PTSD War Veterans and Their Families
PTSD War Veterans and Their Families
On January 2nd, 2013, an elderly war veteran in Las Vegas was charged with two murders after he allegedly killed two women with more than 20 blows to their heads with a hammer. His ex-wife reported that he had alcohol and drug abuse issues, and during their marriage, he would often beat her or attempt suicide. According to his medical diagnosis, he suffers from post-traumatic stress disorder (PTSD) and depression.
This type of scenario is common among war veterans with PTSD because they will more likely engage in domestic violence than war veterans without PTSD. And the number of war veterans in the US continues to rise. The Department of Veteran Affairs currently estimates that there are more than 23.8 million war veterans in the US, and at least 50% of them have been involved in domestic violence at some point. However, despite their growing numbers, it is difficult to reach a timely diagnosis and effective treatment.
The first section of this paper will explain how war veterans develop PTSD and how changes in their brain affect their thinking patterns. It will also identify the involuntary coping strategies used by war veterans with PTSD and the limitations of current mainstream treatments. The second section will present directed forgetting as a possible solution to restoring normal relationships between veterans and their families. Although resorting to self-medication or self-therapy in cases of PTSD or associated disorders is not recommended, the findings on directed forgetting presented in this paper can help war veterans and their families take a proactive stance in improving their lives.
How Combat-Related Experiences Affect the Brain and Memory
Memory is usually classified as short-term and long-term memory, but memorizing, reasoning, and comprehension are active processes that are better described by the term “working memory.” Working memory consists of several regions in the brain that manipulate visual or verbal information and store it in long-term memory (Matlin, 2013). One of those regions is the hippocampus, which changes when a person is exposed to traumatic events (as cited in Hall et al., 2012).
In war veterans affected by PTSD, the changes in the hippocampus affect their working memory. Because all human beings have a limited capacity for processing information, war veterans with PTSD have difficulty performing mental tasks that are not associated with the trauma (Hall et al., 2012). Their working memory system spends resources mainly on re-experiencing traumatic events, so they have fewer resources for decision-making, problem-solving, and strategic thinking (Matlin, 2008).
These changes in the brain also affect memory retrieval mechanisms, so traumatic memories are re-experienced through vivid and realistic flashbacks. However, the retrieval of those memories in PTSD is involuntary, which makes it difficult to predict and control flashback episodes (Brewin, Gregory, Lipton, & Burgess, 2010). Those recall episodes are interferences that often lead people to develop maladaptive coping strategies.
PTSD Coping Strategies and Their Impact on Family Relationships
When the neurological processes in the brain are altered by traumatic events, they cause various involuntary coping strategies, such as memory intrusion or emotion numbing (van Rooyen & Nqweni, 2012). These strategies avoid confronting the problem, but they also reduce the person’s ability to perform various social functions because they lose motivation, stop engaging in physical or social activities, and may develop depression. An emotional gap develops between veterans with PTSD and their family members that can lead to both neglect and physical abuse (Zerach, Solomon, Horesh, & Ein-Dor, 2013).
Problems of Mainstream Treatments for PTSD
The Department of Defense and Department of Veterans Affairs currently consider exposure therapy the most effective type of therapy for PTSD because it can be applied even when war veterans suffer from additional disorders. Research shows that even though exposure therapy is emotionally challenging, it has the highest success rates when compared to other mainstream treatment methods (as cited in Rauch, Eftekhari, & Ruzek, 2012).
However, the obvious limitation to all mainstream PTSD treatment methods is that veterans spend only a fraction of their time in treatment. A variety of influences can determine their behavior outside of the clinical setting. Therefore, it is the responsibility of each individual with PTSD and their family members to understand what they can do to minimize flashback episodes in daily life and maintain their emotional connections.
Directed Forgetting Applications for Lessening PTSD Symptoms
Directed forgetting was developed to increase the understanding of how memory works. When people are told to forget a certain list of items, they will remember fewer items than people who were told to remember them (Sahakyan, 2004). With those results, psychologists started observing the application of directed forgetting and remembering in various situations, including the treatment of PTSD.
Of course, facts are easy to forget if they do not activate an emotional response. When war veterans with PTSD try to forget emotionally disturbing memories, they require more effort from the nervous system. However, it is possible to reprogram memories through persistence and proper social support (Nowicka, Marchewka, Jednoróg, Tacikowski, & Brechmann, 2011).
It unknown whether the individual can recover suppressed memories alone, but it is clear that those memories may become accessible just by the passage of time or events that trigger subconscious responses (Anderson & Huddleston, 2012), which explains why PTSD can be delayed in some war veterans (Horesh, Solomon, Zerach, & Ein-Dor, 2011). To prevent those situations, directed forgetting should be used only as a supplemental method to professional counseling.
