Sample Case Study Paper on PTSD in Combat Veterans

Therapeutic Interventions for Post Traumatic Stress Disorder among Combat Veterans

Post-traumatic Stress Disorder (PTSD) is an anxiety disorder that usually manifests after
one has been exposed to an event that caused them trauma. PTSD results to psychological stress
and this overwhelms an individual’s ability to cope with issues. According to the Diagnostic and
Statistical Manual of Mental Disorder ,DSM-IV, (1994) PTSD is defined as the development of
characteristic symptoms following exposure to an extreme traumatic stressor involving direct
People suffering from PTSD will exhibit re-experiencing symptoms by replaying the
traumatic experiences, nightmares and flashbacks. Often these symptoms are accompanied by
palpitations and sweating. Patients can also have avoidance symptoms. They will try to block
any feeling that connects them to the traumatic event. Such patients will avoid activities or
people that have a bearing to their traumatic experience; they will not want have a clear memory
of the experience. They may detach themselves from other people and become emotionally
numb. Assault, military combat, divorce, terminal illness, kidnapping and torture can be some of
the factors that can lead to PTSD.
Patients will also show hyper arousal symptoms. This arousal will come out in having
difficulties falling asleep, being easily provoked to irritability and having difficulty in
concentration. (Fullerton C.S. et al. 2004, p. 78)
Background/ Overview into Post Traumatic Stress Disorder

PTSD has existed for a long time but the name PTSD has been in use from 1980s. During
the first world it was called Shell shock and later on was named as ‘war neurosis’ during the
Second World War Most of the times PTSD is reserved as combat veteran’s disease but it can

PTSD in Combat Veterans 3
also affect assault and rape victims or natural disaster like earthquake and Tsunamis. (Vasterling
K. B et al. 1997, p.51-59).

PTSD prevalence is 1% in the US population is reported to be up 7.8 9% (Helzel et al.
1987, p. 21). Post-Traumatic Stress Disorder was formally recognized as a psychiatric diagnosis
in 1980.

Research on PTSD has been done since the Vietnam War. Vietnam ex soldiers’ body conducted
a study where a recognizable number then, which was a good percentage, had suffered from
PTSD in combat. In recent past, this disorder has been put under scrutiny in war torn countries
where the combat soldiers have been put under study. ( King D.W et al. 1996, p.520-531)

Most people, after a traumatic experience, for example the death of a loved one, are able
to go back to their former self. Those who continue with signs of stress and depression which
greatly impair their occupations, social and family responsibilities that run into months can be
clinically diagnosed as having Post-Traumatic Stress Disorder. A diagnosis with PTSD requires
symptoms be recurrent for more than a month. (Fullerton C.S et al. 2004, p.32)

Children are more prone to PTSD. There are three factors that raise the chances of a child
or an adolescent getting PTSD: The intensity of how that traumatic event occurred, their
guardians or parents take on that event and how close the child was near the area where the
traumatic event occurred. (Andrews B, 1998, p.176-190).

Most studies have established that most people with PTSD tend to have had a traumatic
experience in their lives. It is however worthwhile to realize that while the above statement is
true, not everyone who has had traumatic experiences develops PTSD. One will develop PTSD

PTSD in Combat Veterans 4
depending on how intense the trauma was and for how long they were exposed to it. In cases of
natural disaster and one loses someone during the disaster, and depending on how close or
attached the deceased was to the survivor will determine if they will get PTSD or they will
invoke defense mechanisms and continue with their everyday life. Other peoples’ probability of
them getting PTSD will depend on how attached they were to the event that caused the trauma.
This can be seen in natural catastrophes like where one loses a job that was a part of them and
that job determined the very person that they were. (Herman E 1992, p. 77).

Our ability to feel in control of events will determine when we are exposed to traumatic
experiences if we will survive or succumb to PTSD. In shame related trauma, like for example, if
a woman is a model and makes a living from her looks then suffers some accident that disfigures
her and at the end she will not feel at the helm of her life because she cannot perform like before.
Such a woman is more likely to develop post-traumatic stress disorder with time since feelings of
shame and pity will be greatly manifested.
Support after the traumatic experience will again be a contributing factor to development
of PTSD. Immediate help will most definitely reduce the chances of one getting PTSD. This will
help the victim deal with the resultant emotions from the traumatic experience before they are
deeply imbedded in the subconscious. When such emotions remain in the subconscious one is
likely to develop PTSD.

