Page 64 - Total War on PTSD

combat Veterans will leave environments or situations when anxiety arises, as associated emotional and physical symptoms have previously been a danger indicator overseas and arose when life-threatening events were occurred. Although the Veteran may now be in a safe environment, this overwhelming flood of anxiety and fight/flight (increased heart rate, feeling hot/flushed, adrenal drop, increased breathing patterns, muscle tension, visual/hearing changes, etc.) symptoms can feel intolerable and cause the individual to leave relatively benign situations.
When a combat Veteran first presents for treatment, it is imperative that they, along with their family members, are educated regarding their symptoms of PTSD and that these symptoms are normalized as a natural reaction to experiences that outside the typical range of human experience. Educating them on the nuances of how trauma can impact them emotionally and physically cannot only help them understand that what they are experiencing will not harm them, despite being distressing, but it can also help build rapport, as it gives structure to initial sessions and is not as anxiety provoking for the Veteran who may already feel resistant to therapy. Early treatment sessions should include education regarding how triggers form, breathing exercises to bring fight/flight symptoms under control, grounding exercises to pull back from anxious states, education regarding primary vs. secondary emotions, layers of PTSD (primary emotions-anxiety-anger) and mindfulness exercises to help them regain their ability to be present in the moment.
Breathing training is especially important as a concrete tool to teach Veterans when they first present for treatment. Techniques may include a breathe-and-hold technique to quickly reduce physical anxiety and panic-like symptoms, as well as a diaphragmatic breathing technique coupled with stress ball for less distressing moments. Breathing to
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