The American Psychiatric Association (APA) notes that, post-traumatic stress disorder (PTSD) remains a condition developed by individuals who experience dangerous or shocking events such as exposure to threatened or actual death, sexual violation or severe injury (NAP, 2014) . It is diagnosed after an individual experiences intrusion, changes in arousal and reactivity, undesirable alterations in mood and cognizance, and evasion thirty days after the occurrence of a disturbing event. The United States National Center for PTSD states that approximately seven to eight people in every one hundred individuals have experienced PTSD at some point in their lives (Smith, et al., 2012) . Among these individuals, women have high likelihoods of developing PTSD compared to men. Often, when facing traumatic situations, people exhibit feelings of being afraid. Many split-second changes are thus triggered in the body in response to danger and to help the individual avoid danger in the future. This type of body reaction shown by a person (fight or flight response) is for the protection of the individual from harm. Although almost everyone will experience a range of reactions after undergoing trauma, a significant percentage will recover in due time (Xue, Liu, Kang, Bihan, & Ge, 2015) . However, there are those who continue to experience issues associated with traumatic experiences and thus are diagnosed with PTSD. Individuals with PTSD often may exhibit feelings of being stressed or frightened, even when not in any danger. The paper will discuss PTSD and how it relates to women in the military in addition to the policies placed by the military in their quest to prevent the development of PTSD among female veterans.
PTSD and the military go hand in hand. It is a condition that was not diagnosed until the 1980s. Before being considered as PTSD, it was known as combat fatigue, war neurosis, or shell shock (Smith, et al., 2012) . Moreover, throughout history, it has been recognized that being exposed to combat situations negatively impacts both the mind and bodies of those involved more so women. Currently, there are approximately 200, 000 military women, a number that is expected to rise from nine percent to seventeen percent by 2043 (Herian, Krasikova, & Lester, 2013) . The main reason for the increase in PTSD among women veterans stems from the changes in the dynamic roles that women play in the military. For instance, during the 1700s, women in the military only took supportive roles such as nurses, dressmakers, cooks, and laundresses.
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However, after the removing the ban against women being in the front lines and engaging in direct combat lines by the Department of Defense in 2013, more women are now engaging in direct combat. As more and more women influx the frontlines, the number of those who are being exposed to stressors that place them at risk of developing PTSD are increasing daily. For instance, studies on the participation of women veterans in the OEF/OIF conflicts indicate that women have higher chances of developing PTSD than male veterans (Herian, Krasikova, & Lester, 2013) . One of the reasons for the gap in PTSD between men and women arises from the fact that women often have more trouble feeling emotions, are more likely to be jumpy and often avoid reminders of traumatic events as opposed to men.
Consequently, women have greater chances of developing PTSD from experiencing combat-related issues such as sexual assault, worries regarding families back at home, feelings of isolations and combat operations (Xue, Liu, Kang, Bihan, & Ge, 2015) . Research indicates that one of the risk factors for women developing PTSD is exposure to military sexual trauma (MST) as a result of sexual assaults within ranks, and unwanted sexual advances and sexual activity (Smith, et al., 2012) . Moreover, after the experience of traumatic events, women are more likely to blame themselves when compared to men. According to reports on the prevalence of PTSD among women veterans, one in five women reported to have faced MST are five to eight times more probable to be diagnosed with PTSD compared to women with no history of MST. Additionally, the feelings of detachments that female veterans feel when deployed to new groups where they do not know their new comrades further contributes to them developing PTSD (Herian, Krasikova, & Lester, 2013) . The primary reason for this is that women often find it more challenging to overcome the gender gap in order to build friendship in addition to trusting relationships (Smith, et al., 2012) . Furthermore, veteran women often experience increased stress regarding their families left at home. Because women who serve in the military are mostly given little notice before their deployment, they are often worried about how their elderly parents, young children, and loved ones will be cared for.
Policy for managing PTSD
The United States military (Marines, Air Force, and Army) have implemented various forms of integrated mental health care geared towards the prevention and treatment of PTSD. For instance, re-thinking systems by the army for primary care of PTSD in the military (RESPECT-Mill model of integrating mental health care in primary care setting) has been replaced by a PCMH network consisting of at least forty embedded behavioral health centers. These centers are mainly in support of the expansion of intensive outpatient programs, combat brigades, and standardization of case management (Herian, Krasikova, & Lester, 2013) . On the other hand, the Behavioral Health Optimization Program by the American Air Force works by integrating both mental and primary care services in order to lower the stigma linked to PTSD and to enhance access to mental health care. Additionally, the Navy has integrated mental health personnel within their Medical Home Port Programs (Herian, Krasikova, & Lester, 2013) .
