Excerpted from cover: "Private John White" by Ivor Hele (Australian War Memorial)

Posttraumatic Stress Disorder (PTSD) and War-Related Stress

Information for Veterans and their Families

Coping

It is not very helpful to think of "curing" PTSD in a black-and-white, all-or-nothing manner. Everyone who experiences trauma will be affected by it. Some of those changes may be positive – for example, the survivor may become stronger in some ways, perhaps more caring and understanding of other’s misfortune. They may find that the experience has made them better equipped to deal with future life stress. Unfortunately, some of the changes will be negative, especially in cases of PTSD, and coping with even the smallest frustration’s and difficulties becomes a major challenge.

Some people who develop PTSD seem to recover completely and are left with little or no ongoing distress and impairment. For others, the symptoms may persist and the individual must learn to manage and cope with them in order to minimise the effects on their lives. There is much that people with PTSD can do to help themselves deal with the disorder.

Coping Yourself

The following is a list of tips that some people have found to be useful. Many of them are basic common sense, but that does not mean they are unimportant. On the contrary, if you can do the basics (which is not easy) you will go a long way to successfully managing your PTSD symptoms.

Do not try to do everything at once. When you have read the following sections, you may wish to stop for a while and work out a "plan of action". Which strategies sound particularly useful for you? Which ones are you prepared to try? We suggest that you select only one or two to begin with. Work out a plan to achieve them, one at a time, and set yourself some realistic goals for the next week. At the end of the week, review your progress: modify your goals if necessary and/or try some additional strategies for the following week. Over time, you will gradually develop a range of coping strategies and changes to your lifestyle that will help you to feel more in control of your symptoms and get more out of life. You may be able to find programs in your local community or VVCS (such as Heartsafe, Gutbusters, and Lifestyle Programs) to assist with some of these areas.

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Eat healthy meals. This sounds so simple, but how many of us actually do it? A poor diet will increase your stress levels – if in doubt, talk to your general practitioner or a dietician.
Get regular aerobic exercise like walking, jogging, swimming, or cycling. You might want to take the opportunity to go for regular walks with your partner. Exercise is vital in effectively managing stress. If you have PTSD, your body is almost constantly geared up for "fight or flight". Exercise helps to burn up those chemicals (like adrenalin) that are hyping you up and will help you to become more relaxed.
Get enough rest, even if you can’t sleep. Rest will help to increase your reserves of strength and energy. You may wish to try some kind of meditation, yoga, or relaxation exercises. (See also the section on "Sleeping Better" later in this booklet).
Establish, and try to stick to, daily routines (e.g., go to bed at a set time, get out of bed at a set time, plan activities for the day). Routine is very important in helping us to feel in control and to function effectively.
Set small, realistic goals to help tackle obstacles. At first, things may seem insurmountable but broken down into small steps they are manageable. Some people like to keep lists of tasks to accomplish when they feel capable, crossing them off as they are completed. This can be very rewarding, helping you to acknowledge that you are achieving something.
Redefine your priorities and work out what is, and is not, achievable. Try to be realistic – expect neither too much nor too little of yourself. Then focus your energy and resources on those priorities.
To help stop the constant stream of worrying and anger-producing thoughts, set aside a specific time each day for thinking. Give yourself permission to reflect and deal with issues related to the trauma (e.g., corresponding with the DVA) at appropriate times for a defined period (perhaps 30 minutes each day between 6:00 and 6:30pm). If unwanted thoughts come into your mind at other times, gently remind yourself that you will be thinking about it later in the day.
Ask for support and help from your family, friends, church, or other community resources when you need it. This is not a sign of weakness. In general, other people are very keen to help as long as you let them know what you want.
Join or develop support groups– sharing experiences with others who understand is often useful. Good starting points would be the veterans’ organisations (e.g., RSL, VVAA, VVF, etc.) or the VVCS - Veterans and Veterans Families Counselling Service (VVCS) despite the name, they welcome inquiries from veterans of all conflicts).
Continue to educate yourself and your family about reactions to trauma. A good understanding of PTSD and related disorders is important in coming to terms with your experiences and beginning to deal with your problems.
Look after your partner, if you have one. Try to clarify your feelings and assumptions about him or her, and check out whether those feelings and assumptions are accurate. Many problems are caused by one partner jumping to conclusions or assuming that they know what the other is thinking. Remember that men and women tend to react differently. Women tend to be caretakers and put others first. Men tend to have more difficulty acknowledging and expressing feelings of helplessness and sadness and believe in "toughing it out". We all like our partners to say and do things that show that they value and care for us – make an effort to do this from time to time.
Acknowledge unresolved issues and be honest with yourself: what do you still feel hurt or frightened or angry or guilty about? Recognising, and admitting to, the issues is an important first step to recovery. Use the hurt and pain as a motivator to make the necessary changes to heal (i.e., if you don’t want to continue feeling like that, what can you do about it?).
Talk to your children. Try to be supportive and patient. Obvious- ly, this is not always easy, but losing control and getting angry only makes things worse. Set an example by expressing your feelings gently, controlling your anger, and showing problem solving skills in dealing with family difficulties as they arise. (What exactly is the problem? Let’s work out a plan to handle it and see how we go).
When you’re feeling rotten, remember that those around you are probably also under stress.
Focus on your strengths and coping skills. It may not feel like it at times, but you have many strengths and strategies to deal with difficult times.
Try not to use your PTSD or your war experiences as an excuse for hurting yourself or others. There is no excuse for being violent, aggressive, or otherwise mistreating other human beings. It is important that you take responsibility for your own behaviour.
Remember that you are not alone. Lots of other veterans over the centuries have experienced these kinds of problems. There is always hope.