More often than not, PTSD leads to depression and in order to deal with this depression
sufferers may resort to substance abuse and alcohol. PTSD sufferers may also have other
problems with will include feeling desperate, shame and hopeless. They may again have
employment issues since they cannot keep a job due to their unpredictable mood swings. Back in

PTSD in Combat Veterans 5
their homes they may have problems with their spouses and this may lead them to having divorce
or violence issues. PTSD can manifest itself in physical settings. (Tsolaki F.K. & Karamavrou S,
2009, 85-94).

The prefrontal cortex, amygdale and hippocampus are the three parts of the brain that
PTSD may alter. A lot of studies have utilized Vietnam combat veterans. For instance a study
that used an ex veteran soldier’s head which had been injured showed that injury to the prefrontal
cortex could actually act as a protection against later PTSD development. In a study by Gurvits
et al. (1960, p.30). combat veterans of the Vietnam war with PTSD showed a 20% reduction in
the volume of their hippocampus, a part of the brain that play an important role in the
synchronization of long and short term memory, compared with veterans who suffered no such

Genetics also plays a role in susceptibility to PTSD. From the same study, for twin pairs
exposed to the combat in Vietnam, having an identical twin was associated with an increased risk
of the co-twin having PTSD compared to twins that were not identical. (King D.W et al,1996,

Although a bigger population encounter stress, which is a PTSD causing factor, only a
lesser percentage develops full PTSD. There is enough evidence that past experiences like
neuroticism and childhood trauma and personality structure in the period before the traumatic
experience greatly influence the development of PTSD. In a research on childhood physical
abuse and combat-related post- traumatic stress disorder in Vietnam veterans, it was found out
that sexual abuse which occurs early in life is associated with psychopathology. The study’s
purpose was to compare rates of childhood abuse in Vietnam veterans with and without combat

PTSD in Combat Veterans 6
related PTSD. At the end of it, it was discovered that Vietnamese nationals who had served in
the Vietnamese war with PTSD had been victims of childhood abuse. The final finding of this
was that people seeking PTSD treatment had higher chances of physical abuse. Therefore,
physical abuse is a recipe for the development of combat related PTSD in Vietnam combat
veterans. (Gurvits et al. (1960, p.41-46).
Still according to (Gurvits et al. (1960, p.41-46). nearly half of the male Vietnam
veterans currently having PTSD had previously been arrested or spend time in jail at least once
and another percentage had been formerly convicted of a felony.
Effects of Post Traumatic Stress Disorder
Emotional outbursts
When PTSD affects one family member, it causes other family members to feel
frustrated, hurt and removed from the rest. In cases where the patient is a war veteran, he may
lose interest in his family and if married may not become intimate with the spouse and eventually
they end up being detached emotionally. For the family members, it is like the trauma is
happening everyday because they live with the stressful event every day.
Emotional Detachment/Isolation
People suffering from PTSD tend to find themselves hibernating or hiding from others
because they feel they don’t have anyone to talk to and who will understand them. Because of
that they will hide and avoid any human contact.
Unnecessary Hyperactivity

PTSD in Combat Veterans 7
Survivors of a traumatic experience often feel that there is no future and when they are
approached by family or friends to make decisions that may affect the future they may fail to do
so because it is hard for them to concentrate without being tense, angry or hyperactive.
Relative Inadequacy to socially connect with others/ Neglecting Societal roles
In some cases a parent suffering from PTSD may feel the compulsive need to be over
involved in their children’s affairs because they feel lonely and are in need of positive emotional
feedback. This, in retrospect, has a negative bearing on their relationship with their children
because in as much as they may want to involved in all their children’s affairs, it will bring
conflict as the children do need space to explore and grow on their own unaided.
Sleeping Disorders

Trauma survivors may affect other people’s sleep patterns in the home due to their insomnia
issues, nightmares or sleepwalking. The survivors are afraid to go sleep. In other cases, the
family members may be also scared to sleep as they are afraid to dream or relive their patients’
bad dreams. In severe cases patients suffering from post-traumatic stress disorder suffer from
night running and sleep walking. (Tsolaki F.K. & Karamavrou S, 2009, p. 85-94).

