Post-traumatic stress (PTS) is a condition that can develop after witnessing or experiencing a tragic or traumatizing event. Because PTS is more likely to occur for veterans than for nonveterans, understanding how PTS impacts our nation’s veterans is important for those in both the military and civilian communities.

While the Department of Veterans Affairs (VA) estimates that seven out of every 100 veterans will experience PTS at some point in their lives, rates are higher among those who served in Operation Iraqi Freedom and Operation Enduring Freedom. According to the VA, 29% of veterans who served in these conflicts will experience PTS in their lives.

Among the most important progress that must be made around PTS is eliminating the stigma around the condition that may prevent veterans from seeking help. It is also Mission Roll Call’s goal to highlight current gaps in mental health support and care for former service members that can create hurdles in treatment.

In this article, we’ll explore the following questions:

• What is post-traumatic stress (PTS)?
• Post-Traumatic Stress (PTS) vs. Post-Traumatic Stress Disorder (PTSD)
• Are veterans at higher risk for PTS?
• PTS and suicide risk among veterans
• PTS and the Global War on Terror (GWOT)
• What PTS treatments are available for veterans?
• Service Dogs and PTS
• How can we support veterans experiencing PTS?

What is post-traumatic stress (PTS)?

Post-traumatic stress (PTS) is a common and often adaptive response to an abnormally stressful situation. It begins with exposure to actual or threatened death, serious injury, or sexual violence.

Symptoms of post-traumatic stress may include:

• Flashbacks — memories of the traumatic event that come back suddenly and unexpectedly
• Nightmares — dreams about the traumatic event that occur over and over again
• Avoidance — avoiding places, activities, or people associated with the trauma
• Physical reactions — exhibiting physical signs of stress, such as a racing heart, sweating, anxiety, and nervousness.
• Hypervigilance — an exaggerated startle reflex, like jumping at noises
• Changes in behavior or personality — irritability, anger outbursts, fatigue, depression, loss of appetite, sleep problems
• Persistent negative feelings — like shame, guilt, fear, or detachment

Post-Traumatic Stress (PTS) vs. Post-Traumatic Stress Disorder (PTSD)

PTSD is a medically-diagnosed condition and should be treated by a clinician. Although symptoms of PTS can subside over time, they can also be chronic (lasting a year or longer) and may require ongoing medical attention.

The government, military and mental health community are moving away from using the term “Post Traumatic Stress Disorder (PTSD)” to emphasize the reality that PTS is an injury – not a disorder.

Medal of Honor recipient Ty Carter is one of the country’s most vocal advocates for this change. “Because by calling it a disorder, individuals believe that, ‘If I have this, then there’s something wrong with me,’” Carter said. PTS is not a disorder or mental illness – it is a normal response to a traumatic event.

Two-thirds of respondents with PTS in a 2023 study said that removing the “D” would reduce the stigma associated with the term. Breaking the stigma of the “broken veteran” is critical to getting treatment to those who need it most. This has to happen among the general public, in military and government communities, and in Hollywood and the media. For example, a 2021 study by the University of Cincinnati looked at common stigmas veterans face and found that “depictions of veterans in news media and pop culture often carry negative associations such as poor mental health or violence.”

Eliminating these preconceived notions can make veterans more willing to share their mental health challenges with friends and family or to seek help.

Are veterans at higher risk for PTS?

While PTS is a psychological injury that can affect anyone who experiences trauma, veterans are considered to have a higher risk of developing PTS than the general public due to unique stressors associated with combat and military life.

It is important that U.S. veterans know they are not alone. An estimated 354 million adult war survivors globally have PTS and/or major depression. PTS is a common human response to surviving war or combat.

Deployment during military service can increase the likelihood of PTS. PTS is three times more likely among veterans who deployed compared to those who did not (of the same service era).

Combat experience, in particular, can make a person more sensitive to loud noises or bright lights, trigger insomnia and trouble sleeping, and make everyday situations feel more stressful than they did beforehand.

Other scenarios that can exacerbate risk for PTS are discharging a weapon, witnessing a death, being attacked, lack of support in transitioning from the military, and losing a sense of camaraderie and purpose post-deployment.

In addition, veterans who use VA for health care are more likely to be diagnosed with PTS than those who use community health services – likely because VA screens for PTS for all veteran patients.

A Pew Research study found that 36% of post-9/11 veterans believe they have suffered from PTS. And, being more likely to have been deployed and to have seen combat than veterans of other eras, nearly half said they had “emotionally traumatic or distressing experiences related to their military service.”

