Understanding How PTSD Can Become Post-Traumatic Growth Part One: Trauma’s Role in Robbing the Victim of Important Life Values by Matt E. Jaremko

In the early 1980’s, my Monday evenings were spent as co-leader of an open-ended therapy and support group for Vietnam veterans at the Memphis Vet Center, a storefront clinic and service center housed in downtown Memphis. The Vet Centers were the VA’s program to make services more intimate and available to veterans separate from the larger VA hospitals

Group sizes ranged from 3 to 20 participants, homeless vets alongside retired officers. Most attendees came to only a couple of sessions, but there was a sizable block who were “regulars” attending dozens of sessions in the 3 years I was involved leading the group.

Most group participants had psychological and behavioral problems associated with Post-traumatic Stress Disorder. But as I listened to them talk about themselves and to each other, the most valuable lessons I learned from these veterans had more to do with their strengths than their weaknesses. First, one of the biggest tragedies of their military experience was not necessarily the PTSD symptoms of heightened anxiety, moodiness, nightmares, flashbacks, shame and/or horror of having witnessed or committed horrible acts.  For many, the worst outcome of serving in that war was being robbed of the value system they believed prior to their service.

Most Vietnam veterans volunteered in order to contribute to a cause they thought noble and worth their sacrifice: to protect a democratic way of life by providing a check on Communism. Unfortunately, after serving, many vets concluded that their sacrifice had been wasted by politicized leadership agendas and military tactics that made little sense. The veterans were disillusioned because they began to see they were being used by their country, rather than serving their country.

Moreover, when those combatants returned home, their patriotism was attacked and shamed by the process of citizens involved a war-protest movement.  Home was a place in which the vets no longer fit. They were hurting, alone and bitter about what they had seen and done. The ideals upon which they had decided to serve had been shattered. In the resulting “values vacuum,” only the misery of powerful PTSD symptoms was left.   Additionally, they were rarely taught how to replace or renew the compromised values system.

A second thing I learned from those Vietnam Veterans was the importance of the “platoon”, usually a squad of 10 or 12 men. Even though together for only 13 months, the bond that quickly developed among the platoon was very powerful and motivating. It was not uncommon in the group sessions to hear men talk about how much they cared for the others in their basic small unit. In fact, often it was only other vets these men felt comfortable with and/or trusted.

I came to realize the healing power in those small groups. The Memphis Vet Center Monday Night Therapy and Support group became a “platoon” where vets could work with each other to rediscover or replace their lost values. Once they accomplished this values clarification, many found more strength to cope with the symptoms of PTSD because they became more receptive to learning the cognitive and behavioral skills helpful in rebuilding life after trauma.

 

Traumatic Experiences Change What Victims Consider Valuable/Important In Life

Since those days at the Vet Center, I have been honored to be involved in the treatment of many other folks who had traumatic events in their lives, including Childhood Sexual Abuse, motor vehicle accidents, crime victimization, natural disasters and sexual assault.  A common feature of these trauma survivors is this loss of belief in previously-held values. Values can be defined as life activities or behavioral outcomes considered important, even vital, in a healthy life.  A partial list of values considered essential to healthy living would include but not be limited to perseverance, respect, honor, love, sacrifice, truth, freedom, compassion, bravery, kindness, wisdom, safety and trust. Clarity about what is important in life is often changed for trauma victims. Like the combat veterans’ loss of guiding patriotic values, survivors of Childhood Sexual Abuse (CSA) spend the first 8–10 years of life learning trust, only to find that it was no more authentic than a politician’s promise. Many battered spouses go through life in fear for their physical safety, only to have such fears confirmed by violence, thus eliminating a valuable sense of security. A vacuum is formed where once there was a strongly-held belief about an important feature of life. Without a sense of knowing what is important in life, trauma victims find less motivation to engage in the hard work of facing unpleasant symptoms. Avoiding the constant negative symptoms becomes their main focus of life.

Even a brief examination of the history of humans shows an incredible capacity to cope with the most dire of circumstances when focused on values meaningful to the culture or social group at large. In the absence of those values, coping with hardship is greatly reduced, maybe even non-existent. Individuals have sacrificed much, even their own lives, when pursuing the “higher good.”  But when not clear about that great good, victims tend to remain stuck in self-preoccupation. The values vacuum must be addressed to find increased motivation and strength in coping post-trauma. Since the main method by which we learn values in the first place is through social interaction with important people in our lives, group process is a powerful mechanism by which victims can examine changed values systems and begin to renew and replace them.

