Complementary And Alternative Practices
CAM approaches that have demonstrated some clinical benefits for returning service members with PTSD include meditation mind-body practices like yoga and biofeedback, a form of treatment that involves learning to monitor and control bodily functions like heart rate and blood pressure through the help of electrical sensors. One form of biofeedback that may be useful for PTSD is cardiac coherence training .9
What Makes Ptsd Better
The most effective treatments for PTSD are talk therapies, all of which are referred to as a form of cognitive-behavioral therapy. The types of these treatments with the most scientific evidence for their effectiveness are Prolonged Exposure and Cognitive Processing Therapy.
Prolonged Exposure
PE is the therapy that has the most evidence to show that it works to treat PTSD. When you do this therapy, you will meet individually with a counselor or therapist for about 10-12 treatment sessions that last 90 minutes each. During these sessions, you will make a plan to face many of the things that youve been avoiding. Between therapy sessions you practice going to places that you have been avoiding using the skills that youve learned with your therapist. You will also talk about the traumatic event and make recordings of this. You will listen to these recording between sessions. Doing this work will help you learn that you dont have to avoid things that remind you of your trauma. The trauma is not happening now. Now it is only a memory, and memories cant hurt you. Completing PE can not only reduce the symptoms of PTSD, but it also can give you a strong feeling of accomplishment that you were able to face many things that you thought you couldnt. In addition to PTSD, PE has been shown to help with depression.
Cognitive Processing Therapy
What Makes Ptsd Worse
Avoidance: Avoidance of thinking or talking about previous traumatic events and the avoidance of activities that trigger trauma-related reactions makes things worse over the long run. The following are some examples of avoidance.
Not spending time with people and not talking about the traumatic event: When you have PTSD, you might not want to be around other people. You might not feel like talking to people or worry that they will ask you questions about what happened when you were deployed. Not spending time with people or talking about what happened to you can make PTSD worse and can also lead to depression. People who get better from PTSD talk about what happened to them, even though this is a hard thing to do.
Not going out: You may feel that you dont want to go anywhere, including places that you used to enjoy. You may feel that crowded places like stores or sporting events are dangerous. Not going out makes PTSD worse. It also slowly robs you of your life and your freedom. The more you avoid, the smaller your world becomes.
Trying to not think about the traumatic event: The more you try to not think about something, the more you think about it. Try it right now. Try to not think about a purple cow. If you are like most people, an image of a purple cow popped into your mind. The harder you try to keep pushing a memory down, the more it will keep coming back. Trying to not think about the trauma will make your PTSD worse.
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Personality And Behavioral Disorders
Disturbances of conduct, impulse control disorder, oppositional defiant disorder, or other personality or behavior disorders characterized by frequent encounters with law enforcement agencies, and antisocial attitudes or behavior also warrant disqualification from service. Likewise, a person may be disqualified from enlisting if their personality, conduct, or behavior disorder is believed to be a serious interference in adjusting to the military.
Tips For Grounding Yourself During A Flashback:
If youre starting to disassociate or experience a flashback, try using your senses to bring you back to the present and ground yourself. Experiment to find what works best for you.
Movement. Move around vigorously rub your hands together shake your head
Touch. Splash cold water on your face grip a piece of ice touch or grab on to a safe object pinch yourself play with worry beads or a stress ball
Sight. Blink rapidly and firmly look around and take inventory of what you see
Sound. Turn on loud music clap your hands or stomp your feet talk to yourself
Smell. Smell something that links you to the present or a scent that recalls good memories
Taste. Suck on a strong mint or chew a piece of gum bite into something tart or spicy drink a glass of cold water or juice
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Barriers To Effective Ptsd Treatment
Despite efforts to increase access to appropriate mental health care, many military veterans continue to face barriers to getting PTSD treatment. The largest single barrier to timely access to care, according to a VA audit, is the lack of provider appointment availability. An acute shortage of doctors in the VA, particularly in primary care, combined with the rising population of veterans seeking treatment, has led to months-long waiting times.
Poor availability of mental health services in many parts of the U.S. also presents a significant barrier for Iraq and Afghanistan veterans and their families. Mental health specialists tend to concentrate in larger urban areas, and even in those areas, there are disparities in the per capita number of psychiatrists. Some rural areas have none., According to the VA Office of Rural Health, veterans from these areas are less likely than urban veterans to access mental health services, in part because of the greater distances they must travel.
One of the most frequently cited barriers to veterans getting timely and adequate care for PTSD is the social stigma associated with mental illness., Research indicates that service members may feel ashamed and embarrassed to seek treatment, perceive mental illness as a sign of a weakness, or feel that it is possible to tough it out.
Seeds Of Ptsd Sown By Combat Stress
The threat to mental health posed by battlefield deployment has been highlighted recently by data pointing to rates of suicide in the US military that are higher than in years past. In addition, a record number of US Army combatants are seeking help for mental health issues, according to an Army report issued last month. Unfortunately, mental health issues may persist after the battlefield has been left behind.