The Role of Family in Managing PTSD
PTSD affects family relationships, but family relations can also predict delays in PTSD development. The emotional and social gap between family members in some instances preceded PTSD symptoms (Zerach et al., 2013). That can be attributed to the unconscious influences caused by suppressed memories. While some people will not re-experience traumatic episodes, they will experience emotional reactions to reminders of such events and gradually change their emotional and behavioral patterns (Anderson & Huddleston, 2012).
Besides using behavioral changes to predict potential PTSD symptoms, families can also provide a positive environment and improve the mood of war veterans to alleviate their symptoms. Mood congruence plays an important role in memory retrieval, which means the mind recalls previous events that match its present state and environment material (Matlin, 2013). Therefore, exposure to pleasant events and experiences can be used to shift the focus of neural processes from unpleasant events to pleasant memories.
The importance of contextual factors is supported by a mechanism called “selective directed forgetting.” People can easily choose to forget unrelated scenarios, but they cannot selectively forget information that is within a certain context they are required to remember (Delaney, Nghiem, & Waldum, 2009). Creating a positive and supportive environment will create a context in which a person will forget traumatic events or reduce the severity of flashbacks.
Emotional and Mental Regulation for Veterans with PTSD
Directed forgetting should not be confused with thought suppression. Thought suppression strategies result in the “rebound effect,” which means that people with PTSD increase the intensity of their trauma-related thoughts by trying to suppress them (Hayes, van Elzakker, & Shin, 2012). Directed forgetting is a simple command in imperative form that orders the mind to forget a certain experience.
Directed forgetting can be used effectively for lessening the frequency of PTSD symptoms. Forgetting negative experiences can weaken emotional reactions related to previous experiences (as cited in Saletin, Goldstein, & Walker, 2011). Because veterans often experience flashback episodes during sleep, applying directed forgetting during the day can fortify those instructions and improve their effort to forget certain memories (Saletin et al., 2011). Note that practicing directed forgetting immediately before sleep will not fortify its effects. Directed forgetting should be used during daytime because the brain will have to store the information in long-term memory during wakefulness (Abel & Bäuml, 2013).
Overcoming difficulties associated with PTSD. War veterans with PTSD are often distracted when performing goal-oriented mental processes, especially when traumatic memories resurface (Morey et al., 2009; Fleck, Berch, Shear, & Strakowski, 2011). Because persistence in directed forgetting is required to deal with emotional memories, it is also important to enhance the capacity of working memory. However, computer games that advertise improved working memory are not supported by research evidence (as cited in Jaeggi, Buschkuehl, Jonides, & Perrig, 2008). Only verified tests, such as the Raven's Advanced Progressive Matrices or the Bochumer Matrizen-Test, should be used because of their proven efficiency in improving working memory (Jaeggi et al., 2008).
Because flashback episodes are emotional in nature and rich in sensory experience, directed forgetting alone may be difficult (Mueller-Pfeiffer et al., 2010). However, emotional regulation can be achieved through cognitive reappraisal. The strategy includes consciously changing the emotional response to disturbing circumstances by changing the interpretation of the event (Boden, Bonn-Miller, Kashdan, Alvarez, & Gross, 2012). Cognitive reappraisal is an excellent addition to directed forgetting because it can lessen the severity of flashbacks, which can interfere with attempts at directed forgetting.
Safety considerations. It is important to mention that emotional and mental regulation cannot be used as substitutes for professional evaluation and treatment. This is especially true for veterans who have frequent and severe episodes of reliving past traumatic experiences. Because those episodes take up too much of their attention, they do not have significant results with directed forgetting (Zwissler et al., 2011). If the severity of PTSD is high, professional interventions should be considered before relying on emotional and cognitive regulation through directed forgetting.
Directed forgetting should also be used only as a supplementary technique to make daily functions easier. As the aging process occurs and advances, it becomes more difficult to forget unpleasant memories (Anderson, Reinholz, Kuhl, & Mayr, 2011). Although it is clear that directed forgetting is not the same as suppression, the exact changes in long-term memory after using directed forgetting are not recorded.
With more people in need of PTSD treatment, not everybody can receive individual treatments. However, the symptoms of PTSD are often not predictive or consistent, which means group settings cannot address the needs of every individual. Instead, war veterans and their families can take action to lessen associated symptoms and preserve their relationships. Family members serve an important function because they can create a supportive and pleasant environment. When exposed to positive influences, the mind naturally retrieves more positive memories than negative memories. Finally, war veterans can improve their working memory capacity to improve their focus, decision-making, and strategic thinking. Directed forgetting and cognitive reappraisal should also be used daily in addition to prescribed treatments because they can reduce the impact of flashback episodes on personal well-being and behavior.
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