CHAPTER TWELVE

“I’M THE GUY WITH THE DOG”: LIFE HISTORY OF A COMBAT VETERAN SUFFERING FROM PTSD AND TBI

Stacey Tatroe and Laura D. Elledge

“War and its personal outcome are phenomena different from any-V V thing known in civilian life” (Tick, 2005, as cited in Dillon, 2013, p. 13). As our soldiers continue to serve and protect our interest and freedoms, there are increasing numbers of veterans that have specific medical needs. Current medical practice is not effectively meeting these needs using traditional therapies and medications. Veterans have a significantly high rate of posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) diagnosis as well as an increased risk of suicide. “According to the U.S. Department of Veterans Affairs [2012], approximately 300,000 veterans of the Iraq and Afghanistan wars, nearly 20% of the returning forces are likely to suffer from either PTSD or major depression” (as cited in Dillon, 2013, p. 4). Although these numbers are staggering, they continue to rise as our soldiers are deployed to active theaters of war. McCarl (2013) states that increased suicidal behavior and higher suicide attempts are directly linked to PTSD and TBI. In 2010, the U.S. Department of Veterans Affairs (VA) estimated a loss of 18 veterans per day to suicide (as cited in McCarl, 2013). That number is also estimated to be higher today. The Suicide Data Report, 2012 published by the VA Mental Health Services estimated 22.2 veterans commit suicide each day (Kemp & Bossart, 2012). The purpose of this study is to examine the life history of one such veteran and discover how he has dealt with his diagnosis and treatment of PTSD and TBI since his return from multiple deployments.

Problem Statement

What is one combat veteran’s experience with PTSD and TBI and how did the use of a service dog impact his success in overcoming these diagnoses?

“Since September 11, 2001, more than 1.5 million troops have been deployed in support of the war in Iraq and Afghanistan” (Dillon, 2013, p. 1). In health care practice today, there are increased interactions with veterans who are products of the VA health system. This exposes the dysfunction and lack of managing both physical and psychological conditions and highlights an urgent need for civilian health care to be more involved and more cognizant of all aspects of the care needed by veterans. “To understand what troubles those who go to war, it is vital to understand the nature of trauma and post-traumatic stress reaction” (McGuire, 2010, as cited in Dillon, 2013, p. 13). Although the VA is making strides to renovate the programs available to treat veterans with PTSD with evidence-based psychotherapies, veterans are still struggling and suicide rates continue to rise (Finley, 2014). According to Yount, Olmert, and Lee (2012) returning veterans diagnosed with PTSD or other mental health conditions, 60% of those still meet criteria for PTSD after treatment with empirically supported interventions. The multitude of veterans spilling over into civilian health care demands a better understanding of these veterans, their experiences, their specific diagnoses, and successful treatments.

After a thorough review of the literature on the topic of combat veterans with PTSD and TBI and the use of service dog therapy, there are extremely limited research studies in this specific field of study. It is concluded that not only is the literature extremely limited and cannot be categorized as research, but also the majority of all of the literature pertaining to this subject are in agreement that more research is desperately needed. The current published articles contain anecdotal evidence and background information on separate aspects of the topics. Dillon’s (2013) efforts were not without the same difficulties locating and identifying current research. “While little difficulty was experienced finding literature regarding outcomes of PTSD treatment, the effects of service animals and PTSD seemed to be lacking within the literature” (Dillon, 2013, p. 48). Dillon’s thesis (2013) concludes the following: states the obvious problem with the incidence of PTSD and suicide among combat veterans; acknowledges the failures of current treatments; recognizes the benefits of animal-assisted therapies (AAT); praises the efforts of current programs using service dogs in treating veterans with PTSD; and tirelessly attempts to initiate a local program of such with the VA to benefit veterans with PTSD. Dillon’s thesis and area of study is social work. “From a social work perspective, this gap in literature is alarming when attending to the needs of clients from a holistic, bio–psycho–social systems approach” (Dillon, 2013, p. 48). These concerns from a primary health care perspective are equivocal.

Assumptions

This life history will be conducted with the assumption that this combat veteran will be relaying the truth as he sees it.

Definitions

It is important to note there are specific differences between a veteran and a combat veteran. A veteran is anyone who has ever served in the military. A combat veteran is defined as a military person, including reservist and National Guard, who served on active duty in a theater of combat operations, otherwise known as war. War “pushes soldiers to go beyond what is thought to be humanly possible” (Dillon, 2013, p. 14). Although there are many illnesses, psychiatric and medical, that plagued veterans, the combat veteran in this life history study leads the focus to PTSD and TBI.

PTSD is defined by the American Psychiatric Association (APA, 2000) as numbed emotions, hyperarousal, reliving the traumatic event(s), and avoiding stimuli associated with the trauma(s) (as cited in Dillon, 2013, p. 15). Although PTSD can affect anyone following a trauma, Shay (1994) suggests there are essential manifestations in postwar veterans following combat trauma (as cited in Dillon, 2013, p. 15). These include loss of authority over mental functioning (especially memory and perception); persistent mobilization for lethal danger; potential for violence; chronic health problems; expectation of betrayal and exploitation; lack of trust; and substance abuse (Shay, 1994, as cited in Dillon, 2013).

