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Transcript
Training Prepares Families Of Service Members The Family of Heroes program is aimed at mitigating many common conflicts in families that have members returning from combat Virginia's Wounded Warrior Program has launched an online pilot project to teach families of veterans how to help their loved ones adjust to civilian life. The resiliency training was prepared in collaboration with the Virginia Department of Health. The initial project targets the families of 280,000 veterans in the state's northwest region, but the Virginia Wounded Warrior Program's Executive Director, Catherine Wilson, says plans are to expand it if the results are beneficial. "The program actually allows the family member to choose an avatar or a character and to engage in practice conversations with a family member who is a combat veteran, for example, that maybe experienced posttraumatic stress or some kind of post-deployment stress," explains Wilson. "And they give various different situations where the family member can learn to communicate with the military member that is just coming off of deployment. So it's sort of a real-time, interactive conversation that, without really being aware, it's teaching new skills on how to communicate." The simulation also teaches signs and symptoms, how to motivate the veteran to seek help, and where to go for assistance. Combat PTSD Symptoms – Hyperarousal (Being “Keyed Up”) What is Hyperarousal? Hyperarousal simply means “increased arousal” and can easily be thought of as feeling “keyed up.” People experiencing hyperarousal are often constantly jittery, overreact to small things and are always looking around them for danger. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (the manual responsible for creating the diagnostic criteria for disorders like PTSD), a person must experience two of the following as a response to a trauma as part of a PTSD diagnosis: Irritable or aggressive behavior Self-destructive or reckless behavior Hypervigilance (an enhanced state of sensitivity and exaggerated behaviors designed to detect threats; may be accompanied with anxiety) Exaggerated startle response Problems in concentration Sleep disturbance The study: Predicting Symptom Clusters of Posttraumatic Stress Disorder (PTSD) in Croatian War Veterans: The Role of Socio-Demographics, War Experiences and Subjective Quality of Life, found that a higher total number of traumatic events and a lower quality of life contribute, significantly, to the symptoms of hyperarousal. The Problems with Hyperarousal in Civilian Life When in a combat zone, it’s natural to feel hyperarousal and constantly be on the lookout for danger when danger could be all around you. Back in civilian life, though, always looking out for danger no longer makes sense. For example, if you’re constantly hyperaware of everything going on around you, you may see a person walking behind you on the street. You may see a flash from an object in this person’s hand. If you’re experiencing hyperarousal, you may think that the person is an enemy with a knife and react accordingly when, in reality, it is just a person with his or her car keys. Of course, not only can the symptoms of hyperarousal cause problems in behavior but they, themselves, can also be very unpleasant to live with. Not being able to sleep or concentrate and jumping out of one’s skin at the slightest startle is no fun at all. Treating Hyperarousal Hyperarousal in combat PTSD can be treated primarily with therapy or, in more extreme cases, medication. Therapy that focuses on exposure to small events that elicit the symptoms of hyperarousal (exposure therapy) may help the veteran learn, and train the body and brain, that such arousal isn’t necessary in civilian life. It’s worth noting that hyperarousal and quality of life are closely linked; so an improvement in quality of life tends to reduce hyperarousal symptoms and a reduction in hyperarousal also increases quality of life. This means that social interventions aimed at improving general well-being can also improve the symptoms of hyperarousal. What’s important to remember is that while hyperarousal symptoms may feel out of your control, with therapy, and sometimes medication, they start to become within your control and you can overcome them. Hyperarousal One of the main symptoms of post traumatic stress disorder is hyperarousal. According to Dorland’s Medical Dictionary, hyperarousal is “a state of increased psychological and physiological tension marked by such effects as reduced pain tolerance, anxiety, exaggeration of startle responses, insomnia, fatigue and accentuation of personality traits.” [1] It has also been described as a chronic state of fight or flight. The fight or flight response was necessary when mankind was faced with physical threats, such as those of wild animals, on a daily basis. Veterans returning from combat have lived through a constant barrage of physical threats and their fight or flight responses are often in high gear. For most of us, the daily threats are more emotional or psychological in nature, even so, when faced with such a threat, your fight or flight response may kick in. When this happens, your heart beats rapidly, your breath becomes shallow, your muscles tense and you are instantly alert. The longer your fight or flight response stays active, the more draining – both physically and emotionally. Symptoms Some of the symptoms of hyperarousal include: Irritability Impulsiveness Anger Insomnia Nightmares Aggression Constant feeling of being in danger Difficulty concentrating Hyperarousal can impact your ability to function on a daily basis and interfere with your relationship with family and friends. Marsha described her husband’s experiences after being a witness to a shooting. “Any loud noise would set him into a state of hyperarousal, and this could last anywhere from a few minutes to 24 hours. It could be fireworks, a car backfiring, a neighbor hammering, dropping a pot in the kitchen, any loud and unexpected noise. Joe would go into a state of panic, checking around the house for intruders, wanting to keep the kids indoors where they would be safe, jumping at any noise and getting angry if anyone in the house did something he felt was unsafe, such as answering the door or inviting a friend over. During a hyperarousal event, he usually didn’t sleep for at least 24 hours, making him even more irritable and he might have nightmares for several days. We would all walk around on eggshells for a few days, whispering and trying to not make any noise.” [2] Treatment Treating hyperarousal usually falls within general treatment for anxiety. Medications and desensitization therapy can help. Cognitive behavioral therapyteaches ways for you to rethink your response to stimuli. Long-term medications, such as antidepressants may be useful and shortactinganti-anxiety medication can sometimes be used to reduce a hyperarousal event. Therapy focusing on stress reduction, such as relaxation techniques (meditation, progressive relaxation, visual relaxation, journaling your thoughts) have also been found to be helpful. Deep breathing and strenuous exercise during a hyperarousal event may help to reduce the feelings of loss of control. For some, taking control of health care, such as quitting smoking, eating right and attending therapy and doctor’s appointments may help. This may be because hyperarousal may occur because of feelings of not having control over the situation, symptoms, such as being hypervigilant are a way of gaining control over your environment. When you take control of your health care, you may feel as if you are “taking control of your life” and the feelings of hyperarousal may diminish.