Tell me something I don't know
Sitting with my morning coffee, my wife leans over to share with me a headline from her Google alerts, “VA, DoD recommended PTSD therapies don’t help many military patients, review finds.” My first thought, accompanied by an adolescent role of the eyes, is “No Shit.”
The article is from the Military Times and discusses the recent findings, which appear to be no different than past results, that primary therapies pushed onto veterans doesn’t work. These therapies include cognitive processing therapy (CPT) and prolonged exposure therapy (PE) as the gold standards of PTSD treatment within the VA. I have personally experienced both through the VA and civilian care.
High and right
Without going too deep into the psychology of these treatments, let me explain to you why these particular therapies simply do not work. PE has been the gold standard of psychology for decades as the primary treatment for individuals who have encountered some manner of trauma and display difficulties processing the traumatic experience. This type of therapy has experienced successful results with the victims of assault, to include sexual assault and rape victims. Let me say that again because it’s important. This treatment has been successful with the victims, and herein lies the issue. The general basis of PE therapy is to relive the said traumatic event, in detail, over and over through repeated therapy sessions. By reliving the event in vivid detail, the patient will presumably lessen the effects of cognitive distortion.
The VA mental healthcare system also uses CPT to treat posttraumatic stress, which relies heavily on challenging the belief patterns associated with the traumatic event. One of the first steps in this process is to write out a detailed account of the event… Ok, let’s just stop.
Combat isn't a victim culture
Look, here is the problem with the primary therapies used to treat PTSD. Posttraumatic stress has long been viewed as an anxiety disorder. Cue the Hollywood veteran in full meltdown, digging fighting holes in the front yard, and crying in the fetal position with a loaded pistol in hand. The primary focus of PE therapy, as stated before, is in victim trauma. Victims. Very few cases of combat-related traumatic stress, if any, are that of a victim. A large portion of veterans deal with two primary issues of combated related stress – decisions and guilt. At the opposing end of these decisions usually lies the victim. To go left, when you should have gone right. To change seats with a buddy, just to watch them get hit by an IED moments later. Seeing something you know didn’t look right but not speaking up about it, and then finding out it was the cause of someone’s death. Pulling the trigger and realizing you were wrong. Surviving an attack when others didn’t. These are just some of the decisions veterans attempt to deal with every day. These are not the questions of victims. These are the struggles of veterans.
Having a veteran relive these struggles again and again, in vivid detail, is like asking a recovering alcoholic to chug a handle of whiskey to start his treatment. One issue that I have come across within the VA is trying to pinpoint one specific moment of trauma as the primary focus. Not working through issues one by one but trying to narrow it down specifically. This is one of the fundamental problems with CPT and writing out a specific event. Write out in detail the traumatic event? I know guys that have more than 30 months in country. What do you want them to write? That’s a series even J.K. Rowling would be impressed with. But most guys I know, including myself, would rather shove a pen into their jugular than put it to paper in an attempt to highlight something they are trying to forget.
There is a bigger problem
I’m not bashing the Veterans Administration and their effort to try and combat a borderline epidemic amongst service members. They are plagued by red tape and protocol, and unfortunately, a large number of veterans undermining the system. Those individuals only seeking financial benefits compounds the problem when trying to analyze the effectiveness of VA mental health treatments. The VA really is fighting an uphill battle. But every battle, especially this one, should start with education.
The more I began to understand how my mind worked, the more I realized it wasn’t broken. The same way I trained to enter into combat, I could prepare myself to reenter civilian life. Neurotransmitters and their effects on the brain makes a large portion of PTSD pretty understandable. Take the relationship of dopamine and serotonin or how adrenaline and cortisol can suppress oxytocin, for example. During a combat deployment, your body is dumping massive amounts of adrenaline and cortisol, sometimes daily. This six-month-long skydive (essentially) filled with the fear and anxiety inhibits the body’s ability to produce oxytocin, “the love drug.” So, returning from a long and intense combat deployment with a feeling that you can’t connect socially or struggle with something as simple as cuddling with your spouse – actually makes perfect sense.
"You are not Broken"
The great thing about the plasticity of the human brain is, if it can be done, it can be undone, which means if you just put in the time and a little effort, you can retrain your brain to accept and even want that social connection again. You can understand that the massive amounts of dopamine released on you in country is the number one culprit for your impulsive behavior stateside. You can become mindful of what is actually going on in your mind. You can then begin to process the decisions that were made, the guilt that still lingers, and the life you have yet to live.
Don't give up
I want to be real with you if you’re a veteran struggling with PTSD. If you’re in treatment, don’t abandon it. If you feel lost, it’s only temporary; you will find your path and your purpose. First, start with fitness, I can’t express to you enough how much your physical health plays a role in all of this. Then, do your homework and be your own advocate. If you’re not finding what you’re looking for at the VA or wherever you are, look elsewhere. Remember that nothing about you is broken, you might just need a little rewiring. Either way, you can train to fight a new battle.