The Science of PTSD
You don’t have to fight it alone – therapy really does help
By Mary Tendall, VietNow National PTSD Chairperson
This is a follow-up to my article, “Looking at the Triune Brain and Understanding Its Role in PTSD,” which appeared in the Fall 2016 issue of this magazine.
When seeking treatment, whether through the VA (Veterans Administration) or with a private practitioner, it’s vital that you feel safe with the therapist, and that the office is set up so that you are at ease. (Of course “safe” and “at ease” have different meaning for different people.) You may have questions such as: Has the therapist ever been in a combat zone? Does the therapist have experience treating combat veterans? Does the therapist have a problem hearing about violence?
Asking these questions isn’t absolutely necessary, but it’s important to realize that the therapist is there to work for you, listen to you, and work toward your goals. Those goals differ with each individual, and may be as simple as wanting to learn to trust again, get rid of a nightmare, decrease anger, honor your partner’s request that you get some help – or yes, even to get documentation and validation of a PTSD diagnosis for your claim. I’m just mentioning common incentives for treatment, and you will have incentives of your own. You are in charge of your treatment.
There are many forms of helpful treatment. The VA institutions have sometimes found that group therapy with other veterans has been more effective than individual treatment. This is based on feedback from veterans. With a well-trained group leader, group therapy can offer an opportunity to feel a sense of belonging in a supportive atmosphere, and knowing that others are aware of the unspoken challenges faced on a daily basis. Group therapy offers the opportunity to be attuned to others, and even the chance to offer support and possible solutions to other members of the group. There should be a feeling of “no judgment” in a place where experiences can be revealed honestly in ways that are not possible with family and friends. Many groups form a type of “tribe sense” that exists outside the VA, and offers socializing that may have been previously almost non-existent.
The VA institutions have sometimes found that group therapy with other veterans has been more effective than individual treatment.
When I ended my contract with the VA many years ago, the group continued on its own, using the same check-in as before. And to this day, they are still meeting, their partners are supporting each other, and one wife just headed up the latest stand down in the area. Many important and lasting friendships have formed as a result of group therapy.
There are too many variations of individual therapy to mention here, but you should know that finding a facility that can work with you on at least a weekly basis at first is important. Finding this is difficult at many VA clinics and hospitals, but many vet centers do have this kind of availability.
Also, it’s essential that you and the therapist are a good match, and that the therapist is able to remain attuned to you during your sessions. Most VA therapists are not specialized in treating war-related trauma, because training in what should be a specialization is very rare. But a good and attuned therapist can offer a significant healing impact for veterans dealing with the difficult and complex issues that often follow deployment in a war zone. It’s important to be able to disclose to the therapist things that you do not want your family to hear. Telling your story is part of the therapy.
It’s essential that you and the therapist are a good match, and that the therapist is able to remain attuned to you during your sessions.
Some veterans have said that talk-therapy methods such as cognitive behavioral therapy have been enough to help them become stable enough to become less reactive. Rory* said, “I did two years of talk-therapy, and my wife and I are doing better, and I can curb my anger. I don’t want to take it further than that, and I am satisfied.” Who is to question Rory on this, since both he and his wife have worked hard to be in a better place? I respect his decision.
Although Rory and others have experienced benefits such as improved understanding of their thoughts, feelings, and actions from talking with a therapist, without neuro-somatic (brain-body) therapeutic modalities, the mid-brain will continue to disregulate (react) without specific therapies that address the regulation within the triune brain. (See “Looking at the Triune Brain and Understanding Its Role in PTSD,” which appeared in the Fall 2016 issue of VietNow.)
