Women constitute approximately 15 percent of the armed services and represent a growing segment of the veteran population (Thomas et al., 2016). They are more likely than their male counterparts to report mental health concerns like posttraumatic stress, depression, and suicidal thoughts (Ramsey et al., 2017). Younger women service members and veterans aged 18 to 34 are three times more likely to die from suicide than their civilian counterparts (Beder, 2016). To improve health outcomes for military women, programs grounded in evidence-based psychosocial education and mindfulness-based practices allow providers to address issues unique to women veterans seeking mental health support following military service (Saltzman et al., 2011).
While the experiences of war can have lifelong impacts on all military service members (Hoge et al., 2008), women veterans often face stressors unique to military service, including relationship challenges, trauma exposure, disruptions of support networks, military sexual trauma and harassment, and transition from military to civilian life (Runnals et al., 2014). For many, the trauma of war may be compounded by military sexual trauma (MST), defined as “physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the veteran was serving on active duty or active duty for training” (Barth et al., 2016; U.S. Code, 2006, supplement 5, title 38—Veterans’ Benefits, 2012). Currently, Veteran Affairs (VA) data show that 20.5 percent of women veterans report experiencing MST, while a majority of women veterans report enduring ongoing sexual harassment (Barth et al., 2016). Survivors of MST are more likely to experience PTSD and other psychological issues, including alcohol and/or drug abuse, depression, anxiety, and suicidal ideation (Mattocks et al., 2012).
Many women veterans face challenges of single parenting (Gewirtz, Erbes, Polusny, Forgatch, & DeGarmo, 2011), separation from family and social supports during trainings and deployments (Street, Vogt, & Dutra, 2009), frequent moves to duty stations (Shivakumar, Anderson, & Suris, 2015), and transition from military to civilian life (Demers, 2013). Women veterans are three times more likely to be single parents than their male counterparts, which can magnify mental health issues stemming from deployments (Segal, Smith, Segal, & Canuso, 2016).
The VA and Department of Defense (DoD) recognize that supporting the mental health of returning military service members, particularly women veterans, requires long-term intervention programs and mental health support (Runnals et al., 2014).
Programs designed specifically for women veterans must account for unique facets of their military experience. Some available mental health services available through the VA include psychological assessments/evaluations, psychotherapy, inpatient/outpatient care, and psychosocial rehabilitation (U.S. Department of Veteran Affairs, 2017). Although there is no consensus on the ideal delivery method for gender-specific mental health services within the VA, several VA facilities have established women-only programs and specialized women’s treatment teams (Oishi et al., 2011). Many existing clinical mental and behavioral health services do not include psychosocial and resilience skill-building, though research indicates that such training offers potential for significant positive health outcomes (Pietrzak, Russo, Ling, & Southwick, 2011).
Many women veterans face real or perceived barriers to care in relation to their military service. These barriers include lack of knowledge of resources or eligibility of resources, lack of gender-specific care, previous poor experiences with the VA, and lack of understanding by personnel of the unique needs of women veterans (Maung, Nilsson, Berkel, & Kelly, 2017).
Gender-specific services that address unique needs of women veterans is a common request (Yano et al., 2010). Along with the lack of specific-care resources for the physical and mental health needs of women veterans, fear of stigma and social isolation are often concerns (Druss & Rosenheck, 1997). Many women veterans avoid treatment because of the associated stigma within military culture (Thomas et al., 2016). Currently, many community organizations are either collaborating with the DoD and VA or providing services privately that seek to meet women veterans’ needs (Meredith et al., 2017).
The Young Adult and Family Center (YAFC) at the University of California San Francisco (UCSF) developed interventions aimed at meeting the mental health needs of women veterans (UCSF Department of Psychology, 2017). The YAFC offers courses such as Women Warriors and Next Mission, both designed to help women veterans. Active-duty military and veterans can access these unique psychotherapeutic, psychoeducational courses online. The courses focus on posttraumatic growth, resilience-building, and empowering individuals to form healthy lives. These programs are rooted in the YAFC’s mission to deliver evidence-based, quality care to those with unmet mental health needs (UCSF Department of Psychology, 2017). YAFC courses are free of charge, and students may earn college credit through the University of California San Diego (UCSD) Extension School.
