AOTA’s Societal Statement on Combat-Related Posttraumatic Stress

Abstract

Self-report of symptoms of post-traumatic stress disorder (PTSD) have tripled among combat-exposed military personnel, compared to those who have not deployed, since 2001 (Smith et al., 2008). Tanielian and Jaycox (2008) have estimated that approximately 300,000 military personnel previously deployed to Iraq or Afghanistan currently experience PTSD or major depression. Military personnel are returning home and demonstrating signs and symptoms of combat-related PTSD, such as nightmares, flashbacks, memory loss, insomnia, depression, avoidance of social interaction, fear, decreased energy, drug and alcohol use, and the inability to concentrate. These signs and symptoms could affect these individuals' ability to effectively negotiate their personal lives and work roles. Specifically during work, the avoidance of social interactions and avoidance of situations that resemble the traumatic event may interfere with coworker relationships or may be perceived as the lack of motivation or ability to be successful in a work setting (Penk, Drebing, & Schutt, 2002). Combat-related PTSD not only affects military personnel but also the family and the community in which military personnel interact. If unidentified and untreated, the effects of combat-related PTSD may have a delayed onset and cause problems such as depression, social alienation, marital communication problems, difficulty with parenting, and alcohol and drug abuse, and each can cause a disruption in military personnel's personal lives, professional abilities, and overall physical and mental health (Baum, 2008). It is vital for military personnel and health care providers to be educated on these signs and symptoms and detect them early to ensure that military personnel receive adequate opportunities for prompt intervention services and to access support. This is something that occupational therapists and occupational therapy assistants can do.

Occupational therapy and posttraumatic stress disorder: A scoping review

“…The OPI discussed most often was sleep disturbances and difficulties (see Alers, 2014; Davis, 1999;Dutra et al, 2016;Eakman et al, 2017;Gerardi, 2009;Hyter et al, 2002;Kjorstad et al, 2005;Pizur-Barnekow & Erickson, 2011;Plach & Sells, 2013;Precin, 2011a;Rivers & Saunders, 2016;Roberts, 1995;Rogers et al, 2014;Scaffa, Gerardi, Herzberg, & McColl, 2006;Smith-Forbes et al, 2014;Speicher et al, 2014). As well, preschool-age children who have been exposed to trauma may experience flashbacks and nightmares, which can cause a decrease in both the quality and quantity of their sleep that further affects concentration and disrupts productive occupations like educational performance (see Alers, 2014; Davis, 1999;Kjorstad et al, 2005), which can further affect productive occupations, such as educational performance, as a result of decreased concentration (Alers, 2014).…”

“…Within these sources, authors discussed problems in school performance (see Alers, 2014; Davis, 1999;Driver & Beltran, 1998;Eakman et al, 2017;Hyter et al, 2002;Kjorstad et al, 2005;Plach & Sells, 2013;Precin, 2011a;Rivers & Saunders, 2016;Rogers et al, 2014;Scaffa et al, 2006;Simó-Algado et al, 2002;Snedden, 2012;Speicher et al, 2014) and being able to drive safely (Classen et al, 2014(Classen et al, , 2017Dutra et al, 2016;Edgelow, 2016;Phillips, Bruehl, & Harden, 1997;Rivers & Saunders, 2016;Speicher et al, 2014). However, returning to, or maintaining, one's position at work was the most commonly reported OPI (see Bracciano et al, 2012;Cowls & Galloway, 2009;Edgelow, 2016;Froehlich, 1992;Gerardi, 2009;Gindi, Galili, Volovic-Shushan, & Adir-Pavis, 2016;Lopez, 2011;Murphy et al, 2015;Phillips et al, 1997;Plach & Sells, 2013;Precin, 2011bPrecin, , 2011cRivers & Saunders, 2016;Smith-Forbes, Quick, & Brown, 2016;Snedden, 2012;Speicher et al, 2014;Whatley Brown, 1990;Yamkovenko, 2011).…”

“…People with a diagnosis of PTSD can experience an overall decrease in interests as well as decreased motivation to engage in activities and hobbies they previously found pleasurable (see Alers, 2014;Bracciano et al, 2012;Davis & Kutter, 1998;Froelich, 1992;Lopez, 2011;Rivers & Saunders, 2016;Roberts, 1995). Most commonly, people diagnosed with PTSD demonstrated interpersonal problems within their friendships and other intimate relationships, leading to social isolation (see Alers, 2014;Bracciano et al, 2012;Clarke, 1999;Davis, 1999;Driver & Beltran, 1998;Dutra et al, 2016;Eakman et al, 2017;Edgelow, 2016;Engel-Yeger, Palgy-Levin, & Lev-Wiesel, 2015;Gerardi, 2009;Gindi et al, 2016;Hyter et al, 2002;King, 2006;Kjorstad et al, 2005;Lopez, 2011;Murphy et al, 2015Murphy et al, , 2016Phillips et al, 1997;Plach & Sells, 2013;Precin, 2011a;Rivers & Saunders, 2016;Rogers et al, 2014;Short-DeGraff & Engelmann, 1992;Simó-Algado et al, 2002;Smith-Forbes et al, 2014;Speicher et al, 2014;Yamkovenko, 2011).…”

“…Overall, occupational therapy's focus is on treating the consequences of PTSD as they impact the ability to complete daily activities (Clarke, 1999) and on enabling those living with PTSD to participate in meaningful occupations as a way to promote wellness, role competence, and satisfaction, all while improving quality of life (Edgelow, 2016;Snedden, 2012). Occupational therapists' unique occupational lens and focus on empowerment and promotion of health and well-being makes them ideally placed to work with persons with PTSD as they work to regain control over their lives (see Clarke, 1999;Gerardi, 2009;Lopez, 2011).…”

“…Regardless of the origin, PTSD can significantly impact an individual's quality of life and can result in decreased community integration and social isolation as well as difficulty forming and maintaining meaningful relationships (American Psychiatric Association, 2013;Bisson, 2007;Ozer et al, 2003). These types of activity restrictions and impacts on participation in the broader community create unique opportunities for occupational therapists to work with people living with PTSD, utilizing meaningful occupations to improve occupational performance as well as increase health and wellness (Gerardi, 2009). The purpose of this scoping review was to identify and describe the ways occupational therapy addresses PTSD in clinical practice.…”