The experience of posttraumatic stress disorder (PTSD) is often described in terms of the symptoms one experiences. For example, PTSD symptoms may include flashbacks (or sudden, unwanted memories) of an unpleasant experience, extreme anger, paranoia, and shame. In this article, we discuss PTSD symptoms, how they may provide some short-term benefit, how they may negatively impact one's well-being, and ways to replace unhelpful symptoms with more positive thoughts and behaviors.
Why Do We Experience Symptoms?
Believe it or not, symptoms you experience either during or following a traumatic event may actually help you survive and cope after the fact. For example, imagine an angry bear is chasing you through a forest and you trip and cut your leg open. You see the blood, but because your adrenaline is pumping, you barely feel it and are able to keep running to safety. This is an example of where physical and emotional "numbness" worked to your advantage by allowing you to focus exclusively on running to safety.
Similarly, PTSD symptoms may also serve a useful purpose following a traumatic event. For example, when thoughts and emotions about the event become overpowering, emotional numbness, or depression, may provide some relief. Or, when unpleasant memories make you feel scared and helpless, a surge of anger directed at another person may make you feel more powerful again. Even feelings of hypervigilance, or paranoia, may help you feel safer when anticipating future threats.
What happens when the threat is gone and these symptoms (such as depression, anger, and paranoia) are now causing you more harm than good? For example, the physical numbness felt by the person being chased by the bear may result in their bleeding to death if they don't eventually stop running and get their leg examined once they've made it to safety. Similarly, while PTSD symptoms may provide you with some short-term relief, they can also negatively impact your day-to-day emotional well-being, functioning and relationships. How do you know when the positive effect of the symptom is outweighed by the negative effect?
Use A "Decision Balance" Strategy to Decide Which Symptoms and Behaviors You No Longer Need
If PTSD symptoms are serving some purpose for you, but also causing problems in your life, then it's important to consider replacing them with something more helpful. This doesn't mean you should stop the symptom or behavior "cold turkey" without a plan for what to do when it comes up again. For example, if you like having a few drinks at the end of the day to relax, then stopping drinking "cold turkey" doesn't work well unless you have some other way to relax—a mug of tea, a walk, a relaxing show, etc.
One way to start thinking about your symptoms and behaviors is to write them down, record why they are helpful, and, how they are harmful. Then, write down a list of behaviors and thoughts you might use instead of the current symptom or behavior. These "replacement" behaviors or symptoms should be ones that you can readily do and that are more helpful to you and your well-being than what you currently do. This is known as a Decision Balance and is kind of like a pro/con list. So, grab a pen and paper or use your phone. Map out the pros and cons of each symptom. Here is an example of using decision balance for anger.
Symptom - Anger:
Pro – At first this helps me feel better, powerful, and more in control of a situation.
Con – Later, I regret yelling at friends and family or punching the wall; it makes things worse at home with spouse and kids; my colleagues have complained and I've been reprimanded at work.
Possible New Behavior - Download Breathe2Relax mobile app and practice deep breathing to calm down when I feel an anger surge coming on; practice recognizing triggers in my life that cause my anger to erupt.
If you are not sure of what to substitute for a current symptom, consider engaging a psychological health care professional. Not sure how to do find the care you want in your area? inTransition is standing by 24/7 to help service members and veterans get connected to care that works for them. Service members, veterans, family, and friends can call the Psychological Health Resource Center at 866-966-1020 or use the Real Warriors Live Chat for help accessing care.
What Line Leaders Can Do
Line leaders are an important influence when it comes to encouraging psychological fitness and managing the aftermath of stressful and traumatic situations. Line leaders have the potential to create a positive environment within their command that promotes trust and encourages seeking care. For tips on establishing a supportive unit culture, check out the Real Warriors Campaign's "5 Ways Military Leaders Can Address Stigma" fact sheet".
Military leadership plays a vital role in unit performance and mission success. If you notice a service member having a hard time, reach out and consider connecting them with care options. Try these tips for starting a conversation when you have a concern about a fellow service member. By promoting psychological fitness in their units, line leaders help strengthen the force as a whole.
Additional Resources:
Sources:
- Fisher, J., & Ogden, P. (2009). Sensorimotor psychotherapy. Treating complex traumatic stress disorders: An evidence-based guide, 312-328.
- Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1-25.
- Human Performance Resources by CHAMP. (2018, Feb. 26). Total Force Fitness: Your Roadmap to Peak Performance.
- Meredith, L.S., Sherbourne, C. D., Gaillot, S. J., Hansell, L., Ritschard, H. V., Parker, A. M., & Wrenn, G. (2011). Promoting Psychological Resilience in the U.S. Military. RAND Corporation.
- Military Health System. (2020, Jan. 7). Joint Chiefs Say Mind, Body, Spirit All Part of Total Force Fitness.
- Messina, L. A. (2018, Oct. 22). A Broader Perspective of Health: Total Force Fitness and Treating Depression. Psychological Health Center of Excellence.
- Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change. Guilford Press: New York, NY
- National Center for PTSD, Department of Veterans Affairs. (n.d.). Coping with Traumatic Stress Reactions.
- Wetherford, R. (2018). Janina Fisher on Innovations in Treating Trauma. psychotherapy.net.