Introduction
Post-Traumatic Stress Disorder (PTSD) has been an ardent problem to the healthcare sector in American as reported cases seem to be accumulating rapidly. This condition is brought about when an individual is exposed to the stressful and develops amongst individuals who have experienced shocking, scary and dangerous experiences (Haagen et al., 2015). It is considered normal to feel afraid when faced with such events, but high levels of exposure to danger can lead to the development of paranoia thus making the mind think that one is in danger even when the stimulus does not exist. PTSD is most common among war veterans due to their working conditions in their previous engagement. Many of them witness deaths of their colleagues, attacks, and violence that leaves them scarred for life. Consequently, they portray signs and symptoms such as flashbacks, frightening dreams, anxiety, and depression. According to the United States DOD, there is a projection that more than 31% of the individuals who have participated in the wars have exhibited symptoms of PSTD (Haagen et al., 2015).
The veterans who develop this disorder become emotionally numb, and they find it hard to maintain close relationships. Their aggression levels are high, and they get easily irritated and also may exhibit lack of sleep. This calls for the intervention of the behavioral therapists working with the Veteran Administration to assist the individuals to control the symptoms. One of the methods in which this health condition can be tackled is by developing community programs which aim at visiting them in their residence. This paper describes PTSD causes, the effect of multiculturalism, and the interventions. For this population, it is not easy to find a treatment that identifies the condition and teaches coping methods (Jakupcak et al., 2008). With the number of veterans being 20 million by 2014, the medical issue becomes a problem. Therefore, a proper health program is ideal for them to prevent the dangers such as suicide cases. But before the plans are implemented, it is imperative to understand the origin of PTSD and what makes it manifest in high rate.
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Causes of PTSD
Post-traumatic stress disorder has many theories to explain why it happens. There have been explanations that the condition is caused by the exposure to the battlefield or combat (Xue et al., 2015). However, these arguments fall short of explaining the feeling the soldier has when at war and when witnessing the killings and sufferings around them. This leads to the theory of “moral injury.” During their reporting for diagnosis, the veterans rarely mention fear as part of what they go through. What they talk about instead, is guilt, shame, or regret. They feel like they have let down all those people who looked up to them for protection. They left America feeling like heroes, setting out to protect the weak, and be the keepers of their colleagues. However, they mistakenly killed civilians, saw wounded children as they drove through, witnessed their colleagues being murdered, and sometimes became oblivious of the real world they lived. This fills them with guilt, grief, moral injury, and they feel that their leaders betrayed them. It haunts them their entire lives and thus questions their morality.
The feeling of being a witness and a participant in the massacre of human beings, the suffering of children, and the evil meted upon populations and their property, makes them develop stress, and regret. Another theory suggests that the exposure to battlefronts lead to the development of this disorder. According to a study by Jakupcack et al. (2008), the veterans who fought in the Afghanistan and Iraq wars reported higher levels of anger and hostility than others who have not participated in the violent battle.
Multiculturalism and Veteran PTSD
A matter of importance that warrants study is the effect of multiculturalism in the handling of the programs on veterans. It is well known that the US is undergoing a massive transformation in the health reform that has a vision of supplying healthcare to the entire population regardless of race. The conversion is as an answer to the ever-changing cultural facet of the country. The demographic landscape is continuously changing its face, and the diversity is on the rise making culture an essential aspect of healthcare provision. Where patient-provider relationships influence the quality of care, it is critical to provide culture-sensitive care to patients in a culturally diverse population by having culturally diverse healthcare providers, thereby meeting the needs of the patient from the diversity perspective as well (King, 2014).
According to the Census Bureau, the average population by 2043 will have a third of the people being of Hispanic descent, which according to the current statistics of a sixth, is an increase. Also, the African Americans will increase to 14.7 percent of the whole population, while the Asian Americans will be 8.2 percent (Blustein, 2008). This means that the entire minority groups will increase thus prompting a reaction in the healthcare sphere. This means that the growth will be experienced in the veteran’s population as well which now stands at 85.5 percent white, 9.7 African American, 4.3 percent Hispanic, 1.2 percent Asian American and 0.7 percent Native Americans (Banks & Banks, 2009). The issue of culture or ethnic group affects the way a person reacts to PTSD. It has found that the African Americans and the Latino veterans are more likely than their white counterparts to experience the condition. The same case is seen in the Hispanic Vietnam veterans in comparison to their white non-Hispanic colleagues.
