A B C T F A C T S H E E T S

MILITARY POSTTRAUMATIC STRESS DISORDER

What Is Posttraumatic Stress Disorder (PTSD)? What Is Cognitive Behavior Therapy?
PTSD is a stress-related disorder that develops after a traumatic experience. It Behavior Therapy and Cognitive Behavior Therapy
involves a combination of emotional, physical, and behavioral symptoms that are types of treatment that are based firmly on re-
occur as a consequence of experiencing the traumatic event and that greatly search findings. These approaches aid people in
achieving specific changes or goals.
affect a person’s everyday life. PTSD is not uncommon in military personnel who
Changes or goals might involve:
have deployed and experienced one or more of the many traumas that can occur
• changing behaviors: going to places that the child
in a combat zone. Although PTSD is often thought to be a chronic, lifelong condi- has been avoiding;
tion, it is actually a disorder that can be effectively treated in most military serv- • changing feelings: helping the child be less scared,
less depressed, or less anxious;
ice members and veterans. • changing thoughts: learning to challenge thoughts
of self-blame;
What Is a Trauma? • helping to deal with physical or medical problems:
helping the child idenfy quesons he or she has for
Most people experience one or more potentially traumatic events during their his or her doctor or helping a person comply with
lifetime. The most common forms of trauma include motor vehicle accidents, the doctor's instrucons;
• helping with coping: helping a parent help a child.
natural disasters (hurricanes, tornados, earthquakes, floods, fires, etc.), physical
or sexual assaults, or the sudden death of a loved one. Traumatic events often Behavior therapists and Cognitive behavior thera-
pists usually focus more on the current situation
include situations in which your life or the life of someone else was in danger; you and its solution, rather than the past. They concen-
experienced or witnessed an assault or severe injury; or you were involved in an trate on a person’s views and beliefs about their life,
event in which someone was killed. Deployed military personnel are at risk for not on personality traits. Behavior therapists and
exposure to a number of unique combat-related traumas. Some of these events cognitive behavior therapists treat individuals, par-
ents, children, couples, and families. Replacing ways
include exposure to gruesome injuries or human remains, which commonly occur of living that do not work well with ways of living
after the detonation of improvised explosive devices (IEDs) or other explosions. that work, and giving people more control over
Many deployed military personnel are frequently exposed to life-threatening situ- their lives, are common goals of behavior and cog-
ations, and some fear for their life on a daily basis. Some common sources of nitive behavior therapy.
trauma in deployed military settings include exposure to the following: HOW TO GET HELP: If you are looking for help, ei-
ther for yourself or someone else, you may be
tempted to call someone who advertises in a local
o Seriously injured people publication or who comes up from a search of the
o Dead bodies, human remains, or body parts Internet. You may, or may not, find a competent
o Blast explosions (IEDs, mortars, rockets, rocket-propelled grenades [RPGs] therapist in this manner. It is wise to check on the
credentials of a psychotherapist. They should be
o Mortuary duty listed as members of professional organizations,
o Near misses such as the Association for Behavioral and Cognitive
o Seeing others die Therapies or the American Psychological Associa-
o Motor vehicle accidents tion. Of course, they should be licensed to practice
in your state. You can find competent specialists
o Fearing for your own life who are affiliated with local universities or mental
o Severely injured or ill medical patients health facilities or who are listed on the websites of
o Moral injuries (events that impact your moral values or beliefs) professional organizations. You may, of course, visit
o Hearing details or viewing images of traumatic events our website (www.abct.org) and click on “Find a
CBT Therapist.”
o Sexual assault
The Association for Behavioral and Cognitive Therapies
o Physical assault (ABCT) is an interdisciplinary organization committed
o Severe sexual harassment to the advancement of a scientific approach to the un-
derstanding and amelioration of problems of the human
condition. These aims are achieved through the investi-
What Happens After Trauma Exposure?
gation and application of behavioral, cognitive, and
After trauma exposure, military personnel often have repeated thoughts about other evidence-based principles to assessment, preven-
the details of traumatic events they have experienced, and these memories may tion, and treatment.
trigger physical reactions such as muscle tightness, an upset stomach, excessive
sweating, or a rapid heartbeat. Recurring nightmares about the traumatic
event are also common. For most individuals, these repeated thoughts, physi-
cal symptoms, and nightmares will fade away naturally with the resumption
of regular duties and the support of their supervisors and leaders, battle bud-
dies, friends, and family. This often occurs without any professional help,
counseling, or treatment. When symptoms following a traumatic event persist
and start to interfere with everyday life, it may be an indication of a combat-
related stress disorder. The military often uses the term “Combat Operational
Stress Disorders” to describe these reactions to combat-related or deploy-
ment-related traumas. However, other terms are used by the diagnostic clas-
sification manuals such as the International Classification of Diseases (ICD)
or the Diagnostic and Statistical Manual of Mental Disorders (DSM). When a
person’s trauma-related symptoms are significant enough to interfere with
his or her day-to-day life, and when these symptoms continue for more than a
few days but less than a month, this is called Acute Stress Disorder. When the
symptoms continue for more than a month, get in the way of everyday life,
and cause distress, it is called Posttraumatic Stress Disorder, or PTSD. People
who have PTSD have four types of symptoms. Most people do not have all of
the symptoms, but to have PTSD, they will have some symptoms of each type.

