Beyond the battlefield

Unravels Complexities Of Trauma And Resilience In Veterans

From our earliest history of war to the current conflicts in Iraq and Afghanistan and beyond, veterans have endured and witnessed significant trauma. These traumatic experiences have significant impacts on the mental and physical health of our veterans and their families – and the population as a whole.

Research on trauma among veterans has become increasingly important in the last several decades. Not only has this research helped to understand the effects of trauma on veterans, but it has also led to the development of effective treatments, informed policy decisions and improved quality of care for veterans and their family members.

A leader at the forefront of this research is Sandra B. Morissette, professor and chair of the Department of Psychology in HCAP.

Morissette has dedicated her career to researching and understanding trauma psychology, particularly in the context of veteran support. Her research has focused on understanding factors that influence risk, resilience and functional recovery following warzone deployments. She has conducted important research related to trauma, anxiety disorders and other commonly co-occurring conditions. She has received funding from U.S. Department of Veterans Affairs (VA), the Department of Defense and the National Institutes of Health, and has published more than 100 scientific articles.

During nearly two decades working for the VA, Morissette developed and directed the first cognitive-behavioral anxiety disorders clinic at VA Boston Healthcare System (VABHS), established a new primary care behavioral health program at VABHS, and contributed to the development of a congressionally-mandated research center for returning post-9/11 veterans in Waco, Texas.

“Notably, Texas has a vast shortage of clinical psychologists, and Waco is an area of particularly high need, neighboring Fort Hood, the thirdlargest military base in the world,” Morissette explained. In Waco, among other accomplishments, she and her collaborators established and led a 10-year, VA-funded longitudinal program of research called Project SERVE (Study Evaluating Returning Veterans’ Experiences).

Project SERVE is a network of studies designed to independently and collectively contribute to a better understanding of risk, resilience and functional recovery processes in post-9/11 veterans and their families following warzone deployments. Although Morissette left the VA in 2015, she continues to actively collaborate and lead projects related to this research at UTSA.

“I couldn’t have accomplished what I have without an outstanding team of SERVE investigators from around the country,” Morissette said.

“We are particularly interested in understanding PTSD risk and resilience within the larger context of cooccurring conditions like depression, alcohol/ substance use disorders, TBI, pain, sleep, suicide and non-suicidal self-injury. Our overarching aim is to develop translational clinical treatment programs using empirically-supported predictors of risk and resilience for PTSD, co-occurring conditions and functional recovery.”

As one example, several papers from this line of research have converged around the importance of a construct called psychological inflexibility, which refers to a tendency to avoid unwanted thoughts and emotions with a degree of rigidity that interferes with acting upon one’s life values. Psychological inflexibility is associated with worse PTSD symptoms, disability, quality of life and suicidal ideation in veterans. Reciprocally, psychological flexibility is predictive of resilience and PTSD recovery. Collectively, these findings point to the importance of investigating whether intervening at the level of psychological inflexibility could move veterans with PTSD and other co-occurring conditions, such as depression, pain and TBI, to improved functional trajectories and recovery.

In 2021, Morissette was elected as fellow to the American Psychological Association (APA), Division 56 (Trauma Psychology). This national recognition is awarded on the basis of outstanding contributions to the field of psychology that have had a national impact.

“Lethal means safety is particularly important because it has been widely established that access to lethal means increases risk for violence, not only for the veteran, but all members of the household,” Morissette said.

“Dr. Morissette’s work on veterans’ psychological trauma is critical, and it’s especially relevant to our San Antonio community known as Military City, USA,” said Lynne Cossman, dean of the college. “While we train our military members to be resilient, the trauma they experience on our behalf is substantial. It is imperative to ease that burden and Dr. Morissette is leading the charge.”

More recently, Morissette served a guest editor with Jack Tsai, dean of the UT School of Public Health, for a special section in Psychological Trauma: Theory, Research, Practice, and Policy. In the introduction, Morissette focused on building human flourishing and resilience, noting that these areas in particular have had less research and development than post-traumatic stress recovery areas.

Human flourishing and resilience may be particularly important for suicide prevention. Since her election as fellow for APA, Morissette has also published several new articles with her collaborators in various academic journals on topics ranging from firearms safety among veterans to veterans’ experiences with suicide ideation, non-suicidal self-injury and social support.

Morissette received her doctoral degree in clinical psychology in 2001 from Boston University. Her work has contributed in part to a shift in the field to considering complex co-occurring conditions, particularly anxiety/ traumatic stress disorders and addictive behaviors. Moreover, her research has contributed to increased attention on understanding longterm functional recovery processes among returning veterans.

“This work is far from done,” Morissette said. “Although most veterans are resilient and will never develop mental health conditions, risk for PTSD is elevated in the context of their higher trauma exposure. We must continue to build a workforce of researchers and clinicians to more fully understand and treat the complexities of PTSD and co-occurring conditions, and promote functional recovery.”

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