Page 63 - Total War on PTSD

initially evoke some anxiety in them. Again, this should be normalized and practicing sitting with their experiences can reduce this over time.
Many Veterans will present for psychotherapy, not due to their nightmares or even their anxiety, but due to anger issues and their spouses or loved ones insisting they get help. The triggering and agitation that are experienced secondary to the Veteran’s anxiety will often lead them to be reactive and snappy, as well as possibly have significant anger management issues. Although this is not true for all combat Veterans, it is a fairly common occurrence. Basic anger management skills, such as the ABCs of thinking, weighing stressors on a 1-10 scale to help keep them in proportion, and basic time-out skills will help at least keep damage in their relationships to a minimum until some of the underlying issues can be addressed.
Combat Veterans have ongoing safety beliefs they have developed related to their trauma, including a significant distrust of people, believing everyone is a potential enemy, and fearing that negative events can occur at any moment, especially in undefined or ambiguous situations. In treatment, time is spent exploring these belief patterns and helping the Veteran understand why their perspective has shifted due to their trauma. In trauma work, the “overgeneralization” occurs when aspects of the individual’s experience of the traumatic event negatively shift their beliefs of the world and they start to view all environments through that newly formed trauma- based belief system. For example, if a combat Veteran suffers a VBIED (vehicle born improvised explosive device/bomb) attack by a red vehicle, the combat Veteran may be fearful and leery of all red vehicles upon returning home. Because combat Veterans are immersed in an ongoingly dangerous environment for months and sometimes even years at a time, these belief systems become very ingrained. Their vigilance in the community, anticipatory thinking patterns that involve worrying about potentially harmful events occurring in their environment, and their distrust related to the unpredictability of people only perpetuates their isolation and intolerance of being outside of their home. Combat Veterans are often resistant to letting go of this distrust and guarded perspective, as they believe if they are complacent, something bad will happen. As a therapist, they may often view you as naïve to the true evils of the world and will often state that their experiences in the war zone have opened their eyes to the true potential of humans. These beliefs are challenged and actions, including the Veteran’s actions in the combat zone must
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