o Reexperiencing symptoms: Memories of the traumatic event that come

out of the blue, dreams related to the event, flashbacks, or other intense dis-
tress when reminded of the experience.
o Avoidance symptoms: Avoiding distressing memories, thoughts, or feel-
ings or reminders of the event.
o Arousal: Aggressive, reckless or self-destructive behavior, sleep prob-
lems, being on guard, difficulty concentrating.
o Negative thoughts and mood: Blame of self or others, feeling cutoff from
others, loss of interest in activities, inability to remember important parts of
the event.

Common Problems for Service Members and Veterans With PTSD

Alcohol or drug use: Many service members and veterans with PTSD use
nonprescription drugs or drink alcohol to try not to think about what hap-
pened to them. Some people drink to help themselves sleep or because they
think it will help them avoid nightmares. Although drinking sometimes helps
people fall asleep, it actually makes it more likely they will wake up during the
night, makes it harder to stay asleep, and can increase flashbacks and night-
mares. Using drugs and alcohol can also increase anger, create problems at
work and home, and result in many other health problems. Alcohol may seem
to work in the short term, but it causes even more problems in the long term.

Relationship problems / not being close to others: The symptoms of PTSD

can get in the way of important relationships. Marital problems and divorce
are common for people who have PTSD. They can have a hard time talking
with others about what they’ve gone through or what they’re experiencing.
Some people with PTSD think others won’t understand or be able to love
them if they know some of the things they’ve done during combat or deploy-
ments. People who have PTSD often worry that they aren’t good parents.
They may have a hard time feeling love or closeness to other people.
 Depression: Avoidance is a symptom of PTSD that keeps people from
doing things that they used to enjoy. The result of avoidance can be depres-
sion as they stop spending time with other people or doing things that used to
be meaningful or fun.
Feelings of guilt: Many people who have PTSD feel guilty about what
they’ve been through and what they have done or not done. It’s common for
them to think that they could have done something differently that might have
changed the outcome. People with PTSD often think, “It’s my fault” about sit-
uations that they could not control.
Difficulties at work: PTSD symptoms can hurt people’s job performance.
For example, if nightmares or other symptoms cause sleep problems, they are
likely to go to work feeling tired and lacking the energy required to do their
jobs effectively. Thoughts about the trauma may come up during work and
make it hard for them to stay focused, or they may feel less interested in a job
that they used to care about. They may also feel irritable or prefer to be left
alone, making it difficult to get along with coworkers.
Having a hard time trusting (leadership, people in general): Trust is an
area that is often impacted by PTSD. Some people who have PTSD feel as if
their leaders let them down. They may go so far as to think they can’t trust
anyone. While not trusting people or not opening up to them can protect a
person from getting hurt in the short term, it can lead to long-term feelings of
loneliness.
Being worried about safety: Some people who have PTSD never feel com-
pletely safe. Others only feel safe after they check their surroundings many
times. They may feel as if they have to do “guard duty” in their own home or
check the perimeters of their yard. Some people with PTSD get up several
times a night to check on every noise they hear. Not feeling safe can keep peo-
ple from doing things in life that they need to do, like going to the store or
driving in traffic, because they believe these things are dangerous.
Working long hours: There are many ways that people with PTSD try to
avoid the distressing memories and thoughts that come into their minds.
Some people will work long hours or take jobs that involve overtime just to
keep themselves from thinking about the trauma. However, for people with
PTSD, the memories keep coming up anyway.
Being a perfectionist or needing to have control of everything around you:
When you go through a terrible situation over which you have no control, it
can be terrifying. It can also lead to the belief that if you would have taken
control of the situation, you could have changed the outcome. People with
PTSD often think, “If we had just followed all of the rules, nothing bad would
have happened.” They may think this even though many things in combat
don’t go by the book, and even when everything is done perfectly, people can
still be killed. This way of thinking can lead people with PTSD to try to control
every aspect of the world around them, a tendency that can cause problems at
home. Some people with PTSD treat their family members as if they are in the
military. They may think there is a “right” way to do everything and demand
that their family live up to this standard. This can put a lot of stress on rela-
tionships.

