay dad, we are going to get this figured out”. The next day, I had to leave because I was getting ready to start training in my new job. I said my goodbyes and told him that I would be back in a couple months and that he better be ready to get schooled in a game of basketball. The next thing he said will haunt me for the rest of my life, he told me “Justin, I will never play basketball again”. At the time I just saw it as him being negative and not having a good outlook on his injury. Looking back, it was him telling me that he did not plan to live that long.
On May 31st, 2005, I called to check on my dad. I spoke with my mom first and she told me that she had no clue what to do because he was getting worse as each day passed. I asked her to put him on the phone which only lasted a few moments. I remember getting so upset and angry with him, why couldn’t he just snap out of this? After only a few words, he handed the phone back to my mom and she asked me to call back to talk to him the following day. The next morning, I woke up like it was every other day. I had to get up early so I could get to physical training with the rest of my Group. It was 0600 and I thought to myself that I should call to check in on my dad, but decided that because he hadn’t been sleeping much I would call afterwards so if by chance he was sleeping I wouldn’t interrupt it. I was on Mountain Time and he was on Eastern Standard Time so I figured he would be up by the time I was done. After my training, my life changed forever. I called my dads phone right as I was getting to my office where my mom answered which was unusual to me. I asked her where dad was and she began to cry. I distinctly remember her asking me several times if there was others around me as I continued to tell her yes. She then spoke the ten words I will never forget “Justin, your dad is dead. He shot himself this morning”. I automatically dropped to my knees and prayed that I had heard her wrong, but as she dropped the phone and our family friend picked it up, she verified the one thing that I had feared my entire life. I don’t remember much from that day, but I do remember that was my own breaking point. I went to my house to get ready to fly home to New York, I picked up the 9mm handgun I had just bought after my deployment, put it to my head and was ready to pull the trigger when thankfully I pulled myself out of it thinking about my mom, sister, and four month old daughter. Later that week I buried my best friend and hero, little did I know that I had jumped on board a train that would slowly take me to the depths of my own hell, chaos, and destruction.
For thirteen years, I blamed myself for my dads suicide. I blamed myself for not seeing the signs and being there when he needed me. I also blamed myself for not making the call earlier that morning simply because, I would have called him at 0800 and he took his own life at 0816. For the next thirteen years I just did not care about anything, I tried many forms of therapy to include, Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Eye Movement Desensitization and Reprocessing, Acceptance and Commitment Therapy, as well as Neurofeedback. Although I got some minor results from each, I was still mad at the world. I would fall into rages that I could not snap out of, I would yell for hours on end and punch holes through doors and walls. I tried to run off anyone important in my life because I knew one fact in my mind, I was going to die. For four years, I was actively suicidal. I would go to work with a mask on and pretend that everything was great in my world. I was winning awards such as Noncommissioned Officer of the Year, being awarded medals for stepping into a deadly crash that I came across and tried to save a mans life, I was making rank fast and doing what I needed to do to make sure no one else knew what I was really facing. Little did those whom I worked with know, that at the end of the day I was going home and sitting there with the blinds drawn contemplating ways to take my own life. In September of 2015 everything finally came to light when I could no longer handle the constant chaos in my mind. I finally snapped and was going to end it no matter what it took. For the next thirty two days, I would stay in a military mental health program at a hospital in Salt Lake City, Utah. I learned a lot about myself in that program and it actually pointed me down the road of wanting to be a counselor. My military career was coming to an end because of my diagnosis of Bipolar I and PTSD, I was going to have to figure out a way to get myself better so I could help other veterans like myself who were fighting a war no one else could see. That is when my prayers were answered and I was soon going to be on my way to recovery.
The story leading up to this point is important simply because everyone’s individual story builds who they are. This story is why I am here today and why my mission has become to help other veterans with their mental health. My story however, is not complete without one of the most important aspects of my recovery and the hundreds of other lives that have been saved thanks to a group of people at the University of Utah that have too, made it their mission to help as many veterans as possible gain their lives back through the use of Cognitive Processing Therapy. Cognitive processing therapy has many different aspects of focus. Some of the aspects include evaluations of stressful events, trust, safety, control and power, intimacy, and self-worth (Bryan, 2017). By focusing on these involuntary thoughts along with their own core beliefs, veterans are able to use a series of worksheets to help them process and replace the unwanted thoughts and feelings that they are experiencing
In an ongoing study, veterans were invited to take part in a two week long “retreat” in which they would receive cognitive processing therapy on a daily basis for twelve straight days. Participants are first recruited for the program by completing an assessment and a structured interview. Once they are determined to meet the criteria for post-traumatic stress, they are invited to the retreat that takes place every other month in Park City Utah. Along with therapy, they also partake in team building exercises with fellow veterans. During this time, they have a chance to build camaraderie with those veterans which is an integral part of a veterans recovery. Another important aspect of this treatment is that the veterans family is allowed to attend and be a part of no more than two counseling sessions. This allows the doctors to explain to them what their veteran is going through and how they can help while at home.
