Post Traumatic Stress Disorder in Combat Veterans

Introduction

The psychological disorder has been a common term in mental health and the field of psychology since time immemorial. At the onset of the psychological disorder, the patient experiences abdominal discomfort and incoherent speech and judgment of real-life problems. Psychological disorders are thought to result from complex relationship between genetics and life experience. The increase in individuals with psychological disorders in the recent past has been great concern. A survey conducted in 1994 by National Comorbidity Survey showed that 30 percent of participants had experienced at least one psychological disorder. Such studies and common observation of increase in individuals with psychological challenges call for more attention on the subject.

Often people experience traumatizing experiences. A person may be involved in an accident, war or any other traumatizing experience. PTSD (Post Traumatic Stress Disorder) is defined as severe anxiety that results from being exposed to traumatizing events. Events leading to psychological trauma may involve events that threaten one’s or others’ lives, events that threaten one’s physical safety, or those that may affect an individual’s psychological integrity (Atchison & Papay, 1994). Post Traumatic Stress Disorder has been a common psychological disorder in the recent past. Exposure of individuals to traumatizing events that are beyond their ability to cope with often leads to this disorder. Events such and terrorist attacks, natural catastrophes such as earthquakes and floods leave people venerable to psychological challenges. Just as in other psychological disorders, individuals with Post Traumatic Stress Disorder, require assistance for them to be able to overcome their trauma and continue with their lives. This paper reviews psychological therapies that can be used with veteran soldiers suffering from Post Traumatic Stress Disorder.

Post Traumatic Stress Disorder and Veteran Soldiers

Post Traumatic Stress Disorder is common in veteran soldiers regardless of war or conflict that they are involved in. Over the years, doctors have learned that people frequently exposed to situations of conflict show high vulnerability to psychological problems. Diagnosis of Post Traumatic Stress Disorder, in fact originated from effects observed on returning veteran soldiers. For instance, the symptoms that are associated with PTSD were previously referred to as war neurosis, combat fatigue or shell shock (Friedman, Schnurr & McDonagh-Coyle, 1992). This shows that this psychological disorder is common with veteran soldiers. Because of observed relationship between PTSD and combat situations, various studies have been conducted to relate the two. For instance various studies try to find out rate of PTSD in various combat conflicts. The extent PTSD on solders that have been participated in combat role in Vietnam, Gulf war and most recent Iraq War has been widely studied. National Vietnam Veterans Readjustment Study surveyed post-Vietnam War victims. They found out that women had significant effects of the war just like men, as it resulted in varying degrees of PTSD in both sexes. The study also showed that about thirty percent of all the soldiers that participated in the war had experienced PTSD at least once during and after the war. These rates were higher than the rates observed in no veterans involved in the conflict. Persian Gulf War also had its psychological effects on the veteran soldiers that were involved. Rate of Post Traumatic Stress disorder in veteran soldiers involved in Persian Gulf War was also high. Although the war lasted for a short duration of time, Post Traumatic Stress Disorder was observed in 9 to 24 percent of the soldiers (Friedman, Schnurr & McDonagh-Coyle, 1992). The recent war in Iraq also had post-traumatic stress disorder effects. Although the effects are not yet accounted for, veteran soldiers were exposed to one form or the other of trauma that could lead to PTSD. A study conducted on several US infantry has shown that about 92 percent of soldiers were exposed to traumatic situations such as being ambushed. 85 percent of the veteran solder reported to either have been shot or having known of an individual that was seriously injured during the war. Such experiences form a foundation of occurrence of PTSD. Generally the level of soldier predisposition to PTSD increased after deployment to the battlefield as compared to the situation experienced before the relocation (Scaer, 2007, p. 199).

