Page 54 - Total War on PTSD

places that are busy or crowded. The Veteran should work on learning to be in the moment and focusing on “what is” happening, as opposed to “what if” scenarios that fuel their anxiety. They need to work on disengaging from safety behaviors, such as having their back to the wall, sizing up people, and watching exits. Ultimately, they need to be willing to give up their basic need for a sense of control and to recognize they can still be safe even If they are not constantly vigilant or “battle-ready.” They will need to place effort into learning to refocus on positive aspects of their environment, as opposed to looking for potential threats or negative aspects. Throughout the course of treatment, we explore how combat Veteran walked around in the world prior to their deployment vs. after returning from combat, focusing on helping the combat Veteran see how their perspective was changed due to these experiences and whether they can safely give up their sense of control slowly over time. Again, the combat Veteran can feel highly uncomfortable with letting go of control, as they will feel they are being complacent and have been inculcated with the belief “complacency kills.” Veterans will need to recognize the cost of their vigilance, including never actually enjoying environments, how their negative anticipatory thinking patterns actually feed their anxiety, not being truly mentally present with their family at the events, and recognizing that being on guard all of the time steals precious moments from them and their family that they cannot get back. There is a saying that goes, “The nature of anxiety is drowning in the past or worrying about the future, while the moment is lost.” Part of the goal of going to environments is to stay through the anxiety peak and tolerate it, teaching them that avoidance only perpetuates their anxiety, while pushing through it can help them to feel more efficacious and competent to handle their own emotions. Until they confront their anxiety, it will most likely will dictate “if they go, when they go, where they go, and how long they go.” Through the course of treatment, hopefully the combat Veteran can gain insight that they are not controlling their anxiety through their behaviors, but actually it has a great deal of control over them.
Even in this brief treatment summary, it is clear that PTSD is a highly complex disorder that can be challenging to treat. Despite its challenges, PTSD is highly treatable and symptoms do progressively improve over the course of recovery, to the point they resolve and the Veteran no longer meets criteria for PTSD. The journey can clearly be arduous and it takes a great deal of
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