Prone to Lashing Physical Abuse
Trauma survivors in great deal struggle with sudden intense anger outbursts and in some
instances domestic violence. Plenty of the times, the patients are not aware of the pain they are
inflicting when they are gripped by intense anger outbursts. If their trauma was caused by
physical abuse, they may do the same to other family members. In such cases the family
members do feel abused.

PTSD in Combat Veterans 8

Prevalence in Substance Addiction
Family members that have a PTSD patient who is addicted to a substance or alcohol have
to deal with emotional, financial and domestic violence issues. Studies have indicated that
trauma survivors may seek relief from addictive behaviors like gambling. Addictions like alcohol
often offer short solution to the problem and once the alcohol wears off, PTSD’s symptoms like
anger and tension set in.
Highly Suicidal

Most war veterans with PTSD contemplate committing suicide. (Tsolaki F.K. & Karamavrou S,
2009, p. 85-94).

At times, there can the tell-tale signs of a suicide victim. They can be threatening to take
their own lives frequently. In such cases this puts a strain on the family members who have to be
vigilant at all times to stop such an incident from happening. Again, walking around with
feelings of death on their conscience is bound to bring an emotional toll on them.
Understanding and administering therapeutic Interventions to Post Traumatic Stress Disorder
There is a relationship between physical health and PTSD. Some studies have suggested
that PTSD explains the association between exposure to trauma and poor physical health.
Professionals like ex soldiers, civilian men and women, fire marshals and police units often make
the association with PTSD when they gauge their health. This relationship cites that those with
PTSD are more likely to have more health issues than those without. Veteran populations have
been the only ones whom study has been carried on the relationship between physical health and

PTSD in Combat Veterans 9
PTSD. For the future, a research on PTSD, physical illness and medical service utilization in
both veteran and traumatized populations is highly prospected.

The behavioral and psychological effects of PTSD are inherent in anxiety and depression
disorders. Patients with PTSD may experience anxiety disorders. (Fullerton C.S et a.l (2004) p.

The key to understanding PTSD is by knowing the concept of ‘trauma.’ A Psychiatric
association has put a traumatic event as a catastrophic stress that is beyond the normal human
experience. Initial research and findings on PTSD diagnosis associate it with war, torture, rape
and natural disasters like airplane crashes, automobile accident and hurricanes. These earlier
researches did not, however, conceptualize traumatic events could stem from normal life stresses
like phobias, financial woes, divorce, rejection and personal failure. (Shepherd, 2000, p.1914-

Phobia generally refers to an unexplained or extreme fear of a certain object, place or a
event. A phobia is medically grouped as a form of neurosis since anxiety exhibits itself like a
sign. A phobia can be of dark places, tall heights, water and such a person with phobia can
exhibit a self- evaluation, bipolar disorder, panic disorders and they are often thinking of taking
their own lives or engaging in extreme activities that are dangerous enough to endanger their
own lives.

PTSD is different from other psychiatric diagnosis like clinical depression because of the
importance that is attached to the traumatic stressor. (Shepherd, 2000, p.1914-1994).

PTSD in Combat Veterans 10
Combat veterans are more likely to suffer from PTSD because they are likely to be
exposed to torture, hostage situations, kidnapping, sexual assault or being a prisoner of war all
which are traumatic events that can cause PTSD. Again, the risk of developing this disorder is
that the more the exposure, the more the risk of developing PTSD. Often, key aspects of PTSD
are persistent shame and fear. The above causative factors can give birth to shame and fear
which in turn result to PTSD.
Again, a soldier—who at war believes that they cannot sustain injuries—is at a higher
risk of developing PTSD than one who has accepted the reality that at war, one can easily sustain
an injury. Moreover, the higher occurrences of injured soldiers committing suicide back at home
during, or after recuperation, points strongly to the fact that they could probably have developed

PTSD can be treated medically or through therapeutic interventions. For successful
interventions, they have to be administered immediately after the trauma. This has been referred
to as Critical Incident Stress Debriefing (CISD). A trauma survivor has better chances of healing
if they receive CISD after a short while of exposure. Such interventions usually arrest further or
later development into PTSD. (Read J.D, 1997, p.357-360).

