VietNow National Magazine

Can PTSD be healed, or is therapy just a band-aid, something that will simply help me cope? For decades combat veterans seeking treatment to reduce their combat-related symptoms of post traumatic stress disorder (PTSD), have asked that question. Often, healthcare providers respond with something like, “You’ll just have to learn to cope with it. You will have these symptoms for the rest of your life.” Today, however, as a result of current brain research, the prognosis is positive, and many veterans experience a profound release of their symptoms.

The most common treatment modalities for PTSD are cognitive therapy and veterans’ support groups. Cognitive therapy (sometimes called cognitive behavioral therapy) is based on the concept that the way we think about things affects how we feel emotionally. It focuses on present thinking, behavior, and communication, rather than on past experiences, and is oriented toward problem solving. Often used to treat a broad range of problems including depression, anxiety, panic, fears, eating disorders, substance abuse, and PTSD, cognitive therapy can help veterans understand their symptoms, decrease their reactivity, and learn coping skills.

Group therapy (or a veterans’ support group), offers camaraderie and an opportunity to openly share locked-up experiences with other veterans who truly understand and listen without judgment. The groups also validate the fact that symptomatic behavior – exaggerated startle response, nightmares, trust issues, emotional numbness, irritability, isolation, avoidance of crowds, and avoidance of social events – is a normal response to the untreated trauma caused by the combat experience. During confidential group sessions, domestic and other unresolved issues can be discussed without guilt or shame. For many veterans, listening to “brothers” in the group is the first time they have created an authentic kinship since combat. Statistics gathered by the United States Department of Veterans Affairs (VA) suggest that when compared to traditional talk therapy, veterans’ support groups are more effective. However, when the possibility of joining a vets’ support group is first discussed with a combat veteran, the response is almost always negative. An explanation that generally helps veterans be more receptive is hearing another veteran say, “We are a group of men who would never be caught dead joining a support group.”

New Treatments Bring Hope

Although cognitive and group therapy are important for the healing process, it is a neurological approach that retrains the nervous system to release unnecessary combat-ready reactivity that has proved to be the most effective treatment modality. This type of treatment goes well beyond “learning to cope,” and actually allows the elimination of symptoms, which are a result of a “misfiring” of the nervous system that occurs when the brain stem picks up certain sensory information and misinterprets it as danger. This misinterpretation causes the physical and emotional reactivity that results in the PTSD symptoms mentioned above. (See sidebar: New Therapies and the Brain).

Eye Movement Desensitization and Reprocessing (EMDR), a therapy founded by Diane Shapiro, uses cognitive treatment and imagery to create resolution for intruding silent statements such as, “I’m not safe,” or “Don’t trust anyone!” EMDR is a complex process involving eight treatment phases, and requires an experienced licensed clinician specifically trained in this area. More information about EMDR – including a list of clinicians – is available on the Internet at www.emdr.com.

Another treatment that works successfully with the nervous system following trauma is Somatic Experiencing. Created by Peter Levine, this treatment uses relaxation, breathing techniques, and imagery to create resolution within the nervous system. By using these techniques, veterans can learn to cope with stress, and bring resolution to their combat experience. More and more institutions and private therapists are making use of these and similar techniques to actually end the symptoms of trauma. Treatment takes time. But the time it takes to actually heal this trauma is very short compared to how long it has been going on.

One Story

Seeking treatment is a very big decision for many veterans. At his first session, “Paul” (name has been changed) said that his wife gave him an ultimatum – either seek treatment, or consider separation. After 26 years of marriage, Paul opted for treatment. He stated that his wife had problems with his loud voice and thought he was always yelling. “She just doesn’t understand that I have a loud voice. If I was really yelling, she’d know it!” Paul spent many years creating a rationale for his symptoms, but during the therapeutic process he discovered that many of his behaviors were related to his untreated combat experience.

This unexpected insight motivated him to make positive changes in his life. Paul learned to modify his language by omitting such combat terms as sabotage, mission, breaking my perimeter, and kill. He also learned to recognize the physical symptoms he felt in his body – sweaty palms, tight gut, rapid heart rate, neck tension, shallow breathing – when he was triggered. When he eventually discovered how to de-trigger the physical reactions, Paul was able to think more clearly, make better decisions, and deal with issues more effectively. By using de-triggering techniques to calm his nervous system and stop the flow of adrenaline, Paul was able to monitor and decrease his reactivity within minutes. Each week Paul showed progress, and it wasn’t long before he was ready to do deeper trauma-release work.

An additional benefit of therapy was the complete elimination of the nightmares that used to plague Paul’s sleep. Paul’s wife now says that they are enjoying their time together, and for the first time in years they talk about a variety of subjects without getting into a debate. With his unnecessary defenses down, Paul and his wife have learned to listen to each other – and while both admit there are still many hurdles to overcome in their relationship, they now look forward to sharing the future together. Paul’s wife also realized that she is able to let go of her past defenses, which also contributed to their long and tedious disagreements.

Paul’s story is not unique – however each veteran will have a threshold for the depth of treatment he or she is willing to undergo, and that threshold or tolerance must be respected. For some, learning how to communicate and manage anger is as much as they are willing to do. Others, especially those who have a therapist they trust, will stay in therapy longer and accomplish much more.

Choosing a Therapist

In choosing a therapist, it is always a good idea to ask whether the therapist has training in the area of combat trauma, and what type of therapeutic approach the clinician intends to use. This article can serve as a catalyst for that type of discussion. One place to start the search for a therapist is at a Veterans Assistance Center. Veterans Assistance Centers, Veterans Hospitals, and satellite clinics are located across the country. (If you request treatment, be sure that you can be seen at least two to four times a month in the beginning).

Keep in mind that several factors determine the degree of success that is experienced from the therapeutic process. These include the veteran’s determination to create changes in the way he or she copes with stressful triggers, willingness to trust the therapeutic process (which can be a challenge, especially after one or two unsuccessful experiences), and life experiences following combat. For some, there is much regret regarding relationships and lifestyle choices. Early background, current support and family system, and the specific experiences from combat are also factors that influence the outcome of therapy. The skill level of the therapist is also essential. (It’s a good idea to ask the therapist questions regarding training and experience before treatment begins so that you feel confident about his or her abilities.)

Note: Names and some situations in this article have been changed.

Mary Tendall has worked for almost 14 years with combat veterans as a licensed marriage and family counselor, specializing in PTSD.

Jan Fishler is a freelance writer, trainer, and video producer who is married to a Vietnam veteran.

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