Recovering From Military Trauma

Each year on Veterans’ Day, we honor the men and women who protect our country by serving in the military. Their courage and integrity are an inspiration every day, but on November 11 we pay special homage to those who have served and are now serving, many of whom risk their lives by going into harm’s way.

Military personnel are highly trained, skilled, and resilient.

Yet there is no preparation for the extreme danger and deadly encounters of war. Even the strongest person can be completely impervious to the traumatic shock and stressful aftermath. Symptoms of post-traumatic stress are almost universal in the wake of life-threatening military incidents. Lasting problems with posttraumatic stress disorder (PTSD), anger, depression, or addictions occur for years to at least one in three soldiers.

Nor is there any way to prepare for the traumatic shock of betrayal and violation of one’s body that happens when a sexual or physical assault is perpetrated by one’s own military comrades. At least one in every three to five women serving in the United States military is sexual assaulted, and most (an estimated 80%) suffer silently without reporting the trauma for fear of the stigma or retaliation. Military men also are sexually assaulted, albeit more rarely and almost never officially reported. These women and men are highly likely—50% or more—to develop severe and chronic PTSD and related problems.

Effective psychotherapeutic treatments are increasingly available to traumatized military personnel and veterans through Department of Defense and Department of Veterans Affairs healthcare programs. Hundreds of DoD and DVA mental health professionals have been trained to provide two therapies at bases and VA centers nationally: Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). These therapies guide the recipient in safely re-experiencing specific traumatic events that are particularly troubling memories. The goal is to break the vicious cycle of attempts to avoid these memories, which only increases their strength and the distress they cause. PE and CPT have been found to be effective in promoting recovery from PTSD for many military personnel and veterans.

However, at least half of the men and women with military PTSD do not recover, or only partially recover, with these therapies. And many others never seek treatment because they do not want to re-live traumatic events even with the best therapeutic guidance. These soldiers and veterans often get no treatment, or receive only medications, which can be helpful but rarely are sufficient to overcome PTSD.

Fortunately, new approaches to psychotherapy for PTSD without re-experiencing trauma memories have been developed to meet this need.

One therapy, called Trauma Affect Regulation: Guide for Education and Therapy (or TARGET), shows recipients how their brains have shifted into a perpetual alarm state in order to survive traumatic danger—and how to use the mind’s capacity to focus in order to reset that alarm system in the brain.

Military personnel and veterans are not surprised to learn that they have an alarm in their brains. They know what it’s like when that alarm kicks off an adrenaline rush in the body and the fight-flight response essential to surviving extreme threats.

But they’ve never been provided with a user’s guide to turning down or resetting the alarm. That’s what is needed in order to stop a healthy survival reaction from becoming a toxic perpetual alarm state of hypervigilance, anxiety, and anger.

The TARGET intervention explains how to reset the brain’s alarm, so that it no longer hijacks the brain and creates a chronic state of PTSD. The area of the brain that coordinates all conscious thinking—the pre-frontal cortex, or for short, the brain’s “thinking center”—can be activated to reset the brain’s alarm center. TARGET shows how we all intuitively activate this thinking center and reset the alarm by following a set of steps that focus the mind simultaneously on two essential things:

• What we need to be alert to in order to recognize actual or potential problems
• What we most deeply value and care about in life that is a solution, not a problem

These focusing steps seem deceptively simple once you know them, but they are almost impossible to follow unless they are carefully understood, and diligently and purposefully practiced many times each day.

Fortunately, there is a way to focus that takes only a few moments of concentrated thought, and can be repeated almost any time and anywhere. Target explains the focusing steps as an exercise easily remembered as "SOS":

1. Sweep your mind clear of all thoughts
2. Orient yourself to one thought that you choose because it is the most important thing (or person, relationship, activity, or resource) in your life at this moment
3. Self-check your stress level (from 1=no stress to 10=worst stress ever) and your level of personal control (from 1=confused and out of control to 10=completely mentally focused and in control)

In a research study ongoing at the University of Connecticut, military men who have been deployed to Afghanistan or Iraq in the past 10 years are receiving TARGET or Prolonged Exposure, in order to compare the effectiveness of the two therapies.

Although the study is not complete, results to date indicate that recipients view both therapies as meeting their needs. TARGET recipients are finding the focusing perspective and skills to be the “user’s guide” that they have needed in order to reset their alarm states.

An added benefit for TARGET recipients has been taking what they’ve learned about their posttraumatic stress alarm reactions and sharing this information with their families. Family members experience troubling stress reactions as a result of the fear and anxiety of not knowing if their military member will come home safely, and as a side-effect of living with a military member who is in an alarm state because of PTSD.

The focusing perspective helps the family to understand their military members’ stress reactions and their own stress reactions, and enables them to join together in healing from the trauma.

Hijacked by Your Brain blogs are co-authored by Jon Wortmann. Visit our website at www.hijackedbyyourbrain.com. You can follow us on facebook or join us on twitter @hijackedbook. Thank you to S. Brawsell for her photography.