Post Traumatic Stress Disorder is mostly prevalent in veteran soldiers that witness firsthand military combat. The disorder results from experiencing life-threatening situations. According to Diagnostic and Statistical Manual of Mental Disorder (DSM-IV-R), PTSD is defined as a psychological disorder that results from experiencing situations that lead to severe stress. Individuals who are victims of trauma may relive their experiences for the rest of their lives. PSTD makes its victims have nightmares or flashbacks of traumatic experiences and, thus, they are not able to live their lives normally. Although anybody who has experienced traumatic situation may experience nightmares and flashbacks, in PTSD the nightmares and flashbacks are severe that and individual is not able to carry on with their normal lives (Friedman, Schnurr & McDonagh-Coyle, 1992). For instance, the thoughts about traumatic experiences may become so realistic that an individual dissociates from family members and friends, and may not be able to perform their daily duties in their normal way. This psychological disorder is in most cases accompanied by other problems of psychological nature such as depression, substance abuse among others. PTSD often affects family system. Because of its effect on relationships, parenting concerns and marital problems, families of PTSD victims experience a lot of challenges. Post Traumatic Stress Disorder is not only associated with war but can result from any traumatizing experience that an individual is not able to handle. Effects of a traumatizing experience vary from one individual to another. While one individual may develop PTSD after witnessing or participating in war while others may not develop.

Effects of Post Traumatic Stress Disorder on Families

After veteran soldiers return home, they are received with joy by their families. A period of happiness usually follows as families are reunited. This moment of happiness, however does not last for long. As life settles and a solder is back to his normal routines, family members start to notice abnormal behavior from the soldier. Family members may realize that a veteran is acting or feeling differently from how he or she did before deployment (Atchison & Papay, 1994). Although the family or the veteran may not realize it immediately, the new behavior is related to trauma of war. A veteran may realize that he or she is experiencing nightmares, panic, anxiety, irritability and anger, distressing thoughts or unwanted memories and in some cases substance abuse. All these symptoms suggest that such a veteran suffers from Post Traumatic Stress Disorder.

According to Bowen’s family system theory, members of a family are either positively or negatively affected by a change in one member of their family (Mertens, 2009). In case of a veteran with Post Traumatic Stress Disorder, changes in emotions and behavior can affect other members of the family. Since Post Traumatic Stress Disorder in veterans is mainly severe, it can lead to great effect on family system. Family members may react to PTSD’s effect on one of their members by showing sympathy, fear and worry, shame, guilt, alcohol and substance abuse, and depression. Thus, eventually traumatic effect on a veteran may end up traumatizing other members of the family. Family Members are the major source of emotional support for veterans who could be struggling to cope with post-war trauma. Since family members are close to the veteran, they can be able to monitor emotional state of the veteran, give him a sense of belonging and provide social support as the soldier adapt to normal life. The family members are also able to confront the solder when he starts to show signs of depression, withdrawal or substance abuse. Family can not only help to mitigate further effects of trauma, but also facilitate healing.

Cognitive-behavioral Therapy

Veterans suffering from Post Traumatic Stress Disorder resulting from their experience in fighting environment can get relief from cognitive behavioral therapy. This is a package of therapies that try to assist a PTSD patient overcome their trauma. Symptoms of Post Traumatic Stress Disorder such as nightmares, fear, substance abuse, guilt or suicidal thoughts are not signs of weakness. Instead, they are behavioral adjustments where a trauma victim tries to forget or avoid trauma memory (Zinbarg, Barlow & Hertz, 1992). Veteran soldiers may have experienced very traumatic experiences. Some of them could have been involved in fierce ambush, some could have witnessed killing while some could have participated in the killing. Thus, a veteran may experience a mixture of emotions. Some may relive traumatizing memories of battlefield while others may feel guilt for their roles in war (Roth & Heimberg, 2002). The aim of cognitive-behavioral therapy on veteran soldiers is to help them accept their past as past and be able to manage their thoughts and emotions. It is natural for individuals to try to avoid thoughts or memories of bad experiences. Suppressing memories of traumatic experiences, however, does not help. Instead of helping a patient, suppressing only helps to worsen posttraumatic stress disorder. The methods employed in controlling posttraumatic stress disorder include (Cognitive Behavioral Therapy) CBT in exposure therapy, stress inoculation, cognitive processing therapy as well as training.