Who Gets PTSD?

 PTSD can develop after exposure to a significant trauma. However, not
everyone who experiences a trauma will develop PTSD. It is currently estimat-
ed that about 12% to 17% of military service members and veterans who have
deployed to Iraq and Afghanistan are at significant risk for the disorder.
Individuals do not have to be combatants to develop combat-related PTSD.
Medical personnel, individuals tasked to work at mortuary affairs, and people
who collect human remains are all at risk, as are combat support personnel at
locations with frequent indirect fire from mortars and rockets. The most sig-
nificant factors related to the development of PTSD are the frequency, intensi-
ty, and duration of trauma exposure. The majority of military personnel cope
extremely well with exposure to multiple, sometimes even hundreds of trau-
matic events that occur during their deployment. This is usually because they
are well trained for their deployments, and they are prepared for exposure to
certain types of trauma. Unfortunately, even the best military training cannot
prepare people for the unexpected or for the gruesome horrors that can occur
in a war zone. In fact, some events that occur during military deployments are
so unbelievably horrific that the majority of people who experience them are
haunted by the memories of these events, sometimes for the rest of their lives.

What Makes PTSD Worse?

Avoidance: Avoidance of thinking or talking about previous traumatic
events and the avoidance of activities that trigger trauma-related reactions
makes things worse over the long run. The following are some examples of
avoidance.
Not spending time with people and not talking about the traumatic event:
When you have PTSD, you might not want to be around other people. You
might not feel like talking to people or worry that they will ask you questions
about what happened when you were deployed. Not spending time with peo-
ple or talking about what happened to you can make PTSD worse and can also
lead to depression. People who get better from PTSD talk about what hap-
pened to them, even though this is a hard thing to do.
Not going out: You may feel that you don’t want to go anywhere, including
places that you used to enjoy. You may feel that crowded places like stores or
sporting events are dangerous. Not going out makes PTSD worse. It also slow-
ly robs you of your life and your freedom. The more you avoid, the smaller
your world becomes.
Trying to not think about the traumatic event: The more you try to not
think about something, the more you think about it. Try it right now. Try to
not think about a purple cow. If you are like most people, an image of a purple
cow popped into your mind. The harder you try to keep pushing a memory
down, the more it will keep coming back. Trying to not think about the trauma
will make your PTSD worse.
Drinking too much: Drinking alcohol can cause many PTSD symptoms to
get worse, including sleep disruption, increased flashbacks, feelings of anger,
problems controlling your impulses, and making your nightmares seem more
real. Drinking can also create new problems in your life in addition to your
PTSD.
Being on “guard duty” 24 hours a day: You may feel that you have to
patrol your house and respond to every noise that you hear. Consider how
much time you’ve spent doing this in the last year. How many times have you
checked only to find that the noise you heard was your neighbor’s dog barking
or the wind? If you are always on guard, you can never relax. The more you
check, the more you will feel that you need to check.

