Tag Archives: PTSD

Understanding PTSD as we Honor Veterans

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Saturday, November 11 is Veteran’s Day. As we pause in our busy schedules to thank those who have served our country, we must remember that many returning from deployment come back suffering from Post-Traumatic Stress Disorder or PTSD. Let’s take a few moments to review our understanding of this often devastating condition. The following information was excerpted from Veterans: Surviving and Thriving after Trauma by Ester R.A. Leutenberg & Carol Butler, MS Ed, RN, C.

Flickr - DVIDSHUB - Marines march in 2011 New York Veterans Day Parade (Image 1 of 10)

By DVIDSHUB [CC BY 2.0], via Wikimedia Commons

Exposure to combat, witnessing death and destruction, and other trauma can lead to common reactions that resolve soon. When reactions persist over time they become PTSD symptoms. Many veterans have an array of post-traumatic stress symptoms. These symptoms may not rise to the level of a formal diagnosis. Nevertheless, they may significantly hinder the joy and quality of daily living and need to be addressed. They can include:

  • Anxiety, the fight or flight reaction, freezing with fear, being jumpy and watchful
  • Sadness or depression, crying, lack of interest or enjoyment, self-isolation, fatigue
  • Guilt and shame: The serviceperson feels they could have done more; they feel guilty because they survived when others did not
  • Irritable and angry about being treated unfairly, low levels of patience, overreacting
  • Behavior changes, increased substance use, reckless driving, self-neglect

Symptoms of PTSD for the person who experienced or witnessed an event involving actual or threatened death or serious injury and responded with intense fear, helplessness or horror, include the following:

  • Re-experiencing or reliving the event with the same terror, images, thoughts, perceptions; dissociative flashbacks, nightmares, illusions, hallucinations
  • Intense psychological distress reaction to triggers which are internal or external cues that resemble an aspect of the trauma
  • Avoiding reminders – people, places, things such as crowds, cars if their convoy was attacked, fireworks, keeping too busy, and not addressing related thoughts and feelings, and not talking about traumatic experiences
  • Numbness, feeling shut-down, detached or estranged from others, not feeling affection or joy, inability to recall aspects of the trauma, diminished interest in formerly significant activities, harboring a sense of foreshortened future, not expecting a normal life-span
  • Hyper-arousal, easily startled, poor sleep patterns; irritability or anger outbursts, hyper-vigilance, (on guard)
  • Feeling lost, alone, distrustful, awkward, and afraid most of the time

Veterans are at greater risk if they had earlier trauma such as child abuse, mental illness, a family history of emotional problems, poor support system, limited education, or other recent life changes.

PTSD often leads to self-medicating through substance abuse, employment and relationship problems, hopelessness, depression, despair, shame, aggression and suicidal ideation.

People may not seek help due to the perceived stigma of mental illness, long waits for treatment, denial, or cultural factors such as being stoic versus false a perception of weakness if asking for help.

When family members suggest getting help veterans are urged to follow through to respect their loved one’s concerns.

Denial is a common response yet tough people suffer symptoms, not always combat-related. Victims of abuse, accidents, and natural disasters are at also at risk.

Physical reactions may involve chronic pain, heart palpitations, trouble breathing, profuse perspiring, stomach upsets, and other bodily reactions to anything that reminds the person of the stressful military experience.

How do we open a discussion with a Veteran about the possibility that they may be experiencing PTSD? The following are tips from the U.S. Department of Veterans Affairs, and were retrieved on Nov. 7 from https://www.mirecc.va.gov/coaching/tips-for-family-friends.asp.

  • Be respectful and calm during conversations.
  • Be patient ‒ it usually takes more than one conversation before most people accept the idea of seeking care.
  • Don’t argue or attempt to talk a Veteran out of their feelings, thoughts, and/or emotions
  • Allow the Veteran in your life to decide whether or not they want to talk about what they have experienced or what they are currently dealing with. If they don’t, that’s okay. Let them know the door is always open and you’re willing to listenwithout offering advice or suggestions.
  • Do not take the Veteran’s social withdrawal or isolation personally. Be willing to invite them and accept that they may not want to participate. Let them know they are welcome to change their mind.
  • Avoid giving advice unless the Veteran specifically asks for it.
  • Minimize distraction during conversations with the Veteran by turning off phones, TV, radio, etc. Be willing to limit conversations to 10 to 20 minutes at a time, if necessary. Think small steps.
Joseph Ambrose, an 86-year-old World War I veteran, attends the dedication day parade for the Vietnam Veterans Memorial. He is holding the flag that covered the casket of his son, who was killed in the Korean War.

Joseph Ambrose, an 86-year-old World War I veteran, attends the dedication day parade for the Vietnam Veterans Memorial. He is holding the flag that covered the casket of his son, who was killed in the Korean War.