The former are more likely to develop PTSD than the latter. Also, the cultural differences affect the way one responds to the knowledge of them having PTSD. As for the whites, it is evident that they take more time in the hospital than other races like Hispanic veterans despite having almost similar symptoms of schizophrenia. According to the above theory, it means that the approach to which the treatment of PTSD is offered should be able to accommodate the best recovery percentage to the patients whose number is rising. Without the proper procedures, we would be witnessing a rising trend in the post-service suicide cases. One of the means to achieving this is through restructuring the service delivery to give a realistic picture of the experience on the ground.
Some efforts are being made currently to address this issue. For instance, in nursing, a lot of young people who are joining the healthcare services are diverse regarding ethnicity, gender, and race (Banks & Banks, 2009). Also, the young graduates are gaining a lot of skills to work with culturally different backgrounds, and they exhibit what is referred to as cultural competency (Mitchell & Lassiter, 2006). Thus, the need for embracing cultural diversity and multiculturalism is imperative in the education level and further into practice. Without these changes, which is currently the case, widespread disparities occur, and these outcomes affect the quality of care for thousands of veterans across the United States.
Goals and Objectives
Goal 1: Setting up ten meeting venues in three months for 100 veterans with PTSD.
Objective 1: Giving homework assignments such as journal writing on a weekly basis to all 100 veterans in attendance for the three month period.
Objective 2: Collecting feedback on the progress for each of the 100 veterans every Friday within the three month period.
Goal 2: Counselling to 100 veterans within a three-month period.
Objective 1: To create awareness of PTSD defining its causes, effects, and cure in the first two weeks of the program.
Objective 2: To understanding the perception of PTSD from the general public and the veterans through various discussions and surveys in the three month period of the program.
Goal 3: Designing a personalized PTSD programs for all our visitors in the three weeks of their visit.
Objective 1: To empower the veterans to take mental health into their hands through group therapy twice a week for three months
Objective 2: To enforce a healthy culture/lifestyle that reduces the impact of PTSD during the three months of group therapy and counseling.
Treatment Interventions
During the research, the responses in interest were cognitive processing therapy (CPT), and the behavioral exposure therapies (Haagen et al., 2015). CPT is a therapy that clinicians manually apply to the treatment of PTSD and similar psychological conditions. This approach incorporates cognitive behavioral therapy (CBT) treatment elements ( Dobson, & Dobson, 2016). The theory that the CPT lies on suggests that PTSD is a non-recovery condition that arises when the beliefs of the sufferer on the causes and consequences of events that cause trauma produce strong negative feelings, which hinder the patient from processing the memories and the emotions that result from the scenario. The feelings are always devastating and terrible hence proving difficult for the sufferer to cope, thus blocking the natural recovery process by abstaining from triggers as a daily coping strategy.
But, the result is always that the management in this manner limits their opportunities to process the experience and gain more understanding about adapting to it (Haagen et al., 2015). Also, the theory of moral guilt holds in this approach. The veterans feel that they are to blame for the ills that happened during their period of the war. This makes them tend to avoid any activity, place, or people that would bring back the old memories because they feel guilty of the things that happened and being blamed on something that was not their fault. Thus, CPT becomes useful in incorporating cognitive techniques that are trauma-specific which helps the individual with PTSD to accurately assess the points where they feel withdrawn and progress towards recovery ( Dobson, & Dobson, 2016) . This approach is an educative one as it tends to demonstrate to the veterans that the abstinence from trauma increases the chances of worsening the degree of their conditions. It is essential that the veterans obtain and evaluate the emotions that the injury generates so that a comprehensive plan can be created to address their issue.
Behavioral exposure therapy is an approach that targets the actual source of the anxiety or its context in veterans or any other psychological patient without intentions of causing any danger to them. By doing this, it is believed that they would overcome their distress or anxiety. This intervention is supported by the analogy of fear extinction paradigm in the experimental rodents ( Dobson, & Dobson, 2016) . The approach bases its explanation on the principle of respondent conditioning also known as Pavlovian extinction. The theorist categorizes emotions, cognitions, and psychological stimulation that complement fear-inducing events and then tries to distort the pattern of escape that maintains the fear. The maximum effect comes when the patient is exposed progressively to stronger fear-inducing stimuli. The extent of anxiety is seen to reduce at each of a series of steps that are escalating steadily, and these can be dynamic or static challenges until it is finally gone (Haagen et al., 2015). To the veteran, the events that cause fear is the war zone. Now the therapy can utilize the imaginations of the individual by asking them to note down the experiences they had during the combat. By knowing their source of fear, they can execute the approach anytime. Like the CPT, exposure therapy is also educative and leads to earlier screening of undiagnosed PTSD in the subjects.
