The struggle is real right now. The media has done an excellent job of sharing the mental health implications of social isolation and the dangers of relying on substances or alcohol to cope with this crisis. There has been emphasis on identification of warning signs that you or someone you know may be in trouble, in need of professional support. A treasure trove of self-help resources has been made available from the world’s leading experts in trauma and tolerating distress. However, there is one group’s resilience that has not been thoroughly appreciated – our nation’s veterans.
As psychotherapists primarily providing therapy to veterans and their family members, we have been inspired by the resilience we have witnessed in the veterans we are working with. While not the case with every client, the overall presentation is a healthy degree of concern and a desire to contribute to the mission of protecting others through careful physical distancing. During this global pandemic, it is not uncommon for a veteran to be struggling with the novel challenge of distance learning while earning a degree with their GI Bill benefits, struggling with the ongoing challenges of significant emotional and physical trauma, and sometimes the aftermath of a significant traumatic brain injury. Others seek mental health care because they are struggling to mend marriages and relationships wounded by distance caused by extended and frequent deployments, and now find themselves in close quarters attempting to feel like more than strangers with their partner or families. Some are on the frontlines once again as they are deployed with the National Guard to fight this pandemic. Many are themselves falling ill or having family members impacted. However, the sacrifices and challenges are met with a remarkable sense of duty and honor. Despite all of the well-publicized warnings to expect the mental health of our community members to suffer significantly in the face of this crisis, it has become increasingly clear that the unique background of veterans might be buffering against the negative mental health ramifications of COVID-19.
Upon further reflection, we realize that this remarkable resilience should not have come as a great surprise. The field has long acknowledged and sought to understand how prior exposure to challenging experiences common to military service (including, but not limited to combat exposure) can lead to significant psychological resilience in the face of subsequent life stressors. Resilience has been shown to be associated with a variety of positive attitudes and behaviors linked with more adaptive responses to future crises, including effective behavior in response to fear (Charney et al., 2004). The idea that exposure to stress can have an “inoculation” effect on later risk for mental health difficulties has been well-documented in civilian populations (Bonanno, Westphal, & Mancini, 2010), and a handful of studies have shown similar trends in military personnel. For example, a study of Israeli security agents engaged in terrorism prevention efforts demonstrated that those without prior combat exposure experienced higher levels of work-related stress than agents who were previously exposed to combat (Vaisman-Tzachor, 1997). Kaminsky and colleagues (2007) outlined several empirically-supported “ingredients” to enhance resilience during disasters, highlighting the need for realistic preparation, group cohesion, identification with a greater purpose (e.g., nationalism), and a sense of self-efficacy and hardiness. The requisite training background and core values of military culture match up well with these key ingredients, and it has been suggested that involvement in disaster response efforts post-service can help trauma-exposed military veterans connect with a renewed sense of meaning or purpose (McCaslin et al., 2020).
By Amanda Spray, PhD and Emily Brackman, PhD
Editor’s Note: This is the first in a two-part series authored by Steven A. Cohen Military Family Center at NYU Langone Health clinicians. Part two will run next week.
Bonanno, G. A., Westphal, M., & Mancini, A. D. (2011). Resilience to loss and potential trauma. Annual review of clinical psychology, 7, 511-535.
Charney, D.S. (2004). Psychobiological mechanisms of resilience and vulnerability: implications for successful adaptation to extreme stress. Am J Psychiatry, 161(2), 195 – 216 .
Der-Martirosian, C., Schmitz, S., Wyte-Lake, T., & Dobalian, A. (2019). US Military Veterans: An Untapped Resource as Disaster Volunteers. AJPH Perspectives, Supplement 109(4).
Kaminsky, M., McCabe, O. L., Langlieb, A. M., & Everly Jr, G. S. (2007). An evidence-informed model of human resistance, resilience, and recovery: The Johns Hopkins’ outcome-driven paradigm for disaster mental health services. Brief Treatment and Crisis Intervention, 7(1), 1.
McCaslin, S. E., Bramlett, D., Juhasz, K., Mackintosh, M., & Springer, S. (2020). Veterans and Disaster Response Work: The Role of Continued Service in Meaning Making and Recovery. In Positive Psychological Approaches to Disaster (pp. 61-79). Springer, Cham.
Rosenheck, R., & Fontana, A. (2003). Use of mental health services by veterans with PTSD after the terrorist attacks of September 11. American Journal of Psychiatry, 160(9), 1684-1690.
Vaisman-Tzachor, R. (1997). Positive impact of prior military combat exposure on terrorism prevention work: Inoculation to stress. International Journal of Stress Management, 4(1), 29-45.