Healing Wounded Warriors
Inner IDEA: Using mind-body skills to cope with the stress of war.
“Veterans are the light at the tip of the candle, illuminating the way for the whole nation. If veterans can achieve awareness, transformation, understanding and peace, they can share with the rest of society the realities of war. And they can teach us how to make peace with ourselves and each other, so we never have to use violence to resolve conflicts again.”
—Thich Nhat Hanh, Vietnamese monk and author (b. 1926)
The military excels at creating trained combat professionals who stand out in their ability to protect American interests. The military challenge lies in helping soldiers transition back from battlefields and into families and neighborhoods, a challenge made more difficult if soldiers have served several tours of duty. While warfare and medical technological improvements result in fewer physical casualties, more of our returning troops are experiencing mental health issues. Shining a positive light is the emerging recognition of the value of mind-body training in reducing the severity of stress disorders and enhancing recovery from the emotional wounds of war, which, though not always visible, can be deeply scarring.
The military experience, often a model of physical fitness achievement, has in recent years highlighted the fact that physical, mental and spiritual well-being requires balance. Up to 50% of returning National Guard and Reservists, 38% of Soldiers and 31% of Marines report mental health problems, according to various surveys (Stanley & Jha 2009; Milliken, Auchterlonie & Hoge 2007; Hoge, Auchterlonie & Milliken 2006). Studies funded by the U.S. Department of Veterans Affairs (VA), the National Institutes of Health and various branches of the armed services show that exposure to military trauma and stress can lead to memory lapses and loss of mental focus. Findings confirm that stress degrades the capacity of certain soldiers to manage emotions and to control impulsive, reactive behavior (Jha et al. 2010; Stanley & Jha 2009).
Research reveals a strong linear relationship between mental health problems and combat exposure. A study published in the Journal of the American Medical Association estimated that 20% of the approximately 2 million veterans returning from Iraq and Afghanistan suffer from posttraumatic stress disorder [PTSD], defined as “an anxiety disorder that can occur following the experience or witnessing of a traumatic event”—that is, “a life-threatening event such as military combat” (Seal et al. 2009; Milliken, Auchterlonie & Hoge 2007; Hoge, Auchterlonie & Milliken 2006).
Trauma survivors frequently present with multiple symptoms. “Even before a formal diagnosis of PTSD, people often have sleep trouble. Others start getting into drugs and alcohol as a way of self-medicating,” says David Emerson, E-RYT, director of yoga services at the Trauma Center, Justice Resource Institute, in Brookline, Massachusetts. Lucy Cimini, founder of Yoga Warriors and Central Mass Yoga and Wellness Inc. in West Boylston, Massachusetts, adds, “People who suffer from PTSD often relive their trauma through flashbacks and nightmares. They might feel angry, anxious, guilty, hypervigilant and paranoid. This condition is also marked by biological symptoms. Some veterans experience chronic pain, headaches, muscle tension and sleep disorders.”
Other trauma exposure symptoms include avoiding talking or thinking about the event; feeling emotionally numb or unable to express feelings toward other people; being unable to enjoy previously pleasurable activities; lacking all trauma memory; or being very startled if surprised. Common concerns consist of feeling hopeless, shameful or despairing; having trouble keeping a job or maintaining a relationship; or even becoming violent.
Many vets speak of fits of uncontrollable rage triggered by mild events that make them feel completely out of control. Describing a reaction when his dog misbehaved that would have been uncharacteristic before his deployment, Iraq War veteran Donnie Apted choked up as he told Fox 5 news reporter Chris Shaw in Atlanta, “I lost control, and I went in, and I pinned my dog to the ground, and I was just waling on her. . . . It was like I could not control myself.”
These mental health issues may have contributed to the recent growth in suicide rates, particularly among male veterans. Suicides increased by 26% from 2005 to 2007. In 2008, the Marine Corps experienced more suicides than in any year since the Iraq War began in 2003; and as of this June, nearly as many American troops at home and abroad had committed suicide in 2010 as had been killed in combat in Afghanistan (Tarabay 2010; Stanley & Jha 2009; Alvarez 2009; Perry 2008). At Fort Hood, Texas, and throughout other Army posts, “suicide prevention cards” are distributed with instructions about taking care of friends with suicidal tendencies (Slevin 2009).