Twenty years ago, Clark had a cognitive idea of why and how his perceptions and emotions could take over, but he was unable to curb his reactivity. He was also experiencing severe pain in his shoulder, even though x-rays and other scans showed nothing wrong. Clark and I began a neuro-somatic modality called EMDR (Eye Movement Desensitization and Reprocessing), in order to explore, treat, and regulate his mid-brain. There was not a lot of talking during these sessions, but a great deal of emphasis was focused on his physical response. Clark quickly remembered his Vietnam experience, and noticed that his shoulder was in great pain due to his memory as a helicopter pilot. He remained focused on the experience using a modality that included bilateral stimulation in his ears, and at the end of the session the pain in his shoulder was gone for the first time since he could remember.
This veteran’s shoulder pain was directly related to an unresolved experience. We did many more sessions regarding his feelings of safety, and after nearly a year of this kind of work he said, “My wife said she got me back. And I feel like I think differently as well as feel like a human again.” Talk therapy would never have reached that level of healing.
I also use brainspotting as a powerful modality in my practice. Milt was a Ranger in Panama, and reported frequent nightmares. The dreams involved a specific incident when he was dropped out of a plane and landed in the wrong spot. He was in direct danger from those surrounding him, and it was a real challenge for him to finally find himself at the landing strip where he was safe. After two brainspotting sessions, he reported that the nightmare was finally gone. Brainspotting works with the part of the nervous system that is involuntary until interrupted. Other problems related to his combat duty have also been resolved, and his brain no longer goes into “combat mode” as it did before. Milt says, “I look at that experience as a chapter in my life rather than something I have to try to stuff after talking to my fellow rangers on the Internet.” I have found brainspotting to be extremely effective in reprocessing the disregulation in the survival areas of the brain.
Available neuro-somatic modalities for trauma
Brainspotting, EMDR, Sensorimotor Psychotherapy, and Somatic Experiencing. You can look up descriptions of each of these online. It’s best if you can have both individual and group therapy.
Equine therapy Trained equine therapists work with the attunement of a horse and a veteran. This can be a very powerful and healing experience. John had experienced multiple deployments in Iraq – and he and his wife were struggling, and she asked me what could be done. He refused to do traditional therapy, but I met with them for coffee, and John agreed to do an equine-therapy session with a friend of mine who is a licensed therapist and a trained equine specialist. I was allowed to watch the session as John and his wife were told to let the horses choose them. When a beautiful horse walked over to him, John felt an immediate connection, and began grooming the horse – but after about ten minutes the horse turned away and went to an area where people were not allowed. At first John was startled and hurt, but then looked at us and said, “I do that to my wife all the time.” (He was referring to the fact that he often walked away from his wife when she wanted connection.) The horse soon returned to John, and allowed him to interact with it.
I saw a tenderness in John that I had never seen before. Much more happened in that session, and I can say that the horse’s intuitive connection with John allowed for a turning point in the couple’s relationship.
Yoga Research shows that the practice of yoga has done a lot to offer a sense of safety and acceptance, as well as improved regulation in the mid-brain. Bilateral stimulation of the body, along with a soothing environment contribute to a sense of well-being. You could call it an integration of the mind, body, and spirit.
Acupuncture May help relieve symptoms of physical and emotional stress.
Neuro-feedback Can teach helpful self-regulation and understanding of the body under stress.
Expressive arts Music (listening and performing), visual arts, dancing, drama, etc.
Team sports Physical activity along with camaraderie can add a sense of teamwork.
Veteran retreats Retreats such as Soldier’s Heart (yes, that’s a plug) and others are designed to create a welcoming and therapeutic environment. Many veterans speak of breakthroughs following their experiences in a retreat setting.
Nature Hiking, fishing, or just sitting. Nature is therapeutic for us all.
Service to other veterans Driving, listening, taking on errands, and helping other veterans in your community can help.
You are invited to contact Mary Tendall with comments and/or questions regarding PTSD. Her e-mail address is email@example.com.
*The names of any veterans and/or family members mentioned in this article have been changed for privacy reasons.
Mary Tendall, MA, LMFT, serves as the VietNow National PTSD Chairperson. She has worked for over 20 years with combat veterans and their families, specializing in PTSD. She also works with groups such as Soldier’s Heart, Train Down, and America’s Heroes.