In treating PTSD, it is paramount to know the nature of the patients’ traumatic experience
that led to development of PTSD. This is so because some incidents of trauma will most often
trigger PTSD than others. Those that are likely to invoke PTSD usually paint vivid painful
pictures in the mind. Actual violence when it’s meant for that patient or to someone that they
deeply care about, the care, which leaves them vulnerable to emotional pain infliction, will most
likely lead to that survivor developing PTSD.

PTSD in Combat Veterans 11
Again it is important to take note of the patients’ former take on the world before they
experienced the trauma. People who rarely have an opinion of their own about the world and
what is happening around them are at a higher risk of developing PTSD. On the other hand,
people with a strong character and know that anyone can experience trauma will not feel
ashamed to share a traumatic experience and will automatically seek help when that happens.
(Kilmrtin, C, 2005, p.59-68).
Treatment results are most likely to be disheartening in patients with chronic PTSD.
Therapeutic interventions will work best in group sessions for patients with mild or moderate
PTSD. In group therapies, the patients discuss traumatic memories where others with same
PTSD symptoms shall share. This therapeutic intervention has shown great success among war
veterans, rape victims and survivors from natural disasters. (Kilmrtin, C, 2005, p.59-68).
Interventions simply refer to planned efforts made by someone in order to find
professional help for someone going through some substance addiction problem or a traumatic
event. In therapeutic interventions, it is important for the goals be realistic. This is because in
some cases, the PTSD is so severe and no current psychiatric intervention invention can be able
to satisfactorily address it.
Therapeutic interventions have been used to treat Post-Traumatic Stress Disorder in
combat veterans because reactions based on fear are effectively treated by psychotherapeutic
treatments. Most of the therapies include behavioral and cognitive strategies for managing fear
by exposure to the feared stimulus whether in the real or imagined world. Exposure therapy has
helped violence victims and combat veterans. In this form of therapy the patient is encouraged to
reduce avoiding that which causes fear to him. Exposure to their phobias can be non existent or

PTSD in Combat Veterans 12
real. Post-traumatic presentation, which affects the patient’s concept of self, has been called
complex PTSD (Herman, 1992, p. 66).
He describes the characteristics of complex PTSD as: experience of prolonged abusive
coercion, alterations in consciousness especially depersonalization and de-realization states,
difference in self perception, change in relations with other people and alteration in perception of
trauma or perpetrator of the trauma. (Herman, 1992, p. 66).
Most behavioral and cognitive therapy focus on confronting the fear by making the
patient comes face to face with the thing that triggers the fear in their minds. Exposure therapies
can be combined with cognitive processing interventions (Resick & Schnickle, 1993 p. 57).
Nonetheless, these exposure methods work better when combined with relaxation.

A lot of studies on fear based therapies indicate a decrease to the patients’ reaction to
their phobia or trauma stimulant. There is also a decreased mark on the frequency of the patients’
flashbacks. Fear therapy normally records a higher rate of success in patients who are not deeply
depressed and are not addicts to any substance. Again it fear therapy is more successful in
patients whose traumatic experience did not have a very profound effect in their lives. Good and
clean bill of health before the traumatic experience aids success in fear therapy. (Kessler R.C et
al. 1995, p.1048-1060)

On the other hand, in the cases of complex PTSD, shame-based therapies help restore the
patient’s former self worth and dignity. The aim of such therapy is to create an environment with
the patient where feelings of shame and in some instances underlying rage can be dealt with. A
good way to reduce psychological shame is to decrease the sense of alienation and isolation that

PTSD in Combat Veterans 13
it brings. It may be for this reason that group therapies have been widely used in post-traumatic
psychotherapy (Turner et al. 1996, p.88).
Shame is closely related to the feeling of depression and remorse. These feelings
negatively affect on ones self-esteem and criticism. After a traumatic experience there comes the
feeling of shame and patients experience this re-experience an incident which is linked to PTSD.
During therapy, such patients will run the events in their head and say what went wrong, how
they could not be of any help and how hopeless they felt. In such instances of failing to rise up to
the occasion and do what they were expected to do; it becomes clear that the patient is more
concerned of their incapability to do something than the fact that their lives could be in danger.
This clearly brings out a sense of shame and fear, symptoms of PTSD. (Turner et al. 1996, p.88).