TBI is defined as an injury to the brain caused by trauma. It can be graded as mild, moderate, or severe. Symptoms included for TBI are photophobia, hyperacusis, anxiety, chronic depression, detachment, stoicism, malaise, delayed thought processes, recurrent headaches, fatigue, difficulty with concentration, and simple organizational difficulties (as cited in Dillon, 2013).

Today, the VA (2015) states, “Clinically, there is not enough research yet to know if dogs actually help treat PTSD and its symptoms. Evidenced-based therapies and medications for PTSD are supported by research” (VA, 2015, para 2). According to the VA and U.S. Department of Defense (DOD), current recommended or traditional treatments for PTSD and TBI include a combination of psychosocial or cognitive behavioral therapies and pharmacologic interventions. Dillon (2013) reports that first-line therapies used by the VA and DOD are prolonged exposure (PE) therapy and cognitive processing therapy (CPT). The PE therapy includes four main therapy components: psychoevaluation, in vivo exposure, imaginal exposure, and emotional processing (Dillon, 2013). CPT therapy includes both cognitive and exposure components (Dillon, 2013). Currently, these are the only VA financially covered therapies provided for veterans with PTSD. Psychotropic medications are also commonly used in the treatment of PTSD. Pharmacotherapy is easier than talk therapy, is less time-intensive, and can be administered by nonmental health professionals (Dillon, 2013). Despite the fact that research has found insufficient evidence supporting the efficacy of medications for PTSD, it continues to be included in the current recommended treatment guidelines (Sharpless & Barber, 2011, as cited in Dillon, 2013).

The key feature in this combat veteran’s recovery is the introduction of a trained service dog. Service dog is defined as “any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability” (as cited by Shubert, 2012, p. 21). Yount et al. (2012) find that there is a void in rigorous scientific evidence needed to gain the support from the VA and DOD to fund programs in the placement of service dogs with veterans suffering from psychiatric disabilities. “Successful programs such as animal assisted therapy remain unknown to the medical community at large and, consequently, underutilized, despite their demonstrated efficacy and the rehabilitative milieu” (Yeager & Irwin, 2012, p. 57).

LITERATURE REVIEW

It is significant to point out the lack of existing research studies that are focused on veterans suffering with PTSD and/or TBI and the utilization of service dog therapy in their treatment. The gaps in said research are glaringly evident and potentiate the lack of financing of alternative therapy programs for veterans.

Service Dog Training Program for Treatment of Posttraumatic Stress in Service Members

This is a cumulative review of Yount’s research projects involving service dogs and veterans with PTSD (Yount et al., 2012). Yount developed a program for the treatment of veterans suffering from PTSD using service dogs. The service dog program he established was designed to be a safe alternative to drug therapy in traumatic brain injury patients (Yount et al., 2012). The program consists of veterans suffering from PTSD being given the opportunity to participate in the training of dogs that are destined to be the service dogs of other veterans with disabilities. The review covers findings discovered through multiple project sites with varying numbers of participants. All were conducted at military treatment facilities. Yount found throughout the research sites that his program was cost-effective by “providing dog-assisted therapeutic relief to the largest number of PTSD patients with a limited number of service dogs” (Yount et al., 2012, p. 64).

Yount et al. (2012) found that both the warrior trainer and the service dog recipient were provided the opportunity to benefit from powerful relief of PTSD symptoms that bonding with the dog provides. Not only was the program found to be cost-effective, but also clinically impactful. Yount et al. (2012) found that the clinicians and instructors from the program recorded many improvements based on a collection of their anecdotal reports.

The theory on why this works is thought to have a medical basis having to do with the neurochemistry of the brain, specifically oxytocin. Handlin et al. (2011) found that after 15 minutes of interaction both dog and owner displayed a decrease in their heart rate along with a significant increase in their serum oxytocin level (as cited in Yount et al., 2012). Yount et al. (2012) hypothesize that this therapy of human–animal bonding works because of increased levels of the neurochemical oxytocin, which is an antistress agent in humans, caused by the interaction with dogs. The goal was not only to advance the understanding of animals and their healing power, but also “provide the rigorous science that the Department of Defense and the Department of Veterans Affairs need to support animal-assisted therapy programs and the placement of service dogs with service members and Veterans with psychiatric and physical disabilities” (Yount et al., 2012, p. 67).

Potential Benefits of Canine Companionship for Military Veterans with PTSD

Let it be noted that this study was not discovered in the original search based on the keywords specific to this study: combat veterans, PTSD, TBI, service dog, veterans. Dates included in the original search went back to 1972. The decision was made to attempt to find and include at least one loosely related research study. It was found that the study does not pertain specifically to service dogs and therefore was not inclusive of the original search criteria. The researchers recognize the study may have limited application (Stern et al., 2013).

The study was a retrospective survey of 30 veterans with a diagnosis of PTSD. The selection for inclusion in the study was based on their participation in treatment at VA outpatient clinics and voluntary admissions made by the veterans to their primary clinicians that they had been helped by their dogs. After obtaining written informed consents, participants were given a packet that contained a series of different questionnaires:

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