Help your Veteran to feel more comfortable and be aware of potential triggers that may aggravate a Veteran’s heightened alertness, such as loud noises on TV, fireworks, a car back-firing, etc.

  • Remind yourself that it’s not about you. Be patient when a Veteran is struggling with feelings, emotions, stress, and so on.
  • Talk about your feelings and encourage the Veteran to share their feelings about what is going on without forcing the issue.
  • Validate the Veteran’s feelings if they are willing to share them by simply listening, rather than offering advice.
  • Try to build in some enjoyable activities with the Veteran in your life on a regular basis.
  • Encourage sticking to schedules and routines.
  • Don’t force a Veteran into social outings. If they agree to go, plan ahead in case they feel uncomfortable and want to leave.

The U. S. Department of Veterans Affairs also reminds caregivers to take care of themselves. You can’t help your Veteran if you are exhausted.

  • Engage in activities you enjoy that help you tolerate or decrease stress.
  • Educate yourself about mental health problems.
  • Consider getting your own counseling and mental health support.
  • Join a support group or talk to others who are struggling with similar issues.

Thank you to all of those who have served our country in the military: The Marines, Coast Guard, Army, Air Force, Navy, and National Guard. Whether a deployed soldier in Afghanistan or a helper in a flood in Texas or a fire fighter in the West, we owe our appreciation, support, and understanding.

Animal Assisted Therapy – How Animals Help Humans Heal

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Animal Assisted Therapy Works!

My dog at work

Those of us who own pets know they make us happy. But a growing body of scientific research is showing that our pets can also make us healthy, or healthier. Animal assisted therapy is gaining more impetus every day.

That helps explain the increasing use of animals — dogs and cats mostly, but also birds, fish and even horses — in settings ranging from hospitals and nursing homes to schools, jails and mental institutions.

What, exactly, is animal therapy? According to the Mayo Clinic,  “Animal assisted therapy is a broad term that includes animal assisted therapy and other animal assisted activities.” Animal assisted therapy can significantly reduce pain, anxiety, depression and fatigue in people with a range of health problems:

  • Children having dental procedures
  • People receiving cancer treatment
  • People in long-term care facilities
  • People hospitalized with chronic heart failure
  • Veterans with post-traumatic stress disorder

And it’s not only the ill person who reaps the benefits. Family members and friends who sit in on animal visits say they feel better, too. Animals also can be taught to reinforce rehabilitative behaviors in patients, such as throwing a ball or walking. (From Mayo Clinic Consumer Health Retrieved 2-10-2016 from http://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/pet-therapy/art-20046342?pg=2.)

Take Viola, or Vi for short. The NPR website tells us her story  in an article entitled “Pet Therapy: How Animals And Humans Heal Each Other” by Julie Rovner: (Julie is now with Kaiser Health News.)

The retired guide dog is the resident canine at the Children’s Innhttp://www.aubreyhfine.com/faithful-companion/ on the campus of the National Institutes of Health in Bethesda, Md. Families stay there when their children are undergoing experimental therapies at NIH.

Vi, a chunky yellow Labrador retriever with a perpetually wagging tail, greets families as they come downstairs in the morning and as they return from treatment in the afternoon. She can even be “checked out” for a walk around the bucolic NIH grounds.

Thelma Balmaceda, age, 4, [loves to] pet Viola, the resident canine at the Children’s Inn on the campus of the National Institutes of Health in Bethesda, Md. Families stay at the inn when their children are undergoing experimental therapies at NIH.

“There really isn’t a day when she (Vi) doesn’t brighten the spirits of a kid at the Inn. And an adult. And a staff member,” says Meredith Daly, the inn’s spokeswoman.

But Vi may well be doing more than just bringing smiles to the faces of stressed-out parents and children. Dogs like Vi have helped launch an entirely new field of medical research over the past three decades.

Aubrey Fine, a clinical psychologist and professor at California State Polytechnic University says that use of animals in medicine dates back to Egyptian times where dogs and serpents were often symbols of powerful healers.  “One could even look at Florence Nightingale recognizing that animals provided a level of social support in the institutional care of the mentally ill,” says Fine, who has written several books on the human-animal bond, including his latest  “Our Faithful Companions: Exploring the Essence of Our Kinship with Animals.”

But it was only in the late 1970s at a conference in Dundee, Scotland researchers started to uncover the scientific underpinnings for that bond. In a study published in October of 1988 authors Vormbrock and Grossberg reported “Results revealed that (a) subjects’ BP levels were lowest during dog petting, higher while talking to the dog, and highest while talking to the experimenter and (b) subjects’ heart rates were lower while talking or touching the dog and higher while both touching and talking to the dog.”

Rebecca Johnson, a nurse who heads the Research Center for Human/Animal Interaction at the University of Missouri College of Veterinary Medicine, explains that interaction with animals can increase our level of oxytocin, the renowned “feel good” hormone.

