Download Trauma Affected Veterans - Supplemental reading

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:
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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.