Filed under: Mind
Post-Traumatic Stress Disorder (PTSD) can tear apart your sense of what is safe and of what is good.
Part of the diagnosis of PTSD is exposure to a traumatic event: death, serious injury, sexual violence, or the threat of any of these. PTSD symptoms such as intrusive memories, avoidance of situations or feelings, problems in thinking or mood, and feeling overly amped up are common reactions to abnormal circumstances. Think of PTSD symptoms as self-preservation instincts gone haywire. One theory holds that, because you nearly died or experienced something awful or could picture it because it happened to someone close to you, your mind/body tries to sound the alarm bells to keep you safe. But the alarm bells sound at the wrong times and in the wrong ways.
However, PTSD symptoms can come from sources other than fear of bodily harm. They also can arise from inner conflict, when emotions trigger feelings such shame and guilt or when you question fundamental beliefs (such as “the world is basically good”). Witnessing or experiencing betrayal (especially by a leader in a high-stakes situation), within-ranks violence, extreme violence, and incidents involving civilians are some of what can disrupt your world view. It isn’t just an event but the interpretation of an event that causes Warfighters to experience “moral injury.”
If you suffer moral injury as part of PTSD, you start believing you live in an immoral world, or you view yourself as immoral, irredeemable, and defective. If you’re a Warfighter experiencing these feelings, you not only feel lousy, but you are more likely to isolate yourself just when you need others more than ever. Isolation can lead to self-handicapping or self-destructive behaviors.
So how do you save yourself from experiencing moral injury as a part of PTSD? Having a healthy sense of self-esteem can be one of your best protectors. There are no quick fixes. But forgiveness—of others and of yourself—can help you to let go of moral injury. With the help of a psychotherapist, you can begin to wrap your heart and mind around what happened. And pursuing positive interactions, such as getting involved with charitable groups, can give you opportunities to relearn that you are good and the other people in the world are generally good too. Last but not least, connecting with your spirituality—in whatever way is comfortable to you—can help you navigate this difficult journey.
Bad things happen. Unfortunately, you can count on experiencing different traumas, deaths, illnesses, and injuries. As a Warfighter (or military family), you can probably expect to face these kinds of situations more often than other people. That doesn’t make these experiences any more pleasant, and often it doesn’t make them any less surprising. After a major trauma, illness, or life-changing event, it is often necessary to adapt and create a “new normal.”
Studies of “post-traumatic growth” have found that trauma survivors can grow mentally, emotionally, and spiritually after horrendous experiences such as cancer, terrorism, sexual assault, plane crashes, and even combat. It’s common to react with an emotional roller coaster of denial, anger, bargaining, depression, and acceptance. Your natural instinct might be to run from these feelings. However, post-traumatic growth can be accomplished better by taking steps to approach them. The people who support you (including but not limited to therapists and family members) can do the following:
- Listen empathically, accepting and encouraging full expression of feelings.
- Avoid clichés and easy answers. Hearing “there will be brighter days” is not helpful.
- Be patient. Changing perspective won’t happen overnight.
- Offer a helpful relationship, recognizing there is no “magic technique” or “quick fix.”
You can also be an active agent in your own healing. One technique that can be useful to you is to tell and retell versions of your story in order to become more immune to the hard parts and to reach a point where you can find new meaning in it. People of any age, including Warfighters, can benefit from actively embracing a “new normal” through taking advantage of your relationships and developing a new twist on their story, even when this initially might seem far-fetched.
Whether training for a mission, an athletic event, or simply to maintain your edge, there are strategies you use to enhance your chance of success, including “rules” such as figuring out where you are before you start and setting up an environment that supports your new plan. Check out HPRC’s new card, “Peak Performance: Rules of Engagement,” to learn all of them. And for even more information, check out the accompanying Performance Strategies.
Prescription stimulants can improve attention and alertness, and doctors prescribe them for people with Attention Deficit Hyperactivity Disorder (ADHD) or excessive fatigue. Used improperly and without the supervision of a health provider, these drugs have serious side effects. Some people misuse and/or become addicted to them. Learn more in HPRC’s “Stimulant drugs: use and misuse.”
Have you heard of Total Force Fitness, but you aren’t sure what it is? It’s a framework for building and maintaining health, readiness, and performance in the Department of Defense. It views health, wellness, and resilience as a holistic concept that recognizes “total fitness” as a “state in which the individual, family and organization can sustain optimal well-being and performance under all conditions”—a connection between mind, body, spirit, and family/social relationships. Total fitness shifts the perspective from treatment to wellness and focuses on prevention and strengths.
The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury created a slide presentation for units and groups on Total Force Fitness: A Brief Overview that describes what TFF is, its core components, and each of its eight “domains” (behavioral, social, physical, environmental, medical and dental, spiritual, nutritional, and psychological). For more in-depth reading, check out the original Military Medicine Supplement that started it all, including a scholarly chapter for each domain.