This program is also effective because confidentiality is guaranteed 100%. Confidentiality is a very important aspect to serving veterans because this is a big reason they do not receive care while on active duty, especially when they are being seen by a provider on a military instillation. According to the American Counseling Associations Code of Ethics, Section B (B.1 through B.7.b), counselors are held to the highest standards when it comes to client information. Counselors are not allowed to share any vital or identifying information with anyone unless the client has given consent. Although there are several exceptions to this rule such as harm to self or others, this is a very important aspect to ensuring veterans reach out for help when they are struggling. This is a big reason why veterans do not self-identify while in the military, once a military member commits to treatment individuals such as the Commander and First Sergeant are automatically made aware of the treatment.
Lastly, this program is completely free for veterans who qualify. The National Center for Veteran Studies, works strictly on grants and money from the university. By offering this program for free, it allows more veterans to participate without the burden of accruing debt or having to go through the hassle of getting referrals from their primary care doctor.
During their time at the retreat, the veterans have to complete a weeks’ worth of homework each night and share that work with the counselor the next morning, assessments are also given each morning to see if there has been progression or regression in the baseline they had coming in to the program. Each veteran and counselor walk through each question of the homework and focus on problems that are known to be “stuck points”. Working through these daily worksheets, the veteran was able to visually break down the issues they are facing and focus on removing their “all or nothing” thinking from their thought processes. The visual learning and processing was something that was very powerful for the veterans and is something they can refer back to if the issue resurfaces again in the future. Results of this study have shown that with daily cognitive processing therapy sessions, team building, and knowledge of the program being completely confidential, the veterans were able to quickly and effectively advance in their recovery. “Military personnel and veterans in the present study showed large and statistically significant reductions in post-traumatic stress symptom severity and rates of post-traumatic diagnosis across a variety trauma types. Participants also reported significant reductions in the severity of suicide ideation over time” (Bryan, 2018). After the retreat concludes, the work is not done for the team of doctors. As a part of their research, they conduct assessments every three, six, nine, and twelve months. At the end of year long study on each individual, a final structured interview is conducted again and a final prognosis is made regarding their diagnosis.
When taking a look at Cognitive Processing Therapy, it is important to know that it is associated with Cognitive Behavioral Therapy and it has been tested on many military veterans with strong empirical evidence. Cognitive processing therapy has been proven that it can notably reduce the symptoms of post-traumatic stress, while estimated that 70% of individuals who are diagnosed, will no longer meet the criteria for the disorder after they have completed cognitive processing therapy with long-term follow-ups lasting as long as 10 years (Bryan, 2018). It has also shown in the same study, that cognitive processing therapy has reduced suicidal ideation by 76% in these veterans who have participated in the program (Bryan et al., 2016; Gradus, Suvak, Wisco, Marx, & Resick, 2013; Resick etal.,2017). Because of these findings, it was recommended to the Department of Veterans Affairs and Department of Defense that cognitive processing therapy should be the focus of treatment for all military and veterans currently diagnosed with post-traumatic stress.
In the current military and veterans affairs mental health system, many veterans do not receive care because of the stigma associated with it as well as the knowing of not having confidentiality. They also refuse help because the system is so backed up they become frustrated and give up, thinking no one will be able to help them out of the hole they are in or no one cares. The mental health care system in the military and the VA are broken. Although in the past year and a half the government has made it a point to work hard to change this, many veterans suffering from post-traumatic stress and other mental illness have taken their own lives. Suicide rates continue to increase and has now become an epidemic no one seems to know how to stop or even reduce. This is why Dr. Bryan and his teams findings are so important, with the training and educating of everyday counselors, this epidemic may soon see a decrease in veterans dying by their own hand.