These grim statistics may have contributed to an emphasis shift among military leadership, particularly in the Army. “Your social, spiritual, family and emotional fitness are just as important as your physical fitness,” says Lieutenant General Jack Stultz, chief of the Army Reserves, when describing the Army’s new, holistic Comprehensive Soldier Fitness (CSF) Program, which features the slogan “Strong Minds, Strong Bodies.” The Army, leading the way to an integrated mind-body approach to optimal fitness in the armed forces, initiated CSF in October 2009, to proactively improve combat performance and to reduce the severity of mental health issues, such as depression, PTSD and suicide, among troops.
“People in the military, particularly combat personnel, need to be prepared for the effects of what they will be dealing with in their deployment—living in extreme danger, where they may be killed; experiencing the possibility of having to kill another human being; or seeing another person die, especially someone who may be close to them. These three factors are above and beyond what most people experience in their daily lives,” says Kaye Coker, MSW, LCSW, a Mindfulness-Based Stress Reduction teacher and a psychotherapist in Decatur and Snellville, Georgia, who has been involved in mindfulness training of military personnel since 2005.
The Army is investing $125 million in CSF and is launching its Master Resilience Training program to teach soldiers how to develop in all five dimensions of health: physical, emotional, social, spiritual and family. The Army defines resilience as “the ability to grow and thrive in the face of challenges and bounce back from adversity.” Based on more than 30 years of scien-tific study and developed with the help of researchers from the University of Pennsylvania’s Positive Psychology Center, the program includes a confidential individual assessment, online training, classroom education and the use of embedded resilience trainers. “A master resilience trainer is a subject matter expert who helps service members change how they look at problems and challenges,” explains Sergeant Major of the Army Kenneth O. Preston, the Army’s senior noncommissioned officer, on June 3, 2010, at Schofield Barracks in Hawaii (Aranda & Tesfaye 2010).
While CSF has been developing, numerous yoga and even yoga nidra (“yogic sleep”) programs specifically tailored to needs of military personnel and veterans have also been appearing at Army, Naval and VA Hospitals, at yoga centers and even at military bases. Emerson, who has been teaching a yoga class for the past 4 years at the Bedford VA Hospital in Massachusetts, said, “They have a residential program for vets to stay for a period of time if they need acute treatment for drugs and alcohol. Those guys tended to be Vietnam era vets, but now we’re seeing younger guys from Iraq and Afghanistan.”
Program founders include vets who discovered the power of mind-body tools in their own healing. Sue Lynch, JD, RYT, a Gulf War veteran, created There and Back Again in Charlestown, Massachusetts, a nonprofit center that offers veterans a variety of wellness practices, including yoga, meditation, martial arts, massage therapy, acupuncture and Reiki. Yoga was instrumental in Lynch’s own recovery from PTSD; she then became a certified instructor to share yoga’s benefits with other veterans.
“Through my own experience with PTSD, I sought different healing modalities over a decade. I discovered that some holistic practices worked and others didn’t. By offering access to such services and educational workshops within one program, we give veterans an opportunity to explore healing avenues that work for them in a safe environment without having to search for it on their own. The benefit of offering different modalities increases the level of support, creates a sense of community and promotes self-care, a concept that isn’t cultivated in the military,” says Lynch.
Warrior Mind Training (WMT), a meditation program introduced to military bases in 2005, has now expanded to 11 military installations and veterans centers and has provided training to over 3,500 active-duty and reserve service members and veterans. Created by Sarah Ernst and Ilene Gregorian of San Diego and Jennifer Simon of Stamford, Connecticut, WMT typically begins with a 1-hour training session once per week for 4 consecutive weeks; WMT maintenance classes then meet once weekly for 45–90 minutes, depending on specific military base timing requirements. Participants have reported that the training has helped them handle stressful situations, sleep better, feel more positive, feel calmer and feel they have more self-control.