Even after deployment ends, experiences of war can lead to long-lasting intrusive memories, avoidance behaviors or emotional numbing, and increased anxiety or emotional arousal, the hallmarks of PTSD.
For instance, some PTSD sufferers may withdraw and have trouble engaging others about everyday civilian concerns. Others may find it very difficult to let down their guard, habitually viewing each new public encounter as a potential threat.
PTSD, especially if unrecognized and untreated, may persist for many years after deployment has ended, diminishing the quality of life and even hastening the development of physical health problems, research now shows.
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Common Problems For Service Members And Veterans With Ptsd
Alcohol or drug use: Many service members and veterans with PTSD use nonprescription drugs or drink alcohol to try not to think about what happened to them. Some people drink to help themselves sleep or because they think it will help them avoid nightmares. Although drinking sometimes helps people fall asleep, it actually makes it more likely they will wake up during the night, makes it harder to stay asleep, and can increase flashbacks and nightmares. Using drugs and alcohol can also increase anger, create problems at work and home, and result in many other health problems. Alcohol may seem to work in the short term, but it causes even more problems in the long term.
Relationship problems / not being close to others: The symptoms of PTSD can get in the way of important relationships. Marital problems and divorce are common for people who have PTSD. They can have a hard time talking with others about what theyve gone through or what theyre experiencing. Some people with PTSD think others wont understand or be able to love them if they know some of the things theyve done during combat or deployments. People who have PTSD often worry that they arent good parents. They may have a hard time feeling love or closeness to other people.
Depression: Avoidance is a symptom of PTSD that keeps people from doing things that they used to enjoy. The result of avoidance can be depression as they stop spending time with other people or doing things that used to be meaningful or fun.
What Happens When Youre Diagnosed With Ptsd During Active Duty
Many soldiers experience post-traumatic stress disorder while on active duty but may not realize theyre suffering from this medical condition. After witnessing or being involved in a traumatic, life-altering event, some military personnel might not understand the changes in their personal behavior or be able to cope with the nightmares and flashbacks that often follow a traumatic incident and resort to substance abuse to cope.
If youre a soldier on active military duty and believe you may have PTSD, its important to seek treatment for it while youre in service.
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How Common Is Ptsd
Although most people feel much better within a month or two after a trauma, some people do develop PTSD orother problems like depression or substance use problems.
Did you know?
- About 9.2% of Canadians will have PTSD in their lifetime.
- Women develop PTSD more often than men.
- Certain types of trauma, such as those related to combat and rape, can cause higher rates.
Prevention Efforts In The Navy And Marine Corps
The Marine Corps developed the OSCAR program in the 1990s to prevent and manage stress reactions as early as possible. It is not PTSD-specific, but attempts to provide support to marines in dealing with deployment and nondeployment stressors. It uses embedded personnel who have been trained to combat stigma and to connect marines with mental health professionals when necessary. This peer support can also help marines to handle daily stress. OSCAR is being expanded throughout the corps and is in the process of being evaluated by the RAND Corporation .
The Navy and Marine Corps COSC program, based on the stress injury model, assesses service members resilience. A color-coded continuum for indicating stress ranges from red, representing illness, to green, representing readiness . The COSC program distinguishes between combat stress and operational stress, with the understanding that the latter can be experienced with or without deployment. The program focuses on positive emotions to foster resilience .
The Navy provides boot camp survival training for new recruits in which it uses a series of COSC modules to target specific issues and phases before, during, and after deployment, including modules for spouses and significant others. The Navy also has training for caregiver occupational stress control .
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Behavioral Approach Instead Of Medication
The fight-or-flight response has undoubtedly proved useful for survival throughout evolution and to this day. Heightened responses to a stressful event also may prime us to recall the event and respond similarly when a new situation appears similar. However, this response may arise even when there is no comparable threat.
The idea is that excessive anxiety right around the time of a traumatic event can consolidate a type of memory called fear conditioning, says Thomas Neylan, MD, UCSF professor of psychiatry and head of PTSD research at the San Francisco VAMC.
In studies of other traumatizing events, psychological debriefing in which the person who has experienced the event talks about it in the immediate aftermath with a trained and sympathetic counselor is more likely to do harm than good. Its better not to dwell on the event.
Charles Marmar, MD, a former UCSF and VAMC researcher who now heads the Department of Psychiatry at New York University, earlier worked with collaborators on a French study showing that the drug propranolol administered within 24 hours of a traumatic event may help people to better manage these memories. Propranolol is a heart drug, but it also blocks the action of stress neurotransmitters on the amygdala, a brain structure with a crucial role in fear conditioning and vigilance.
But within the military, taking a drug to manage ones mental state has the potential to be stigmatizing.
What Are The Risk Factors For Ptsd Among Military Service Members
Risk factors for PTSD among people in the military include lower education status, previous traumas, drug and alcohol use, poor social support, and a history of mental illness. Prior to joining the military, if you have mental health issues, youre more likely to develop PTSD, says Bret Moore, PsyD, a prescribing psychologist and board-certified clinical psychologist in San Antonio, Texas, and author of The Posttraumatic Growth Workbook.
