PTSD in Military Veterans
Symptoms, Treatment, and the Road to Recovery for Post-Traumatic Stress DisorderIn This Article
Are you having a hard time readjusting to life outside the military? Are you always on edge, always on the verge of panicking or exploding, or, on the flip side, do you feel emotionally numb and disconnected from your loved ones? Do you believe that you’ll never feel normal again? For all too many veterans, these are common experiences—lingering symptoms of post-traumatic stress disorder (PTSD). It’s hard living with untreated PTSD and, with long V.A. wait times, it’s easy to get discouraged. But you can feel better, and you can start today, even while you’re waiting for professional treatment. There are things you can do to help yourself overcome PTSD and come out the other side even stronger than before.
What is PTSD?
Post-traumatic stress disorder (PTSD), sometimes known as shell shock or combat stress, occurs after experiencing severe trauma or a life-threatening event. It’s normal for the mind and body to be in shock after such an event, but this normal response becomes PTSD when your nervous system gets “stuck.”
The latest research into the brain shows that there are three ways of regulating the nervous system and responding to stressful events:
- Social engagement is the most evolved strategy for keeping yourself feeling calm and safe. Socially interacting with another person—making eye contact, listening in an attentive way, talking—can quickly calm you down and put the brakes on defensive responses like “fight-or-flight.”
- Mobilization, otherwise known as the fight-or-flight response, occurs when social engagement isn’t an appropriate response—such as in a combat situation—and you need to either defend yourself or escape the danger at hand. Your heart pounds faster, muscles tighten, blood pressure rises, breath quickens, and your senses become sharper. These physical changes increase your strength and stamina, speed your reaction time, and enhance your focus. Once the danger has passed, your nervous system then calms the body, slowing heart rate, lowering blood pressure, and winding back down to its normal balance.
- Immobilization. Immobilization occurs when you’ve experienced a traumatic amount of stress—in combat, for example. The physical danger of war has passed but you find yourself “stuck,” your nervous system unable to return to its pre-stress state of balance. This is PTSD.
Who is affected by PTSD?
Many military veterans develop symptoms of PTSD. In fact, military service is the most common cause of PTSD in men. Close to 30 percent of Afghanistan and Iraq War veterans treated at V.A. hospitals and clinics have been diagnosed with PTSD. For veterans who saw combat, the numbers are even higher, up to 49%.
The more tours you made and the more combat you experienced, the more likely it is that you’ll develop PTSD. But however isolated or emotionally cut off from others you feel, it’s important to know that you’re not alone and there are things you can do to help yourself.
What are the symptoms of PTSD in veterans?
Symptoms sometimes don’t surface for months or even years after returning from deployment. While PTSD develops differently from veteran to veteran, there are four symptom clusters:
- Recurrent, intrusive reminders of the traumatic event, including distressing thoughts, nightmares, and flashbacks where you feel like it’s happening again. Experiencing extreme emotional and physical reactions to reminders of the trauma (panic attacks, uncontrollable shaking, heart palpitations, etc.).
- Extreme avoidance of things that remind you of the traumatic event, including people, places, people, thoughts, or situations you associate with the bad memories. Withdrawing from friends and family and losing interest in everyday activities.
- Negative changes in thoughts and mood, such as exaggerated negative beliefs about yourself or the world and persistent feelings of fear, guilt, or shame. Diminished ability to experience positive emotions and feeling detached from others.
- Being on guard all the time, jumpy, and emotionally reactive, as indicated by irritability, angry outbursts, reckless behavior, difficulty sleeping, trouble concentrating, hypervigilance, and an exaggerated start response.
Suicide Prevention in Veterans with PTSD
Suicidal thoughts and feelings are common symptoms of PTSD among military veterans. Feeling suicidal is not a character defect, and it doesn't mean that you are crazy, weak, or flawed.