What Makes PTSD Better?

The most effective treatments for PTSD are talk therapies, all of which are
referred to as a form of cognitive-behavioral therapy. The types of these treat-
ments with the most scientific evidence for their effectiveness are Prolonged
Exposure and Cognitive Processing Therapy.

Prolonged Exposure (PE)

PE is the therapy that has the most evidence to show that it works to treat
PTSD. When you do this therapy, you will meet individually with a counselor
or therapist for about 10-12 treatment sessions that last 90 minutes each.
During these sessions, you will make a plan to face many of the things that
you’ve been avoiding. Between therapy sessions you practice going to places
that you have been avoiding using the skills that you’ve learned with your
therapist. You will also talk about the traumatic event and make recordings of
this. You will listen to these recording between sessions. Doing this work will
help you learn that you don’t have to avoid things that remind you of your
trauma. The trauma is not happening now. Now it is only a memory, and
memories can’t hurt you. Completing PE can not only reduce the symptoms of
PTSD, but it also can give you a strong feeling of accomplishment that you
were able to face many things that you thought you couldn’t. In addition to
PTSD, PE has been shown to help with depression.

Cognitive Processing Therapy (CPT)

CPT has more than two decades of research to show that it works to treat
PTSD. CPT can be done in either a group or individual format, usually for
about 12 sessions lasting 60 to 90 minutes each. CPT focuses on thoughts that
get in the way of healing from PTSD. Thoughts about guilt are the focus at the
start of treatment. During this treatment, your therapist will teach you how to
use tools to test out your thoughts about the trauma, and you will decide if
these thoughts are based on facts or feelings. You will also come up with more
balanced thoughts and work toward accepting what happened. Later on in
CPT, there are special sessions that target specific issues related to PTSD,
including trust, power and control, safety, self-esteem, esteem for other peo-
ple, and intimacy.

Studies of civilians with PTSD indicate that about 80% of individuals treated
with PE or CPT do well and recover to the point where they no longer have
significant PTSD symptoms that interfere with daily living. These results have
been found to be stable 5 to 10 years after completing treatment. How well
these treatments work for active duty service members and veterans with
combat-related PTSD is less clear. Both the Department of Defense and the
VA have selected these two treatments as the primary treatments to be avail-
able at military treatment facilities and VA hospitals and clinics. There are
also other cognitive-behavioral therapies similar to PE and CPT that have also
been found to be effective for the treatment of PTSD.
Things You Can Start Doing Now
Stop avoiding. The treatments that work the best for PTSD all help you to
stop avoiding. This means you should live your life and go out even when you
don’t feel like it. Try to remember that when you feel like you don’t want to do
something, this is often a symptom of PTSD, and it keeps PTSD going. What
makes PTSD better is to talk with others about what you’ve been through and
continue to go out, even when you don’t want to. Going out and doing things
that you used to avoid—such as driving a car—helps you to understand that
these are not dangerous activities, or that they involve only an acceptable level
of danger, and that nothing bad is likely to happen to you.
Experience your feelings. Many people with PTSD start to feel numb or say
that they don’t have any feelings other than anger. It is important that you
allow yourself to experience your feelings instead of pushing them away. This
includes feelings that most of us don’t like, such as sadness, fear, and grief.
Continuing to push your feelings down will not make them go away and will
stop you from getting better. Allowing yourself to experience them again
allows you to see that you can tolerate them and that there is no need to avoid
these human emotions as you work through them.

