The BraveHeart: Welcome Back Veterans Southeast Initiative, a program led by Emory University with the support of the Atlanta Braves and funded by the Welcome Back Veterans Initiative, is a screening, assessment and service program designed to make it easy for veterans of the wars in Iraq and Afghanistan to gain access to mental health and counseling services. The Initiative provides online services, educational outreach, clinical care coordination, confidential online screenings and a referral service.
As members of the U.S. military, they’ve driven Humvees through desert roads laced with buried explosive devices. They’ve spent years away from family and home, living in cramped tents, barracks, or submarines. They’ve followed orders to search out those who would like nothing better than to see them dead.
If they are lucky enough to survive, they get called heroes. But sometimes acting heroically can take a psychological toll. That’s where Emory’s Barbara Rothbaum and Ursula Kelly come into play. They are leading research that explores what it takes to help new generations of veterans adapt emotionally once they’ve physically returned home.
Post-traumatic stress disorder (PTSD) became an official diagnosis in 1980 in response to patterns of behavior among Vietnam veterans who were experiencing difficulty in adapting to civilian life. These vets could be shopping in a suburban grocery store, hear a loud bang, and suddenly feel transported back to the jungles of Vietnam—ducking behind produce bins, vigilant for an attack coming from the frozen dinner aisle. At night, while most of their neighbors might leave doors unlocked and windows open, they would sleep with a gun under their pillows, alert to the slightest noise. Their actions made complete sense in a war zone but were hard to stop once they were home.
Around this same time, Emory psychologist Barbara Rothbaum was starting a career that focused on researching and treating anxiety disorders. On a job interview, she told her prospective boss, “I don’t know anything about PTSD.” The boss, a preeminent anxiety researcher replied, “That’s all right, we don’t know anything either.”
But it was time for Rothbaum and the mental health community to learn. For many veterans, flashbacks and hyper-vigilance made it hard to keep a job and maintain a relationship. The stigma against seeking help was strong, and many tried to self-medicate their anxiety and depression with alcohol and drugs. For these reasons, a fifth of homeless people today are veterans, and half of all homeless veterans served during the Vietnam era, according to estimates from the Veterans Administration and National Coalition for Homeless Veterans. (Since the 1970s, psychologists have determined that PTSD also can result from rape, abuse, traumatizing accidents, and other life events.)
To combat PTSD, Rothbaum started focusing on exposure therapy. “One of the things that maintains PTSD is avoidance,” she says. When something traumatic happens, “it’s so painful to think about that all those with PTSD want to do is push it away. But it’s unfinished business, and they haven’t really processed it. Emotionally, it haunts them.”
Rather than avoid their trauma, Rothbaum hypothesized that veterans needed to face it head-on in controlled, safe environments. “Going over and over and over it helps decrease their distress, and they can look at it,” she says. “So we do the exposure therapy repeatedly and in a therapeutic way to help them see that they can handle it.”