The Veteran’s Toolkit for PTSD

The supply convoy was on its third and final day on the road heading from Kuwait to northern Iraq. The tanker trucks carried loads of diesel, a task which they had successfully accomplished many times before. SSG Gray sat in the passenger seat while PFC Jones took over the afternoon driving. The trip had been relatively uneventful. There were two long delays due to suspicions of IED’s on the side of the road, but these proved to be simply roadside debris. The two soldiers were feeling a sense of relief that in approximately two hours they would be enjoying the comforts of the large base they were heading to. As they passed by a cluster of trees growing close to the road, suddenly an RPG slammed into the cab of the truck on the driver’s side. The explosion blew SSG Gray out of the cab and onto the ground below, but not before being peppered with shrapnel on his left side. Deaf from the explosion, he could see the truck slowly grinding to a halt in the shallow roadside ditch just ahead. Almost as soon as it stopped, he watched horrified as the cab of the truck burst into flames and slowly started to engulf it. Jerking himself to his feet, he shuffled as fast as he could up to the cab. He didn’t hear the small arms fire going on about him, but another RPG round aimed at the disabled truck flashed overhead and he knew the convoy was still under attack. Nine months later, Gray walked with his wife and son through the local community fair celebrating the Fourth of July. His return home had been a difficult one so far. He felt distant from his wife and had too frequently been short-tempered with his son. His wife had even suggested that he needed to seek help. At night he had been having nightmares related to his experiences and had taken to sleeping in another room so as not to disturb his wife. As night fell at the fair, the first volley of the firework display shot into the sky exploding in a beautiful display of reds, blues and whites. For Gray, however, the sounds and the sights were not so enjoyable. In fact, they were overwhelming and reminiscent of the sounds and sights in Iraq. Ducking instinctively to the ground and pulling his wife and child with him, he covered them with his body as surprised bystanders looked on nervously. A flashback is re-experiencing mentally the traumatic events that cause PTSD symptoms. Often the veteran feels and acts as if the traumatic event is happening again and may even lose awareness of the present moment. Not only is this emotionally and mentally overwhelming, but the person undergoing it often is anxious about the reaction of others around them who witness them experiencing a flashback, such as their spouse, children or friends. Along with flashbacks, veterans may also experience dissociation, which is an experience in which they feel disconnected from themselves and their surroundings. With dissociation, like flashbacks, veterans may lose connection with events around them for periods of time in which they can recall nothing. Flashbacks and dissociation are usually preceded by a trigger, or something that reminds them of the traumatic event and launches them into a flashback episode or dissociation. Triggers can affect any of the five senses including what the veteran sees, hears, smells, tastes or touches. For example, the smell of burning diesel can be a trigger. Witnessing a crime can be a trigger. Hearing a rifle go off while hunting can be a trigger. Attending a funeral in which taps is played can be a trigger. Many times triggers are unknown until experienced for the first time, and their effect can be overwhelming once a flashback or dissociation occurs. There are several tools that you can use to limit or prevent the impact of triggers, flashbacks and dissociation: 1. Triggers are best managed by becoming aware of what your triggers are and then limiting your exposure to them or by learning to cope with them when they do occur. Often the only way you will know what your triggers are is by first experiencing them. Experiencing triggers the first time can be difficult, but is usually unavoidable as it happens unexpectedly, so when it does happen use that constructively as a learning experience. Once you know your triggers, you can seek to limit your exposure to those situations in which you know the trigger will be present. On the other hand, some individuals find when they absolutely can’t avoid a trigger such as when they are at work, that repeated exposure to the trigger gradually increases their tolerance to it. Coping with triggers involves using all the other suggestions in this book such as talking with a trusted friend, using expressive writing and using relaxation techniques. 2. Identify early warning signs for flashbacks and dissociation. Sometimes it seems flashbacks and dissociation come out of nowhere, but closely examining what happens beforehand will often reveal warning signs. For example, you may start to feel fuzzy or dizzy or you may feel as though you are separating from your self. Around you everything may begin to take an unreal nature. You also may feel anxious and sense your heart beating faster. Identify as many typical warning signs as you can, and when you start to experience them use grounding, which is described next. 3. Grounding is a way of coping that keeps you in the present and helps prevent actively reliving a flashback or dissociating. Just like one of your five senses sensing a trigger, grounding uses the five senses to keep you solidly in the present. • Sound: Turn on something loud. Loud music or talking is hard to ignore and helps to bring you back into the present moment. Be careful, however if using ear buds not to damage your hearing. • Touch: Hold on to something cold like an ice cube or cold drink. The coldness of the object will help you to stay in touch with the present moment. • Smell: Sniff something with a strong smell such as vinegar. The strong smell helps to stay in the present like smelling salts help to bring around an unconscious person. • Taste: Bite into something very tart or sweet. The tartness or sweetness of the sensation can force you to stay in the present moment. • Sight: Start naming by name all the objects you see around you which will help keep you connected with the present. Feel free to make substitutions to any of these so that they best fit your needs and situation. 4. Enlist the support of others to help you through your most challenging moments. Bring along a trusted friend at those times you think you might be most vulnerable to flashbacks or dissociation and tell them what to do to help you. 5. Seek professional treatment if the flashbacks and dissociation become debilitating and you need that extra support.