The major difference between fear-based and shame-based therapy is that in a shame-
based therapy; the relationship between the patient and the therapist is most often a major part of
the therapeutic process. This happens since for lots of patients, what traumatized them in the
first place took place in the context of an ongoing relationship. The patient’s thought and
fantasies about the therapist and their relationship becomes part of the clinical treatment.
(Kessler R.C et al.1995, p.1048-1060)

Another therapeutic method commonly used is the Eye Movement Desensitization and
Reprocessing (EMDR) which was developed by Franncine Shapiro in 1987. According to
Mental health today, Dr. Shapiro was in a park and was thinking about some unpleasant
memories. She noticed that when she moved her eyes to and fro round the corners that the
intensity of the negative emotions of these unpleasant memories seemed to dissipate.

PTSD in Combat Veterans 14
Eye Movement Desensitization and Reprocessing (EMDR) is a form of exposure therapy
whereby the patient is asked by the therapist to move their eyes rapidly following a movement by
a pencil or the therapist’s finger as they think of traumatic event. EMDR has been used a
treatment for Post-Traumatic Stress Disorder. Traumatic experiences are stored in the brain
unlike pleasant ones. We get through these negative experiences by talking about them. Painful
experiences are not always erased from our memories by doing talk therapy. The trauma remains
fresh even after many talk sessions. It has been suggested that EMDR is able to remove these
traumatic memories. (American Psychiatric Association, 1994, (4) IV).

EMDR theory asserts that the eye movement creates similar activity in the brain to Rapid
Eye Movement (REM) that is experienced during sleep. By doing REM, one is therefore able to
process ideas and resolve conflicts. In rapid eye movement, we are able to retain the memory
without trauma that created it. (American Psychiatric Association, 1994, (4) IV).

Results from numerous scientific researchers have proved EMDR to be an effective form
of PTSD. One such research had 80 subjects with PTSD subjected to EMDR treatment. From the
study it was realized that the subjects appeared to have improved significantly with this treatment
and when further subjected to the same treatment more improvement in 15 months later. (Lindsy
J. 1996, p. 525-536).

Flooding therapy is another therapeutic treatment that has been used to reduce PTSD
symptoms in combat veterans. It works on respondent conditioning. This therapeutic technique
works by making the patient confront their phobias or painful memory. In a controlled
environment where it is clinically safe, the therapist makes the patient confront their fears by
making the fear seem inconsequential and replacing it with something that is soothing and

PTSD in Combat Veterans 15
relaxing. At times this method can be painful but it is quick and effective. It is an exposure
therapeutic process which is imaginary actual exposure to the real thing. Once exposed to that
which causes them fear, adrenaline will automatically increase and eventually one will calm
down when adrenaline runs out and upon realizing that there is nothing to be scared of. (Keane et
al.1960, p.245-260).

According to (Keane et al. 1960, p.245-260), flooding therapy greatly reduces PTSD
symptoms in Vietnam combat veterans. In a clinical trial, Vietnam veterans who had been
diagnosed with it were exposed to flooding therapy. After six months of treatment, they were
found to have improved unlike those who had not been subjected to the treatment. Specific
changes in the PTSD dimension were noticeable. This confirmed that systematic exposure to
memories that were traumatic to the veterans as a treatment for PTSD.

In a spontaneous clinical trial, 24 war veterans who had been diagnosed with post-
traumatic stress disorder (PTSD) were randomly distributed to small groups either receiving 14
to 16 sessions of implosive (flooding) therapy or were put to a waiting-list control. They were
subjected to standard psychometrics in the beginning and during the course of the six month
treatment and after the period too. A therapist obtained their therapist ratings by interviewing
them on the symptoms that they depicted during that time. When their results were subjected to
those in the waiting list control the patients who were administering implosive therapy showed to
be getting better. Specific changes in the re-experiencing dimension of PTSD, anxiety, and
depression were notable, while treatment did not seem to influence the numbing and social
avoidance aspects of PTSD. The results are discussed with respect to the importance of
systematic exposure to traumatic memories, as one component of comprehensive treatment of

PTSD in Combat Veterans 16
combat-related PTSD, and the need for skills training interventions directed at improving social
competence in interpersonal interactions. (Keane et al. 1960, p.245-260).

