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«A Readjustment Handbook A Guide to Understanding and Coping With Readjustment Issues Following a Military Deployment For service members, veterans, ...»

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Just as war veterans are often afraid to address what happened to them, family members also may avoid talking about the trauma or related problems. They may avoid talking because they want to spare the veteran further pain, or because they are afraid of his or her reaction. Family members may feel hurt, alienated, or discouraged because the veteran has not overcome the effects of the trauma and may become angry or feel distant from the veteran.

The Important Role of Families in Recovery

The primary source of support for the returning soldier is likely to be his or her family. Families can help the veteran avoid withdrawal from others. Families can provide companionship and a sense of belonging, which can help counter feelings of separateness and difference from other people. They can provide practical and emotional support for coping with life stressors.

If the veteran agrees, it is important for family members to participate in treatment. It is also important to talk about how the post-trauma stress is affecting the family and what the family can do about it. Adult family members should also let their loved ones know that they are willing to listen if the service member would like to talk about war experiences. Family members should talk with treatment providers about how they can help in the recovery effort.

What Happens in Treatment for PTSD Treatment for PTSD focuses upon helping the veteran reduce fear and anxiety, gain control over traumatic stress reactions, make sense of traumatic experiences, and function better at work and in the

family. A standard course of treatment may include:

• Assessment and development of an individual treatment plan.

• Education of veterans and their families about posttraumatic stress and its effects.

• Training in relaxation methods, to help reduce physical arousal/tension.

• Practical instruction in skills for coping with anger, stress, and ongoing problems.

• Discussion of feelings of anger or guilt, which are common among survivors of war trauma.

• Detailed discussion to help change distressing beliefs about self and others (e.g., self-blame).

• If appropriate, careful, repeated discussions of the trauma (exposure therapy) to help the service member reduce the fear associated with trauma memories.

• Medication to reduce anxiety, depression, or insomnia.

• Group support from other veterans, often felt to be the most valued treatment experience.

Mental health professionals in VA Medical Centers and community clinics and Readjustment Counseling Service Vet Centers have a long tradition of working with family members of veterans with PTSD.

Educational classes for families and couples counseling may be available. Family members can encourage the veteran to seek education and counseling, but should not try to force their loved one to get help. Family members should consider getting help for themselves, whether or not their loved one is getting treatment.

Self-Care Suggestions for Families

• Become educated about PTSD.

• Take time to listen to all family members and show them that you care.

• Spend time with other people. Coping is easier with support from caring others, including extended family, friends, church, or other community groups.

• Join or develop a support group.

• Take care of yourself. Family members frequently devote themselves totally to those they care for, and in the process, neglect their own needs. Watch your diet, exercise, and get plenty of rest. Take time to do things that feel good to you.

• Try to maintain family routines, such as dinner together, church, or sports outings.

Additional Resources

For more information about PTSD and treatment, visit the National Center for PTSD website at www.ncptsd.org.

Matsakis, A. (1996). Vietnam wives: Facing the challenges of life with veterans suffering posttraumatic stress. Baltimore, MD: Sidran.

Mason, P. (1999). Recovering from the war: A woman's guide to helping your Vietnam vet, your family, and yourself. High Springs, FL: Patience Press.

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Importance of Active Coping When veterans take direct action to cope with their stress reactions and trauma-related problems, they put themselves in a position of power and start to be less helpless.

• Active coping means recognizing and accepting the impact of trauma on your life, and taking direct coping action to improve things.

• It means actively coping even when there is no crisis; coping is an attitude of mind and a habit that must be strengthened.

Understanding the Recovery Process

Knowing how recovery happens puts you in more control of the recovery process.

• Recovery is an ongoing daily gradual process. It doesn't happen through being suddenly "cured."

Some amount of continuing reactions is normal and reflects a normal body and mind. Healing doesn't mean forgetting traumatic war experiences or having no emotional pain when thinking about them.

Healing may mean fewer symptoms and less disturbing symptoms, greater confidence in ability to cope with your memories and reactions, and improved ability to manage emotions.

Coping with Traumatic Stress Reactions: Ways that DON'T Help

• Using drugs and alcohol as ways to reduce anxiety or relax, stop thinking about war experiences, or go to sleep. Alcohol and drug use cause more problems than they cure.

• Keeping away from other people. Social isolation means loss of support, friendship, and closeness with others, and more time to worry or feel hopeless and alone.

• Dropping out of pleasurable or recreational activities. This leads to less opportunity to feel good and feel a sense of achievement.

• Using anger to control others. Anger helps keep other people away and may keep bad emotions away temporarily, but it also keeps away positive connections and help from loved ones.

• Trying to constantly avoid people, places, or thoughts that are reminders of the traumatic event.

Avoidance of thinking about trauma or seeking treatment doesn't keep away distress, and it prevents progress on coping with stress reactions.

• Working all the time to try and avoid distressing memories of the trauma (the "workaholic").

–  –  –

There are many ways you can cope with posttraumatic stress. Here are some things you can do if you have

any of the following symptoms:

Unwanted distressing memories, images or thoughts

• Remind yourself that they are just that-memories.

• Remind yourself that it's natural to have some sorts of memories of the events(s).

