PTSD in veterans: you're not alone and you can get better
Are you a military veteran struggling with post-traumatic stress disorder (PTSD)? You’re not alone. In late 2012, the Department of Veterans Affairs released a report showing that since 9/11, 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, with one Pew Research Center report showing a 49% rate of PTSD.
The 4 PTSD 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.
We don’t know why some soldiers develop PTSD and others don’t, but we do know that the incidence goes up with the number of tours and the amount of combat you experienced. This isn’t suprising, considering many symptoms of PTSD—like hypervigilance, hyperawareness, and adrenaline-quick reflexes—helped you survive when you were deployed. It’s only now that you’re back home that these responses are inappropriate.
As a veteran with PTSD, the job of recovery is to transition out of the mental and emotional war zone you’re still living in. It won’t happen overnight, but if you take it day by day, you’ll soon see progress. And as you learn how to deal with your combat stress, you’ll also be learning skills that will translate into success in the rest of your life—tools you can use for much more than overcoming PTSD.
PTSD recovery for veterans: Tips for establishing safety
As a survivor of a war zone, you already know that the world can be a dangerous place at times. The problem with PTSD is that it makes you feel as if you’re still in danger, even when you’re not. And it isn’t necessarily just a sense of physical danger, but also of mental and emotional danger. You may feel like you can’t trust your own mind or that your feelings may hurt you or make you go crazy—even kill you. That’s why the first priority in dealing with PTSD is reestablishing safety. It’s a crucial step before facing any traumatic memories and emotional issues.
What is your sense of safety?
Answering the following questions will help you evaluate your sense of safety:
- How safe is your environment (your home, your neighborhood, etc.)?
- Are you safe with the friends or family you live with? If so, what makes them safe? If not, what makes them unsafe?
- What makes you feel safe when you’re alone? When you’re with others?
- When do you feel the most safe? When do you feel the most unsafe?
- Are you safe with yourself? Do you ever think about hurting yourself?
Based on your answers, think about what you can do to make yourself safer, both physically and emotionally. For those whose physical environment is unsafe (for example, if you live in a dangerous neighborhood), it’s important to make a change if at all possible. Perhaps you can move or take measures to make your home more secure. If your close relationships are unsafe or abusive, get out if you can or minimize contact with the unsafe individuals. Focus your energy on the people, activities, and beliefs that contribute to your feelings of security.
Creating a safe place
One of the most helpful things you can do is create your own safe place (ideally someplace close and convenient). Your safe place is where you can sit and think, relax or meditate, or work through your traumatic memories.
The safe place should be a secure, private location with limited access—somewhere you don’t have to worry about outside dangers or others intruding. Maybe it’s your bedroom or your office. Or it could be a corner of your back yard or an isolated spot outdoors. Make sure it’s not a place where you’re likely to be interrupted. It’s also important that it’s calm and clean (no stressful paperwork, unfinished projects, or messes to distract you). You might want to add things that help you relax and make you feel good: plants, photos of loved ones, a big poster of a favorite place, etc.
If you don’t have a safe place accessible, you can create one in your mind. It can be anything and anywhere: your childhood home, an impenetrable castle, a cabin in the woods, a penthouse apartment. Be imaginative, filling it with things that make you feel secure (a high-tech security system, weapons, meaningful mementos, cozy furniture). Visualize everything you can see, hear, and smell, both inside and outside. Concentrate on the feeling of safety these sights and sounds bring. In the future, if you’re feeling unsafe, you can return to this safe place in your mind and draw strength from it.
Take advantage of relaxation techniques
Relaxation techniques such as mindfulness meditation, tai chi, deep breathing, and progressive muscle relaxation are powerful defensive weapons against the symptoms of PTSD. Among their many benefits, they reduce stress, ease the symptoms of anxiety and depression, help you sleep better, and increase your feelings of peace and well-being. The only catch is that you need to practice your relaxation technique of choice regularly. It’s like military training. You practice until it’s second nature, so when the crisis comes, you’re able to act quickly and decisively. To reap the most benefits, try to set aside at least 30 minutes each day. To learn more, see Relaxation Techniques for Stress Relief: Finding the Relaxation Exercises That Work for You.
PTSD recovery for veterans: Reconnecting to what you feel
If you’re a veteran with PTSD, it’s not unusual to want to avoid remembering or re-experiencing what you went through. Why put yourself through that again? But the problem is that avoiding those memories doesn’t make them go away. In fact, it takes considerable energy to push them down. Meanwhile, the feelings associated with the trauma are still inside you. When you try to suppress them, the thoughts, images, and dreams can actually become more threatening and intrusive.
The only way to heal and move on is to reconnect to what you feel. This can be a terrifying step. You may even feel like you’ll die or go crazy if you allow it. But it’s essential for working through your PTSD. The important thing to remember is that feelings, while powerful, are not reality. They won’t kill you. They won’t drive you insane. The true danger to your physical and mental health comes from avoiding them.