Rates of Trauma and Overcoming It

A recent study (Kilpatrick, et al, 2013) reveals that over 80% of 3000 people surveyed report having experienced a major trauma. 80%! These traumas include physical or sexual abuse-53%; death of a family member due to violence-51%; natural disaster-50%; accident/fire-48%; witnessing physical or sexual assault-33%; and combat or warzone exposure-8%.

Most victims of trauma (including most veterans of military combat) “get over it” in 12-18 months. But 20% don’t. They develop PTSD. What is the difference between the 80% who adjust and the 20 % who can’t “get over it”?

An entire article can and should be devoted to the complicated concept of “getting over it.” For starters, even if victims can get past the trauma, their life narrative is forever changed. Plus, somewhere between 40-60% of folks who have a life trauma end up eventually saying that their life is better for it: an outcome called post-traumatic growth (Calhoun and Tedeschi, 2103).

In fact, if one thinks about it carefully, a good question to consider is WHY IS THERE NOT MORE PTSD, if over 80% of people report having had trauma in life?  My experience with Vietnam veterans and other trauma survivors has led me to the conclusion that folks who “get over it” address the destruction of their values system in some kind of group interaction, formal or otherwise.

 

Changes to One’s Life Narrative

PTSD is a disorder of “being stuck” in a never-ending cycle of avoiding the unpleasant experiences, believing and/or trusting in nothing once-valued and a lack of belief that something can be done to change this cycle (self-efficacy).

In order to overcome the effects of trauma, a victim can’t just learn new skills to cope. The altered values system must be addressed. The sad fact of the matter is that traumatic experience drastically changes one’s life narrative. The purpose and meaning of the life traumatized are shaken to the core.

The narrative of a life can be going along great, maybe even according to one’s life plan, and then WHAM!—a trauma happens, and the narrative changes. Before trauma, a glimpse of the internal dialogue might be summarized as “Everything is okay/I’m in charge/I like my life/ I have hope/this is fun, if not hard.” After trauma, however, it becomes “The hurt is unbearable/I can see no end to it/I can’t do anything to stop this pain/others don’t understand/nothing matters anyway/my life is awful/I’m awful/HELP/leave me alone.”

That changed narrative must be re-written to include a new story line, one that rediscovers or replaces the lost value system. The second half of this two-part article examines the process of how one’s internal dialogue creates a life narrative and how that life narrative can be changed so that post-trauma reactions can become post-trauma growth.

We hope you begin to investigate this approach to trauma recovery through rearranging social interaction in healthy and progressive ways. Our new book, Trauma Recovery: Sessions with Dr. Matt is one way to visualize such a journey in that it describes in detail the narratives of seven trauma victims whose interactions with a therapist and each other achieved the needed changes to recover from trauma. While the book is on sale at Amazon and other booksellers, both Matt and Beth are committed to making a copy of the book available to anyone who is not able to afford its purchase. We can be contacted through our website, drmattbook.com.

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Being Tender yet Tough with Veterans

As any subgroup of Americans, military veterans cover a wide spectrum of personality types and pre-service adjustment history. While there is almost universal agreement that veterans should be honored for serving, across the board admiration without constructive criticism may be unwise. Not every hero acts heroically all the time. Sometimes folks with adjustment difficulties need tolerance and tenderness; but sometimes they need toughness and truth. Military veterans are no different. Three points worth considering in detail come to mind.

The alarming suicide rate may not simply be due to cultural and economic difficulty in reintegrating “into the world.” Many times suicide is an extreme case of rage and anger expression meant to hurt others deemed responsible for the pain felt by the suiciding individual. Unfortunately any person having difficulty expressing strong emotion prior to enlisting might likely be at greater risk to demonstrate unhealthy emotional expression after being stressed by military life, especially combat. Help for such predisposed individuals probably requires retraining in emotional intelligence where a certain “tough love” adherence to abstaining from careless emotional and social acting out is enacted. Like a substance abuser needed to work a program of sobriety, emotionally immature vets might need to increase careful self-discipline when attempting to convey strong and complicated emotion.

Second, it is not accurate to say that services in the VA system are unsatisfactory or unavailable. Well over 85% of veterans report being highly satisfied with help gotten in this system (Even though surveys are oft used for political agendas and there are at times horror stories of care gone wrong). Plus is it not a complete picture to conclude there are unacceptable wait times in the VA system. Since 1979, veterans have been able to use the walk-in, storefront clinics of 300 Vet Centers nationwide to get immediate support, social service and counseling. For over three years in the 1980’s at the Memphis Vet Center I personally conducted a weekly, open ended support and therapy group in which hundreds of men and woman worked through a full range of issues. There is no wait in these “store-front” services, veterans just “walk-in.”  Additionally, there are currently available online and smartphone delivered services for those who suffer from PTSD. Any veteran who wants and needs treatment can get it in a timely fashion.

https://tango.uthscsa.edu/ssads/040/

Additionally the detail, quality and efficiency of treatments available for PTSD is increasingly outstanding. Here’s a website, cptforptsd.com, that explains the treatment in clear terms and provides a searchable list of therapist certified to conduct it.