A critical hypothesis of each course at the YAFC is that military personnel will be more willing to engage in activities to understand their reactions to extreme stress within the context of a less stigmatizing environment. Additionally, technology-savvy veteran cohorts may appreciate opportunities for interactive learning, computer-based models of information-gathering, and social network sharing.
The VA and DoD recognize the mental health of returning service members requires long-term intervention programs and mental health support. During current ongoing conflicts, military service branches shifted perspective on the psychology of the experience of war, from a focus on acute reactions to extreme stress to a broader view that addresses the life cycle of exposure to extreme stress (Rubin, Weiss, & Coll, 2013; Wooten, 2015). Many mental health treatment efforts target the negative outcomes of exposure to extreme stress, such as posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI; Pietrzak, Johnson, Goldstein, Malley, & Southwick, 2009). Identifying and treating the negative outcomes is essential but only one part of the solution. A growing body of literature documents the positive outcomes that service members experience because of exposure to extreme stress (Spiro, Settersten, & Aldwin, 2016). Schok, Kleber, and Lensvelt-Mulders (2010) discuss the following benefits that service members and peacekeepers have reported from their experience: “Adversity coping”; “developing self-discipline”; “broader life perspective”; “greater independence”; “expanding horizons”; “increasing stress-tolerance”; “better self-worth, assertiveness and ability to take responsibility”; “not taking things for granted”; “learning to cooperate”; “developing stronger friendships”; “valuing life more”; “appreciating peace”; “realizing the importance of family”; and “strengthening faith/spirituality.” Some evidence suggests that the experience of growth in the face of adversity can alleviate stress (Schok et al., 2010; Spiro et al., 2016).
One model for understanding the perspective on treating psychological trauma views the development of positive (e.g., growth) and negative (e.g., PTSD) outcomes as separate and distinct pathways (Schok et al., 2010). The model of resilient resources, developed by Schok et al. (2010), posits that functional adaptation is a result of balance between positive and negative outcomes. For example, because of war, a service member may develop negative symptoms (Schok et al., 2010), but the same service member may develop positive outcomes, such as an ability to overcome adversity. In sum, this service member’s level of adaptation in response to war experiences may be high, despite negative symptoms. By focusing on both positive outcomes, reintegration programs could enhance individual resilience.
To reach military women, such programs do better in training spaces than clinical treatment (Thomas et al., 2016). Both the VA and the DoD have expended millions of dollars to address barriers to care, including ensuring anonymity of care and using online mediums (www.afterdeployment.org). However, barriers persist. The service members’ experience of, and response to, stress may be pathologized (Fala, Coleman, & Lynch, 2016). Military members value strength (Zinzow et al., 2013) while remaining skeptical acknowledging the negative impacts of stress.
In contrast, providers can use the military profession’s value of training/education to overcome specific cultural challenges associated with seeking aid from mental health providers (Caforio, 2006). From the basic assumption promulgated by military recruiters that the military is a learning experience to military leaders’ belief that service members are trainable for any assignment, training and education are integral parts of the culture of the military (Gagne, 1962). Thus, an intervention that focuses on educating soldiers on stress and a balanced perspective on positive and negative outcomes could be therapeutic and motivate individuals to seek care.
The eight-week Women Warriors course is based upon the principles developed in the Next Mission course on posttraumatic growth. YAFC delivers the course through a Health Insurance Portability and Accountability Act (HIPAA)–compliant telemedicine platform allowing students to read course material, submit assignments, and engage each other socially. Students watch video lectures with two course instructors. Lydia Davey, a veteran, and author of this chapter, discusses her experiences on active duty, her return to civilian life, and the ways that these experiences connect to each topic. Dr. Christine Garcia, a clinical psychologist, discusses the neuroscience and psychology behind stress, trauma, resilience, and growth. Students participate in in-class activities such as goal-setting, barriers to goals/growth, homework assignments, and in-class discussions. All content is based on evidence-based practices, including those approved by the DoD for the treatment of PTSD.
