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Description
Combat trauma is a classification of psychological trauma, which is specific to combatants and other individuals in war situations. Psychologists describe psychological trauma as damage or injury to the head that occurs due to events that cause a lot of distress. Such events may occur once in a victims lifetime or continuously over a certain period. A key feature of combat trauma is that the painful events result in the sense of being overwhelmed and a subsequent lack of ability to integrate ideas and emotions involving the events (Courtois, 2004).
In most cases of combat trauma, the events in question include occurrences that are prominent in war situations, such as loss of loved ones, feelings of isolation, confusion on things that constitute reality, physical injury, and the threat of physical injury. In most cases, combatants and their families subscribe to certain beliefs regarding various institutions that they depend on for survival (Johnson, 2011).
In some cases, the effects of combat trauma are immediately visible; however, in most cases, there is often a delay for prolonged durations extending to months and even years after the occurrence of a traumatic event. For this reason, diagnosis is often ambiguous, and sometimes clinicians fail to recognize the existence of symptoms in victims. Sometimes, symptoms that occur temporarily are identical to signs of stress in any other individuals, and thus psychologists may fail to gauge the severity of a victims suffering.
Patients in advanced stages of combat trauma exhibit symptoms such as excessive irritability, nightmares, disruptive behavior and mistrust, feelings of loss of control, suicidal tendencies, and disconnection from reality. Some of the events that result in combat trauma include actual battle, witnessing the loss of lives, feeling of isolation from family and friends, harsh living conditions, kidnappings, torture, physical assault and humiliation, and the reality of death.
The severity of the symptoms
The severity of symptoms that a victim of combat trauma exhibits depends on several factors. The existence of a supportive structure is one such factor. Psychologists argue that the absence of supportive family members, friends, or institutions creates a false need for the victim to keep hidden symptoms. However, by doing so, the victim foregoes the help that s/he needs to alleviate the symptoms, thus making them worse.
The environment forms the second factor influencing the severity of symptoms. Victims who live in environments with features similar to that of a traumatic experience have the risk of having severe symptoms as opposed to those living in different settings. Thirdly, lack of early intervention and treatment often makes symptoms worse, especially if the victim also lacks a support system. Lastly, the occurrence of events similar to those of the traumatic event is likely to worsen existing symptoms for a combat trauma survivor.
Demographics
Given that combat trauma affects fighters, civilians caught up in war situations, and families of such individuals, it is often difficult to establish the exact population undergoing such trauma at a time. According to a report in NHI Medline Plus published in 2009, information from the U.S Department of Veteran Affairs estimates that almost 31% of the Vietnam War veterans, 10% of the Gulf War (Desert Storm) veterans, 11% of veterans from the Afghanistan war, and 20% of Iraqi war veterans suffer combat and combat-related trauma (Wood, 2012).
Some of these veterans also suffer physical injuries that aggravate their situations. These percentages exclude the civilian population, which mostly comprises close family members and friends of the soldiers. A separate report puts the number of American adults suffering from combat-related trauma at over seven million, most of whom are young people in their early twenties or extending to their early thirties. This assertion holds as the majority of the people that enlist in the military comprise young people who opt to join the service after their high school and sometimes college education.
Classification of combat trauma
Psychological trauma falls under two general categories, viz. simple and complex trauma. The characteristic symptoms of trauma form the criteria for the classification. Simple trauma occurs where suffering emanates from a single definable painful event. The effects of such trauma are usually easy to associate with the event, thus making it easier to treat using psychotherapy. On the other hand, complex trauma emanates from multiple or continuously occurring harrowing events whose effects sometimes overlap, thus making it difficult to separate symptoms from one event from those emerging from subsequent events.
Treatment for complex trauma is often more difficult as symptoms from recurring events overlap and sometimes intensify over time (Courtois & Ford, 2009). According to psychologists, most victims of psychological trauma rebuild their lives around the events in a bid to forget the occurrence of the events or reduce symptoms of the accompanying trauma. For instance, some victims choose to live in areas where people do not know them to avoid questions on the events and their effects on their lives. However, this aspect only provides temporary relief, as the issues causing the symptoms to remain unattended. In consideration of this view, it is often difficult to identify the changes associated with certain reasons in a victims life if he or she suffers from complex trauma.
Combat trauma falls under complex trauma. Although some scholars argue that symptoms directly resultant of a single event such as the Gulf War qualify as simple trauma, classifying a war as a singular event would be an erroneous assumption (Courtois, 2004). It is impossible to isolate instances of trauma occurring within a war situation, for in some cases, the victim experiences direct trauma such as being shot at, while in other cases, he or she experiences such trauma from passive events such as watching someone die. Therefore, the classification of war as a single historical event does not amount to the same classification in terms of traumatic events (Bracha, 2004).
