Residential PTSD Treatment for Army, Navy, Air Force & Marine Corps
Our nation’s veterans are facing a health care crisis: more troops than ever before have returned home with the burden of post-traumatic stress. They are living with life-threatening symptoms of mental illness: depression, frustration, sleeplessness, nightmares and flashbacks and feelings of isolation.
Physical injuries, combat exposure, psychological trauma and prolonged separation from loved ones take a severe toll on the body and mind. Veterans returning home from combat and military deployment cope with psychological and emotional trauma of battlefield experiences. They carry invisible mental and emotional wounds that have profound effects on their lives. The physical and mental stress of serving in the armed forces exposes veterans to a high risk of post-traumatic stress disorder (PTSD). Professional treatment for PTSD may involve:
Cognitive Behavioral Therapy (CBT) helps veterans understand the relationship between thoughts, emotions, and behaviors, learn new patterns of thinking, and practice new positive behaviors. CBT counselling involves gradually “exposing” the veteran to reminders of the event and replacing distorted thoughts with a more balanced picture.
Cognitive Processing Therapy (CPT), a form of CBT that involves writing out one’s traumatic experience and correcting negative thought patterns so that memories of trauma don’t interfere with daily life.
Prolonged Exposure Therapy (PE) helps veterans reduce fear and anxiety triggered by reminders of the trauma. This is done by confronting (or being exposed to) trauma reminders in a safe treatment environment until they are less troubling. In this way, individuals can stop avoiding and reacting to trauma reminders and live their lives more fully.
Eye Movement Desensitization and Reprocessing (EMDR) therapy incorporates elements of CBT with eye movements or other rhythmic, left-right stimulation to help you become “unstuck.”
Residential PTSD Treatment
Treatment begins with a comprehensive evaluation and assessment, with evidence based treatment options that include group therapy; intensive individual therapy; cognitive processing therapy and trauma-based therapy.
Cognitive Behavioral Therapy (CBT) is the most effective type of counseling for PTSD and two forms of cognitive behavioral therapy offered for PTSD are Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy. A similar kind of therapy is eye movement desensitization and reprocessing (EMDR) and used to treat PTSD.
cognitive behavioral therapy
In cognitive therapy, your therapist helps you understand and change how you think about your trauma and its aftermath. Your goal is to understand how certain thoughts about your trauma cause you stress and make your symptoms worse.
You will learn to identify thoughts about the world and yourself that are making you feel afraid or upset. With the help of your therapist, you will learn to replace these thoughts with more accurate and less distressing thoughts. You will also learn ways to cope with feelings such as anger, guilt, and fear.
After a traumatic event, you might blame yourself for things you couldn’t have changed. Cognitive therapy, a type of CBT, helps you understand that the traumatic event you lived through was not your fault.
In exposure therapy your goal is to have less fear about your memories. It is based on the idea that people learn to fear thoughts, feelings, and situations that remind them of a past traumatic event. By talking about your trauma repeatedly with a therapist, you’ll learn to get control of your thoughts and feelings about the trauma. You’ll learn that you do not have to be afraid of your memories. This may be hard at first. It might seem strange to think about stressful things on purpose. But you’ll feel less overwhelmed over time.
With the help of your therapist, you can change how you react to the stressful memories. Talking in a place where you feel secure makes this easier.
You may focus on memories that are less upsetting before talking about worse ones. This is called “desensitization,” and it allows you to deal with bad memories a little bit at a time. Your therapist also may ask you to remember a lot of bad memories at once. This is called “flooding,” and it helps you learn not to feel overwhelmed. You also may practice different ways to relax when you’re having a stressful memory. Breathing exercises are sometimes used for this.
Eye movement desensitization and reprocessing (EMDR)
Eye movement desensitization and reprocessing (EMDR) is another type of therapy for PTSD. Like other kinds of counseling, it can help change how you react to memories of your trauma.
While thinking of or talking about your memories, you’ll focus on other stimuli like eye movements, hand taps, and sounds. For example, your therapist will move his or her hand near your face, and you’ll follow this movement with your eyes.
Experts are still learning how EMDR works. Studies have shown that it may help you have fewer PTSD symptoms. But research also suggests that the eye movements are not a necessary part of the treatment.
Many people want to talk about their trauma with others who have had similar experiences. In group therapy, you talk with a group of people who also have been through a trauma and who have PTSD. Sharing your story with others may help you feel more comfortable talking about your trauma. This can help you cope with your symptoms, memories, and other parts of your life.
Group therapy helps you build relationships with others who understand what you’ve been through. You learn to deal with emotions such as shame, guilt, anger, rage, and fear. Sharing with the group also can help you build self-confidence and trust. You’ll learn to focus on your present life, rather than feeling overwhelmed by the past.
In psychotherapy you learn ways of dealing with emotional conflicts caused by your trauma. This therapy helps you understand how your past affects the way you feel now.