The course relies on three principles of healing and posttraumatic growth: (1) stress-focused coping strategies through narrative therapy, cognitive behavioral therapy (CBT), and trauma-based salutogenic exercises; (2) the science behind traumatic stress and its impact on the brain; and (3) community engagement for peer-to-peer support. Understanding the physiological responses to emotional and physical injury is crucial in combating the stigma of brain injury, PTSD, and other illnesses that many veterans carry. Students study brain structure and function (1) as related to normal stress, (2) when undergoing trauma exacted from the war zone, and (3) in relation to the culture of the military.
The course relies on multiple evidence-based modes of healing. Students learn and utilize aspects of (1) acceptance and commitment therapy (ACT; Hayes, Luoma, Bond, Masuda, & Lillis, 2006); (2) dialectical behavior therapy (DBT; Scheiderer, Carlile, Aosved, & Barlow, 2017); and (3) emotion regulation (Rabinak et al., 2014). The instructors use Pennebaker’s work on trauma, Writing to Heal (2004), heavily throughout the course. The process of writing allows students to “take control of the narratives that control them” (Pennebaker, 2004). Course instructors ask students to journal through collaging, free-writing, and creating trauma maps that describe different trauma points in their lives. Trauma-based salutogenic strategies (Mittelmark et al., 2017) capitalize on exposure-based exercises paired with relaxation work, such as Parnell’s bilateral stimulation through resource tapping (Hartung, 2010). This exercise asks participants to activate the right and left hemispheres of the brain through tapping the right and left arms or legs with hands, or tapping the right and left feet on the floor, in rhythmic motion, while experiencing distress. Through exposure to the uncomfortable emotion while utilizing a relaxation or distraction-based activity, individuals become more able to tolerate discomfort (Hartung, 2010). The instructors utilize other body-based exercises that apply mindfulness techniques such as body scan, gratitude practice, yoga for warriors, and breathing exercises.
In the Women Warriors course, students explore coping skills through discussions. As students engage in activities like journaling, relaxation, cognitive behavioral skills, and stress-reduction strategies, they engage with fellow classmates through discussions on course materials and personal experiences that may connect with course topics. Due to the sheer ratio of men to women service members across the years (Segal, 1995), it is likely that women students have not previously had the opportunity to engage with other peers with similarly rare experiences. Their ability to form connections without the barriers of geography provides an extra measure of healing to this course experience.
Module One provides an overview of differences in the neuroanatomy and physiology of men and women and explores unique challenges and stressors faced by women in the military. Women veterans learn that they can be active participants in creating stronger, healthier lives for themselves and others.
Module Two examines the link between women’s physical symptoms of stress and their emotions. Referencing the Yerkes-Dodson curve (Yerkes & Dodson, 1908), students discover some stress is necessary for optimal performance, while too much stress can be damaging. The instructors discuss ways to decrease stress and introduce a mindfulness exercise to increase awareness of what is happening in the body.
Module Three focuses on choices. It explores what happens in the human brain and body when making choices, how they make these choices, and what strategies may be employed to make the best possible choices based on personal goals. The module examines choice through neuroanatomical, neuropsychological, and psychological lenses. Students learn that brains may remember things and make decisions in a nonlinear fashion after a traumatic event. The concept of “wise mind” (Sakdalan & Gupta, 2012) is introduced as a place from which to make decisions; it takes into account both logic and emotions and produces outcomes with which people are satisfied.
Module Four moves students beyond stress and into conversation about trauma. They learn different types of traumas, including single catastrophic events, sustained intense trauma, and also “small t” (McCullough, 2002) traumas (a constellation of experiences that together can negatively impact a person). Not everyone who experiences trauma will be negatively impacted; however, an intense reaction to trauma is normal (Gold & Wegner, 1995).
Module Five explores how the human brain maps traumatic events, the powerful mind-body connection, and how to rewrite those maps. Students are introduced to the concept of radical acceptance (Chapman, 2006) and learn that it can be united with a growth mind-set (Tan, 2013) to shape a future that is different than the one students always felt was inevitable.
Module Six teaches students about moral injury (Litz et al., 2009), guilt, and resilience (Dekker, 2013). Many service members believe that military service is honorable and good, but they may also recognize that no nation is perfect in its application of force. To begin owning these potentially competing narratives, students follow Pennebaker’s writing prompt.