Cognitive Behavior Therapy (CBT) as a therapeutic treatment, is also used to treat PTSD.
This therapy focuses on changing the patients’ feelings and actions by altering their thought
pattern and behavior responsible for negative emotions. Its success rate is rated high in phobia
treatment and often involves total therapy time of 12 hours or less according to University of
Washington Human Interface Technology laboratory. It focuses more on the present,, less time is
spend on the therapies and the results come much faster unlike other therapies. ( Rothbaum B.O
& Foa E, 1996 p. 491-509).

This therapy assumes that people perceive situations in relation to their emotional
feelings. This can be used to treat combat veterans by helping them identify that trauma and
phobia and assessing how true their perceived fear is. After that, they will learn how to align and
correct their imagined and distorted thoughts. Usually when one thinks realistically, they end up
feeling better. ( Rothbaum B.O & Foa E, 1996 p. 491-509).

A pilot study for nightmares and insomnia in combat veterans by Swanson (2009, p.639-
642) found that sleep disorder is inherent in PTSD. Here an assessment was done on the effects
of a combined treatment of insomnia and nightmare in combat veterans suffering from PTSD.
They were exposed to cognitive –behavior therapy and the frequency of their nightmares and
insomnia were found to have greatly decreased after 12 days.

Immersion and Implosion Therapy is an exposure type of therapy for phobias. It works
on the assumption that the best way to deal with phobia is to have the patient go through forced

PTSD in Combat Veterans 17
and prolonged exposure to the imagined fear source. This therapy will allow the patients to sort
their feelings in a clinically and psychologically safe setting. For example someone who has fear
of water can be made to stand in a tub full of water until they realize that they are not in any
acute sense of danger. Implosion therapy is acutely close to immersion therapy. It was developed
by Thomas Stampf in 1960s. With this therapy, a patient is made to stay exposed to their source
of phobia for nine hours in a session. In doing this, the patients phobia will be confronted and
become desensitized and had less phobia with time. . (Keane et al. 1960, p.217-225).

Psychodynamic psychotherapy treats PTSD with the focus on the varying factors that
may influence or cause PTSD symptoms. Some of these symptoms can include experiences in
childhood especially the close relationship between kids and their parents and prevailing
relationships. It mainly focuses on the unconscious mind where traumatic feelings, thoughts and
experiences are stored. Even when these feelings are far removed from our awareness they often
are a contributing factor in our behavior. (Swanson, 2009, p.630-635).

Just like cognitive therapy, psychodynamic focuses on bringing out these buried feelings
and dealing with them. In the therapeutic treatment, the therapist will aid the patient in coming to
terms and identifying the defense mechanisms that they use to avoid confrontation with their
pain and getting rid of such destructive feelings. Often anger and guilt is a difficult feeling to
confront so a patient will most probably grow a defense mechanism and direct their anger
towards others. When the therapist notices such, he identifies this defense mechanism and shares
it with the patient and doing so they will both begin to sort through those painful feelings in a
healthier and acceptable manner.

PTSD in Combat Veterans 18
Psychodynamic psychotherapy for PTSD had not been studied deeply like cognitive
–behavioral therapy. However, it has been discovered that after therapy sessions, PTSD patients
reported improvement in their interpersonal relationships and were less hostile. The patients got
more confident and generally their self-esteem went up and eventually the PTSD symptoms as
well. (Swanson, 2009, p.630-635).

Acceptance and Commitment Therapy works on the principle that we should strive to
limit painful experiences and maximize positive experiences. As we grow up, we learn to
associate some experiences with good and others with bad. It is human to want to run away from
bad experiences and we try as much as we can to disassociate ourselves from it. However, at the
end of it this avoidance gets us nowhere.

Avoidance never works out because in the hustles of life, pain becomes part of it.
Everyone at one point in their lives goes through painful experiences and how they choose to
deal with these experiences determines if they will get through the pain or get stuck in it.
Therefore in treating PTSD, avoidance and commitment therapy assumes that what causes
trauma is not the real experience that happened but what happened after the experience, that is,
how one dealt with the pain that resulted. It has also been used to treat other mental disorders.
This therapy strives to help patients trying to escape pain by making them come to terms with the
fact that that pain is part of life. Acceptance and Commitment Therapy intends to help patients
realize that escaping our pain will never work and instead to take their pain head on and control
it would be a better option. (Swanson, 2009, p.630-635).