Welcome

Finally, it could well be that something else is operating in the lives of those veterans who do not avail themselves of services before taking self-destructive action. Recent efforts by dedicated VA mental health practitioners are focused on discovering the parameters that make veterans reluctant to seek treatment (such as Strong Star, https://tango.uthscsa.edu/strongstar/).  A number of helpful resources are beginning to emerge which address such reluctance, like Donald Meichenbaum’s Roadmap to Resilience for veterans and their families or my forthcoming book with Beth Fehlbaum, Trauma Recovery: Sessions with Dr. Matt. These books provide information about what recovery treatment is like and hopefully give inspiration to overcome the reluctance.

Most experienced trauma therapists know that timing is crucial in successful treatment. Sometimes, tenderness and tolerance is required where authentically “being with” someone without judging helps. Other times, a more tough approach is needed to challenge with helpful truths a person who is stuck in a devastated life. If we agree that military veterans deserve our best support, we probably have to dig a little deeper to determine what they need. In the meantime, welcome back, guys; and Happy Veteran’s Day.

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Introduction to our book: Trauma Recovery: Sessions with Dr. Matt

For the past year, I have been collaborating with Beth Fehlbaum to write a book entitled: Trauma Recovery: Sessions with Dr. Matt. The first draft of this book is in the process of editorial submission and review but here we begin to discuss its purpose and anticipated impact.

An overview of the book is provided below as an introduction to what we think is a unique and entertaining fusion of non-fiction self-help writing with fictional storylines of true-to-life trauma survivors as they face the arduous process of rebuilding life after catastrophe. Coming entries to this blog will elucidate and augment both major and minor topics examined in Trauma Recovery: Sessions with Dr. Matt. We welcome you into the inside processes of creating and disseminating this important new book.

OVERVIEW

Exposure to traumatic events has become the “black plague” of the 21st century: it’s everywhere! It is generally believed 70% of all people will experience a traumatic event in their lifetime. 20% of those will go on to develop PTSD. Thus, recovery from trauma has become a major health and human services issues.

This book addresses recovery from trauma in a highly unique dual format.  First, the book is a non-fiction treatise of the current scientific and clinical understanding of the formation of PTSD and its treatment. At the same time, the book is a fictional depiction of seven individuals being treated by a professional psychologist for PTSD secondary to a variety of traumatic events. The fictional sections of the book are used to illustrate the scientific and clinical non-fictional material presented. The combination of the conceptual information with emotionally-charged human examples yields more complete understanding; one that leads the reader to take the action required to recover from traumatic experiences.

While exposure to trauma results in strong negative emotional and behavioral experiences, PTSD happens when the trauma victim gets stuck in a cycle of negative emotion and harmful avoidance behavior to the exclusion of pursuing and/or approaching meaningful and valued life activity.  In fact, over 40% of those exposed to trauma will eventually say they are stronger for having been through such a life-changing event. This leads to a vital question: what is missing in the 60% who don’t experience “post-traumatic growth”? This book carefully outlines why some trauma victims get better; even stronger, and some don’t.

In fact, it is because of the very nature of being stuck that trauma victims with PTSD find it very difficult to seek and complete treatment. Their lives remain in a suspended negative state of fear, shame, anger, isolation and hiding. These patients think no one can understand them and that nothing can be done to help them.

Fortunately, modern psychological treatments are highly effective, but victims first must be convinced to come out of hiding and seek the truth about how their lives have changed. Trauma Recovery: Sessions with Dr. Matt convinces those victims in a unique and effective manner.

This book will appeal to four groups:

  1. Reluctant patients who are stuck in the pain-avoidance cycle: they can find hope from the narratives of seven fictional patients brought to life in the book whose recovery process is described in an engaging format.
  2. Motivated patients: those ready and eager for treatment, can find help from the parts of the book which describe in clear terms the science behind their PTSD symptoms and the collaborative process of treatment for those symptoms.
  3. Therapists who treat patients with PTSD will find it useful to have the book on their shelves to share with either motivated or reluctant PTSD clients.
  4. General readers of fiction and non-fiction alike will find the characters and their recovery stories highly informative as well as entertaining. General readers will also find the scientific explanations of PTSD psychopathology and its effective treatment provided in the book to be enlightening and useful.
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