Module Seven allows students to explore pathways to healing as well as concepts of healing throughout history. Instructors discuss the importance of engaging the total person, internal and external, in the healing process and dig into the role forgiveness can have in empowering posttraumatic growth (Schultz, Tallman, & Altmaier, 2010).
Finally, in Module Eight, students learn about the Hero’s Journey, a narrative pattern seen in epic stories throughout time (Vecchiolla, 2016). For their final project, students map their own journey against the Hero’s Journey.
Telemedicine is a concept that has received considerable attention in recent years (Morland, Greene, Rosen, & Frueh, 2010; Weinstein et al., 2014). Alternatives to traditional in-person care have emerged as ways to address the limitations of brick-and-mortar services (Egede et al., 2015). Health care has moved more comfortably in this direction as advances in technology have made this type of service more intuitive and accessible (Mermelstein, Guzman, Rabinowitz, Krupinski, & Hilty, 2017). Organizations, health care providers, and patients use HIPAA-compliant platforms to supplement, replace, and allow for collaborative care among providers and patients (Molfenter, Boyle, Holloway, & Zwick, 2015). Patients discussed feeling more secure with the perceived anonymity of telemedicine (Morland et al., 2015). Telemedicine interventions allow patients and doctors to transmit clinical information more easily and unconstrained by time or geographic location.
Reviews of studies examining telemedicine’s effectiveness reveal positive outcomes for areas such as diagnosis, assessment, the transmission of information, and communication among providers (Egede et al., 2015; Morland et al., 2015). With specific focus on military veterans with PTSD, patients in rural geographic locations were able to receive services they would otherwise be unable to access (Morland et al., 2015). Further, the scalability of this mode of treatment reduces the cost of service delivery (Egede et al., 2016).
A key step in developing YAFC’s intervention was having an information technology platform to support an online, interactive, college-level course. Core to this strategy was the creation of a social networking platform that embodied privacy protection and security while conforming to HIPAA. The HIPAA-compliant secure social networking platform developed by YAFC, when combined with several emerging technologies, allows information transfer over the Internet (a process known as e-learning). E-learning (Rosenberg, 2001) allows the YAFC instructors to deliver a unique type of therapeutic experience, drawing on synchronous, asynchronous, and social-learning technologies. This allows instructor relationships with students to be interactive while remaining confidential.
YAFC’s technology allows instructors to accommodate different learning styles. Beyond the increased capacity to achieve impacts that e-learning technologies provide, they also provide opportunities to establish social networks to facilitate interaction and promote healing (Rovai, 2001). Using homework assignments as community-building exercises capitalizes on the military’s strong cultural emphasis on training together, deploying together, and sticking together (Caforio, 2006). Encouraging peer-to-peer interactions allows students to develop agency, competence, and expertise—processes that counteract the debilitating effects of trauma. Because many veterans often believe that only other veterans can understand them (Demers, 2010), peer-to-peer interaction allows them to maintain their “expert status” while providing peer-level support.
Important aspects of the success of the courses include recruitment and engagement efforts. Creating a safe environment to share personal experiences is essential from initial recruitment to graduation. YACF recruits via word of mouth, e-mails to veterans organizations, posts on social media platforms, and connections with veterans student organizations. Weekly, instructors send students course material with discussion prompts and homework assignments. Instructors respond to homework assignments and engage with students through discussion postings. Homework assignments are designed to increase contact between students. To this end, students post reactions to items such as coping strategies, readings, videos, and films that correspond to course topics. Instructors also enable the women participating to harness their own resilience by encouraging them to think about and share the positive coping strategies they have used in the past or currently use.
The YAFC courses are part of a voluntary study examining the impact of online delivery and healing through a psychoeducation package. At the beginning and end of each course, students complete a questionnaire that asks them about their history of trauma, mental health, and overall health. While YAFC staff are presently unable to share data, some anecdotal evidence suggests that the course is impactful and can be as good as, if not better than, in-person models for reaching women veterans. Preliminary data show decreases in somatization, levels of fear, and sadness. Increased levels of joy and authenticity have also emerged. Students have reported that the course has replaced and/or supplemented the therapy they were receiving or that the course has placed them on a path that makes them feel more amenable to receiving mental health services.
