How can we better support the mental well-being of veterans returning from service?

Military service is difficult, dangerous, and demanding. But for some veterans, returning to civilian life can also be a challenge. Going from the structure of active duty—with its purpose-driven roles, full-throttle environment, and sense of camaraderie—to the relatively humdrum life of a civilian can be jarring, particularly for veterans who’ve experienced trauma during their service and may suffer from post-traumatic stress disorder (PTSD). 

Researchers at Boston University, including Dawne Vogt and Casey Taft—both professors of psychiatry in the Chobanian & Avedisian School of Medicine—are utilizing a variety of data-backed strategies to support veterans struggling to adapt to their new normal lives. 

Taft takes a hands-on approach to the downstream effects of such trauma. He and his colleagues in the Department of Veterans Affairs’ healthcare system, where he holds a clinical appointment, have created a program to help veterans who’ve engaged in intimate partner violence or aggression. 

The program, called Strength at Home, is the only domestic violence program found effective in a randomized clinical trial in preventing and reducing physical and psychological violence in service members and veterans, Taft says. It’s also the only one the VA endorses across its entire network of healthcare centers. 

“I think a lot of psychologists become psychologists because they want to have an impact,” Taft says. “And, to me, this just seems to be the most impact I felt like I could have working on a problem that most people don’t want to work on, and developing a program that’s effective in a field where nothing else has been shown to work very well.”

Vogt, who’s a senior research scientist in the Women’s Health Sciences Division of the National Center for PTSD at the VA, takes a different approach. Where Taft looks to build support for the future, Vogt is interested in the factors that help veterans to be more resilient to trauma from the beginning. 

Her most recent work, published in JAMA Network, found that people with robust social lives and fulfilling careers were better protected against the corrosive effects of trauma. 

And while neither Vogt nor Taft are veterans themselves, they both say they’re driven to help a population whose members have already given so much.

“Doing this work, I have the opportunity to address an important social problem,” Vogt says. “People who serve in the military make huge sacrifices to support our country, and we need to make sure that we support them when they come out of military service.” 

A Strong Case for Strength at Home

Taft describes the program he founded, Strength at Home, as a trauma-informed and evidence-based group program for veterans who struggle with conflict in their relationships. The 12- to 26-week program is for veterans whose anger threatens to overwhelm their relationships; maybe they’ve been court-ordered to attend an intimate partner violence intervention program or maybe they’re volunteering because they worry they’re at risk for resorting to violence. It’s a cognitive behavioral approach, rather than an in-your-face, boot camp–style reform. 

“One of the ways that this program is different from a lot of other programs out there in the community is that it is more trauma-informed. There’s more of a discussion of the influence of past trauma and past learning on current problems with aggression,” Taft says. “For a lot of the folks we see, they actually have difficulties being assertive—they tend to stuff their feelings inside and don’t really set boundaries or limits with other people. And then, after stuffing their feelings down for so long, eventually they explode in aggression.”

While it’s difficult to measure the full scope of these issues, one thing is clear: veterans who have been exposed to trauma during combat, and who consequently develop PTSD upon returning home, are at a much higher risk for using violence in their intimate relationships, compared to the general population and to veterans who don’t develop PTSD, Taft says.

Veterans in the program meet in small groups with trained facilitators to work through a range of issues: taking responsibility for abusive behavior; understanding what abuse actually is, including psychological abuse; de-escalating conflict situations; recognizing when they’re getting angry as early as possible, so they can do something to cool down; and communicating and expressing their feelings better. 

This educational approach has proven to be more effective than the typical punitive or carceral route, Taft’s research shows. In a 2023 paper in JAMA Network, Taft and his colleagues analyzed more than 1,700 veterans who went through the program. They found that it was associated with reductions in intimate partner violence, PTSD, and alcohol misuse. 

“What we’ve seen—and this has been consistent across different studies—is that those who do the Strength at Home program, compared to those who get other kinds of counseling, see a greater reduction in their physical aggression in their relationships, their psychological abuse, and their coercive controlling behaviors,” Taft says, adding that coercive behaviors can include constantly checking up on their partner, controlling who they can see and where they can go, and rifling through their partner’s phone or other personal things.

