Page 53 - Total War on PTSD

complex and often takes time to work through, especially in individuals who have experienced multiple traumatic events. Directly processing these events and helping combat Veterans sit fully with their experience, especially emotional aspects with which they have not dealt, is paramount to recovery. Veterans are often skeptical of repeatedly processing these events, as they play daily already without their desire or consent. This repetition of trauma playing is often the body’s way of trying to purge the trauma, although quite unsuccessfully, as only the most intense parts tend to play and emotions that arise are avoided. The primary therapies used to treat PTSD (PE, CPT, and EMDR) all repeatedly visit the trauma to help the Veteran sit with their experience more fully, as well as work on helping them view their experience through a different lens. Although these therapies use different modalities to process the trauma, the goal is to help resolve the Veteran’s inner conflict over their trauma, challenge negatively held trauma beliefs about themselves and the world, and to come to an acceptance of events as they occurred.
Combat Veterans are often avoidant of the community. They are commonly triggered by benign aspects of their environment that remind them consciously or unconsciously of the combat zone. For Veterans who have been to Iraq or Afghanistan, for instance, common triggers can include loud noises, sewer smells, diesel fuel, heat, crowds, driving, potholes, debris, and even Middle Eastern Individuals, just to name a few. Ambiguous situations, environments that are overstimulating, or unplanned events can also be quite anxiety provoking for combat Veterans. It is essential in treatment that combat Veterans understand and come to recognize triggers in their environment, so they can learn to modulate their anxiety response. Combat Veterans often externalize their reaction to the environment, believing others are causing them to be angry or anxious. They may also focus on negative aspects of their environment when they are anxious, causing them to feel irritated and more empowered. Although this is not a healthy cycle, feeling angry is a much more familiar feeling to the combat Veteran and comparatively, they will feel more comfortable in an angry state than when they feel anxious or vulnerable. Until the Veteran starts to learn it is not others causing their discomfort or irritability, they will not gain an internal sense of control over their emotional reaction.
In treatment, combat Veterans are assigned to go to avoided or feared environments that should include social scenarios, places that have specific triggers identified by the Veteran, and public
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