As a mind-body fitness professional, you may have something to offer returning veterans. There are various ways to contribute:
Seek Out Training on Military Culture and Trauma Survivors. All practitioners who work with military personnel and vets agree that more help is needed, but before you can serve this population, you must receive specific training both on military culture and on working with trauma survivors. Coker cautions, “You must be prepared. Too many mistakes can be damaging to people [and] push them further away, just out of ignorance. It’s very important that trauma-sensitive training be undertaken, because so much memory is being held in the body—so many things are opening up. You’ll find that most veterans believe that (1) no one cares about this ‘stuff’—their experience; (2) no one ‘gets it,’ from families to strangers; and (3) this ‘stuff’ is so awful, if I tell people, it will hurt them.”
For example, says Cimini, “Yoga Warriors is a scientifically based yoga program that is designed to help veterans heal from combat stress and PTSD. Our program is movement-based and integrates treatment principles from the field of neuro-rehabilitation and, more specifically, occupational therapy . . . using sensory integration theory and treatment. To augment the innately healing qualities of yoga, the Yoga Warriors program carefully incorporates some sensory integration treatment principles into its yoga protocol used in Iraq, October 2009, for veterans.” Yoga Warriors uses breath work, affirmations, some yoga postures and more.
Lynch observes, “There is such a separation [between our military] experiences and the ‘civilian world.’ Understanding the underlying experiences will pave the way. That said, veterans suffering from PTSD or traumatic brain injury want help. It’s just a matter of finding a way to break through that ‘tough guy/girl’ exterior. In my experience, once you discover the key that will unlock the door and create a trusting relationship, veterans open up quickly.”
Donate Your Services and Facilities. Each of us can make a difference in addressing the challenge of ensuring that our veterans receive the support that they need. Paul Zipes, founder and executive director of Yoga for Vets LLC, in Panama City, Florida, says, “Every studio, university or gym has room for at least one extra student. Help send a loud and clear message that we care about our vets by supporting Yoga for Vets.” Zipes’s organization, which lists studios, gyms, teachers and veterans’ hospitals that offer at least four free classes to combat veterans, is entering its fourth year of existence on the Internet and has increased its location listings by 50% in the last calendar year.
“The best way for communities to outreach and help our vets is to offer yoga, acupuncture, exercise programs, massage and so much more that is specifically geared for veterans. This war is bringing home more trauma than even the Vietnam War, and [veterans] feel alone with their experience. Especially those who have experienced combat and bombs are not comfortable in large groups,” says Cimini.
Working together to help veterans reintegrate fully into American life helps not only our soldiers but also ourselves. If we want to achieve peace, we—and our veterans—must first find it within ourselves. Since combat training and exposure is a physical, mental and emotional experience, healing the wounds of combat must also be integrative. By offering our skills and support, we can stand by the men and women who serve, and help them in their quest for wholeness; our support may even save a life.
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Contemporary treatment methods now offered to veterans to manage mental health symptoms include a variety of therapies, from counseling and psychotherapy to medications and cognitive behavioral therapies. According to David Emerson, E-RYT, director of yoga services at the Trauma Center, Justice Resource Institute, in Brookline, Massachusetts, “The issue with medications is that [they tend] to make [veterans], at least the Marines that I worked with at Camp Lejeune, feel even more out of control. What they want is to feel empowered, not dependent, to feel in control and to be able to calm themselves down when they need to.” Other vets describe being on meds as feeling numbed, able to go through the motions of daily life, but not feeling like themselves.
Other treatments, like individual or group counseling and cognitive behavioral therapy, heal through release and analytic processing of emotional experiences and reactions; often, however, these approaches do not reach the trauma memory stored in the body. Veterans have been taught to “weaponize” their minds and bodies for warfare. Says Emerson, “Vets have told me that their bodies are vehicles for violence, and that works in combat but is dysfunctional when they return. These folks deserve to have their lives and their bodies back in a way that is safe and functional in a noncombat reality.” What only mind-body approaches offer is for vets to have the integrative visceral and spiritual experience once again of peace and tranquility—an opportunity to be physical, but in a nonviolent way.