What Family Members Can Do to Help

Don’t encourage avoidance. It’s okay for your partner or family member to
feel anxious in some situations, such as at a store or a restaurant, but it is
important for them to have the goal of trying to stay in the location or situa-
tion anyway. The more they do it, the easier it gets. Remember that anxiety is
uncomfortable, but avoiding it will keep PTSD going. To get better, it’s impor-
tant for your loved one to hang in there and stay in the situation even when it’s
hard. Encouragement and support of your loved one’s efforts to stay and to
tolerate the discomfort until it passes is therapeutic for them in the long-term,
keeping in mind that they may have to work up to this goal.
Let your loved one know that you won’t judge him or her no matter what
he or she has been through. Sometimes people who have PTSD think that
their family members will be shocked to learn about some of the things they
did while deployed and will no longer love them. This may cause them not to
talk about their experiences, which will worsen their PTSD. Encourage your
loved one to talk to someone about it, even if it isn't you. Let him or her know
that you will love them no matter what happened or what they did.
Don’t be afraid if he or she starts to show more emotions when treatment
starts. Showing emotions is actually a sign that your loved one is getting bet-
ter, not worse! It may look like your loved one is “getting worse” or “falling
apart,” but this isn’t true. Feeling emotions is a part of the healing process.
Don’t ask him or her to leave therapy because it seems hard. Let your
loved one know that you will be there to support him or her through therapy
and after.
It’s okay to sleep in separate bedrooms. It doesn’t mean you have a bad
marriage; sometimes people who have PTSD will kick or punch in their sleep.
If this is the case, don’t be afraid to sleep in another room until the symptoms
get better.
Difficulty with anger and concentration are symptoms of PTSD, not signs
that your partner doesn’t love you. If your partner seems irritable or has a
hard time remembering what you said, try not to take it personally.
Top Myths About PTSD
1. PTSD is an untreatable, lifelong condition [FALSE]. We know from
decades of research that treatments such as PE and CPT are highly effective.
2. You should avoid “triggers,” or situations that remind you of your
trauma and trigger PTSD symptoms [FALSE]. Avoiding your PTSD triggers
will just make them last longer. Remember to stop avoiding and face your trig-
gers.
3. Other people’s traumas are much worse than yours [FALSE]. Traumas
affect people differently. Don’t let this myth stop you from getting help.
4. You should just be able to get over it [FALSE]. No matter how strong
you are mentally or physically, you can still get PTSD. Cognitive-behavior ther-
apy can give you the skills to get better.
5. It must get worse before it gets better [FALSE]. Talking about trau-
matic events can be difficult and temporarily distressing, but only a small per-
cent of people with PTSD (about 1 out of 10) actually get worse before they get
better.
6. Treatment is dangerous [FALSE]. Although it may sound or feel dan-
gerous, treatments for PTSD are safe and effective!
7. You shouldn’t get help because you may be treated differently at work
[FALSE]. The military and VA have made great strides in not treating people
differently because they are getting help for PTSD. Help is available. If you
have concerns about how treatment might affect your job, don’t be afraid to
ask.
8. No one will understand [FALSE]. You aren’t the only one with PTSD!
While no one has been through exactly what you’ve been through, there are
people with the similar symptoms and therapists who know how to help.
9. You don’t have any control of your anger [FALSE]. If you really didn’t
have control of your anger, you probably would have punched a few people in
the face today and you’d likely already be in jail. Think of all the times you did-
n’t act on your anger.
10. You’ll have to give up your career and be disabled for life [FALSE].
The majority of people with PTSD continue to work and are not on disability.
11. Having PTSD means you’re weak [FALSE]. Many service members
and veterans have PTSD because they were strong enough to face the most dif-
ficult dangers. Even the strongest person could develop PTSD.
12. If you see a doctor, they’ll take away your security clearance or
weapons [FALSE]. Although this does occur in some circumstances, it is rare
that seeking PTSD treatment results in a loss of a security clearance or
weapons-bearing status.

For more information or to ind a therapist:

Where to Get Help
• ABCT providers (http://www.abct.org/Members/
?m=FindTherapist&fa=FT_Form&nolm=1) ASSOCIATION for BEHAVIORAL
• Military One Source (http://www.militaryonesource.mil/) and COGNITIVE THERAPIES
• National Center for PTSD (http://www.ptsd.va.gov/) 305 Seventh Avenue
• VA (http://www.va.gov/) New York, NY 10001
• Vet Centers (http://www.vetcenter.va.gov/) 212.647.1890
• Veterans Crisis Line (1-800-273-8255)
www.abct.org
• STRONG STAR (http://www.STRONGSTAR.org)
Please feel free to photocopy or reproduce this fact sheet, nong
that this fact sheet was wrien and produced by ABCT. You may
also link directly to our site and/or to the page from which you
took this fact sheet.