Filed under: PTSD
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.
Virtual reality was first introduced as a therapy tool for people with anxiety disorders such as phobias, but it is now used for a wide range of conditions, from PTSD to childhood ADHD. In fact, it recently warranted its own symposium at Walter Reed National Military Medical Center, where experts exchanged ideas on the current state of research.
Virtual environments used in therapy sessions are created for the individual’s needs—for example, a noisy classroom for a child with ADHD, the re-creation of the 9/11 attacks for a firefighter or police officer, or “Virtual Iraq” for a soldier. “Virtual Afghanistan” is the newest creation and is already being used to help service members overcome PTSD. Active-duty men and women are gradually brought back to their traumatic event using the virtual world as the therapist provides verbal cues to facilitate the healing process.
With a view to mitigating future need for therapy, a series of episodes is currently being created to provide pre-deployment “Stress Resilience Training for Warfighters.” The goal is to help reduce the risk of PTSD and better prepare warriors for actual scenarios they will encounter in theater.
For more information about how to prevent and manage stress, visit HPRC’s Stress Control section.
A working group of military chaplains makes time each month to discuss new research, practical strategies, and frontline experiences around topics like PTSD, spirituality, moral injury, and sexual assault. The September 2012 meeting focused on PTSD. From participant LTC Dave Grossman came this advice: “We are all going to have bad days as we walk our warrior path. Do not destroy yourself because of the bad days and never judge yourself by your worst day.” The article from the Defense Centers of Excellence highlights some advice from this group for tackling tough issues from a spiritual perspective.
If you would like more information on the Chaplain Working Group, you can send an email to firstname.lastname@example.org.
The physical and emotional stress associated with post-traumatic stress disorder (PTSD) can raise your blood pressure and cholesterol and increase body mass index, all of which are risk factors for heart disease. Veterans suffering from PTSD are more than twice as likely to die from a heart attack than those without PTSD. While the exact relationship between PTSD and heart disease is not fully understood, we know that regular exercise can help prevent heart disease and other risk factors, which could be helpful for those with PTSD. Some types of exercise can be effective in reducing psychological symptoms associated with PTSD and also can play a role in reducing unhealthy behaviors such as smoking, being overweight, and physical inactivity—sometimes byproducts of trying to cope. If you think that exercise might help you or a loved one cope with PTSD, speak with your healthcare provider to assess how much and what kind of exercise is best!
Yoga’s popularity is growing in the United States, but many Americans are still not familiar with the details of this ancient practice. Yoga roots are holistic in nature—body and mind are of equal importance, and the asanas, or poses, which define yoga for many of us, are only one aspect of practice. Together with meditation and breath control, yoga promotes strength, flexibility, and awareness of body and mind. Yoga can help achieve wellness through meditation, deep relaxation, stretching, and breathing. Several organizations are now beginning to provide yoga classes tailored to veterans and active-duty service members who suffer from combat stress. VA facilities, Warrior Transition Units, and civilian studios are using it to complement traditional treatment of patients with post-traumatic stress disorder and traumatic brain injury.
Individuals who struggle with PTSD describe it as a feeling of disconnectedness from themselves and others. Yoga, which means “bringing together parts as a whole,” helps people feel connected again. One traditional type of yoga that has been shown to decrease anxiety in the military population is sensory-enhanced hatha yoga, which involves breathing, meditation, and certain poses. A specific benefit reported by participants in sensory-enhanced yoga was a decrease in insomnia. Combat-stressed adults also experienced reduced hyperarousal symptoms such as anxiety, depression, and rage. Integrative Restoration (iRest) is a yoga-based meditative practice that teaches a person to focus on breathing when a negative memory arises. Soldiers and marines have expressed satisfaction in these breathing techniques because of the method’s simplicity and ease. It allows a person to regain control over his/her thoughts whenever symptoms of PTSD present themselves. A study found that iRest decreases rage, anxiety, and emotional reactivity all of which encourage negative thoughts and memories. Those practicing iRest also reported increased feelings of relaxation, peace, self-awareness, and self-efficacy. Walter Reed Army Medical Center (WRAMC) was one of the first military facilities to research the outcomes of yoga for veterans and active-duty warriors suffering from PTSD. WRAMC immediately added iRest to its weekly treatment programs for soldiers suffering from PTSD and TBI after observing its effects: increased calm and peaceful feelings, less severe reactions to situations, and increased outlook on life.
There are many more yoga practices than the ones mentioned here, and each yoga method is different, so you can find the right one for you!
Post-Traumatic Stress Disorder (PTSD) has been one of the military’s top priorities in the past few years, especially after reports of projected rates as high as 30% in veterans. However, a May 2012 Science article points to new findings that might indicate lower PTSD rates currently across all services—between 2.1 and 13.8%. Taking into consideration under-reporting due to stigma, the authors suggest these low rates might be due to the targeted attention that PTSD has received, along with interest in bolstering Warfighter resilience. The article cites the military’s adoption of resilience programs such as “Battlemind” as possible contributors to these low rates. The authors recommend more in-depth research to determine the effectiveness of such programs.
PsychCentral’s March 2012 "Ask the Therapist" article addresses how mindfulness relates to military performance—especially important now that the military has been incorporating mindfulness tactics for enhancing Warfighter mental and physical resilience. Of particular note is a study from the Journal of Clinical Psychology that demonstrated significant improvements in PTSD symptoms, depression, etc. in veterans after completing a Mindfulness-Based Stress Reduction (MBSR) program. The article also noted other studies that showed long-term stress-reduction, well-being, and positive experiences. Simply put, acknowledging emotional pain helps you overcome it. You are then able to focus and communicate with loved ones more effectively.
If you’d like to learn more about meditation and mindfulness, check out the Mind Tactics section of the HPRC website, which contains many resources related to meditation and mindfulness, as well as resources related to mental fitness, mental toughness, and resilience.
Recognizing the expanding use of acupuncture within military medicine, the December 2011 issue of Medical Acupuncture is dedicated to exploring the uses of acupuncture in military medical care. Often used as a treatment for pain, post-traumatic stress syndrome, and mild traumatic brain injury, the practice of acupuncture is growing as a medical treatment for a broad range of ailments in the military, even in war zones. Featured articles include a roundtable discussion on challenges and opportunities for using acupuncture, an account of a U.S. Navy doctor’s use of acupuncture downrange, and future directions and applications of acupuncture.
Military Pathways presents an “infographic” (a graphic fact sheet) that highlights basic information on post-traumatic stress disorder (PTSD). The sheet includes are statistics on PTSD in both the general population and military to help put this syndrome in perspective, as well as possible causes and outcomes of not getting help for PTSD, and identifies prevention and treatment methods that you can use to help avoid or minimize the occurrence and effects of PTSD.