Seeking Safety for Women Veterans
It has been well documented that there can be multi-faceted barriers preventing female veterans from seeking mental health care from the Department of Veterans Affairs. Women veterans are a growing and historically underserved population. As of November 2011, the VA reports that nearly 1.9 of the 22.2 million (8%) of the total veteran population are women.
Supported by funds from the Judy Hall Early Career Psychologist Award, I provided a time-limited, community-based, group treatment specifically offered for women service members and veterans in my community of Anchorage, Alaska. It was offered free-of-charge as a community service, outside of the DOD/VA systems, on a time-limited basis, for a group treatment cycle of 8 sessions over 4.5 weeks in the spring of 2012. Each group session was two hours long.
The treatment utilized the Seeking Safety model, a manualized cognitive-behavioral group psychotherapy that has been shown to successfully decrease substance use and trauma-related symptoms among women with histories of trauma, primary PTSD, and substance abuse . Treatment content addresses cognition, behavior, interpersonal relations, and case management, and is designed to be inclusive and practical. The therapy has been found to be effective for female veterans as well as other populations.
Seeking Safety consists of 25 modules that can be conducted in any order and can be used alone or in combination with any other treatments the client is receiving. The following combination of cognitive-behavioral and interpersonal modules were selected for this project: Safety, PTSD: Taking Back Your Power, Setting Boundaries in Relationships, Healing From Anger, Healthy Relationships, Compassion, Creating Meaning, Detaching from Emotional Pain (Grounding), Termination.
The group was titled “Coping Skills for Women.” I was greatly assisted by the Alaska Veterans Organization for Women, local military health providers in Anchorage, and Alaskan Senator Mark Begich’s office liaison staff to disseminate information and recruit active duty and/or veteran participants. The group was advertised as voluntary, primarily didactic and not intended to replace any existing mental health services that a participant may be receiving.
The group was designed to be highly structured, with the focus and intent being to learn how to cope with overwhelming emotions safely. Participants were informed that there would be no explicit trauma disclosure in the group, and that the focus would be on skill building to cope with the impact of trauma and/or other emotional distress. One participant described the treatment focus as “concrete action we can take to move our lives forward.”
A total of 9 women completed the brief group intervention of 8 sessions over 4.5 weeks. All women who were offered the opportunity began treatment. Age ranged from 25 to 64 years old, with seven veteran (including two OEF/OIF veterans), and four active-duty US Army service member participants. 27% were minorities. Completion of the treatment was defined as attending six or more sessions (met by 82% of the 11 who initially enrolled).
Assessments were conducted at pre-and post-treatment; participants completed a treatment satisfaction measure (author-created), as well as the following psychometrically validated measures: the PTSD Checklist-Military Version (PCL-M; Weathers et al. 1993, 1994), and the Beck Depression Inventory-II (BDI-II; Beck, Steer, & Garbin, 1988).
Seven of the nine completers (78%) had PCL scores of 50 or higher pre-intervention, which is consistent with or supportive of a PTSD diagnosis. Substance use data was not collected. While this project was not intended as a formal outcome study, treatment effectiveness was supported by changes pre-post intervention on the PTSD Checklist and BDI-II. All 9 completers decreased in PCL total score and BDI-II total score. Of the 9 that improved on the PCL, 6 (67%) had a clinically significant decrease of ten or more points. Seven out of 9 (78%) completers decreased their BDI-II total score by 15 points or more.
All participants reported that Seeking Safety was helpful in each of the following areas: overall, for traumatic stress symptoms, to focus on safety, and to learn safe coping skills. Measures of participant satisfaction and therapeutic alliance were very high. Despite the brief treatment duration, participants showed improvement in trauma-related symptoms, depression, suicidal thoughts, social adjustment, family functioning, coping ability, and didactic knowledge related to the treatment. One participant wrote, “This was a profoundly moving influence on my daily life in such a short period of time.”
United States Government Accountability Office. (2011). VA Mental Health: Number of Veterans Receiving Care, Barriers Faced, and Efforts to Increase Access. Retrieved from: http://www.gao.gov/assets/590/585743.pdf
Department of Veteran Affairs, Center for Women Veterans. (2012). Advisory Committee on Women Veterans 2012 Report. Retrieved from: http://www.va.gov/WOMENVET/docs/Final_
Najavits, L. (2009). Seeking Safety: An implementation guide. In A. Rubin & DW Springer (Eds). The Clinician’s Guide to Evidence-Based Practice. Hoboken, NJ: John Wiley.