The negative consequences of avoidance and numbing
It’s important to note that not all avoidance is a bad thing. There’s a time and a place for facing your traumatic memories. It’s not helpful to obsess over disturbing thoughts and feelings. Sometimes you’ll need to take a step back in order to take care of yourself, get through your day, and avoid retraumatizing yourself. It’s when you’re doing everything you can to avoid any reminder of the trauma that avoidance becomes unhealthy.
The following symptoms are indications that you’re avoiding and numbing in unhelpful ways, and could benefit from reconnecting to your feelings:
- Feeling emotionally or physically shut down. You don’t feel emotions and bodily sensations like you used to (you might even have trouble differentiating between pleasure and pain).
- Feeling separate from your body or your surroundings (you may feel like you’re watching yourself or the situation you’re in, rather than participating in it).
- Trouble concentrating and remembering things. Your mind feels cloudy or confused.
- Using stimulants, risky activities, or physical pain to feel alive and counteract the empty feeling inside of you.
- Compulsive use of drugs or alcohol.
- Escaping through fantasies, daydreams, or excessive TV, video games, and pornography.
- Feeling detached from the world and from the people in your life. Loss of interest in sex and other activities you used to enjoy.
Paying attention to danger signals from mind and body
As you stop trying to numb yourself and avoid traumatic reminders, you’ll need to learn to pay attention to your feelings. Your body and emotions give you clues when you’re starting to feel stressed and unsafe. These clues include:
- feeling tense anywhere in your body
- holding your breath
- racing thoughts
- nervous behaviors (pacing, nail biting, picking at your skin)
- shortness of breath
- pounding heart
- sweating, hot flashes
- dizziness, nausea
When you pick up on these symptoms of stress, take steps to self-soothe before they spiral out of control. These are the times when you can take advantage of the relaxation techniques and quick stress relief strategies you have in your arsenal.
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 you can take advantage of at your own pace. Our Emotional Intelligence Toolkit teaches you how to reconnect to uncomfortable or frightening emotions without becoming overwhelmed. It also teaches you techniques for quickly calming yourself down when things start to get too intense. The toolkit can be used in conjunction with therapy, or on its own. 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.
PTSD recovery for veterans: Dealing with flashbacks, nightmares, and intrusive thoughts
Flashbacks usually involve visual and auditory memories of the trauma you experienced. But they can also involve intense emotions, body memories (including pain), and behaviors (for example, reverting to your military training). Regardless of what you’re experiencing, it feels as if the trauma is happening all over again.
Before you work on your trauma-related memories, dreams, images, or flashbacks, it is very important for you to accept and reassure yourself that your traumatic experience is not occurring in the present. Trauma specialists call this “dual awareness.”
Dual awareness is the recognition that there is a difference between your “experiencing self” and your “observing self.” On the one hand there is your internal emotional reality: you feel as if the trauma is currently happening. On the other hand, you can look to your external environment and recognize that you’re safe. You’re aware that despite what you’re experiencing, the trauma happened in the past. It is not happening now.
Tips for strengthening dual awareness
One effective technique for strengthening dual awareness is to state to yourself (either out loud or in your head) the reality of both selves. 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, frightened, overwhelmed, etc.] because I am remembering [traumatic event], but as I look around I can see that [traumatic 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 or touching your arms or describing your actual environment and what you see when look around (for example, name the place where you are, the current date, and three things you see when you look around).
The movie technique for PTSD memories
The movie technique is a powerful method for dealing with traumatic memories and flashbacks. The idea is to think of the memories that are plaguing you as a movie in your mind. As a movie, you can play it a little bit at a time, pausing when you need a break. You can fast-forward past certain parts, freeze on a specific frame, or play the memory backwards. You can even edit in new material (e.g. a different ending, other scenes that put the memory in context, an image of your safe place). You’re in control of the movie. You get to choose how you remember.
| 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.); change the position of your body; 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 a Slinky, worry beads, or a stress ball
Blink rapidly and firmly; visualize your safe place in your mind; look around and take an 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, soda, or juice
PTSD recovery for veterans: Soothing your overstimulated nervous system
The benefits of the great outdoors
Numerous studies show that outdoor recreation can have positive effects on depression, stress, and PTSD.
Check out Sierra Club Military Outdoors for one great option. This program provides service members, veterans, and their families with opportunities to get out into nature.
Trauma overstimulates your nervous system, leaving you amped up and on high alert all the time. This state of hyperarousal is hard on your body. The effects include insomnia, fatigue, irritability, angry outbursts, concentration problems, and jumpiness. Eventually, your health will suffer. That’s why, if you have PTSD, one of the best things you can do is to soothe and care for your body. That means putting a priority on sleep, exercise, healthy food, and relaxing activities.
You may find it very difficult to relax at first. In fact, it’s common for veterans to be drawn to activities and 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, stimulant drugs, cigarettes (even if you’ve never smoked before), violent video games, action and horror movies, and daredevil sports. If you recognize these urges for what they are, you can make better choices that will calm instead of fuel your overstimulated nervous system.