• Talk to someone you trust about them.

• Remember that although reminders of trauma can feel overwhelming, they often lessen over time.

Sudden feelings of anxiety or panic These are a common part of traumatic stress reactions, and include sensations of your heart pounding and

feeling lightheaded or "spacey" (often due to rapid breathing). If this happens, remember that:

• These reactions are not dangerous. If you had them while exercising, they would not worry you

• It is the addition of inaccurate frightening thoughts (e.g., I'm going to die, I'm having a heart attack, I will lose control) that makes them especially upsetting.

• Slowing down your breathing may help.

• The sensations will pass soon and you can still "go about your business" after they decrease. Each time you think in these positive ways about your arousal/anxious reactions, you will be helping them to happen less frequently. Practice will make it easier to cope.

Feeling like the trauma is happening again ("Flashbacks")

• Keep your eyes open. Look around you and notice where you are.

• Talk to yourself. Remind yourself where you are, what year you're in, and that you are safe. Trauma happened in the past, and you are in the present.

• Get up and move around. Have a drink of water, and wash your hands.

• Call someone you trust and tell them what's been happening.

• Remind yourself that this is quite common traumatic stress reaction.

• Tell your counselor or doctor what happened to you.

Trauma-related dreams and nightmares

• If you awaken from a nightmare in a "panic," remind yourself that you are reacting to a dream and that's why you are anxious/aroused...and not because there is real danger now.

• Consider getting up out of bed, "regrouping," and orienting yourself.

• Engage in a pleasant, calming activity (e.g., listen to soothing music).

• Talk to someone if possible.

• Talk to your doctor about your nightmares; certain medications can be helpful.

Difficulty falling or staying asleep

• Keep to a regular bedtime schedule.

• Avoid strenuous exercise within a few hours of going to bed.

• Avoid using your sleeping area for anything other than sleeping or sexual intimacies.

• Avoid alcohol, tobacco, and caffeine. These harm your ability to sleep.

• Do not lie in bed thinking or worrying. Get up and enjoy something soothing or pleasant; reading a calming book, drink a glass of warm milk, do a quiet hobby.

Irritability, anger, and rage

• Take a "time out" to cool off or to think things over. Walk away from the situation.

• Get in the habit of using daily exercise as a friend. Exercise reduces body tension and helps get the "anger out" in a positive and productive way.

• Remember that anger doesn't work. It actually increases your stress and can cause health problems.

• Talk to your counselor or doctor about your anger. Take classes in "anger management."

• If you blow up at your family or friend, find time as soon as you are able to talk to them about it. Let them know how you feel, and what you are doing to cope with your reactions.

Difficulty concentrating

• Slow down. Give yourself time to "focus" on what it is you need to learn or do.

• Write things down. Making "to do" lists may be helpful.

• Break task down into small do-able "chunks."

• Plan a realistic number of events or tasks for each day.

• Perhaps you may be depressed; many who are do have trouble concentrating. Again, this is something you can discuss with your counselor, doctor, or someone close to you.

Having difficulty feeling or expressing positive emotions

• Remember that this is a common reaction to trauma, that you are not doing this on purpose, and that you should not feel guilty for something you do not want to happen and cannot control.

• Make sure to regularly participate in activities that you enjoy or used to enjoy. Sometimes, these activities can re-kindle feelings of pleasure.

• Take steps to communicate caring to loved-ones in little ways: write a card, leave a small gift, phone and say hello.

Final Word

Experiment with these ways of coping to find which ones are helpful to you. Practice them, because, like other skills, they work better with practice. Talk to your counselor or doctor about them. Reach out to people in VA, Vet Centers, your family, and your community that can help. You're not alone.

–  –  –

Reunion is part of the deployment cycle and is filled with joy and stress. The following tips can help you have the best possible reunion.

Tips for Soldiers:

• Support good things your family has done.

• Take time to talk with your spouse and children.

• Make individual time for each child and your spouse.

• Go slowly when reestablishing your place in the family.

• Be prepared to make some adjustments.

• Romantic conversation can lead to more enjoyable sex.

• Make your savings last longer.

• Take time to listen and to talk with loved ones.

• Go easy on partying.

Tips for Spouses for Reunion:

• Avoid scheduling too many things.

• Go slowly in making adjustments.

• You and your soldier may need time for yourself.

• Remind soldier he or she is still needed in the family.

• Discuss splitting up family chores.

• Stick to your budget until you've had time to talk it through.

Along with time for the family, make individual time to talk.

• Be patient with yourself and your partner.

Tips for Reunion with Children:

• Go slowly. Adapt to the rules and routines already in place.

• Let the child set the pace for getting to know you again.

• Learn from how your spouse managed the children.

• Be available to your child, both with time and with your emotions.

• Delay making changes in rules and routines for a few weeks.

• Expect that the family will not be the same as before you left; everyone has changed.

• Focus on successes with your children; limit your criticisms.

• Encourage children to tell you about what happened during the separation.

• Make individual time for each child and your spouse.

–  –  –

Uniformed Services University of Health Sciences, Bethesda, Md.

Coming together as a couple after war deployment isn't always easy or something that happens naturally.

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