If you are thinking about taking your own life, seek help immediately. Please read Suicide Help, talk to someone you trust, or call a suicide helpline:
- In the U.S., call 1-800-273-TALK (8255).
- In the UK, call 08457 90 90 90.
- In Australia, call 13 11 14.
- Or visit IASP to find a helpline in your country.
Self-help for PTSD in veterans
While it’s common for veterans with PTSD to have to endure long waits for treatment at the V.A., there are plenty of things you can do for yourself to start feeling better.
The job of recovery is to transition out of the mental and emotional war zone you’re still living in and help your nervous system return to its pre-war state of balance. As discussed above, the best way to regulate your nervous system is through social engagement—interacting with another human being, be it a loved one, a family member or a professional therapist. However, as a veteran with PTSD, you need to first become “unstuck” and move out of the immobilization stress response.
With these recovery steps, you’ll learn how to deal with your combat stress and also learn skills that can benefit the rest of your post-war life. You’ll learn how to feel calm again, reconnect with others, deal with nightmares and flashbacks, cope with feelings of depression, anxiety, or guilt, and restore your sense of control. And when you do get to see a doctor or therapist at the V.A., you’ll be in a better position to benefit from professional treatment as well.
The road to PTSD recovery step 1: Get moving
Getting regular exercise has always been important for veterans with PTSD. As well as helping to burn off adrenaline, exercise can release endorphins and make you feel better, both mentally and physically. However, new research suggests that by really focusing on your body and how it feels as you exercise, you can actually help your nervous system become “unstuck” and move out of the immobilization stress response.
Any exercise that engages both your arms and legs—such as running, swimming, basketball, or even dancing—will work well if, instead of continuing to focus on your thoughts as you exercise, you focus on how your body feels instead. Try to notice the sensation of your feet hitting the ground, for example, or the rhythm of your breathing, or the feeling of the wind on your skin. Many veterans find rock climbing, boxing, or martial arts especially effective as these activities make it easier to focus on your body movements—after all, if you don’t, you could get seriously hurt.
The benefits of the great outdoors
Spending time in nature and pursuing outdoor activities like hiking, camping, mountain biking, rock climbing, whitewater rafting, and skiing can help challenge your sense of vulnerability, help your nervous system become “unstuck,” and help you transition back into civilian life.
Seek out local organizations that offer outdoor recreation or teambuilding opportunities or, in the U.S., check out Sierra Club Military Outdoors. This program provides service members, veterans, and their families with opportunities to get out into nature and get moving.
The road to PTSD recovery step 2: Connect with others
Social interaction with someone who cares about you is an effective way to calm your nervous system. For any veteran with PTSD, it’s important to find someone you can connect with face to face—someone you can talk to for an uninterrupted period of time, someone who will listen to you without judging, criticizing, or continually being distracted by the phone or other people. That person may be your significant other, a family member, one of your buddies from the service, or a civilian friend.
You may feel like the civilians in your life can’t understand you since they don't know what it's like to be in the military or to have seen the things you have. But people don't have to have gone through the exact same experiences to understand and relate to painful emotions and be able to offer support. What matters is that the person you're turning to cares about you, is a good listener, and is able to be there for you as a source of strength and comfort.
- If you're not ready to open up about the details of what happened, that's perfectly okay. You can talk about how you feel without going into a blow-by-blow account of events.
- You can also tell the other person what you need or what they can do to help, whether it's just sitting with you, listening, or doing something practical. Comfort comes from someone else understanding your emotional experience. You’ll also find that people who care about you welcome the opportunity to help. Listening is not a burden for them but an opportunity.
How PTSD can get in the way of connecting with others
Many veterans find that PTSD can leave them feeling disconnected, withdrawn and, while their nervous system is still stuck, make it tough to connect with other people. No matter how close they are to the person, or how helpful that person tries to be, they just don’t feel any better after talking with them. If that describes you, there are some things you can do to help the process along.