Barth, S. K., Kimerling, R. E., Pavao, J., McCutcheon, S. J., Batten, S. V., Dursa, E., & Schneiderman, A. I. (2016). Military sexual-trauma among recent veterans: Correlates of sexual assault and sexual harassment. American Journal of Preventive Medicine, 50(1), 77.
Beder, J. (Ed.). (2016). Caring for the military: A guide for helping professionals. New York, NY: Routledge.
Caforio, G. (2006). Handbook of the sociology of the military. New York, NY: Springer.
Chapman, A. L. (2006). Acceptance and mindfulness in behavior therapy: A comparison of dialectical behavior therapy and acceptance and commitment therapy. International Journal of Behavioral Consultation and Therapy, 2(3), 308–313.
Dekker, S. (2013). Second victim: Error, guilt, trauma, and resilience. Boca Raton, FL: Taylor and Francis Group.
Demers, A. (2010). When veterans return: The role of community in reintegration. Journal of Loss and Trauma, 16(2), 160–179.
Demers, A. (2013). From death to life: Female veterans, identity negotiation, and reintegration into society. Journal of Humanistic Psychology, 53(4), 489–515.
Druss, B. G., & Rosenheck, R. A. (1997). Use of medical services by veterans with mental disorders. Psychosomatics, 38, 451–458.
Egede, L. E., Acierno, R., Knapp, R. G., Lejuez, C., Hernandez-Tejada, M., Payne, E. H., & Frueh, B. C. (2015). Psychotherapy for depression in older veterans via telemedicine: A randomized, open-label, non-inferiority trial. The Lancet Psychology, 2(8), 693–701.
Egede, L. E., Gebregziabher, M., Walker, R. J., Payne, E. H., Acierno, R., & Frueh, B. C. (2016). Trajectory of cost overtime after psychotherapy for depression in older veterans via telemedicine. Journal of Affective Disorders, 207, 157–162.
Fala, N. C., Coleman, J. A., & Lynch, J. R. (2016). Anticipatory anxiety in the treatment of combat veterans with posttraumatic-stress disorder. Journal of Aggression, Maltreatment & Trauma, 25(2), 210–229.
Gagne, R. M. (1962). Military training and principles of learning. American Psychologist, 17(2), 83–91.
Gewirtz, A. H., Erbes, C. R., Polusny, M. A., Forgatch, M. S., & DeGarmo, D. S. (2011). Helping military families through the deployment process: Strategies to support parenting. Professional Psychology Research and Practice, 42(1), 56–62.
Gold, D., & Wegner, D. (1995). Origins of ruminative thought: Trauma, incompleteness, nondisclosure, and suppression. Journal of Applied Social Psychology, 25(14), 1245–1261.
Hartung, J. (2010). Tapping in: A step-by-step guide to activating your healing resources through bilateral stimulation. Journal of EMDR Practice and Research, 4(2), 96.
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes, and outcomes. Behavior Research and Therapy, 44(1), 1–25.
Hoge, C. W., McGurk, D., Thomas, J. L., Cox, A. L., Engel, C. C., Castro, C. A. (2008). Mild traumatic brain injury in US soldiers returning from Iraq. New England Journal of Medicine, 358, 453–463.
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29, 695–706.
Mattocks, K. M., Haskell, S. G., Krebs, E. E., Justice, A. C., Yano, E. M., & Brandt, C. (2012). Women at war: Understanding how women veterans cope with combat and military sexual trauma. Social Science & Medicine, 74(4), 537–545.
Maung, J., Nilsson, J. E., Berkel, L. A., & Kelly, P. (2017). Women in the National Guard: Coping and barriers to care. Journal of Counseling & Development, 95(1), 67–76.
McCullough, L. (2002). Exploring change mechanisms in EMDR applied to “Small-t Trauma” in short term dynamic psychotherapy: Research questions and speculations. Journal of Clinical Psychology, 58(12), 1531–1544.
Meredith, L. S., Wang, Y., Okunogbe, A., Bergman, A. A., Canelo, I. A., Darling, J. E., & Yano, E. M. (2017). Attitudes, practices, and experiences with implementing a patient-centered medical home for women veterans. Women’s Health Issues, 27(2), 221–227.
