Acceptance and commitment therapy (ACT) is a behavioral intervention designed to increase and improve psychological flexibility. Psychological flexibility, from the ACT perspective, is defined as contacting the present moment fully, as a conscious human being, experiencing what is there to be experienced and working to change behavior such that it is in the service of chosen values. The therapeutic work explored in ACT counters the problem solving approach. Clients are taught to be aware of their thoughts and emotional experiences. An important feature of the therapy is that the therapist approaches these issues with humility and compassion for the client’s experience. Many clients who have experienced military sexual trauma (MST) have limited their lives in a number of ways in an effort to control or prevent fear or fear-related experiences such as anxiety or difficult memories.

This chapter presents a case study of Isabella, who has lived through a long history of interpersonal abuse. Although the case of “Isabella” is fictitious, it is not an atypical story of a military sexual trauma (MST) survivor, depicting interpersonal abuse across the life span, encompassing emotional, physical, and sexual abuse, and living in an ongoing context of abuse. The self-concept may take on qualities of self-blame, and internalize a sense of pending danger rendering him or her fearful, insecure, and distrustful of others. Warrior Renew was developed to address sexual trauma, specifically MST, and issues related to trauma across the life span. Warrior Renew proposes to promote improvements in interpersonal functioning by addressing affect regulation, interpersonal connectedness, and resolution of past trauma utilizing an integrated cognitive-experiential approach. Clients direct the imagery and are able to address their own unmet emotional needs.

This chapter provides an overview of the application of eye movement desensitization and reprocessing (EMDR) therapy in the treatment of military sexual trauma (MST) along with a description of the therapy’s protocol incorporated in the treatment process of MST. It concludes with the efficacy of EMDR therapy endorsed by numerous professional organizations worldwide including the Veterans Affairs (VA)/Department of Defense (DoD) Clinical Practice Guidelines and the World Health Organization (WHO). Positive life experiences were noted as resources, because they could be utilized by the therapist to strengthen the client’s perceived abilities for managing aspects of life while undergoing the treatment. Memories of disturbing events included being physically beaten on school property while in the sixth grade, being scared of dying during his deployment to Iraq due to the rockets and mortars frequently striking the base he was camped on, and the military sexual assault.

Suris, Lind, Kashner, and Borman surveyed 89 female participants who reported a history of military sexual trauma (MST) and reported that “all of the respondents endorsed some amount of sleep difficulty”. Woods, Hall, Campbell, and Angott examined relationships among interpersonal violence, posttraumatic stress, and physical symptoms in a sample of women and found that different types of sleep complaints were among the most frequently reported problems and that they were significantly correlated with having experienced sexual violence. Traditionally, insomnia has been associated with posttraumatic stress disorder (PTSD), and every version of the diagnostic criteria for PTSD contains some version of disturbed sleep. This chapter recommends a thorough assessment of medical and psychological comorbidity as well as trauma history to identify factors that may affect sleep. Chronic pain should be reviewed with the patient’s primary care physician for possible medication changes that can alleviate pain and improve sleep.

Sexual abuse can create sensitivities and problems that infiltrate a person’s sexuality years after the actual trauma occurred. A Guide for Survivors of Sexual Abuse provides basic information and recovery strategies for helping survivors of military sexual trauma (MST) overcome the repercussions of abuse and establish healthy and pleasurable sensual lives. Sexual healing tends to be more advanced recovery work. Sexual behavioral changes often seem to fall into two extremes, withdrawing from sexual activity, or becoming compulsively drawn to engaging in it. Victims of MST may have a challenging time finding enough private space, social support, and safety to face what happened to them and begins healing. Initial recovery tasks, such as dealing with fear of the offender, overcoming depression, expressing anger, improving physical care, improving assertiveness skills, and coping with posttraumatic stress symptoms are fundamental to sexual abuse recovery.

This chapter explores vicarious trauma, compassion fatigue, and burnout and the potential impact on professionals who treat victims of military sexual trauma (MST). Professionals who provide counseling to sexual trauma survivors will be affected by the exposure to the personal and, sometimes, graphic accounts of sexual victimization reported by their clients. Although brief exposure to extreme or shocking trauma material can have a significant impact on the helping professional, prolonged exposure to emotional pain and the explicit details of other people’s suffering can be more problematic. Psychologist Jacob Lindy pointed to this concern in his book on treating war veterans with posttraumatic stress disorder (PTSD). Burnout was originally used in the 1970s by psychoanalyst Hebert Freundenberger in reference to occupational exhaustion. Burnout may involve psychological, physical, or behavioral symptoms in both personal and professional settings.

The neurobiology of posttraumatic stress disorder (PTSD) and the effects of lifetime trauma on an individual have been covered extensively in the literature over the past two decades. This chapter reviews some of the relevant trauma-related neurobiology literature as it applies to military sexual trauma (MST), both in men and in women. The presentation of premilitary factors is structured around three major areas in the neurobiology of traumatic stress: early life trauma and the emergence of the emotional response; lifetime cumulative effect of trauma and the hypothalamic pituitary axis (HPA); and additional factors contributing to long-term vulnerability or resiliency. The brain and behavioral patterns are molded in parallel with early life experience. When a child develops the ability to recall events, he or she experiences the beginning of autobiographical memory. Primary affective states originate in the reticular activating system (RAS) of the brain.

This chapter discusses the main treatment components of cognitive processing therapy (CPT) and prolonged exposure (PE) and provides evidence for CPT and PE, and highlights common clinical issues seen in patients with military sexual trauma (MST) related posttraumatic stress disorder (PTSD). Janoff-Bulman posits a model of PTSD in which trauma is conceptualized as “an emotional shock” that shatters beliefs about safety and self-worth. Therapeutic techniques derived from several theories typically process the traumatic memory so that individuals can integrate it into their autobiographical memory base, identify and modify maladaptive trauma-related beliefs, and decrease cognitive, emotional, and behavioral avoidance. In clinical trials, PE demonstrates consistently large clinically meaningful changes across PTSD, depression, anxiety, and functioning in heterogeneous trauma-exposed samples including sexual assault survivors and veterans.

This chapter explores the dominant theories of why sexual violence occurs in conflict settings around the globe and illustrates how some of the same factors that drive sexual violence in soldiers in these various conflicts may also contribute to acts of military sexual trauma (MST) within the U.S. military. As with MST, sexual violence includes a wide variety of behaviors that includes rape, forced marriages, sexual humiliation, trafficking, and torture. Feminist theory has several subcategories that view wartime sexual violence differently. Similar to structuralism, social constructionism objects to rigid categorization. In addition to enhancing the identity of males, hypermasculinity also serves another objective in highlighting behaviors or roles that are feminine and therefore unacceptable. The chapter describes theories that attribute military culture as the reason for sexual violence occurring so frequently within military conflicts and institutions.

Military sexual trauma (MST) is experiences of sexual trauma that occur while a person is serving on active duty military service. Sexual trauma is anything that happened or was threatened to happen, which was experienced as a violation of a sexual nature. Kimerling and Haskell examined MST rates among veterans who served in these wars, utilizing the centralized medical records of the Veterans Health Administration. Victims of MST need to continue to rely on their unit, command, possibly the perpetrator himself or herself, friends of the perpetrator, and/or command of the perpetrator for survival in battle, health care or other services, promotions, duty assignments, and other experiences of daily functioning. Negative responses from professionals, friends, and family may silence rape survivors and reinforce self-blame and self-doubt. Chronic use of pornography may also influence rape fantasies, objectification of women, and degrading or violent sex as arousing.