Preliminary research on the use of mind-body skills with military personnel includes a study published in the journal Emotion (2010; 10 , 54–84). Soldiers who practiced mindfulness more frequently and for longer periods of time experienced less loss of working memory capacity and did not experience an increase in perceived stress, when compared with soldiers who had also received the mindfulness training but did not practice the techniques as often.
Kaye Coker, MSW, LCSW, a Mindfulness-Based Stress Reduction teacher and a psychotherapist in Decatur and Snellville, Georgia, explains, “Mindfulness practices potentiate emotion regulation, which is important in managing the stresses and effects of war. This is critical in working with combat stress and hopefully preventing it from developing into PTSD. Mindfulness practices also enable us to work with indicators of PTSD, thus offering an effective way of treating the symptoms and alleviating suffering. Emotional avoidance is one of the coping strategies that can become a way of life. We especially see that in our Vietnam vets who have suffered for 40 years. And [emotional avoidance] can be worked with effectively with mindfulness practices.”
Researchers at The Center for Investigating Healthy Minds at the University of Wisconsin, Madison, are currently conducting studies to evaluate and compare the effectiveness of various complementary and alternative programs on veteran populations. Methods being studied range from brain imaging to psychophysiology to clinical evaluation. This research will help determine whether these programs are beneficial for veterans with PTSD; if so, which programs are most effective; and finally, whether different people benefit from programs differently, depending on their psychological differences.
For more information about research on mind-body skills training and the military, go to the following websites:
Aranda. J.J., & Tesfaye, M. 2010. Top army NCO promotes “Complete Fitness” to soldiers. www.army.mil/news/2010/06/07/40471-top-army-nco-promotes-complete-fitness-to-soldiers/; retrieved June 7, 2010.
Carey, B. 2009. Mental stress training is planned for U.S. soldiers. The New York Times (Aug. 18).
Cavallaro, G. 2009. Comprehensive soldier fitness program kicks off. Army Times. www.armytimes.com/news/2009/10/army_ausa_csf_100509w/; retrieved Oct. 5, 2009.
Emerson, D.E. 2008. Yoga: For Peace of Body and Mind, A Manual for Clinicians. New York: The Trauma Center at JRI.
Emerson, D., et al. 2009. Trauma-sensitive yoga: Principles, practice, and research. International Journal of Yoga Therapy, 19, 123–28.
Hoge, C.W., Auchterlonie, J.L., & Milliken, C.S. 2006. Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. Journal of the American Medical Association, 295 (9), 1023–32.
Jha, A.P., et al. 2010. Examining the protective effects of mindfulness training on working memory capacity and affective experience. Emotion, 10 (1), 54–64.
Milliken, C.S., Auchterlonie, J.L., & Hoge, C.W. 2007. Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq War. Journal of the American Medical Association, 298 (18), 2141–48.
Perry, T. 2009. Marine suicides in 2008 at a yearly high since Iraq invasion. The Los Angeles Times. http://articles.latimes.com/2009/jan/14/nation/na-marine-suicides14; retrieved Jan. 14, 2009.
Russell, M. Army reserve communications. Comprehensive Soldier Fitness. www.usar.army.mil/arweb/soldiers/Pages/CSF.aspx.
Seal, K.H., et al. 2009. Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs Health Care, 2002–2008. American Journal of Public Health, 99 (9), 1651–58.
Slevin, Peter. 2009. Healing the warrior: Fort Hood has been an innovator in the battle against combat stress. The Washington Post. www.washingtonpost.com/wpdyn/content/article/2009/11/15/AR2009111503162_pf.html; retrieved Nov. 17, 2009.
Stanley, E.A., & Jha, A.P. 2009. Mind fitness: Improving operational effectiveness and building warrior resilience. JFQ, 55, 144–51.
Stultz, J. 2010. My Army Reserve video message: “CAR pushes Comprehensive Soldier Fitness.” www.flickr.com/photos/myarmyreserve/4426782687/; Mar. 12, 2010.
Tarabay, J. 2010. Suicide rivals the battlefield in toll on U.S. military. National Public Radio. www.npr.org/templates/story/story.php?storyId=127860466; retrieved June 17, 2010.
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