Since September 11th, 2001 the United States has been at war. We currently have operations in Iraq, Afghanistan, Iran, Syria, Uganda, Yemen, Cameroon, our southern border as well as military personnel stationed throughout the world (Global Security, 2018). For almost eighteen years, our military has been pounded into the ground and suffering for it. Currently, post traumatic stress disorder is the most diagnosed psychiatric condition for veterans who have served in the Iraq and Afghanistan conflicts (Department of Veteran Affairs, 2017). Because of this, suicide rates have increased over the years with both active military and veterans. Because of the negative stigma against mental health care within this community, many individuals choose not to get care. Many are afraid of the repercussions that may come if they admit they are struggling. Individuals are afraid to look weak to their peers as well as having the fear or losing their job or even their career. For these reasons, they choose to suffer in silence and allow themselves to drift down a dark road that eventually leads to significant mental health problems. These problems can then lead to decreased life satisfaction, decreased marital satisfaction, violence against self or others, alcohol and substance abuse, and even suicide.
With the proper training and knowledge of resources, we as counselors can step up and make a difference with this current epidemic. Each day 20 veterans are taking their own lives (Department of Veteran Affairs, 2018) because they feel they do not have anywhere to turn, cannot trust anyone, and see themselves as a “lost cause”. The truth is, there is empirical evidence that cognitive processing therapy is very effective and can save the lives of those veterans who have lost hope. The benefits of this therapy include gaining an overall state of well-being, self-worth, and purpose in life. With our help, we can promote post-traumatic growth within these individuals that may not have the knowledge they have the ability to get better. Post-traumatic growth as defined by the University of North Carolina at Charlotte, post-traumatic growth research team as, “a positive change experienced as a result of the struggle with a major life crisis or traumatic event” (Post-traumatic Growth Research, 2014). This growth allows for individuals to develop new opportunities, change in relationships, an increase in the ability to see their own strengths, as well as find out who they really are. As counselors, we can teach veterans that they are not broken and they are not “stuck” like this forever. Post-traumatic stress does not have be the end all for these men and women that took the oath to defend our great country.
The use of this information can be vital to all counselors because we never know when a veteran may reach out to us. Having the knowledge of programs such as The National Center for Veterans Studies R&R program as well as partnering nonprofits like Project UnBreakable, counselors will be prepared to help any veteran that walks through their door. It is also important to know that, walking through your door was probably the hardest thing they have ever done. They will walk in terrified that the first meeting will result in them losing their job and that everyone they have ever worked for will find out. They will be lacking in trust and will more than likely assume this will be the one and only time they will be there. It is our responsibility to ensure they walk out not having those fears and are preparing to commit to counseling and a positive change in their lives. Without that, the stigma will continue to stay strong and others will refuse to seek help based solely on word of mouth. We need to remember that all of these veterans that are struggling and thinking of ending their own lives do not want to die, they simply want the pain they are enduring on a daily basis to end. We can help our veterans by advocating for them, treating them, and giving them hope this will one day come to an end and they will be on the other side of their trauma. We have the ability to help reduce the current numbers and make a difference in the military and veteran community. These men and women have sacrificed so we can sleep safe at night. In return, they no longer sleep, have nightmares, flashbacks, and live in a constant state of fight or flight. Let us step up and become more educated in what they are suffering from so no one feels alone anymore and family members no longer have to wonder what more they could have done to save their loved one.
It has been a long road for me and my recovery. For so many years, I lived a life of anger and hatred, mistrust and disappointment. I never imagined that I would be here to write this paper let alone graduate from one of the best universities in the country. Since 2003, my life was the military, it was my purpose and identity in life. When forced to retire after only thirteen years, it was a devastating blow to who I was and what made me want to get up each and every day. I felt I had no reason to live and that I was a burden on all those who loved me. I wanted the pain to end and I wanted my friends and family to not have to worry about me every single day. It wasn’t until I was given a second chance with this program, that I realized I had a lot to live for. I needed to get help and there was a group of doctors from The National Center for Veteran Studies that were ready to help me get my life back. Through their research, they have found proven ways to effectively treat post-traumatic stress and suicidal ideation through the use of cognitive processing therapy. They have helped hundreds of veterans work through their traumas and gain something back many have lost; hope. Veteran suicides are at an all time high, with very few answers to the problem in sight. With this current research and the findings they have produced, hopefully an answer is within reach and this can be implemented throughout the Department of Veteran Affairs and the Department of Defense. As counselors, we can help the process by advocating for our veterans and ensuring them confidentiality. The hardest thing for them to do it reach out for help, the thought of appearing weak, or losing their career will outweigh their perceived need to seek counseling. By educating ourselves and being aware of resources, we will be able to help in the process of reducing veteran suicides and helping them gain an overall state of well-being. This is the least we can do for those who signed a blank check in the amount of their life, so we can sleep well at night knowing we are protected from the evil in this world.