Mermelstein, H., Guzman, E., Rabinowitz, T., Krupinski, E., & Hilty, D. (2017). The application of technology to health: The evolution of telephone to telemedicine and telepsychiatry: A historical review and look at human factors. Journal of Technology in Behavioral Science, 1(1), 1–16.
Mittelmark, M. B., Sagy, S., Eriksson, M., Bauer, G. F., Pelikan, J. M., Lindstrom, B., & Espnes, G. A. (2017). The handbook of salutogenesis. New York, NY: Springer.
Molfenter, T., Boyle, M., Holloway, D., & Zwick, J. (2015). Trends in telemedicine use in addiction treatment. Addiction Science and Clinical Practice, 10(14), 1–9.
Morland, L. A., Greene, C. J., Rosen, C., & Frueh, B. C. (2010). Telemedicine for anger management therapy in a rural population of combat veterans with posttraumatic stress disorder: A randomized noninferiority trial. The Journal of Clinical Psychology, 71(7), 855–863.
Morland, L. A., Mackintosh, M., Rosen, C. S., Willis, E., Resick, P., Chard, K., & Frueh, B. C. (2015). Telemedicine versus in-person delivery of cognitive processing therapy for women with posttraumatic-stress disorder: A randomized noninferiority trial. Depression and Anxiety, 32(11), 811–820.
Oishi, S. M., Rose, D. E., Washington, D. L., MacGregor, C., Bean-Mayberry, B., & Yano, E. M. (2011). National variations in VA mental health care for women veterans. Women’s Health Issues, 21(4), S137.
Pennebaker, J. W. (2004). Writing to heal. Oakland, CA: New Harbinger Publications.
Pietrzak, R. H., Johnson, D. C., Goldstein, M. B., Malley, J. C., & Southwick, S. M. (2009). Psychiatric Services, 60(8), 1118–1122.
Pietrzak, R. H., Russo, A. R., Ling, Q., & Southwick, S. M. (2011). Suicidal ideation in treatment-seeking veterans of Operations Enduring Freedom and Iraqi Freedom: The role of coping strategies, resilience, and social support. Journal of Psychiatric Research, 45, 720–726.
Rabinak, C. A., MacNamara, A., Kennedy, A. E., Angstadt, M., Stein, M. B., Liberzon, I., & Phan, K. L. (2014). Focal and aberrant prefrontal engagement during emotion regulation in veterans with posttraumatic stress disorder. Depression and Anxiety, 31(10), 851–861.
Ramsey, C., Dziura, J., Justice, A. C., Altalib, H. H., Bathulapalli, H., Burg, M., … Brandt, C. (2017). Incidence of mental health diagnoses in veterans of Operations Iraqi Freedom, Enduring Freedom, and New Dawn, 2001– 2014. American Journal of Public Health, 107(2), 329–335.
Rosenberg, M. (2001). E-learning: Strategies for delivering knowledge in the digital age. Columbus, OH: McGraw-Hill Companies, Inc.
Rovai, A. P. (2001). Building classroom community at a distance: A case study. Educational Technology Research and Development Journal, 49(4), 35–50.
Rubin, A., Weiss, E. L., & Coll, J. (2013). Handbook of military social work. Hoboken, NJ: John Wiley & Sons.
Runnals, J. J., Garovoy, N., McCutcheon, S. J., Robbins, A. T., Mann-Wrobel, M. C., Elliott, A., & Strauss, J. L. (2014). Systematic review of women veterans’ mental health. Women’s Health Issues, 24(5), 485–502.
Sakdalan, J. A., & Gupta, R. (2012). Wise mind—risky mind: A reconceptualisation of dialectical behavior therapy concepts and its application to sexual offender treatment. Journal of Sexual Aggression, 20(1), 110–120.
Saltzman, W. R., Lester, P., Beardslee, W. R., Layne, C. M., Woodward, K., & Nash, W. P. (2011). Mechanisms of risk and resilience in military families: Theoretical and empirical basis of a family focused resilience enhancement program. Clinical Child and Family Psychology Review, 14(3), 213–230.
