What can you do to help a veteran having mood or anxiety issues following a deployment? While many veterans return home and are well adjusted, for those who struggle it’s important to know there is help.

Problems like depression, substance abuse, and post-traumatic stress disorder (PTSD) are common in veterans. Particularly with PTSD, many veterans don’t qualify for a full diagnosis, but for those who struggle, it can be life-saving to get help. Depression is also common — even more so than full-blown PTSD — and it can show up as irritability and anger, particularly in men. 

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Symptoms of PTSD in veterans

PTSD is usually related to experiencing something traumatic, either to yourself or to someone close to you, such as seeing something horrific in combat. PTSD happens as the body’s normal physiological and psychological response to something that doesn’t fit our perceptions of how the world works.

Many veterans do not meet full criteria for PTSD or depression, but they will meet some of the criteria, and they can still receive help. To receive a full diagnosis of PTDS, a person must meet all four areas below, experience them for more than a month, and have them be related to one traumatic event or a series of events:

1. Re-experiencing: The person has nightmares or they might be fully awake and experience flashbacks. They usually are very reactive to triggers, such as the sound of a car backfiring. They have this fight or flight response.
2. Hyperarousal: The person is jittery and always on the lookout for danger. They feel like they’re going to be attacked at any moment. It might be difficult to sleep or concentrate. When going into a public place like a restaurant, instead of looking for a comfortable seat, they might seek a quick exit route.
3. Avoidance: The person avoids crowds and anything that triggers or reminds them of the traumatic event. They might avoid talking or they will stay very busy, so there isn’t an opportunity to think about the event.
4. Negative changes in beliefs: The person might not have as positive or loving feelings toward others and stay away from relationships. It’s almost as if the traumatic event has caused them to have this universally pessimistic outlook about relationships. There might even be a foreshortened perspective about the future.

Problems related to PTSD

People with PTSD will find that their symptoms are impairing them in some way, such as not being able to get a job, not being close to family, and using drugs and alcohol — including opioids and benzodiazepines, like Valium and Xanax — to numb out. 

For veterans with PTSD, they often have histories of abuse. This is not the case for everyone, but if there was abuse in childhood, it can trigger PTSD while at war. Statistically speaking, there’s a higher likelihood of a veteran having PTSD or depression if they came from what we call an “invalidating environment,” where their voice wasn’t heard. There could have been neglect or abuse for speaking up, or the experience of invalidation for having certain feelings.

One thing I discuss with patients is “the window of tolerance”

For many people who’ve seen something traumatic or have an abuse history, their emotional experience is never within “the window of tolerance.” I use this to describe a place where emotions are tolerable and regulated. Here’s how to think of it.

Imagine a box or a window. Below it is a state of numbness where a person feels dead inside or detached. Above it is hyperarousal where there’s not only feelings, but those feelings are too much and there’s flashbacks. What’s inside the box, that’s the window of tolerance, where a person can feel emotions, know what they’re feeling, and those feelings are within bounds. Many people are either below or above the box. They’ll ping pong back and forth from hyperarousal to numbness.

This is where drug and alcohol problems occur — because hyperarousal is like panic land — a person might have flashbacks or feel like they’re going insane or having a heart attack. So it’s understandable that some people will use alcohol or other substances as way to numb themselves. 

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3 PTDS coping skills

Veteran’s and anyone experiencing PTSD symptoms can receive help and learn how to cope. Three of the skills and practices I recommend in therapy include:

1. Grounding, which means being connected to the present moment. This is noticing, “Now I’m hearing the ticking of a clock… now I can feel my feet in my shoes…” The idea is to bring a person back from hyperarousal to within the window of tolerance (i.e., you can feel your feelings but not impulsively react to them). A qualified mental health provider can help if this feels too difficult to do on your own.
2. Lowering stress levels through breathing and muscle relaxing, so that the feelings become more manageable.
3. Healthy connection and talking. The last thing we want someone with PTSD to do is shut off from others. While people don’t need to overextend themselves or be the life of the party (because some people use socializing as a way to avoid), it’s important to connect to others and get support, such as joining a group from an organization like the US Department of Veteran Affairs (VA).

How can you approach a loved one you’re worried about?

I recommend finding a good moment and planning what you’ll say ahead of time. You don’t want to have a talk during an argument or right after a blow up. Shame is a very powerful emotion, particularly people who consider themselves warriors. When someone is being reactive, usually the emotion underneath is shame. It might be shame that they can’t control their feelings or that their family is disappointed in them.

Keeping this in mind, here’s a way to frame a conversation:

• Ask permission and keep the conversation to 2-3 minutes. Try something like, “Hey I’m concerned about you because it seems like a couple things have changed. Can you give me two minutes to tell you what I’ve observed?”
• Tell them what you’ve noticed. “It seems like you’re really tense and I’m worried. It might be worth talking with your primary care physician or a therapist for a couple sessions. I don’t want to wait until something bad happens.”

Know that having a talk might not be successful, but if you approach your loved one with care, you might sow some seeds. Part of PTSD is wanting to avoid talking about the issues, so if you can choose a positive time, they’ll be more receptive.