Contributed by Geoffrey P. Smith, Psy. D., Administrative Director of Inpatient Mental Health, Section Chief of Specialty Mental Health, Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System
The Department of Veterans Affairs is devoted not just to effective treatment of Post-traumatic Stress Disorder (PTSD) but to developing a greater societal understanding of the impact of trauma and promoting Post Trauma Growth.
Effective treatment is developed through rigorous scientific investigation and the National Center for PTSD (https://www.ptsd.va.gov/) is dedicated to research and education on trauma and PTSD. This body assists the VA in offering a number of so-called “Evidence-Based Practices” to Veterans including: Cognitive Processing Therapy (CPT), Eye Movement Desensitization and Reprocessing (EMDR), Prolonged Exposure (PE), and Stress Inoculation Training (SIT), and antidepressant medications.
Such a list of jargon and acronyms begs the question: What aspects of the human trauma response do these treatments target and how do they work? Understanding the impact of trauma and sending a message of hope that recovery can happen are key early starting points for Veterans beginning treatment. The effects of traumatic events have consistent reactions in people that occur in various constellations but the themes are quite constant:
Normal human responses to trauma:
- Vigilance and Arousal: When people have been hurt threatened or have seen the un-seeable they naturally stay on watch for the next threat. This can look like difficulty sleeping, pervasive worry and anxiety, mistrust of others, difficulty sitting with their back to a door, and/or always watching the perimeter.
- Re-experiencing Symptoms: Nightmares, flashbacks, and/or feeling like it is happening all over again especially when triggered by some reminder of the event
- Numbing and Avoidance: People naturally avoid triggers, isolate from others, use substances, deny the problem, and a host of other strategies to try not to feel the intense consequences of trauma. The urge to avoid intense discomfort and deep frustration with living life this way can even lead some to contemplate suicide.
- Negative thinking: When life feels so lousy and people have been struggling with lost jobs, lost relationships, inability to sleep or escape from nightmares and flashbacks, their minds naturally make negative conclusions about the future, themselves and others.
Although these themes are constant, every individual has a unique experience and constellation of which elements of the list above are most interfering with living a valued life. Sending the message of hope that recovery is possible and asking people to flesh out their own particular version of their trauma response can lead to making informed choices about which kind of treatment is best suited for them.
Trauma-informed care understands that all forms of trauma whether from combat, domestic violence, childhood abuse, car accidents, or natural disasters have in common that the impacted person had a loss of power and control. So, the best programs offer choices, hear voices, and provide information about what to expect. In this manner, the VA seeks to describe and offer options of types of trauma treatment and build upon their preferences, strengths, values, and existing resources/successes.
Evidence-based treatments for PTSD have common guiding principles that directly address the four normal human responses to trauma. Key examples include:
- Exposure with Response Prevention: This is a central feature of Eye Movement Desensitization and Reprocessing (EMDR), Prolonged Exposure (PE), and Stress Inoculation Training (SIT). When people develop skills for tolerating distress, soothing themselves, and expressing uncomfortable feelings they are better able to engage in community activities, connect to family and friends, sustain gainful employment and pursue recreational and leisure activities. Engaging in a valued life in these ways helps people replace avoidance and numbing behaviors and promotes reasons for living which can be powerful new protective factors and social support preventing suicide
- Skills training for self-soothing and relaxation: The VA is actively promoting not just traditional methods for reducing arousal/vigilance like diaphragmatic breathing but also exploring a host of nontraditional and holistic strategies including trauma-informed yoga, meditation, and mindfulness practice. Through building community collaborations, the VA is also increasing referrals to organizations that provide nature walks, equine assisted psychotherapy, and other outdoor activities like white water rafting, skiing, and mountain biking
- Promoting Flexible Thinking: All of the types of psychotherapy offered through the VA assist people in noticing their thoughts and developing the skills for reframing the kinds of rigid harmful thinking that are not helpful for recovery. This portion of treatment targets those negative beliefs or “stuck points” that so often have Veterans convinced that they are no good or should have been the one who died or that the world is a terrible unsafe place.
Emerging promising practices in the treatment of trauma and stress include integration of Peer Support Specialists and Volunteers. A Peer Support staff member is a Veteran with the lived experience of recovery in mental health and or addictions problems who acts as a symbol of hope and provides disclosure of elements of their own journey of recovery to Veterans in care. Five years ago the VA rolled out a national endeavor to hire and train over 800 Peer Specialists who are now embedded in various mental health programs. The science can be potent but there is nothing quite as credible as the testimony and encouragement from someone who has lived a similar experience.
Other recent innovations in Trauma treatment include using smart phone technology with applications such as PTSD Coach, PE Coach, CPT Coach, Breathe2Relax, Tactical Breather and Life Armor.
Reach out to your local VA medical center or community clinic and find out which kinds of trauma informed services they offer. VA healthcare system Mental Health resources vary by location but typically offer individual and group therapies by clinicians specially trained in these treatments.
Websites for more resources and information: