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Serving your nation is one of the most truly noble acts that a person can do in life. Setting aside your own desires, dreams, and plans to help secure the future of someone else’s way of life is an act that many people are unable and unwilling to perform. But for those who make the sacrifice, their return to the civilian side of life can be a major adjustment. Friends and families left behind during a soldier’s tour of duty feel their absence and miss their loved one, but they continue with the monotonous routine of everyday life; dishes, groceries, bills, and carpools don’t get put on hold. When their soldier returns, they often expect that person to step right into the “normal” everyday life they have been experiencing.
But for that returning soldier, their everyday “normal” didn’t include ball practices and dance recitals, math homework and leaky roofs. The everyday experiences they had included roadside bombs, always being on the lookout for tripwires, feeling distrust of any unknown individual, sleeping in terrible conditions, and being subjected to all elements of the weather. Witnessing close comrades being killed or seriously wounded changes someone; they cannot simply walk back into the life they knew without learning how to accept that things are different and a healthy way to decompress. Unfortunately, the number of returning troops with some of the most serious and life-altering injuries is staggering. Injuries both seen and unseen are reaching an all-time high. And the main resource for the U.S. Military, the Veteran’s Administration, is struggling immensely to keep up and provide the services these soldiers and their families need. Many soldiers have turned to alternate means to try to function and deal with the emotions they experience. Substance abuse is at a record high among soldiers. Depression and suicide are at crisis levels. More and more soldiers are coming home only to realize that they feel completely out of place and at a loss on how to function in civilian society.
Soldiers are experiencing a trauma in various forms; themselves, other soldiers, and civilians. Many have TBI’s (traumatic brain injuries) which can have an altering effect on personality and mental acuity. Soldiers with multiple amputations is at another all-time high. Young, otherwise healthy men and women are returning home having to face a future far different than what they envisioned. While their peers at home are concerned with what college or vocation to pursue, what newest restaurant to try, or contemplating childcare options, they are having to relearn how to walk, talk, and function. Many have experienced injuries causing infertility. Some addictions may start out with medications prescribed to help ease pain received from traumatic injuries and proceed to abuse. Many soldiers are facing multiple tours of combat, leading to even more exposure to traumatic events.
Why are we seeing such a large number of people who are having such extreme difficulty returning to civilian life? Four letters: PTSD. Post-Traumatic Stress Disorder. Those four words have changed thousands of lives and without proper acknowledgement and treatment, a person may never regain a functional life. PTSD is talked about across news stations and in training sessions around the country. But what does it mean for the person struggling to get through a day? PTSD differs from encountering a traumatic experience, feeling shaken but walking away from that situation with anything more than added caution and gratefulness. PTSD can occur after a person experiences one single traumatic event or a series of events. Symptoms can appear soon following the event(s) or years later. It all relates to the physiological effects of the body’s “fight or flight” response. It is a protective measure your body uses in stressful situations to insure the best chance of survival. Your body dumps massive amounts of adrenaline, your blood flow increases, and you become alert; literally ready to stand and fight or flee from imminent danger. In PTSD, your body doesn’t turn off that fight or flight response. You become constantly on edge, awaiting whatever is coming. PTSD can exhibit itself in various ways. Some people experience anxiety, a restless sensation, constant fearful feeling, difficulty sleeping, lack of concentration, and increasing frustration or temper, guilt, or apathy¹. So how does this relate to substance abuse in veterans? The National Center for PTSD estimates that 1 out of 3 veterans who are struggling with substance abuse also have PTSD². “
So, with so many veterans struggling with these problems, why aren’t more coming forward for help? Why is the suicide rate so high? An overall culture of discouraging soldiers to ask for help and repercussions of being labeled as a drug-user keep many from stepping forward³. The VA is starting to issue campaigns, encouraging those struggling to come forward for help. But do the veterans actually have accessibility to that help? The numbers of suicide, drug abuse, and homelessness are not decreasing. Per the Substance Abuse and Mental Health Services Administration, 70% of homeless veterans were fighting substance abuse⁴. Families are not immune to the issues their returning soldier is facing. Spouses and children are dealing with the effects of substance abuse in their daily life.
What options exist for a veteran and their family? Where can they go to get the help they deserve? Church sponsored support groups offer a community for veterans to turn to; local governments can connect veterans to sources. Private treatment centers can offer a private and focused plan that includes the veteran and the family. New programs are being developed, many by veterans themselves, to provide realistic, affordable, and relevant care. Therapy with animals, from adopting rescue dogs to working with horses, has shown very positive results. Outdoor related activities, like hiking, camping, hunting, and fishing, offer real-world environments for a veteran to adjust to civilian life.