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Coping Within A Family

Partners and close friends are often at a loss as to how to help someone with PTSD. There are several things that loved ones can do to help the traumatised person and you may find the following suggestions useful.

If possible, listen and empathise when the traumatised person wants to talk. Remember that it may be very hard for them to express what they’re going through. A sympathetic listener is important in minimising the tendencies of people with PTSD to withdraw and "shut down". It is best not to say "I understand what you’re feeling" (you probably don’t, since you haven’t been through the same experiences). Instead, show your empathy by comments such as "it must be really difficult for you; I can see that it upsets you; is there anything I can do to help?"
Spend time with the traumatised person. There is no substitute for personal presence. Just keep doing the usual things that people do together. Do not feel that you have to talk about the trauma or be their counsellor. Just being with people who care about them is very important for traumatised individuals. Equally, try to respect the person’s need for privacy and private grief at times.
Don’t tell survivors that they are "lucky it wasn’t worse" or to "pull themselves together and get over it". They are not consoled by such statements. Tell them, instead, that you’re sorry they were involved in such an event, and that you want to understand and assist them.
Reassure them that they are now safe.
Care about each other. Give hugs. Tell each other how much they are appreciated. Offer praise. Make a point of saying something nice to each other every day. Good relationships are characterised by lots of positive interactions, but they take a lot of hard work.
Don’t be afraid to suggest that they see a clinical psychologist, psychiatrist, or counsellor, or that they seek support from peer groups. (But remember to do this in a tactful and caring manner – not in the middle of an argument!).
Laugh. Use humour (although not about the traumatic event).

Sleeping Better

Sleep disturbance is very common in PTSD and in depression. Medication sometimes helps, but it should be used with caution and only as directed by your medical practitioner. There are several simple "non-drug" strategies you can try that can be very helpful in improving sleep:

Get into a regular routine. In particular, get up at the same time each morning even if you haven’t slept well.
If you are not asleep within 30 minutes, get up for a while before returning to bed. If you don’t drop off within 30 minutes, get up again and so on.
Try to avoid caffeine (coffee, tea, cola, chocolate) from 6 pm onwards. Avoid alcohol and, if possible, cigarettes from dinnertime onwards. Try not to eat a meal within a couple of hours of going to bed.
Starting a gentle exercise routine and losing a bit of weight often helps with sleep.
Don’t do anything in bed except sleep (and, perhaps, sex): don’t watch TV, read, do crosswords, or think about worrying things. Reserve bed for sleeping.
Get into the habit of doing something relaxing before bed: listen to a relaxation tape or some relaxing music, have a warm bath, slow down!
Try not to worry about not sleeping: the more you worry about it, the less likely you are to drop off to sleep. You can survive without much sleep, even though you will be tired.
Sleep, like any habit, takes a while to change. Try to stick to the above guidelines for at least two weeks before deciding whether or not they help.

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