The following VA data was compiled from a large study of veteran demographics across the U.S.:

Service Era	PTS in the last 12 months	PTS at some point in life
Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF)	15%	29%
Persian Gulf War	14%	29%
Vietnam War	5%	10%
World War II and Korean War	2%	3%

PTS and suicide risk among veterans

While it’s important to note that a variety of factors can play a role in veteran suicide (see Mission Roll Call’s The State of Veteran Suicide, there are links between PTS and high suicide rates among veterans.

Among veterans who experienced combat trauma, the highest relative suicide risk has been found to occur in those who were wounded multiple times and/or hospitalized for a wound. “This suggests that the intensity of the combat trauma, and the number of times it occurred, may influence suicide risk in veterans,” according to the VA.

Ending veteran suicide is Mission Roll Call’s top priority. The VA’s data shows that the age- and sex-adjusted rate for veterans was 71.8% greater than that of non-veteran adults. And America’s Warrior Partnership’s research suggests the rate may be higher than the VA’s estimates, with at least 40-44 former service members dying every day by suicide or self-harm.

Veterans may face distinct barriers to accessing adequate mental health treatment. Research shows that less than half of veterans in need of mental health services receive treatment, and of those who do — for PTS and major depression — less than one-third receive evidence-based care.

These concerning statistics highlight the need for comprehensive mental health care that takes a holistic approach to veterans’ needs. More than that, service members must be given proper resources and information on health benefits prior to military separation. Specifically, they should be provided with clear roadmaps for identifying symptoms and finding treatment for PTS and other mental health challenges.

PTS and the Global War on Terror (GWOT)

PTS has come to be known as the “signature wound” of veterans who served in the Global War on Terror (GWOT). The war’s protracted length played a major role in elevating the risk of PTS among these veterans, since it exposed more service members to combat than previous wars, and many deployed more than once.

The VA reports that 15 out of 100 veterans who served in Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF) – in Iraq and Afghanistan – have exhibited PTS symptoms within the past year, and 29 out of 100 of those who served in those operations will experience PTS at some point during their lives.

The Wounded Warrior Project’s most recent survey of post-9/11 veterans found that 75.9% reported experiencing PTS; 49.8% reported moderate to severe symptoms of two or more mental health conditions, such as depression and anxiety; and 28.3% reported having suicidal thoughts in the last 12 months. The survey consistently shows that these veterans experience PTS at a much higher rate than the VA estimates.

The GWOT also saw a rise in improvised explosive devices (IED) and traumatic brain injury (TBI) impacting service members. Data shows that injured patients with a TBI (and with multiple TBIs) are more likely to develop PTS than those without a TBI history. PTS can develop even in the absence of a clear memory of an event causing TBI.

What PTS treatments are available for veterans?

Therapy is usually regarded as a “first-line approach” for veterans with PTS. The success of PTS treatment depends on the severity of symptoms and how long they have been present. For long-term PTS, treatment often also includes medication and lifestyle changes.

The VA offers three forms of therapy for PTS:

1. Cognitive processing therapy (CPT): CPT teaches you how to evaluate and change the thoughts that have occurred since the trauma. The goal is to understand how certain thoughts about the trauma cause stress and make symptoms worse.
2. Prolonged exposure therapy: A form of talk therapy, this therapy gradually approaches trauma-related memories, feelings, and situations that a patient may have been avoiding. Its effectiveness in treating PTS among veterans has been clinically demonstrated.
3. Eye movement desensitization and reprocessing (EMDR): While thinking of or talking about their memories, people undergoing EMDR therapy focus on other stimuli like eye movements, hand taps, and sounds. A study by the National Center for PTSD found that EMDR was effective in treating PTS.

Over 50% of patients who receive one of these three therapies will find relief, according to the National Center for PTSD. With medication alone, 42% have been found to achieve remission — though there have been concerns in the veteran community about negative side effects associated with some prescribed medications.

But only 50% of veterans — around 9 million — are enrolled in VA healthcare or affiliated with a veteran service organization. Without the support they need, in the VA or their community, many veterans may turn to self-destructive coping mechanisms.

This is why Mission Roll Call advocates for a holistic approach to combat the feelings of isolation, depression, and potential suicide ideation that can come with PTS. It is important for veterans to have a strong network during this process; having people to check in with, spend quality time with, or who serve as mentors can be a vital source of encouragement.

Ensuring positive outcomes must include implementing increased community care provisions (as outlined in the MISSION Act) so that veterans can find quality care within a reasonable timeframe or distance. This is critical because so many veterans do not use VA care.

It is also important to improve transition assistance programs to ensure veterans are fully aware of the healthcare benefits available to them upon exiting the military.

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Spotlight: Boulder Crest Foundation

Boulder Crest Foundation, located in Virginia, offers life-changing programs free of charge to members of the military, veterans, and first responder communities, and their families.

