Research published in the Journal of the American Medical Association in 2015 showed that the most commonly used treatments for PTSD—cognitive processing therapy (CPT) and prolonged exposure therapy (PE) may not be as effective as those in the medical community had hoped.
Meadows Senior Fellow Dr. Bessel van der Kolk is world-renowned for his work pertaining to the treatment of Post-Traumatic Stress Disorder (PTSD), childhood trauma, and abuse.
In a video interview on bigthink.com, Dr. van der Kolk explains how the emotional and relational difficulties faced by war veterans shaped the diagnosis of PTSD and how the effects of trauma are major contributing factors.
By Dr. Jon Caldwell, D.O., Ph.D. Chief of Psychiatry at The Meadows
Note: This post was originally published on TheGriffon108.com. The Meadows is proud to be a TRICARE Preferred Provider of behavioral health and addiction inpatient services in the West Region. Call us today at 800-244-4949.
Trauma is part of the human experience. Being alive comes with the inevitable risks of stress, injury, sickness, loss, and death. There’s no escaping it. Critically though, these threats to health and life are perhaps most pronounced for individuals who serve in the military. Few other circumstances in modern times make these threats more real than military service. Military service members are required to complete their mission while facing significant risk and threat.
Fortunately, humans are equipped with a highly functional nervous system that, under typical conditions, can successfully deal with most stressors and threats. For example, relatively common experiences like nearly running over a piece of garbage on the freeway, an argument between two people in a retail store, or being disappointed by a loved one are stressful and somewhat threatening situations that are usually managed effectively by most people’s nervous systems.
In circumstances like these, most people feel a temporary surge of adrenaline and hyper awareness to the potential threat; their nervous system prepares them for “fight or flight” and mobilizes the necessary resources to effectively deal with the situation. In relatively short order, the fight or flight reactivity usually subsides naturally, and they are able to return to the flow of their lives: driving, shopping, and social engagement.
However, under extreme or chronic conditions of stress and threat, as is common in military service, the nervous system can become overwhelmed. In fact, the chemical and physical make-up of the brain-body stress response system can be altered by experiences of extreme or chronic stress (i.e., trauma). For many service members, this can result in decreased “resiliency”, or the capacity to effectively manage everyday life circumstances. This shift in resiliency can occur immediately after the experience of trauma, but very often it can occur down the road, sometimes years later.
For some service members, the trauma-related changes to the nervous system progresses to the point where he or she qualifies for the diagnosis of Post-Traumatic Stress Disorder (PTSD). The diagnosis of PTSD is made when a person was directly or indirectly exposed to an extremely stressful or threatening event or series of events that resulted in symptoms of intrusion (e.g., disturbing memories, nightmares, flashbacks), avoidance (e.g., avoidance of thoughts, people, places, and things associated with past trauma), negative alterations in thinking and mood (e.g., self-blame, guilt, shame, isolation, withdrawal, depression), and alterations in arousal and activity (e.g., insomnia, hypervigilance, irritability, anger, self-destructive behavior).
These trauma-related symptoms are very distressing. But, for a variety of reasons, many service members don’t seek help and, despite their best efforts, are unable to manage the symptoms on their own. Therefore, it is common for these individuals to cope with their symptoms by turning to addictive behaviors, like alcohol and drugs, pornography and sex, gambling, video games, and disordered eating. Of course, while these behaviors may temporarily modify unpleasant trauma-related symptoms, they frequently result in more distress and added functional limitations.
The everyday situations mentioned above will be used here to better understand the experience of PTSD. For many service members, a piece of garbage on the freeway would likely elicit thoughts, memories, or flashbacks about Improvised Explosive Devices (IEDs). This experience could easily result in driving-related stress and hypervigilance, intrusive memories or flashbacks, poor concentration while driving, fear and avoidance of driving, or anger and road-rage.
When encountering an argument between two people in a retail store, a service member who is affected by past trauma might experience a pronounced fight or flight response. If it is a fight response, he or she may experience intrusive memories or flashbacks of previous violent encounters and surges of adrenaline in preparation for defending oneself or attacking others. If the individual has a flight response, he or she may experience overwhelming urges to leave the store, avoid that store and similar retail stores, and retreat further from public places and crowds.
If a military service member who is affected by trauma is disappointed by a loved one, he or she may escalate quickly to irritability and anger, perhaps reacting by yelling, throwing things, or becoming violent. Alternatively, the anger might secretly fester into resentments that result in addictive acting out behaviors. On the other hand, being let down by a loved one might result in painful feelings of being misunderstood, guilt and shame, self-loathing, sadness, and depression.
As these vignettes illustrate, services members can have pronounced nervous system reactivity in response to everyday situations as a result of their history of traumatic experiences. This reactivity takes them out of the present moment flow of routine life and leaves them feeling uncomfortable in their own skin and disconnected from other people. In this state, they are more likely to resort to addictive and unhealthy behaviors. Sadly, many service members suffer in silence, and some don’t get help before it’s too late.
Fortunately, it’s never too late to get help, and there is hope! Appropriate treatment can help to identify past traumas, current symptoms, and unhealthy coping mechanisms. Additionally, treatment can help reduce nervous system reactivity and restore its natural capacity for self-regulation. Treatment can help affected service members to let go of shame and self-destructive behaviors. Restoration of resiliency means that service members will once again feel confident in their abilities to manage everyday life situations. Lastly, service members who receive appropriate treatment can reestablish safe connections to peers, loved ones, and the world around them – they are able once again to enter the flow of life and experience all that it has to offer!
Veterans Day is an opportunity for Americans to honor ALL of our Veterans, both living and deceased. It is a day that the United States has set aside to thank veterans for their dedication and loyal service to their country. November 11th of each year is the day that we ensure veterans are aware of how deeply we appreciate the sacrifices that they have made in order to keep our country free.
On the 11th hour of the 11th day of the 11th month of 1918, an armistice, or a temporary suspension of hostilities, was declared between the Allied nations and Germany in the First World War, which was then known as “the Great War.” Commemorated as Armistice Day beginning the following year, November 11th became a legal federal holiday in the United States in 1938. After the tragedies of World War II and the Korean War, Armistice Day then became known as Veterans Day, a holiday dedicated to American veterans of all wars.
The Meadows is committed to supporting members of our nation’s military who have selflessly served our country. Our treatment staff and world-renowned Senior Fellows have dedicated themselves to developing treatments and becoming a proven resource for our military service members and their families. We are profoundly aware of the sacrifices and courage that has been asked of our veterans.
That is why today, and every day, The Meadows works hard to extend our deepest gratitude and appreciation to everyone who has given so much on our behalf.
To all of the Veterans, “Thank You.”