The mission of the Association of Traumatic Stress Specialists (ATSS) is to organize, educate, and professionally certify our world-wide membership in order to assist those affected by trauma. We encourage all members to share with us any trauma resources available for the brave men and women of the military.
Author: John Becker Jr. MHS-C, CTR (Former Detective Sergeant)
Should emergency services workers maintain work routines after exposure to trauma?
As a police manager I’ve thought about this question because I’ve seen officers who take time off after witnessing trauma, and I’ve seen others that stick to their normal work schedule. I’m not talking about just taking a day or two off, since that wouldn’t throw your work routines out of whack, however some officers get a doctor’s note giving them a few weeks, sometimes over a month off of work. That would definitely throw their routines off.
I recently read an article from Journal of Adolescent Health (2006) Maintaining Routine despite Ongoing Exposure to Terrorism: a Healthy Strategy for Adolescents? The researchers (Pat-Horenczyk, Schiff, Doppelt) studied high-school age youth in Jerusalem during the Al Aqsa uprising of 2002-2003. During that time there were 26 suicide bomb attacks in Jerusalem. They happened in buses, coffee shops, fast-food restaurants, shopping centers, and in the downtown area. Those are all areas that teens would typically go to hang out with their friends.
Of the 1336 Israeli adolescents examined, the majority (approximately 70%) continued with their routines and did not avoid buses, malls and restaurants. Even adolescents who reported exposure to terrorist attacks were as likely as teens reporting no exposure to maintain their level of routine activities. Thirty percent of the teens avoided taking buses and going to those locations, either because of their own choice or due to parents not allowing it.
The study found that a reduced level of routine was a significant predictor for higher post-traumatic stress and functional impairment. Interestingly, it didn’t matter why the subjects avoided going out, whether it was their own choice to avoid danger, or whether it was due to their parents limiting them, the outcome was the same – significantly higher rates of PTS and functional impairment. Maintaining routine was associated with less PTS, and parental encouragement for maintaining routine was associated with less PTS.
The article also mentions that it is consistent with other coping theories suggesting that “avoidance” coping strategies, including avoiding routines are associated with greater PTS than “approach” or active coping strategies.
The study doesn’t go as far as to determine why, but I’ll give some of my thoughts on it. It may be because teens stuck at home without their friends are more isolated and don’t have their normal support system of peers. It may be due to the avoidance behavior increasing their fear, instead of facing their fear which would likely reduce it.
It may be that the adolescents who continued their routines felt more confidence and self-efficacy and felt more in control of their environment. Despite the fact that they placed themselves in more physical danger, it was psychologically protective.
Does this apply to emergency services personnel? In my opinion it does. I think depending on the level of exposure to trauma, in most cases the members should be encouraged to return to work and re-establish routines sooner than later. I wouldn’t question the recommendation of a clinician, but often the subject is also getting advice from peer support teams or CISM members. Even after minimal exposure, sometimes their advice to the member is to take time off work. This is done with sensitivity and caring for the member, but may actually increase the chance of PTS and functional impairment.
I had one member who was involved in a traumatic incident. He told me that the peer support member told him he could take a month off work if he needed it, but he told me that his father used to say “When you fall off a horse you get back on”. He was back at work the next day. That was healthy for him.
Should EAP counselors, CISM teams, and peer supporters encourage members to get back to work as soon as possible? As a manager I may be biased, but I would like to hear your opinions and your experience with this.
Brad Coulbeck CTSS, Vice-President, Board of Directors, ATSS
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Our ATSS Board of Directors has reviewed your very thoughtful comments in our recent member survey. And we agree that we need to improve communication and engagement with our members and provide opportunities for connection with one another. We are not simply an association that provides opportunities for professional recognition through certification. We are an established and committed community of caregivers that edify, support and strengthen each other.
I think we’ve got the first part down, so now we are moving towards creating the community. We can do that through the blog, surveys and other communication to the membership.
As the blog evolves, we hope that it will provide:
- New research
- Opinions on different intervention models
- Experiences of members
- Tips on job opportunities
- Stimulating dialogue and comments
- A forum to share success stories
- Links to interesting articles
- A place to get to know each other
- And More!
Of course with any articles about psychology there are differences of opinions. We, as committed a Community of Caregivers, will be no different. We have members who will disagree with some things and will be able to back up their positions with peer-reviewed scholarly articles or quotes from leading researchers. Even leaders in the field don’t agree on everything. We encourage that dialogue, but request that it be done respectfully and without personal attacks. Have fun with it though. It’s for you.
Brad Coulbeck CTSS, Vice-President, Board of Directors, ATSS
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