Scheiderer, E., Carlile, J. A., Aosved, A. C., & Barlow, A. (2017). Concurrent dialectical behavior therapy and prolonged exposure reduces symptoms and improves overall quality of life for a veteran with posttraumatic stress disorder and borderline personality disorder. Clinical Case Studies, 16(3), 216–233.
Schok, M. L., Kleber, R. J., & Lensvelt-Mulders, G. J. L. M. (2010). A model of resilience and meaning after military deployment: Personal resources in making sense of war and peacekeeping experiences. Aging & Mental Health, 14(3), 328–338.
Schultz, J., Tallman, B. A., & Altmaier, E. (2010). Pathways to posttraumatic growth: The contributions of forgiveness and importance of religion and spirituality. Psychology of Religion and Spirituality, 2(2), 104–114.
Segal, M. W. (1995). Women’s military roles cross-nationally: Past, present, and future. Gender and Society, 9(6), 757–775.
Segal, M. W., Smith, D. G., Segal, D. R., & Canuso, A. A. (2016). The role of leadership and peer behaviors in the performance and well-being of women in combat: Historical perspectives, unit integration, and family issues. Military Medicine, 181(Suppl 1), 28.
Shivakumar, G., Anderson, E. H., & Suris, A. (2015). Managing posttraumatic stress disorder and major depression in women veterans during the perinatal period. Journal of Women’s Health, 24(1), 18–22.
Spiro, A. I., Settersten, R. A., & Aldwin, C. M. (2016). Long-term outcomes of military service in aging and the life course: A positive re-envisioning. The Gerontologist, 56(1), 5–13.
Street, A. E., Vogt, D., & Dutra, L. (2009). A new generation of women veterans: Stressors faced by women deployed to Iraq and Afghanistan. Clinical Psychology Review, 29, 685–694.
Tan, S.-Y. (2013). Resilience and posttraumatic growth: Empirical evidence and clinical applications from a Christian perspective. Journal of Psychology and Christianity, 32(4), 358–364.
Thomas, K. H., Albright, D. L., Shields, M. M., Kaufman, E., Michaud, C., Taylor, S., & Hamner, K. (2016). Predictors of depression diagnoses and symptoms in United States female veterans: Results from a national survey and implications for programming. Journal of Military and Veterans Health, 24(3), 6–16.
University of California San Francisco (UCSF) Department of Psychology. (2017). Young Adult and Family Center. Retrieved from http://psych.ucsf.edu/yafc
U.S. Code, 2006 edition, supplement 5, title 38—Veterans’ Benefits, U.S. Code U.S.C. (2012).
U.S. Department of Veteran Affairs. (2017). Mental Health. Retrieved from https://www.mentalhealth.va.gov
Vecchiolla, L. (2016). The Freedom to Live: Finding Empowering Connections between the Hero’s Journey and Trauma Recovery. Available from Dissertations & Theses @ Chicago School of Professional Psychology. Retrieved from http://search.proquest.com/docview/1783996034
Weinstein, R. S., Lopez, A. M., Joseph, B. A., Erps, K. A., Holcomb, M., Barker, G. P., & Krupinski, W. A. (2014). Telemedicine, telehealth, and mobile health applications that work: Opportunities and barriers. The American Journal of Medicine, 127(3), 183–187.
Wooten, N. R. (2015). Military social work: Opportunities and challenges for social work education. Journal of Social Work Education, 51(1), 6–25.
Yano, E. M., Hayes, P., Wright, S., Schnurr, P. P., Lipson, L., Bean-Mayberry, B., & Washington, D. L. (2010). Integration of women veterans into VA quality improvement research efforts: What researchers need to know. Journal of General Internal Medicine, 25(1), 56–61.
Yerkes, R. M., & Dodson, J. (1908). The relation of strength of stimulus to rapidity of habit-formation. Journal of Comparative Neurology and Psychology, 18, 459–482.
Zinzow, H., Britt, T., Pury, C., Raymond, M., McFadden, A., & Burnette, C. (2013). Barriers and facilitators of mental health treatment seeking among active-duty army personnel. Military Psychology, 25(5), 514–535.