Your therapist can help you: Identify what triggers your stressful memories and other symptoms. Find ways to cope with intense feelings about the past. Become more aware of your thoughts and feelings, so you can change your reactions to them. Raise your self-esteem.
PTSD can affect your whole family. Your kids or your partner may not understand why you get angry sometimes, or why you’re under so much stress. They may feel scared, guilty, or even angry about your condition.
Family therapy is a type of counseling that involves your whole family. A therapist helps you and your family to communicate, maintain good relationships, and cope with tough emotions. Your family can learn more about PTSD and how it is treated.
In family therapy, each person can express his or her fears and concerns. It’s important to be honest about your feelings and to listen to others. You can talk about your PTSD symptoms and what triggers them. You also can discuss the important parts of your treatment and recovery. By doing this, your family will be better prepared to help you.
You may consider having individual therapy for your PTSD symptoms and family therapy to help you with your relationships.
Length of Treatment
CBT treatment for PTSD often lasts for 3 to 6 months. Other types of treatment for PTSD can last longer. If you have other mental health problems as well as PTSD, treatment may last longer. It is very common to have PTSD at that same time as another mental health problem. Depression, alcohol or drug abuse problems, panic disorder, and other anxiety disorders often occur along with PTSD. In many cases, the PTSD treatments described above will also help with the other disorders. The best treatment results occur when both PTSD and the other problems are treated together rather than one after the other.
When you begin therapy, you and your therapist should decide together what goals you hope to reach in therapy. Not every person with PTSD will have the same treatment goals. For instance, not all people with PTSD are focused on reducing their symptoms.
Some people want to learn the best way to live with their symptoms and how to cope with other problems associated with PTSD. Perhaps you want to feel less guilt and sadness. Perhaps you would like to work on improving your relationships at work, or communicating with your friends and family.
Your therapist should help you decide which of these goals seems most important to you, and he or she should discuss with you which goals might take a long time to achieve.
Expectation During Therapy
Your therapist should give you a good explanation for the therapy. You should understand why your therapist is choosing a specific treatment for you, how long they expect the therapy to last, and how they will tell if it is working.
The two of you should agree at the beginning that this plan makes sense for you. You should also agree on what you will do if it does not seem to be working. If you have any questions about the treatment, your therapist should be able to answer them.
You should feel comfortable with your therapist and feel you are working as a team to tackle your problems. It can be difficult to talk about painful situations in your life, or about traumatic experiences that you have had. Feelings that emerge during therapy can be scary and challenging. Talking with your therapist about the process of therapy, and about your hopes and fears in regards to therapy, will help make therapy successful.
If you do not like your therapist or feel that the therapist is not helping you, it might be helpful to talk with another professional. In most cases, you should tell your therapist that you are seeking a second opinion.
PTSD in veterans recovery
Step 1: Get moving
As well as helping to burn off adrenaline, exercise can release endorphins and improve your mood. By really focusing on your body and how it feels as you exercise, you can even help your nervous system become “unstuck.”
Exercise that is rhythmic and engages both your arms and legs—such as running, swimming, basketball, or even dancing—works well if, instead of continuing to focus on your thoughts as you move, you focus on how your body feels.
Notice the sensation of your feet hitting the ground, for example, or the rhythm of your breathing, or the feeling of wind on your skin. Rock climbing, boxing, weight training, or martial arts can make it easier to focus on your body movements—after all, if you don’t, you could get injured.
Try to exercise for 30 minutes or more each day—or if it’s easier, three 10-minute spurts of exercise are just as good.
The benefits of the great outdoors
Pursuing outdoor activities in nature like hiking, camping, mountain biking, rock climbing, whitewater rafting, and skiing can help challenge your sense of vulnerability and help you transition back into civilian life. Seek out local organizations that offer outdoor recreation opportunities.
Step 2: Self-regulate your nervous system
PTSD can leave you feeling vulnerable and helpless. But you have more control over your nervous system than you may realize. When you feel agitated, anxious, or out of control, these tips can help you change your arousal system and calm yourself.
Mindful breathing. To quickly calm yourself in any situation, simply take 60 breaths, focusing your attention on each out breath.
Sensory input. Just as loud noises, certain smells, or the feel of sand in your clothes can instantly transport you back to the combat zone, so too can sensory input quickly calm you. Everyone responds a little differently, so experiment to find what works best for you. Think back to your time on deployment: what brought you comfort at the end of the day? Perhaps it was looking at photos of your family? Or listening to a favorite song, or smelling a certain brand of soap? Or maybe petting an animal quickly makes you feel calm?
Reconnect emotionally. By reconnecting to uncomfortable emotions without becoming overwhelmed, you can make a huge difference in your ability to manage stress, balance your moods, and take back control of your life. See our Emotional Intelligence Toolkit.
Step 3: Connect with others
Connecting with others face to face doesn’t have to mean a lot of talking. For any veteran with PTSD, it’s important to find someone who will listen without judging when you want to talk, or just hang out with you when you don’t. That person may be your significant other, a family member, one of your buddies from the service, or a civilian friend. Or try:
Volunteering your time or reaching out to someone in need. This is a great way to both connect to others and reclaim your sense of power.
