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Section 5
Combatting Traumatic Memories in Veterans

Question 5 | Test | Table of Contents

In the last section, we discussed how your client making the transition from soldier to civilian can effectively express their anger. We discussed the following techniques: Expressing Anger Reflection, How Anger Has Helped and Hurt Me Exercise, and Resolving Anger Must-Haves List.

In this section, we will discuss an exercise your clients facing combat PTSD can use to combat unwanted images. We will also discuss ways to relieve the specific anxiety a PTSD combat clients may face regarding redeployment.

Combating Unwanted Images:

Jared, a 26 year old veteran, came to me because he could not cope with the disturbing images and memories that reoccurred every day. He tried his best to keep busy with other activities during the day and at night he turned to alcohol to avoid nightmares. He had a reoccurring image of the suicide bomber who had detonated in front of him during his tour.

I have found with clients who are coping with PTSD that avoiding uncomfortable images or memories often reinforces them, especially the idea that these memories are dangerous and that they continue to be a threat. I shared the following eight steps with clients as an exercise to combat their unwanted images.

1. Make yourself comfortable in a space that is quiet and safe.
2. Focus on breathing slowly and deeply.
3. Create a safe mental space for yourself by taking time to reassure yourself that you are safe and that the image you will focus on is only temporary and the feelings connected to it will pass.
4. Begin with a slightly distressing image that you can rate low on the Stress Scale (0 to 3 on a 10 point scale)
5. While visualizing the image, it is important to repeat to yourself that it cannot harm you. These images will come and go like waves and are not dangerous.
6. When you have the image secure in your head, imagine you are standing upon a platform of a train station. The train you are watching pass by is the image.
7. Once you have successful processed this image, move on to an image that is slightly more distressing (a 4 to 6 on the stress scale).
8. Continually practice this exercise in order to become better at handling unwanted images.

Do you have a client, like Jared, who is having difficulty controlling their unwanted images and who could benefit from this exercise?

We will now transition from discussing how to control unwanted images and discuss ways to relieve the specific anxiety a PTSD combat clients may face regarding redeployment.

Relief Surrounding Redeployment Anxiety:

Anxiety surrounding redeployment is common for clients in the military. As you are aware, there is a lot of uncertainty surrounding redeployment- when, for how long, and in what capacity- that can be a challenge for both clients and their loved ones. This anxiety may cause fatigue, sleeplessness, a changed appetite, headaches, muscle tension, and other symptoms of physical stress. It is important to discuss redeployment when it comes up for your client.

Jared was distressed when he was called up again for deployment. He stated, "It is scary because there is no way of knowing what will happen. I want to tell my family but there is so little I can tell them. I think it will just make them scared and upset."

I stated, "Often by relieving some of the anxiety surrounding redeployment, you can become more open to discussing redeployment." Here are six tips I shared with Jared to help him relieve his anxiety surrounding redeployment anxiety.

1. Communication with your loved ones about your fears about redeployment is important. It is also important that your client listen to the fears that their loved ones face about separation. Encourage them to be open and understanding.
2. Remember that your anxiety is reasonable. Having anxiety about something like redeployment is normal.
3. It is beneficial to avoid keeping secrets from loved ones surrounding your redeployment schedule. Jared shared any information that he could so his loved ones were prepared as well.
4. Talking to other military service personal and having your family talk to other military families can be helpful. This helped make Jared and his family feel less alone.
5. Prepare yourself for redeployment by lining up support for your loved ones in order to prepare for an earlier redeployment.
6. I stated to Jared, "You should keep all options open in regards to your service with the military." Encourage your client to make a list of pros and cons with all their service options. It is helpful if they talk it over with their loved ones.

Do you have a client like Jared who is facing redeployment who can use these tips to relieve his anxiety surrounding the redeployment?

In this section we discussed an exercise your clients facing combat PTSD can use to combat unwanted images: make yourself comfortable; focus on breathing slowly and deeply; create a safe mental space for yourself; begin with a slightly distressing image; repeat to yourself that it cannot harm you; imagine you are standing upon a platform of a train station; move on to an image that is slightly more distressing; and continually practice this exercise. We have also discussed ways to relieve the specific anxiety a PTSD combat clients may face regarding redeployment.

In the next section we will discuss grief exercises for clients who are coping with the death of a comrade.

Source: Armstrong
Reviewed 2023

Update
Impaired episodic memory in PTSD patients — A meta-analysis of 47 studies

Petzold, M., & Bunzeck, N. (2022). Impaired episodic memory in PTSD patients - A meta-analysis of 47 studies. Frontiers in psychiatry, 13, 909442. https://doi.org/10.3389/fpsyt.2022.909442


Peer-Reviewed Journal Article References:
Ashbaugh, A. R., & Brunet, A. (2011). Review of Memory, war and trauma [Review of the book Memory, war and trauma, by N. C. Hunt]. Canadian Psychology/Psychologie canadienne, 52(3), 236–237.

Contractor, A. A., Weiss, N. H., & Shea, M. T. (2021). Processing of positive memories technique (PPMT) for posttraumatic stress disorder: A primer. Journal of Psychotherapy Integration, 31(2), 195–207.

Katz, A. C., Norr, A. M., Buck, B., Fantelli, E., Edwards-Stewart, A., Koenen-Woods, P., Zetocha, K., Smolenski, D. J., Holloway, K., Rothbaum, B. O., Difede, J., Rizzo, A., Skopp, N., Mishkind, M., Gahm, G., Reger, G. M., & Andrasik, F. (2020). Changes in physiological reactivity in response to the trauma memory during prolonged exposure and virtual reality exposure therapy for posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. 

Larson, E., Zollman, F., Kondiles, B., & Starr, C. (2013). Memory deficits, postconcussive complaints, and posttraumatic stress disorder in a volunteer sample of veterans. Rehabilitation Psychology, 58(3), 245–252. 

Roberts, N. A., Burleson, M. H., Burmeister, L. B., Bushnell, M. L., Epstein, D. R., Todd, M., Walter, C. M., Powell, K., Hoffmann, N., Reynolds, C. M., & Goren, K. (2020). Brain boosters: Evaluating a pilot program for memory complaints in veterans. Psychological Services, 17(1), 33–45.

Schatten, H. T., Gaudiano, B. A., Primack, J. M., Arias, S. A., Armey, M. F., Miller, I. W., Epstein-Lubow, G., & Weinstock, L. M. (2020). Monitoring, assessing, and responding to suicide risk in clinical research. Journal of Abnormal Psychology, 129(1), 64–69.

QUESTION 5
What are the eight steps your client can use as an exercise to combat her unwanted images? To select and enter your answer go to Test.

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