Role of Exposure Therapy on Veterans with PTSD

Individuals with Post Traumatic Stress Disorder often experience fear of memories of traumatic events. Reminders of traumatic events may consist of many things that include the environment. Some pictures, sounds, smells or other things in the environment may work as triggers of traumatic events. Experiencing nightmares, intrusive thoughts and so on, may also act as a sign to remind you about traumatic events. Since these reminders often bring fear, a PTSD patient tries to avoid them leading to emotional and behavioral effects. A veteran soldier may try to avoid memories of trauma by exhibiting emotions and behaviors that are not common. Some behaviors may include avoiding family members, effect on sleep, nightmare attacks or substance abuse. Exposure therapy aims to help PTSD patients to overcome their fear and anxiety associated with memories of traumatic events. It works by reducing level of anxiety of fear and consequently reducing avoidance (Zinbarg, Barlow & Hertz, 1992). Exposure therapy works by exposing an individual to the reminders that he or she tries to avoid. To a veteran, exposure can be done by showing veteran pictures or video clips on events in the war. Through gradual exposure to source of trauma, a veteran can learn to deal with anxiety and fear. Exposure helps a PTSD veteran to realize that anxiety and fear lessen with time; helping him to reduce avoidance. The therapy is very useful in reducing in reducing the threat assumed to be caused by the reminders of traumatic events. Thus, a veteran is able to learn how to manage his anxiety or fear and he can go back to normalcy.

Stress-Inoculation Training

Apart from experiencing fear and anxiety over traumatic events, PTSD patients lack confidence in their ability to cope with situations. Stress-Inoculation Training aims at enabling PTSD patients to develop confidence in their ability to deal with their fear or fear resulting from reminders for traumatic events. After a veteran returns, he or she is separated from other veterans with similar experiences. When alone, a solders confidence inability to cope may be reduced (Zinbarg, Barlow & Hertz, 1992). Through stress inoculation training a veteran is assisted to identify things that are reminders of traumatic experience. Apart from identifying sources of anxiety, a veteran is taught various coping skills. Through stress inoculation training, a veteran is able to identify cues to fear or anxiety in time and apply learned coping skills. By doing this, the veteran can address his anxiety in good time before he is overwhelmed by the emotions.

Cognitive – Processing Therapy for PTSD veterans

Post Traumatic Stress Disorder mainly happens because of conflict over the perception of self and the world. Cognitive-processing therapy thus aims at helping an individual to restructure his thoughts and overcome effects of the disorder. To a veteran, PTSD may result from differences in how a veteran perceived himself before deployment and his experience in war (Roth & Heimberg, 2002). For instance, a veteran may have gone way without being fully convinced, in this case the veteran is not ready but experience in war may have come as a surprise. Through this therapy, a therapist helps the patient to identify errors in thoughts that could have led to the disorder. Thus, a veteran is able to restructure his thoughts and be able to cope with his trauma.

Emotionally Focused Therapy (EFT)

Emotionally focused therapy can be used on veteran soldiers to help re-establish their family ties and overcome trauma fears and anxiety. Emotionally focused therapy is an approach used by psychiatrists in dealing with couples. Psychiatrists have also started applying it when dealing with families and other issues outside the couple. The work of counselors is in most cases to facilitate healing, growth, and wholeness of the human being (Hohenshil, 2010). The best thing to do to the families or the concerned individuals is to offer to counsel. The therapeutic goal of counseling is to restructure the personalities of individuals involved (Doss, Rhoades, Stanley & Markman, 2009). This will help them to uncover the unconscious, create social instruments, and help individuals to find some meaning in their lives. Therapeutic counseling also helps to cure emotional disturbance, reduce anxiety, develop trust, and become more self-actualizing. Through it, individuals are capable of examining old decisions and making new ones, shed maladaptive behaviors and learning adaptive patterns, and gaining more control of themselves (Whelton, 2004).

Emotionally Focused Therapy aims at changing the problematic emotional states or the experiences that some individuals go through. A psychiatrist achieves this by activating the emotions in a client so that the emotions in the client can adapt to the problem at hand (Greenberg & Goldman, 2008, 34). Whenever there is a chance for advancement, emotions alert an individual of the situation. The emotions also guide an individual when going through these situations that help meet his or her needs. To help the clients to be able to manage their experiences which are emotional in nature as well as explore and transform them a certain kind of therapy that is emotionally focused is offered.