Warrior PATHH is the first training program to teach our nation’s veterans to experience lifelong Posttraumatic Growth (PTG). It is a 90-day, non-pharmacological, peer-delivered training program that begins with a 7-day intensive and immersive initiation. This is followed by three months of dedicated support, training, accountability, and connection from a team of trained combat veterans.

The Warrior PATHH program delivers results five to seven times better than traditional approaches to mental health. It was designed for the hundreds of thousands of warriors who are fighting to rediscover a life worth living.

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Service dogs and PTS

Service dogs can be an amazing form of support for veterans with PTS. The Puppies Assisting Wounded Servicemembers for Veterans Therapy Act (PAWS) — signed into law on August 25, 2021— requires the VA to conduct a five-year pilot program to provide service dog training for eligible veterans experiencing PTS as part of a “complementary and integrative health program.” The program is meant to explore the benefits of service dog training, and based on the data, the training could potentially be included in comprehensive healthcare benefits for service animals in the near future.

While the VA does not provide service dogs directly, VA benefits will cover care and equipment for service dogs. Veterans must first meet with their healthcare provider to discuss their physical or mental health limitations to determine if a service dog will be an appropriate treatment approach. Each case is individually reviewed by a clinician to assess the goals to be accomplished by getting a service dog and the ability and means of the veteran to care for the dog.

Upon approval for a service dog, veterans are referred to Assistance Dogs International accredited agencies or International Guide Dog Federation accredited agencies to be paired with the right type of service dog. From there, they can also have their service dog enrolled in Veterinary Health Benefits. This includes comprehensive treatment and wellness checks, emergency care, immunizations, and illness treatment for the dog that will be serving the veteran.

There are also several organizations outside the VA that train and provide service animals for veterans, such as K9s for Warriors, the nation’s largest provider of trained service dogs for veterans with PTS, traumatic brain injury, or military sexual trauma. Additional organizations include SemperK9, America’s Vet Dogs, Patriot Service Dogs, and Canine Companions.

How can we support veterans experiencing PTS?

Mission Roll Call research found that 60% of Americans believe that more veterans deal with post-traumatic stress (PTS) than their civilian counterparts. And nearly half (46%) of U.S. adults believe the federal government has “not been very effective” in dealing with veteran healthcare, including mental health support.

There is ample room for individuals to play a role in supporting our nation’s veterans, especially those experiencing PTS.

For those who have a veteran in their life:

• Learn as much as you can about PTS. Understand the symptoms so you can recognize them. Sometimes you may recognize symptoms before the veteran you know does.
• Encourage them to speak to a healthcare provider or therapist who specializes in veterans’ needs.
• Participate in physical activities with them. Consistent exercise is important for overall health, and activities like jogging, taking walks, or going for a bike ride can help improve mental health.
• Provide a listening ear. Don’t push for discussion or information, but let the veteran know that you are there for them if they need to talk about their experience.
• Help them connect with other veterans. Feeling like part of a community is so important. Relationships are critical for veterans’ mental health.
• Encourage veterans you know to share their stories with Mission Roll Call. Our Veteran Voices page has stories of veterans who have been impacted by their service in various ways, and learning they are not alone can help.

The VA’s National Center for PTSD also has information for veterans, service members, families, and providers, and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury offers fact sheets and resources on PTS care as well.

For those who don’t know a veteran but want to help:

• Mission Roll Call has a list of nonprofits we support and have vetted who are doing amazing work for veterans. Consider donating or volunteering.
• There are USO lounges at more than 50 airports in the U.S., which are typically in need of civilian volunteers and donations.
• Contact your local VFW or American Legion and ask if there is a veteran who could use a ride to medical appointments or a home-cooked meal.
• Your support of Mission Roll Call is so important as we advocate for changes that will help veterans receive the care and resources they need. Your financial support and social media support are so appreciated.

Takeaways: What every veteran should know

• PTS is not a sign of weakness but an injury – a normal and adaptive psychological response to trauma.
• PTS impacts veterans at a higher rate than non-veterans.
• The future is not hopeless: There are many treatment options available for PTS – both inside and outside of the VA – that have been proven to help relieve symptoms and feelings of isolation.
• Help is available. There are many organizations with the resources and knowledge to help veterans with PTS, including:
• America’s Warrior Partnership
• Avalon Action Alliance
• Boulder Crest Foundation
• Home Base Program
• Lone Survivor Foundation
• Mission 22
• National Center for Post-Traumatic Stress Disorder
• Operation Mend
• PTSD Foundation of America
• The Mission Continues
• Team Red, White and Blue
• Team Rubicon
• Wounded Warrior Project
• Veterans Affairs
• You can make a difference for other veterans by becoming part of the Mission Roll Call community.