Guest Blogger: John Milwee, Psy.D., Veterans Administration therapist and Beck Institute alumnus

Veterans returning from the conflicts in Afghanistan and Iraq may face many challenges as they begin to reintegrate into their roles as parents, employees, friends, and neighbors. In recent months a great deal of media attention has been focused on those returning Veterans who suffer with symptoms of Post-Traumatic Stress Disorder (PTSD) associated with their combat experience. Alarming statistics are frequently reported that describe the number of these Veterans who, when untreated, commit suicide.

Heightened awareness within the civilian population of PTSD has served as an important catalyst for changing public perceptions of our Veterans’ experience while in theater and, within the VA, for development of new outreach programs to help them once they are back home. The application of empirically-based cognitive behavioral therapies to a growing number of disorders, PTSD among them, is one of the most important and effective tools for addressing our Veterans’ needs and, in some cases, saving lives.

The violence and chaos of war sometimes (but not always) leave some of our Veterans with a second battle to fight once they have gotten back home. As a clinical psychologist in a VA hospital for the past three and a half years, I have learned that the challenges of reintegrating into civilian life do not stop with those Veterans who have been in combat. Simply joining the military requires sacrifices that most of us in the civilian population will never be required to make. Long absences from family and friends, unexpected changes in station and living situation, an unwavering commitment to duty and service, and an obligation to follow the orders of an unquestioned chain of command set the average soldier’s experience apart from most civilian lifestyles.

Cognitive Therapy (CT) has been a very useful means of helping Veterans learn to function effectively in civilian life after they have left the service. The term “military training” refers to much more than education about combat tactics, equipment maintenance and drills. Joining the military requires that the individual learn how to live within a culture that is distinct from that of their previous experience. The structure, rules, and expectations that the military provides our service men and women shape them psychologically in profound ways. This is precisely the kind of learning that contributes to the development of the conditional assumptions and beliefs and the behavioral compensatory strategies that frequently constitute the therapeutic targets of CT.

Cognitive restructuring of dysfunctional, sometimes negative thinking, behavioral activation, and a spirit of collaborative empiricism are excellent helpmeets for veterans who are learning to live in a less structured social environment where success is not always rewarded, failure not always punished, and expectations are not always clear. I have found that Veterans are quite comfortable with the structure of a good Cognitive Therapy session, setting clear goals for treatment and criteria for success, and the collaborative development and testing of hypotheses.

As our Veterans return from the current conflicts and others leave the service because they have fulfilled the obligations of their commitment, it is our duty to ensure that they receive the very best care our medical and psychiatric systems can provide. At the VA, new initiatives in training and service are being rolled out regularly. As the number of new providers being trained in CT increases we can be more confident that our Veterans will be given state-of-the-art treatment that is empirically derived and validated and which truly addresses their most urgent needs and concerns.