Hypnotherapy is also used to treat post-traumatic stress disorder. In this therapy, the
therapist uses hypnosis. Here includes neurolinguistic programming and Time line Therapy. The

PTSD in Combat Veterans 19
doctor here will focus on changing the patients of how things happened in their subconscious
memory by asking questions and giving suggestions. The sole purpose of such hypnosis is to
make the patient subconsciously realize that there is nothing to relive in the past rather than
move and embrace the future with what it has to offer.


Apart from the therapy, there are many other methods of intervening against PTSD. One
such mentionable intervention is the Self-empowered recovery. These, essentially, are proactive
practices that the patient will administer on himself/herself in order to recover from the trauma.
Such activities include learning to do controlled-breathing especially when one feels panicky.
Again, the patient can embark on a self-discovery journey in order to build a new better person
that is able to look in their past and move on into the future. In finality, most people who suffer
from post –traumatic stress disorder do get better after some time and that includes a good
number of war veterans. However, researches note that; in 3 PTSD patients, one may continue to
experience and exhibit some of the symptoms. However, continuous treatment helps the patient
cope and lead normal lives.

PTSD in Combat Veterans 20


Kilmrtin, C. (2005). Depression in men: Communication, diagnosis and therapy. Journal of
Health and Gender, 2 (1) 59.
Miller, J, & Bell C. (1996). Mapping men’s Health, Journal of community and Applied Social
Psychology, (6) 17-327.
Tinker & Becker D. (1995). Journal of Consulting and Clinical Psychology , 2, p.56-60.
Keane, T.M et al. (1989). Behavior Therapy. Implosive (flooding) therapy reduces
symptoms in

Vietnam Veterans, 20 (2) p.245-260.

King D.W et al. (1996). Factors in Combat-related Posttraumatic Stress Disorder: Structural

Equation Modeling with a National sample of Female and Male Vietnam Veterans,
(64) p.520-531.

Herman E. (1992). Self- esteem and self-criticism: Oxford: Oxford University Press.

American Psychiatric Association. (1994). Diagnostic and Statistical Manual for Mental

Disorders (4) DSM-IV.

Andrews B. (1998). Shame and Childhood abuse. In shame: Interpersonal Behaviour,

Psychology and Culture p.176-190.

Lindsy J. (1996) Psychoanalytic psychotherapy of post-traumatic stress disorder: the nature of

the therapeutic relationship. p.525-536.

PTSD in Combat Veterans 21

Kessler R.C et al. (1995). Post traumatic stress Disorder: the nature of the therapeutic

relationship. In traumatic stress. The effects of overwhelming experience on mind, body
and society, 52, p.1048-1060

Read J.D. (1997). Introduction: Inside the specialized in patient PTSD units of the department of

Veterans Affairs. Journal of Traumatic Stress. 10, p.357-360.

Terence M. et al. (1988). Mississippi scale for combat-related Post- Traumatic Stress Disorder:

Three studies in reliability and viability, 56 (1) p.85-95.

Ginsberg J.P et al. (2006). A study of the Association between retrospective appraisal of

childhood reactivity and post-discharge traumatic stress in combat veterans 12 (1) p.61-

Tsolaki F.K. & Karamavrou S. (2009). severe psychological stress in elderly individuals: A

proposed model of neuro-degeneration and its implications 24 (2) p.85-94.

Kaplan H.I. (1994). Kaplan and sadock’s synopsis of psychiatry: Behavior sciences, clinical

psychiatry (7) p.606-609.

Fullerton C.S et al. (2004). Acute stress disorder, post traumatic stress disorder and depression

(161) p.1370.

PTSD in Combat Veterans 22
Kelleher I et al. (2008). Associations between childhood trauma, bullying an psychotic
symptoms among a school-based adolescent sample, 5, p.378-382

Vasterling K. B et al. (1997). Assessment of intellectual resources in Gulf War Veterans:

Relationship to PTSD, 4 (1) p.51-59

Rothbaum B.O & Foa E. (1996). Cognitive-behavioural therapy for post-traumatic stress

disorder. In Treaumatic Stress: The Effects of overwhelming experience on Mind, Body
and Society. p.491-509).

Helzel et al. (1987). Post traumatic Stress Disorder: Oxford: Oxford University Press

Ben S. (2000). A war of Nerves: Soldiers and Psychiatrists. p. 112-120.