Everyone experiences stress, but how you interpret stress determines how stressed you feel. This process is often referred to as the “ABCs of stress”:
Activating event + Beliefs = Consequences
When you experience an event, you interpret that “Activating event” according to your “Beliefs”—the lens through which you view the world. Generally, your interpretation is what causes your feelings of stress—that is, the “Consequences.” This is why two people can go through the same event and be affected in very different ways. If your interpretation of events leads to high levels of stress, you can manage your stress by finding ways to reframe your interpretation.
Afterdeployment.org suggests making a “Stress Toolkit” in which you identify helpful coping strategies. These could be strategies that ignite your relaxation response or reframe your thinking (see above) and/or behavioral methods such as deep breathing.
Another way to help you manage stress is to think through future stressful situations to be better prepared. Afterdeployment.org suggests: 1. Visualize potential stressful situations. 2. Determine how much of the situation you can control. 3. Problem-solve what you can control (using coping methods that work for you), and 4. Remember to lean on your friends and family for support.
For more information and ideas, visit HPRC’s Stress Management section.
The American Psychological Association just released an article suggesting that trial judges make better decisions when they do “STOP” meditations:
- Stop what you are doing
- Take a few deep breaths and focus on the experience of breathing
- Observe your thoughts, feelings, and actions
- Proceed with new awareness
Like Warfighters, judges make very important decisions that affect peoples’ lives, but judges also are not immune to impacts of stress. Like everyone else under stress, they can thoughtlessly make quick decisions based on “rules of thumb,” but because we are human biases creep in, sometimes leading to bad decisions.
So, the STOP technique can be important too for Warfighters, spouses, parents, or anyone else looking to make good decisions when it matters. STOP-ping allows you to monitor and adjust your current stress in order to make good decisions.
Think of stress as a balance scale. All the situations you find stressful are heaped up on one side. How you deal with them is on the other side. The trick is learning to balance the two sides (or even better, having your coping resources outweigh the causes of your stress).
Everyone feels overloaded at times, when stress seems too much to handle. This can be compounded with multiple family demands—from finances, children’s needs, managing work and family demands, and fostering your relationships. Here are two suggestions to help you find balance:
- Find out what practical needs are causing your stress and come up with possible ways to address them using HPRC's problem-solving tips. For example, you know that you need seven to eight hours of sleep a night, but you and your partner seem to manage only five hours or so. So discuss possible solutions with your partner. For example, set a bedtime and stick to it no matter what chores aren’t done; put the kids to bed at an earlier time; create a wind-down routine 30 minutes before bedtime in order to get that eight hours—and stick to it! Then pick one of these possible solutions, try it out for a week, and then re-assess. If it doesn’t work, pick another; or if it does work, maybe tweak it a little to make it even better.
- Once you have plans to deal with the sources of your stress, then you can focus on managing your stressful feelings. There’s no need to continue feeling stressed out while you put your plan into action. Try some of the “behavioral strategies” in HPRC’s Managing Emotions that you can do anywhere with minimum fuss, such as deep breathing, progressive muscle relaxation, or other relaxation strategies. You can even teach them your children and do them together as a family. Learn how in “Calming & Grounding Activities” from the FOCUS Family Resiliency Training Manual, which describes several shared activities.
And check out HPRC’s Mind-Body Skills section for resources that are geared more for you as an individual.
HPRC has strategies to help you focus your attention, so that it goes to the right place at the right time. By honing these approaches, you will find that habits are so well formed that you are able to efficiently maintain an external focus without having to use as much internal focus to guide your actions, allowing you to be more aware of your environment and able to do more. In other words, you can “get out of your own head” so that you experience automatic and smooth movements and avoid “paralysis by analysis.” In other words, you can make quick and accurate judgments—as a parent or as a Warfighter—without having to think about them deliberately. For the complete “how-to,” visit HPRC’s “Performance Strategies: Develop routines to optimize attention.”
You have probably noticed that people tend to be happy when they’re successful. But did you know that it can also work the other way—that happiness can lead to success? Happier people tend to get more excited about chasing after opportunities. Happy people tend to interpret, remember, and even experience life events differently than unhappy people. For example, happy people tend to like other people more readily (leading to positive interactions). And when they are faced with adversity, they tend to use humor and focus on what has gone well recently. Across studies, researchers have found evidence that in marriage, friendship, income, work performance, and health, there is a two-way street: Success leads to happiness and happiness leads to success! Want to experience the successes of a happy person? One strategy is to be sure to somehow experience positive emotions frequently. Check out HPRC’s series highlighting research-based tips for making this happen.