Healthy habits for veterans with PTSD
It takes time to readjust to civilian life and the new normal—an environment where it’s safe to be calm and relaxed. But if you make daily choices to take care of yourself, you’ll get there. Here are some active steps you can take to improve your PTSD symptoms:
- Exercise to burn off adrenaline. Good choices include activities that involve the large muscles, such as running, walking, swimming, weight lifting, and basketball. The benefits of exercise include reducing physical tension and stress, increasing energy, and decreasing symptoms of depression and anxiety. All in all, regular exercise will make you feel better, both mentally and physically.
- Take time to rest and restore your body’s balance. That means taking a break when you’re tired and avoiding the temptation to lose yourself by throwing yourself into activities. Avoid doing anything compulsively, including exercising and working.
- 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. If at all possible, stop smoking, and seek help for drinking and drug problems.
- 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.
The importance of getting enough sleep
Sleep problems are one of the most common and persistent symptoms of hyperarousal in PTSD. Typical sleep problems in veterans include insomnia, waking up frequently, recurrent nightmares, and unrefreshing sleep. This isn’t surprising when you consider that going to sleep means letting down your guard and giving up control. Unfortunately, when you’re tired you become more emotionally reactive. Your judgment is also impaired. That’s a recipe for disaster for anyone—let alone someone coping with PTSD.
In addition to the standard advice for improving the quality of your sleep and combatting insomnia, here are some additional techniques that may help:
- Avoid thinking about traumatic things before going to bed.
- Avoid watching anything on television late at night that could trigger bad memories (such as the news, violent TV programs, or action movies).
- Develop a relaxing bedtime ritual (listen to calming music, take a hot shower, watch a funny show, or read something light and entertaining).
- Make your bedroom as soothing as possible. Think about everything, including the color of your walls, your blankets and sheets, and a comfortable bed.
- Control light and sound in your sleep environment, especially if you’re waking up frequently during the night. Use curtains to block outside light and avoid digital clocks or electronic devices that emit light. If noise is a problem, try playing soothing music or using a sound machine.
Quickly calm down with this breathing exercise
One way to quickly soothe yourself is through deep breathing. Deep breathing has rapid and powerful effects on the areas of the brain that control emotion, thought, and behavior. Here is a simple breathing exercise from Harvard Health that you can use when you want to relax:
Find a comfortable, quiet place to sit or lie down. Start by noting the difference between breathing normally and breathing deeply. First take a normal breath. Now try a deep, slow breath. The air coming in through your nose should move downward into your lower belly. Let your abdomen expand fully. Now breathe out through your mouth (or your nose, if that feels more natural). Alternate normal and deep breaths several times. Pay attention to how you feel when you inhale and exhale normally and when you breathe deeply. Shallow breathing often feels tense and constricted, while deep breathing produces relaxation.
Now practice deep breathing for several minutes. Put one hand on your abdomen, just below your belly button. Feel your hand rise about an inch each time you inhale and fall about an inch each time you exhale. Your chest will rise slightly, too, in concert with your abdomen. Remember to relax your belly so that each inhalation expands it fully. As you exhale slowly, let yourself sigh out loud.
PTSD recovery for veterans: Working through survivor's guilt
Many veterans with PTSD struggle with difficult emotions, including survivor’s guilt. If you’ve experienced combat, you’ve likely seen some horrible things. Many of you have seen people injured or killed, often your friends and comrades. In the heat of the moment, you don’t have time to fully process these things as they happen. You’re preoccupied with the task of surviving and fulfilling your duties as a soldier. But later—often when you’ve returned home—these experiences come back to haunt you. 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
To heal from survivor’s guilt, first you must acknowledge it. It may be helpful to know that feelings of guilt are very common among veterans and is part of the grieving process. Healing from it 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 for the event 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 believe you acted ethically?
- 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 the trauma you went through). The goal is to put your guilt to positive use, and thus to transform tragedy, even in a small way, into something good.
PTSD recovery for veterans: Getting the social support you need
Just as it’s important to reconnect with your feelings, it’s important to reconnect with others. Instead of isolating yourself, make an effort to invest in your personal relationships—whether that’s spending quality time with your significant other, going out with your buddies, or playing with your kids. You can also volunteer in the community, which can help you feel more connected and useful, especially if you’re not currently working.
Turning to others for support
You may feel like the civilians in your life don't understand since they don't know what it's like to be a soldier or to have seen the things you did. But people don't have to have gone through the exact same experiences as you in order 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. That said, it can also be 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 alone.
Tips for talking to someone
Decide carefully who you're going to talk to. It should be someone you trust and feel safe with. You may also want to decide ahead of time what you want to discuss. If you're not ready to open up about the details of what happened, that's perfectly okay. But don't bottle things up either. 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.
Keep quiet because you don’t want to upset others
Keep quiet because you’re worried about being a burden
Assume that others don’t want to listen
Wait until you’re so stressed and exhausted that you can’t benefit from help
Source: National Center for PTSD
Resources & References
Helpguide’s Yellow Pages
Resources for public assistance, social services, and other health and human services.
Help for veterans and their family members
Veterans Crisis Line – A confidential, free hotline for veterans and their families and friends. Call 1-800-273-8255 (Press 1) or connect via chat or text (838255).
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.
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)