- Before you’re due to sit down with a friend over a beer or coffee, for example, take some time to exercise, as described in step 1 above. As well as calming you when you’re feeling anxious, irritable or on edge, physical movement can also open your nervous system’s pathway to social engagement. Think of it as shaking loose all the blockages to connecting with people.
- If working out isn’t practical, find a quiet place and take a few minutes before you meet your friend to move around, jump up and down, swing your arms and legs—in other words, flail around like you did as a three year old. A few minutes of that and you’ll be breathing heavily, your head will feel clearer, and you’ll be in a better place to connect.
- It may sound weird, but vocal toning is also a great way to open up your nervous system to social engagement—even if you can’t sing or consider yourself “tone-deaf.” Again, find a quiet place before hooking up with a buddy and, with your lips together and teeth slightly apart, simply make “mmmm” sounds. Change the pitch and volume until you experience a pleasant vibration in your face. Practice for a few minutes and notice if the vibration spreads to your heart and stomach as well.
Other ways to connect with others
- Many veterans find it helpful to join a PTSD support group or to connect with other veterans or trauma survivors. Listening to others' stories and struggles may help you feel less isolated.
- You can also volunteer in the community, which can help you feel more connected and useful, especially if you’re not currently working.
A powerful program for reconnecting to your feelings
There are many ways for you to start reconnecting to your feelings, including increasing your contact with other people and working through the trauma in therapy. Helpguide also offers a free, online program that teaches you how to reconnect to uncomfortable or disturbing emotions without becoming overwhelmed. Over time, it can make a huge difference in your ability to manage stress, balance your moods and emotions, and take back control of your life.
The road to PTSD recovery step 3: More ways to calm your nervous system
Just as loud noises, certain smells, or the feel of sand in your clothes can instantly transport you back to the trauma of a combat zone, so too can sights, sounds, smells, and other sensory input quickly calm you down. The key is to find the sensory input that works for you.
Think back to your time on deployment: what brought you comfort at the end of the day? Perhaps it was looking at photos of your family? Or maybe it was the taste of candy in a care package from home, or listening to a favorite song, or smelling a certain brand of soap or cologne? Or maybe petting an animal works quickly to make you feel calm and centered?
Everyone responds to sensory input a little differently, so experiment to find what works best for you.
For more ways to quickly calm yourself, see Stress Relief in the Moment.
The road to PTSD recovery step 4: Take care of your body
The symptoms of PTSD can be hard on your body so it’s important to put a priority on sleep, exercise, healthy food, and relaxing activities.
You may find it very difficult to relax at first. It’s common for veterans to be drawn to behaviors that pump up adrenaline. After being in a combat zone, that’s what feels normal. Without the rush, you feel strange or even dead inside. Things you may turn to for that familiar adrenaline rush include energy drinks, coffee, drugs, cigarettes, violent video games, and daredevil sports. If you recognize these urges for what they are, you can make better choices that will calm and care for your body and mind.
Healthy habits for veterans with PTSD
Here are some active steps you can take to improve your PTSD symptoms:
- Take time to rest and restore your body’s balance. Relaxation techniques such as massage, meditation, yoga, and tai chi are powerful defensive weapons against the symptoms of PTSD.
- Avoid alcohol and drugs (including nicotine). It can be tempting to turn to drugs and alcohol to numb painful feelings and memories and get to sleep. But substance abuse can make the symptoms of PTSD worse and compound your problems. The same goes for cigarettes.
- Find safe ways to blow off steam. Pound on a punching bag, pummel a pillow, go for a hard run, sing along to loud music, head to the gym for a vigorous workout, go somewhere private where you can scream at the top of your lungs, or vent in your journal or to someone you trust.
- Support your body with a healthy diet. Eat plenty of complex carbohydrates, such as potatoes and whole grains, to support mental clarity and physical stamina. Limit processed sugars, which can exacerbate mood swings and energy fluctuations.