More importantly, the American military has ensured that all mental health care personnel exist both in mental health centers and in MTFs that are embedded in military brigades (NAP, 2014) . While the purpose of the MTF is to provide both inpatient and outpatient clinical care, embedded clinic, on the other hand, provide only outpatient care although their health care personnel also acts as advisors to commanders to various operational units in the military. Additionally, the United States Army established forty-four embedded care centers in military brigades. The embedded mental health care teams within the brigades are comprised of thirteen providers and staff in addition to at least one mental health care provider. In order to reduce cases of PTSD among military women serving in the navy, the United States Navy deploys full-time clinical psychologists on each of their aircraft carriers for the duration of their overseas deployment (Herian, Krasikova, & Lester, 2013) . Moreover, several military installations offering intensive outpatient treatments programs such as pharmacotherapy and evidence-based psychotherapy have been established according to the recommendations made by the DoD Clinical Practice Guideline for Management of PTSD. Furthermore, alternative and complementary therapies such as meditation, biofeedback, and recreational therapy have been established for the prevention and handling of PTSD amid veteran women.
In the quest to ensure that the quantity of women developing PTSD while in serving the American army reduces, it has established various policies. The United States Army has established a program know as the Comprehensive Soldier and Family Fitness (CSF2) that aims to improve the functioning of soldiers and their families in addition to citizens in the army (Herian, Krasikova, & Lester, 2013) . The CSF2 program comprises five dimensions that are, emotional, physical, social, spiritual and family consisting of four primary components namely; comprehensive resilience modules, master resilience training, the Army Center for Enhanced Performance and global assessment tool. The main aim of the master resilience training is to help noncommissioned officers and middle-level supervisors to pass on lessons learned from their training to soldiers in their respective units.
Effectiveness of the CSF2 program
Preventing the development of PTSD among military women has been the goals of the DoD for an extended period. Thus, all of the service branches in the military have developed their stress control training programs for helping female veterans to cope with the stresses that military life throws at them, especially those related to direct combat and deployment. In doing so, the military can decrease the chances of development of psychological fitness concerns, specifically PTSD. As per the study conducted on the effectiveness of the CSF2 program indicated that long-term exposure of soldiers to resilience training increased their R/PH, a factor associated with reduced chances of developing PTSD (NAP, 2014) . According to the study, female veterans who underwent through resilience training showed significantly lower rates of developing PTSD compared to those did not undertake the training.
Essentially, the results from findings of other studies conducted on a similar concept to demonstrate that resilience training can improve a soldier's level of R/PH bolstered results from the study conducted. More importantly, even though it is stated that there are potential factors that might influence the R/[H of soldiers during deployment, still, evidence from the study conducted show that resilience training has the impact of improving the self-reported R/PH of soldiers (NAP, 2014) .
Findings from the study thus indicate that resilience training positively impacts the objective measures of mental and behavioral outcomes. Additionally, when given considerations at the national level, it is indicated that the effects of resilience training have far more reaching impacts on soldiers. The study indicates that apart from improving the overall health of individual veterans, it has the effect of refining the summative health and efficiency of the army (Herian, Krasikova, & Lester, 2013) . Since diagnosis for mental health problems such as PTSD is one of the leading causes for the hospitalization of women in the military, the findings from the study are evidence that the interventions provided by the CSF2 have the effect of helping relieve stress among female veterans (NAP, 2014) . In improving the R/PH of soldiers through resilience training, the army can be protected against extra difficulties that weaken the efficiency and effectiveness of soldiers.
Personal reflection
However, from the organizational results, there is an indication of some limitations to employing the CFS2 program. First and foremost, the timing cycles of deploying soldiers have potential confounds in regards to the timing of resilience training. From the organizational findings, the timing of deployment of soldiers was that those who had MRTs in their units had high likelihoods of being deployed to the front lines compared to those without MTRs. Therefore, it means that female veterans who have undergone resilience-training were highly prone to have direct experience warfare, a factor that increases their chances of developing PTSD.
Even though these limitations exist, I am in no way surprised since most of the analyses that are employed in determining the effectiveness of the CSF2 program are stringent given the nature of the data provided by the military. However, of most importance is that the results got from the study, and previous studies on the same are relatively consistent. Moreover, the organizational results indicate the current efforts in the ongoing evaluation of the resilience training program. Moreover, in the coming years, additional research might be conducted to fully determine the relationship between the development of PTSD and resilience training. Therefore, future results might differ from the current results as a result of the period between the implementation of the program. In other words, it is not viable to judge the effectiveness of the CSF2 exclusively on the outcomes of a specific assessment, but rather consideration should be provided according to the entire body of work to be done in the near future.
References
Herian, M. N., Krasikova, D. V., & Lester, P. B. (2013). The Comprehensive Soldier and Family Fitness Program Evaluation. Report #4: Evaluation of Resilience Training and Mental and Behavioral Health Outcomes. Lincoln: P.D. Harms Publications.
NAP. (2014). Treatment of Post Traumatic Stress Disorder in military and veteran populations: Final assessment. Retrieved from NAP: https://www.nap.edu/read/18724/chapter/5
Smith, T. C., Hooper, T. I., Wadsworth, S. M., Gackstetter, G. D., Smith, B., Seelig, A. D., et al. (2012). Prospective evaluation of mental health and deployment experience among women in the U.S. military. American Journal of Epidemiology, 176 (2), 1-11.
Xue, C., Liu, Y., Kang, P., Bihan, T., & Ge, y. (2015). A Meta-Analysis of Risk Factors for Combat-Related PTSD among Military Personnel and Veterans. Plos One, 10 (3).