Joining a PTSD support group. Connecting with other veterans facing similar problems can help you feel less isolated and provide useful tips on how to cope with symptoms and work towards recovery.
Connecting with civilians
You may feel like the civilians in your life can’t understand you since they haven’t been in the service or seen the things you have. But people don't have to have gone through the exact same experiences to be able to offer support. What matters is that the person you're turning to cares about you, is a good listener, and a source of comfort.
If you're not ready to open up about what happened, that's perfectly okay. Instead of going into a blow-by-blow account of events, you can just talk about how you feel.
You can tell the other person what they can do to help, whether it's just sitting with you, listening, or doing something practical.
Remember: people who care about you welcome the opportunity to help; being supportive is not a burden for them.
If connecting is difficult. No matter how close you are to someone, PTSD can mean that you still don’t feel any better after talking. If that describes you, there are ways to help the process along.
Exercise or move. Before chatting with a friend, either exercise or move around. Jump up and down, swing your arms and legs, or just flail around. Your head will feel clearer and you’ll find it easier to connect.
Vocal toning. As strange as it sounds, vocal toning is a great way to open up to social engagement. Sit straight and simply make “mmmm” sounds. Change the pitch and volume until you experience a pleasant vibration in your face.
Step 4: Take care of your body
Without the rush of still being in a combat zone, you may feel strange or even dead inside and find it difficult to relax. Many veterans are drawn to things that offer a familiar adrenaline rush, whether it’s caffeine, drugs, violent video games, driving recklessly, or daredevil sports. However, the symptoms of PTSD can be hard on your body and mind so it’s important to put a priority on sleep, healthy food, and calming activities.
Take time to relax with relaxation techniques such as massage, meditation, or yoga. Avoid alcohol and drugs (including nicotine). It can be tempting to turn to drugs and alcohol to numb painful feelings and memories and get to sleep. But substance abuse (and cigarettes) can make the symptoms of PTSD worse.
Find safe ways to blow off steam. Pound on a punching bag, pummel a pillow, sing along to loud music, or find a secluded place to scream at the top of your lungs.
Support your body with a healthy diet. Omega-3s play a vital role in emotional health so incorporate foods such as fatty fish, flaxseed, and walnuts into your diet. Limit processed and fried food, sugars, and refined carbs which can exacerbate mood swings and energy fluctuations.
Get plenty of sleep. Sleep deprivation exacerbates anger, irritability, and moodiness. Aim for 7 to 9 hours of quality sleep each night.
Step 5: Deal with flashbacks, nightmares, and intrusive thoughts
Flashbacks usually involve visual and auditory memories of combat. It feels as if it’s happening all over again so it’s vital to reassure yourself that the experience is not occurring in the present.
State to yourself (out loud or in your head) the reality that while you feel as if the trauma is currently happening, you can look around and recognize that you’re safe.
Use a simple script when you awaken from a nightmare or start to experience a flashback: “I feel [panicked, overwhelmed, etc.] because I’m remembering [traumatic event], but as I look around I can see that the event isn’t happening right now and I’m not in danger.”
Describe what you see when look around (name the place where you are, the current date, and three things you see when you look around). Try tapping your arms to bring you back to the present.
Tips for grounding yourself during a flashback
Movement - Move around vigorously (run in place, jump up and down, etc.); rub your hands together; shake your head
Touch - Splash cold water on your face; grip a piece of ice; touch or grab on to a safe object; pinch yourself; play with worry beads or a stress ball
Sight - Blink rapidly and firmly; look around and take inventory of what you see
Sound - Turn on loud music; clap your hands or stomp your feet; talk to yourself (tell yourself you're safe, you'll be okay)
Smell - Smell something that links you to the present (coffee, mouthwash, your wife's perfume) or a scent that has good memories
Taste - Suck on a strong mint or chew a piece of gum; bite into something tart or spicy; drink a glass of cold water or juice.
Step 6: Work through survivor's guilt
Feelings of guilt are very common among veterans with PTSD. You may have seen people injured or killed, often your friends and comrades. You may ask yourself questions such as: Why did I survive when others didn’t?
You may end up blaming yourself for what happened and believing that your actions (or inability to act) led to someone else’s death.
You may feel that you’re the one who should have died. This is survivor’s guilt.
Healing from survivor's guilt
Healing doesn’t mean that you’ll forget what happened or those who died. And it doesn’t mean you’ll have no regrets. What it does mean is that you’ll look at your role more realistically:
Is the amount of responsibility you’re assuming reasonable?
Could you really have prevented or stopped what happened?
Are you judging your decisions based on full information about the event, or just your emotions?
Did you do your best at the time, under challenging circumstances?
Do you truly believe that if you had died, someone else would have survived?
Honestly assessing your responsibility and role can free you to move on and grieve your losses. Instead of punishing yourself, you can redirect your energy into honoring those you lost and finding ways to keep their memory alive.
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