“Strength at Home seems to be really effective in reducing those kinds of problems,” Taft says. 

Founded in Boston 15 years ago, the program is now available across the entire VA healthcare system—and Taft and his team are exploring new ways the program might help people. They’ve launched their evidence-based couples aggression prevention program across the VA over the past few years, and are doing research on the effectiveness of a parenting program, currently undergoing a clinical trial funded by the US Department of Defense. 

Beyond the veteran population, Taft has found promising potential for the program to help civilians too. Civilian pilot studies and implementation efforts in Rhode Island and New York showed Taft and his team that although veterans and civilians certainly have exposure to different types of trauma, the effects—and the best methods for working through those effects—are strikingly similar. There are currently three ongoing randomized controlled trials examining the effectiveness of Strength at Home for civilians.

“Whether we’re talking about a veteran who’s been in combat or a civilian who lives in a violent area, they both tend to go into survival mode, where they have this heightened sense of threat,” he says. “They’re more likely to sense danger that other people don’t see. And while that may, in some ways, be adaptive for them to always be on guard, it also may cause them to misinterpret situations as overly hostile. They learn to assume the worst in people, and that can carry over to their relationship, where they assume the worst in their partners.” 

Broader Well-Being

Decades of research has established that veterans are more likely than their civilian counterparts to experience trauma, which can be broadly defined as an event during which someone fears for their life. And, according to some research, veterans are nearly twice as likely as civilians to develop PTSD, a stress-response condition that persists far beyond the traumatic event itself. 

For Vogt, this long-tail stress poses an important question: How does military service—resulting in PTSD or not—affect veterans’ overall well-being? 

Vogt’s research has focused on how veterans transition back to civilian life. She’s studied how veterans who served in the wars after 9/11 define the meaning of their lives, the trauma exposure and related mental health of LGBTQ+ veterans, and if an experience with military sexual trauma influences a veteran’s willingness to seek out treatment afterward (and if their gender plays a role). 

With her most recent project, Vogt was interested in the factors that might protect a veteran from the worst effects of trauma—or exacerbate them. 

For this research, Vogt and her colleagues engaged a group of veterans who transitioned out of service in 2016. Every six months for the first three years following their discharge, the veterans self-reported their overall social, financial, and vocational well-being. At the same time, Vogt and her team assessed the veterans for their exposure to trauma, both during their service and with new events afterward. 

They found strong evidence, Vogt says, that people who had robust social and vocational satisfaction were more resilient to trauma. That vocational piece—people who were happy and fulfilled in their jobs—was a particularly exciting finding, she says. 

“There’s not a lot of research looking at veterans’ experiences in the workplace,” Vogt says. “People go into military service and a lot of times they find meaning in it. Then they leave service and they have to find another job. And does that new job give them a sense of meaning? Do they find it satisfying? We found that, for people who can answer yes, it’s very protective against risk for PTSD after experiencing a trauma.”

This work is still in its early stages, but Vogt already has plans to work with her colleagues at the VA to utilize these findings to provide more resources for veterans who struggle with these aspects of their broader well-being. Online referral resources—which would connect veterans with social or vocational support—are just one example, she says.

Vogt’s research fits into a broader trend within the VA “to treat veterans as whole people,” she says, rather than simply treating the conditions they come in with. 

Like Taft, Vogt’s decision to focus on veterans stemmed from a desire to have a real, positive effect on people’s lives.

She says the work she was doing in graduate school was “scientifically interesting, but not that meaningful.” But then she had an opportunity, after graduation, to work with veterans at the VA who were struggling with trauma-related issues. 

“I just thought, ‘wow, that’s such an important topic.’ And in doing this work, I really have the opportunity to address an important social problem,” says Vogt, who also has several family members who have served in the armed forces. She hasn’t looked back since. “I love it. It feels so meaningful to me.”