Genetics may also make certain individuals more predisposed to developing PTSD than others. In a study in Molecular Psychiatry, 29 percent of a group of American and European women who had PTSD had a genetic risk factor for the mental illness. They also found that those people who had other mental illnesses were at a higher risk for developing PTSD after exposure to trauma.
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Mental And Physical Health Conditions
Service members are more prone to living with particular mental health conditions, including but not limited to:
The same study notes that those with PTSD and MDD also experience an increased risk of:
- death from homicide, injury, and cardiovascular disease
- medical illness
- homelessness
Physical health conditions, such as chronic pain or traumatic brain injury , can adversely impact mental health as well.
PTSD and TBI are more common among service members than civilians and are considered signature injuries of military service, Bryan says.
The Connection Between Ptsd And Military Service
Post-traumatic stress disorder and the military are commonly linked. PTSD can be considered a “young” diagnosis. It was not until 1980 that the diagnosis of PTSD as we know it today came to be.
However, throughout history, people have recognized that exposure to combat situations can have a profound negative impact on the minds and bodies of those involved in these situations.
In fact, the diagnosis of PTSD originates from observations of the effect of combat on soldiers. The grouping of symptoms that we now refer to as PTSD has previously been described in the past as “combat fatigue,””shell shock,” or “war neurosis.”
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What Is Schizoaffective Disorder
Depending on the severity of their symptoms, as well as whether theyre deployed, in combat, or on reserve, they may be discharged if they admit theyre dealing with a mental health problem. Because of this risk, many people stay tight-lipped, Stahl says, explaining, The closest thing theyll complain about is insomnia and overstimulation.
At the very least, being diagnosed with PTSD may prevent a service member from being promoted, Stahl says. Promotions are considered to be more stressful and more responsibility, and if you are cracked and at a lower level, why would they advance you? Its the kind of question thats in the air, if unspoken, Stahl says.
But the way the military views PTSD is changing. Within the past 10 years, its leadership has made headway in trying to destigmatize PTSD, Stahl says. I do think it has gotten the attention of the leadership, and there are some notable leaders that have even admitted to their own PTSD and others who are supportive of destigmatizing, he explains.
Can You Take Antidepressants In The Military
In the past, the military has disqualified just about any medication related to mental health.
However, the current policy is a little different.
It generally disqualifies anyone that is or has taken medication for mental illness in the last year.
If its been more than a year you may receive a waiver but the military will need to examine your medical records and speak to your physician.
The rules apply to medications like Zoloft, Prozac, Paxil, Celexa, and Wellbutrin.
However, that doesnt stop the military from reportedly prescribing antidepressants to a surprisingly high number of active-duty soldiers.
Its worth pointing out that some people advise not mentioning any previous mental health diagnoses or medications to a recruiter, as well as MEPS.
The decision is up to you, but some strongly believe that what isnt known doesnt hurt anyone.
However, the military has ways of finding out if the mental health condition is on your medical records.
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Take Care Of Your Body
The symptoms of PTSD, such as insomnia, anger, concentration problems, and jumpiness, can be hard on your body and eventually take a toll on your overall health. Thats why its so important to take care of yourself.
You may be drawn to activities and behaviors that pump up adrenaline, whether its caffeine, drugs, violent video games, driving recklessly, or daredevil sports. After being in a combat zone, thats what feels normal. But if you recognize these urges for what they are, you can make better choices that will calm and protect your bodyand your mind.
Take time to relax.Relaxation techniques such as massage, meditation, or yoga can reduce stress, ease the symptoms of anxiety and depression, help you sleep better, and increase feelings of peace and well-being.
Find safe ways to blow off steam. Pound on a punching bag, pummel a pillow, go for a hard run, sing along to loud music, or find a secluded place to scream at the top of your lungs.
Support your body with a healthy diet. Omega-3s play a vital role in emotional health so incorporate foods such as fatty fish, flaxseed, and walnuts into your diet. Limit processed and fried food, sugars, and refined carbs which can exacerbate mood swings and energy fluctuations.
Ptsd Resilience And Performance
As director of the VAMCs PTSD program, Neylan oversees research ranging from biochemical, sleep physiology, and brain imaging studies to novel treatments and new clinical care models that better integrate primary and mental health care. In his own recent research Neylan has been focusing on sleep studies and resilience to stress in the context of performance and preparedness. He is collaborating with Marmar on a controlled clinical trial to study a DART-like intervention in a New York City hospital emergency room. In addition, working with Marmar at NYU, Neylan is studying police officers, their personalities and responses to stress.
Were trying to find out if there is a profile that will tell you who is resilient, and who is at greater risk, Neylan says. It would not be the intent of the police or military to exclude those who might be at greater risk, but rather to make sure they get adequate preparation for the stressful situations they will encounter, according to Neylan.
For us at the VA this is a new development in our collaboration with the military and with UCSF, because were focusing on resilience and cognitive performance, as opposed to disease. Were trying to prevent disorders from arising, Neylan says.
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