The two interventions are essential in reducing the abstinence from the dangers that may lead to the veterans being depressed further and which could lead to other negative thoughts. They will help them come back to the reality that the world has stimuli that cause fears and anxiety. This appraisal would, in turn, make them appreciate the fact that what they feel is just a state of mind. The most significant achievement would be to make them grow their psychology back to the state of positive thoughts using the things that produce negative thoughts. It would also make them talk to people, visit places and do activities that they previously deemed raising shame, paranoia, and distress.
By making the veterans change their behavior from abstinence to exposure, the goals of the research would be achieved. Their mental health would be necessary to them, and this would lead to their empowerment. They would be able to share their experiences with people, and through group therapies, they would feel the difference and importance of moral support. During the study, exposing the veterans to the behaviors that they deem dangerous and stressful will make them change their avoidance behaviors that lead to worse levels of PTSD.
Challenges
Several challenges are possible during the study. One of them is participation that arises from the fear of stigmatization. Many veterans feel like they show weakness by acknowledging PTSD openly (Jakob et al., 2017). The program hopes to create a safe environment for the stigmatized with the help of other veterans by encouraging them and inviting them in group therapies.
Another challenge is the issue of continuity. The program is expected to run for a given period. For this reason, when it closes other veterans will need the assistance and expertise that the PTSD program offers. Hopefully, with the help of donors and investors, we hope to keep the program running for as long as possible. Also, the real meeting will be handed to community organizers that will use the already existing structure to help others who need it (Zohar, & Fostick, 2014). This approach will increase the success stories that the program is aiming.
References
Banks, J. A., & Banks, C. A. (2009). Multicultural education: Issues and perspectives. New York: John Wiley & Sons.
Blustein, D. L. (2008). The role of work in psychological health and well-being: a conceptual, historical, and public policy perspective. American Psychologist, 63(4), 2228
Dobson, D., & Dobson, K. S. (2016). Evidence-based practice of cognitive-behavioral therapy: Guilford Publications.
Haagen, J. F., Smid, G. E., Knipscheer, J. W., & Kleber, R. J. (2015). The efficacy of recommended treatments for veterans with PTSD: A meta-regression analysis. Clinical psychology review, 40, 184-194.http://www.sciencedirect.com/science/article/pii/S0272735815000987
Jakob, J. M., Lamp, K., Rauch, S. A., Smith, E. R., & Buchholz, K. R. (2017). The Impact of Trauma Type or Number of Traumatic Events on PTSD Diagnosis and Symptom Severity in Treatment Seeking Veterans: The Journal of nervous and mental disease , 205 (2), 83-86.
Jakupcak, M., Conybeare, D., Phelps, L., Hunt, S., Holmes, H. A., Felker, B., & McFall, M. E. (2008). Anger, hostility, and aggression among Iraq and Afghanistan war veterans reporting PTSD and sub threshold PTSD: Journal of traumatic stress, 20(6), 945-954.http://onlinelibrary.wiley.com/doi/10.1002/jts.20258/full
King, M. (2014, September 15). The Importance of Cultural Diversity in Health Care Retrieved October 6, 2017, from UVM Outreach: https://learn.uvm.edu/blog-health/cultural-diversity-in-healthcare
Mitchell, D. A., & Lassiter, S. L. (2006). Addressing health care disparities and increasing workforce diversity: the next step for the dental, medical, and public health professions. American Journal of Public Health, 96(12), 2093-2097.
Shay, J. (2014). Moral injury. Psychoanalytic Psychology , 31 (2), 182.
Xue, C., Ge, Y., Tang, B., Liu, Y., Kang, P., Wang, M., & Zhang, L. (2015). A meta-analysis of risk factors for combat-related PTSD among military personnel and veterans. PloS one, 10(3), e0120270.http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0120270
Zohar, J., Fostick, L., & Israeli Consortium on PTSD. (2014). Mortality rates between treated post-traumatic stress disorder Israeli male veterans compared to non-diagnosed veterans European neuropsychopharmacology .