- Get plenty of sleep. Sleep deprivation exacerbates anger, irritability, and moodiness. Aim for somewhere between 7 to 9 hours of sleep each night. Develop a relaxing bedtime ritual (listen to calming music, watch a funny show, or read something light) and make your bedroom as soothing as possible. Use curtains to block outside light and if noise is a problem, try using a sound machine.
The road to PTSD recovery step 5: Deal with flashbacks, nightmares, and intrusive thoughts
Flashbacks usually involve visual and auditory memories of combat or other trauma you experienced. It feels as if it’s happening all over again so it’s vital for you to accept and reassure yourself that your traumatic experience is not occurring in the present.
One effective technique is to state to yourself (either out loud or in your head) the reality that while you feel as if the trauma is currently happening, you can look around and recognize that you’re safe. Here’s a simple script you can use when you awaken from a nightmare or start to experience a flashback or intrusive thought:
“I am feeling [panicked, overwhelmed, etc.] because I am remembering [traumatic event], but as I look around I can see that the event isn’t happening right now and I’m not actually in danger.”
Other techniques that can be helpful in bringing you back to the present include tapping your arms or describing what you see when look around (name the place where you are, the current date, and three things you see when you look around).
|Tips for grounding yourself during a flashback|
If you’re starting to disassociate or experience a flashback, try using your senses to bring you back to the present and "ground" yourself. Experiment to find what works best for you.
Move around vigorously (run in place, jump up and down, etc.); rub your hands together; shake your head
Splash cold water on your face; grip a piece of ice; touch or grab on to a safe object; pinch yourself; play with worry beads or a stress ball
Blink rapidly and firmly; look around and take inventory of what you see
Turn on loud music; clap your hands or stomp your feet; talk to yourself (tell yourself you’re safe, that you’ll be okay)
Smell something that links you to the present (coffee, mouthwash, your wife’s perfume) or a scent that has good memories
Suck on a strong mint or chew a piece of gum; bite into something tart or spicy; drink a glass of cold water or juice
The road to PTSD recovery step 6: Work through survivor's guilt
Feelings of guilt are very common among veterans with PTSD. You may have seen people injured or killed, often your friends and comrades. You may ask yourself questions such as:
- Why didn’t I get hurt?
- Why did I survive when others didn’t?
- Could I have done something differently to save them?
You may end up blaming yourself for what happened and believing that your actions (or inability to act) led to someone else’s death. You may feel like others deserved to live more than you—that you’re the one who should have died. This is survivor’s guilt.
Healing from survivor's guilt
Healing doesn’t mean that you’ll forget what happened or those who died. And it doesn’t mean you’ll have no regrets. What it does mean is that you’ll look at your role more realistically. Remember, you are only human.
The following questions can help you “reality test” your guilty feelings:
- Is the amount of responsibility you’re assuming reasonable?
- Could you really have prevented or stopped what happened?
- Could you really have reacted differently?
- Are you judging your decisions based on full information about the event, or just your emotions?
- Did you do your best at the time, under challenging circumstances?
- Do you truly believe that if you had died, someone else would have survived?
Honestly assessing your responsibility and role can free you to move on and grieve your losses. Instead of punishing yourself, you can redirect your energy into honoring those you lost and finding ways to keep their memory alive. And in those cases where you truly believe you did something wrong, you can make amends. Even when you can’t make amends directly, there is always something you can do (such as volunteering for a cause that’s connected in some way to one of the friends you lost). The goal is to put your guilt to positive use, and thus transform tragedy, even in a small way, into something good.
The road to PTSD recovery step 7: Seek professional treatment
Under the guidance of an experienced therapist or doctor, there are several different types of professional treatment for PTSD available.
- Cognitive-behavioral therapy or “counselling” involves carefully and gradually “exposing” yourself to thoughts and feelings that remind you of the event. Therapy also involves identifying distorted and irrational thoughts about the event—and replacing them with more balanced picture.