As stated before, EFT arose from emotional theory and attachment theory (Crawley & Grant, 2005). Emotional theory has an argument that the experiences of an individual in the world make the nervous system trigger some physiological events. Physiological changes in turn trigger emotions but do not cause the emotions. On the other hand, attachment theory argues that if the attachment security is not certain, an individual may harass his or her spouse in response to the attachment cues. The individual does not even mind the impact of his or her actions on the relationship. The therapy started being developed in the 1980s and is more humanistic but has less the behavioral features. The methods developed are based on research that has taken place for over thirty years it explains how people change in therapy to know, express, and regulate their emotions. This helps individuals in a couple to avoid some emotions and assume other emotions that would better their relationship (Anker, Duncan & Sparks, 2009). As a matter of fact, emotion is a powerful and necessary agent of change. EFT entails reprocessing and reframing emotions to repair the injuries caused by attachment. According to EFT, emotions are very important in the experience of self. Emotionally focused therapy is applied in both adaptive and maladaptive functioning and therapeutic change. For change to take place, an individual must be aware of some experience and reflect on it. EFT is founded in principle arguments, which, reiterates that one has to arrive before leaving. An individual undergoing EFT is therefore made to experience a maladaptive emotion, which helps him transform it. The individual adapts to another emotional state after experiencing a moment of fear and shame.

According to Compton (2008), when members of the American military return from war from Iraq and Afghanistan, they face many challenges and this may negatively affect their families and couples. He argues that EFT is very effective in dealing with such people. It is important in that it helps reduce interpersonal conflict; increases social support, and addresses experimental avoidance which maintains the posttraumatic symptoms. Combat veterans and their partners are exposed to the emotionally focused therapy that helps reduce conflict and increase intimacy through acceptance. The individuals are exposed to the therapy to emotions, interpersonal situations and activities that help them recover from the distress related to the combat. The therapy helps them relate with their couples just like they used to before going for the war.

The emotionally Focused therapy is well developed and tested to ensure effectiveness. It is empirically tested and has been proved to deal with problems experienced by couples effectively. The model integrates systems, experiential and attachment theories that help make it more effective (Church, Geronilla & Dinter, 2009). Responsibilities of each partner are addressed by the. It also looks at emotional experiences of the partners using a systematic framework. These help in understanding the interactions of the couple. The model is of many benefits to practitioners as it equips them with approaches for addressing several issues as well as challenges that are likely to emerge. EFP focuses on the creation of a secure attachment that is effective for distressed couples. It is capable of dealing with one or both individuals in a couple in case of a trauma. Trauma in this case defines a wound. It occurs when an individual is confronted with a threat that overwhelms him or her. It evokes responses of helplessness, horror and intense terror (Mertens, 2009). Relational trauma includes events such as miscarriage, childhood sexual abuse, combat and others. An individual experiencing trauma may develop other complications such as acute stress disorder, borderline personality disorder, posttraumatic stress disorder, and other disorders. The emotionally focused therapy will help an individual undergoing such experiences experience the situation and adapt to new emotions.

During the first few years of its discovery, emotionally focused therapy was seen as an evidence-based method for treating depression and for conflicts experienced by couples (Johnson, 2004). Continued research led to advancements where it has now been found useful in treating trauma, interpersonal problems and eating disorders. The model will continue to advance and solve more problems facing not only couples but also other individuals. Its ability to focus on inner emotional experiences with interpersonal, systematic perspectives enables it to cover a wide range of issues.

The emotionally focused therapy takes place over a course of nine stages. It reprocesses emotion to help an individual adapt to new emotions. In the first three steps, the specialist aims at de-escalating the negative cycle (Christensen & Heavey, 1999). The therapist in this case identifies secondary emotions that are hidden and come up with a method of reframing them in terms of attachment. The therapist also shifts to some interaction patterns that contribute to the relationship distress. He or she widens the world of experience and acceptance of both partners by identifying the attachment needs that the partners have left behind them. He or she also helps them own up their underlying emotions. The couples learn to accept each other’s partner experiences and develop a new interaction pattern (Eastaugh & Sternal, 2010). The partners are required to nurture the new interaction patterns. They are encouraged to try new things and feel safe while doing it. The last processes of reprocessing the emotions using EFT involve consolidating new responses. Here, the couple and the therapist recognize new responses to the old problems that the couple experienced. The position of each partner and their attachment behaviors are also recognized.

Mock Therapy

This is mock therapy conducted of veteran who has returned from war in Iraq. The veteran, Carl Smith, and his wife had been experiencing marital problems for some. The wife, Tashira Smith reported that his husband had been detached from family since his return from a mission Iraq. She said that his feeling and behavior had changed significantly as compared to before being deployed to Iraq. For instance, Tashira reported that Smith no longer seemed to enjoy playing with their daughter. She expressed her concern over Smith’s nightmares and lack of sleep. With background that Carl Smith was a returning veteran, I anticipated that she was suffering from PTSD. Knowing that Tashira was not only affected the problem but also instrumental in the healing process, I wanted to incorporate her in the therapy. Principles of Cognitive behavioral therapy and emotionally focused therapy were used.