“That is very beneficial for us,” Johnson said. “Oxytocin helps us feel happy and trusting. Oxytocin has some powerful effects for us in the body’s ability to be in a state of readiness to heal, and also to grow new cells, so it predisposes us to an environment in our own bodies where we can be healthier.”

But Johnson says it may also have longer-term human health benefits. “Oxytocin has some powerful effects for us in the body’s ability to be in a state of readiness to heal, and also to grow new cells, so it predisposes us to an environment in our own bodies where we can be healthier.” From an article by Laurel Johnson to downloaded on Feb. 9, 2016 from http://psychcentral.com/blog/archives/2015/07/29/pets-as-therapy/.

Johnson is now working on a new project with likely benefits for dogs and humans. Military veterans returning from Iraq and Afghanistan are providing shelter dogs with basic obedience training.

And while it’s still early in the research, she says, one thing is pretty clear: “Helping the animals is helping the veterans to readjust to being at home.”

Animals act as therapists themselves or facilitate therapy — even when they’re not dogs or cats. For example, psychologist Fine, who works with troubled children, uses dogs in his practice — and also a cockatoo and even a bearded dragon named Tweedle.

“One of the things that we have always know is that the animals help a clinician go under the radar of a child’s consciousness, because the child is much more at ease and seems to be much more willing to reveal,” he says.

Horses have also become popular therapists for people with disabilities. “The beauty of the horse is that it can be therapeutic in so many different ways,” says Breeanna Bornhorst, executive director of the Northern Virginia Therapeutic Riding Program in Clifton, Va. “Some of our riders might benefit from the connection and the relationship-building with the horse and with their environment. Other riders maybe will benefit physically, from the movements, and build that core strength, and body awareness and muscle memory.”

Our veterans are coming home

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Our veterans* are coming home. We are called to help them heal.Welcome Them Home, Help Them Heal

The wars in Iraq and Afghanistan are not yet over, but our veterans are coming home.

  • Some have completed their military duty.
  • More will return to Iraq or Afghanistan for another tour.
  • 4,865 have died as of March 2009 and will not return home alive.
  • 32,000 have sustained war injuries, and 20,000 are
  • returning with Purple Hearts.
  •  500,000 carry within them deep, invisible, emotional wounds—unknowable to others, often unknown even to themselves.
  • Many have lived through life-altering spiritual trauma and will find the quest for peace and reconciliation more difficult than fighting the war.
  • Too many will commit suicide in the coming years—
  • probably more than the numbers killed in battle.
  •  All—yes ALL—returning service members will experience the challenge of re-entry as they leave the war zone behind and begin to put their lives back together.

*In this book we use veterans, service members, and soldiers as generic terms. We refer to specific branches (marines, reservists, etc.) only in relation to specific studies. To reflect the growing prominence of women in the military we have tried to strike a balance on the use of gendered pronouns.

When they come home, excitement is in the air! . . . at first.

Anyone who has seen a typical welcome home event understands the public expressions of joy and relief felt by family members. Young children sit on relatives’ shoulders to catch a first glimpse of their father or mother. Parents breathe a palpable sigh of relief when they see their son or daughter march onto the tarmac, armory, or gym floor. Prayers have been answered, and everyone anticipates that life together can begin once again. Over a few months and with hard work, many veterans and their family members do find a new “normal.”

Behind the jubilant homecoming celebrations, however, many returning veterans hide invisible wounds.

Upon returning home, many veterans face the biggest challenge of their lifetime and begin fighting a personal, hidden war in earnest. Often well concealed at first, for many the signs and symptoms of post-war trauma and stress—depression, anxiety, domestic problems, substance abuse, isolation, suicide, and homelessness— eventually appear. According to the U.S. Defense Department, of the 96,000 National Guard members and reservists who have completed health reassessments since October 2006, half have reported health problems unrelated to combat wounds.

Providing attentive care in the first few months after a veteran returns home is important for several reasons. First, early detection usually results in more effective treatment and better outcomes. Second, early treatment can prevent a cascade of interrelated problems stemming from unaddressed physical, emotional, and spiritual post-war trauma and distress. Loved ones, friends, and close work associates are often the first to notice emerging problems and also become the key people through whom difficulties are initially addressed.

America faces a crisis of care.

Service members and their families face deep spiritual crises not generally in public view. Sufficient resources have not been committed to help returning veterans recover from the traumas of war. To be sure, many good programs are already in place and actively serving returning veterans. Existing governmental programs, however, are stressed to the limit. Adequate numbers of programs, policies, and personnel are not available to meet current needs—and the largest surge of returning veterans has not yet peaked. America, having put forth its best to fight these wars, must now match that effort in helping our sons and daughters heal.

–Welcome Them Home, Help Them Heal, pp. 7-8