- Medication, such as antidepressants, is sometimes prescribed to people with PTSD to relieve secondary symptoms of depression or anxiety. While antidepressants may help you feel less sad, worried, or on edge, they do not treat the causes of PTSD.
- EMDR (Eye Movement Desensitization and Reprocessing) incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. These work by helping the nervous system become “unstuck.”
More help for PTSD in veterans
- Emotional and Psychological Trauma: Symptoms, Treatment, and Recovery
- PTSD in the Family: Helping a Loved One or Family Member with Post-Traumatic Stress Disorder
- Traumatic Stress: How to Recover From Disasters and Other Traumatic Events
- Post-Traumatic Stress Disorder (PTSD): Symptoms, Treatment and Self-Help for PTSD
- Coping with Grief and Loss: Understanding the Grieving Process
PTSD and trauma
- Depression Symptoms and Warning Signs: How to Recognize Depression Symptoms and Get Effective Help
- Anger Management: Tips and Techniques for Getting Anger Under Control
- Alcoholism and Alcohol Abuse: Signs, Symptoms, and Help for Drinking Problems
- Overcoming Drug Addiction: Drug or Substance Abuse Treatment, Recovery, and Help
Resources and references
Help for veterans with PTSD and their family members in the U.S.
PTSD Program Locator – Find specialized VA PTSD treatment programs near you. (U.S. Department of Veterans Affairs)
Veteran Combat Call Center – A 24/7 hotline where you can talk with another combat veteran: 1-877-WAR-VETS (1-877-927-8387).
Help for Veterans with PTSD – Learn how to earn how to earn how to enroll for VA health care and get an assessment. (National Center for PTSD)
24/7 Outreach Center for Psychological Health & Traumatic Brain Injury – Get help for traumatic brain injury and other psychological health issues. Call 1-866-966-1020 or connect through chat or email. (DoD's Defense Centers of Excellence)
Military OneSource – Call 1-800-342-9647 for confidential counseling, non-medical services, and other resources for veterans and their family members. The line is open 24/7.
Vet Centers – If you are a combat veteran or you experienced sexual trauma during your military service, you can speak with a therapist at your local Vet Center for free, without an appointment, and regardless of your enrollment status with VA. Just bring your DD214.
Help for veterans with PTSD in other countries
Canadian veterans: visit Operational Stress Injury Social Support (OSISS) or call 1-800-883-6094 to talk to a peer who has been through similar experiences.
UK veterans: visit Combat Stress or call the 24-hour helpline 0800 138 1619.
Australian veterans: visit Veterans and Veterans Families Counselling Service (VVCS) or call 1800 011 046.
General PTSD resources for veterans
National Center for PTSD – A comprehensive, helpful resource for veterans with PTSD and their family members, from the U.S. Department of Veterans Affairs.
About Face – A website dedicated to improving the lives of veterans with PTSD. Learn about PTSD, hear real stories from other veterans, and get advice from experienced clinicians.
Make the Connection – Learn about PTSD in veterans and other related issues. Includes honest and candid descriptions from veterans about their experiences.
PTSD treatments and recovery for veterans
What Can I Do if I Think I Have PTSD? – Outlines the steps you can take if you think you may have PTSD, as well as the reasons to seek treatment early. (U.S. Department of Veterans Affairs)
Understanding PTSD Treatment (PDF) – Explore proven treatment and therapy options for PTSD, hear success stories, and debunk common treatment myths. (National Center for PTSD)
Dogs and PTSD – Learn more about service dogs and how they can help you manage PTSD symptoms and boost your emotional well-being. (National Center for PTSD)
Mindfulness and meditation training could ease PTSD symptoms, researchers say – Research shows that mindfulness meditation can help vets with PTSD. (The Washington Post)
Post-Traumatic Stress’s Surprisingly Positive Flip Side – This article explores the positive growth and resilience that can come as you work through PTSD. (The New York Times Magazine)
What other readers are saying
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