Using principles of emotion-focused therapy; I tried to place myself in the place of the couple. My initial task was to ensure trust between the couples to enable express their emotions. I asked the couple to narrate their problems. As the couple told their story, I showed emotional reaction to their emotions. I felt their fear, tension and anxiety. Carl Smith told of how his experience in Iraq had affected his life and family. I allowed him to express his emotional experience and through this, I could understand his source of fear and anxiety. Using principles of cognitive-behavioral therapy, I exposed the Veteran to traumatic events. “Could you tell us a little about your experience in Iraq, How was it!” I prompted him. He was hesitant to narrate his experience. It was evident that he had difficulty speaking freely about his experience. “Maybe writing a short account can help you remember some things” I prompted him to write about his source of trauma.

Conclusion

Often people experience traumatizing events. A person may be involved in an accident, war or any other traumatizing experience. Post Traumatic Stress Therapy (PTSD) is a psychological disorder that affects individuals who have experienced traumatizing situations. The psychological disorder is manifested by great fear and anxiety towards traumatizing events. This fear and anxiety may lead to nightmares, worry, substance abuse and depression. War is a major cause of Post Traumatic Stress Disorder. About seventeen percent of veterans returning from war in places such as Iraq and Afghanistan show signs of Posttraumatic Stress Disorder. PTSD affects the way they cope with life and may have great effect on family systems. Cognitive-behavioral therapy and emotionally focused therapy can be used to help a veteran cope with a traumatic event. Cognitive-behavioral therapy techniques can help a veteran overcome fear and anxiety over traumatic events. On the other hand, emotionally focused therapy techniques can be used to mend family problems that could be associated with PTSD.

Reference List

1. Anker, G.M., Duncan, B.L., & Sparks, J.A. (2009). Using Client feedback to improve couple therapy outcomes: A randomized clinical trial in a naturalistic setting. Journal of Consulting and Clinical Psychology, 77 (4), 693-704.
2. Atchison, M. & Papay, E. (1994). Physical symptoms in Post-traumatic stress disorder. Journal of Psychosomatic Research 38(7) 715-726
3. Christensen, A., & Heavey, C.L. (1999). Interventions for couples. Annual Review of Psychology 50, 165-190. Annual Reviews.
4. Church, D., Geronilla, L., & Dinter, I. (2009). Psychological Symptom Change in Veterans after Six Sessions of Emotional Freedom Techniques (EFT): An Observational Study. The International of Healing and Caring. 9(1).
5. Crawley, J. & Grant, J. (2005) Emotionally Focused Therapy for Couples and Attachment Theory.
6. Doss, B.D., Rhoades, G.K., Stanley, S.M., & Markman, H.J. (2009). Marital therapy, retreats, and books: The who, what, when and why of relationship seeking. Journal of Marital and Family Therapy. 35(1), 18-29.
7. Eastaugh, B. & Sternal, C. (2010) Treating Traumatized couples using Emotionally Focused Therapy.
8. Friedman, M., Schnurr, P., & McDonagh-Coyle, A. (1992). Post-Traumatic Stress Disorder in the Military Veteran. Journal of Psychosomatic Research 17(2)
9. Hohenshil, T.H. (2010). International Counseling. Journal of Counseling and Development, 88(1) 3-15.
10. Johnson, S.M. (2004). The Practice of Emotionally Focused Couple Therapy (2^nd Edition). New York, NY: Brunner-Routledge.
11. Mertens, D. (2009). Research and evaluation in education and psychology (3^rd Ed.). CA: SAGE Publications, Inc.
12. Roth, D., & Heimberg, R. (2002). Encyclopedia of Psychotherapy 1(3) 451-458
13. Scaer, R. C. (2007). The body bears the burden: Trauma, dissociation, and disease. New York: The Haworth Medical Press. p.199
14. Whelton, J. W. (2004) Emotional Processes in Psychotherapy: evidence across Therapeutic Modalities. Clinical Psychology and psychotherapy Journal. 58-71.
15. Zinbarg, R., Barlow, T., & Hertz, R. (1992). Cognitive Approaches to the Nature and Treatment of Anxiety Disorders. Annual Review of Psychology 43 235-267.