Groups vulnerable to combat trauma
Combat trauma cuts across all genders, thus creating some difficulties in the establishment of the most vulnerable groups. Although most people that experience traumatic events directly are combatants, such events also affect the civilian populations in war zones, which comprise men, women, and children who sometimes end up as refugees. However, some of the most vulnerable groups include children in war zones and men.
According to a report from The National Comorbidity Survey conducted in the United States between September 1990 and February 1992, 38.8% of trauma that occurs to the male population in the US is combat-related, while 23.9% of psychological trauma in children occurs from neglect (Ahmed, 2007). Ordinarily, the majority of the population that engages in combat comprises men, which is related to their natural protective instincts.
Civil instability often increases instances of neglect regarding children as most adults undertake a protective role. Therefore, it is understandable why children undergo combat trauma. Their innocent character and lack of understanding of reasons surrounding the occurrence of combat and subsequent traumatic events also increase the severity with which symptoms manifest from such traumatic events. The report adds that most women suffering from psychological trauma attribute the same to domestic violence (Wood, 2012). This element can sometimes be severe, especially if the partner orchestrating such violence suffers combat trauma resulting in bouts of violence and disruptive behavior.
Reactions to trauma
Combat trauma results in different reactions depending on a myriad of factors. Some of the determinant factors include an individuals reaction to stress, existent reminders of the traumatic experience, support from family, friends, and access to medical facilities for intervention. Although some individuals may suffer trauma from the same event, their coping mechanisms may vary depending on their individual personalities.
For instance, introverts opt for denial as they find seeking help from other people uncomfortable, while social individuals find it easier to talk to someone and obtain help before symptoms escalate. Societal cultures also contribute to the form of coping mechanism that an individual adopts due to the roles that they define per gender. For instance, in most cultures, society characterizes men as perpetually strong individuals, thus fostering a need for male victims to appear strong and well even when they are at their breaking points. Dealing with trauma, including that related to combat, is easier for women as most cultures consider them as weak beings and more vulnerable than men (Barrett, 2006; Johnson, 2011).
In some cases, financial constraints may prevent a victim from seeking professional medical assistance, especially when exhibiting advanced symptoms. Some combatants find it difficult to obtain stable jobs after they get home from service. Those that often succeed experience difficulties maintaining the jobs when symptoms of combat trauma begin to surface. In other cases, victims suffering from combat trauma are in a position to identify their symptoms as problems that make their daily lives complex and opt to seek intervention before the symptoms aggravate. For such victims, acceptance is their main reaction to their trauma, and it results in better access to treatment options.
Impact on community and various systems
One of the ways in which combat trauma affects various communities is through alteration and sometimes reversal of gender roles. As mentioned, the majority of the population that engages in combat-related activities comprises men. This change often alters the role of women from caregivers in the family to providers and protectors in a bid to ensure that the family unit remains intact, particularly where the families have children (Schechter & Willheimer, 2009).
The same is true for women who participate in combat situations either as combatants or in supportive roles such as nurses and doctors. In the latter case, men have to assume responsibilities mostly familiar to women, such as taking care of the home and raising children. Depending on the population of people suffering from combat trauma in certain communities, local governments find the need to create support systems and treatment centers for the victims in order to ensure that their assimilation process back to society occurs as smoothly as possible.
Strategies of the intervention plan
Psychologists use more than five models in the intervention and treatment of combat trauma. The model that one chooses to adopt depends on factors such as the intensity of the trauma, unique traits that the victims exhibit, and their coping mechanisms of choice. While some of the methods comprise personal interactions with psychologists and other caregivers, others involve group sessions, usually with peers going through similar experiences. Cognitive processing therapy and peer-based services are two of the most common and most effective models so far.
Cognitive processing therapy (CPT) is a cognitive behavior treatment model whose core characteristic lies in its focus on coping mechanisms that victims develop after combat. However, it is common for such treatment to extend to symptoms of trauma and other related problems. The model is dependent on the cognitive ability of victims in relation to the identification of traumatic events, symptoms related to such events, and coping mechanisms that the victims opt for in a bid to reduce the impact of the hurt in their lives. The model includes an analysis of the victims coping mechanism, psycho-education sessions, and follow-ups on the success of the process.
The most important characteristic that makes the model stand out from the rest is the principal role that the victim plays in the recovery process. While most models primarily adopt a clinical approach to the diagnosis and evaluation of trauma, this model incorporates a social aspect to the process through the inclusion of the victims input. According to Baldwin (2013), a reduction in the sense of helplessness that comes from trauma creates conducive conditions for the recovery of patients, in addition to making them more receptive to ideas on recovery strategies from their psychologists.
Patient empowerment allows the patient to identify and handle symptoms even in the absence of his or her psychologist and reduces dependence on outside support for recovery. The dynamics involved in this model create a relationship between the victim and psychologist, which facilitates trust that most other models do not work on establishing. The phases of recovery include identification of the traumatic events, identification of symptoms occurring from the event, and coping mechanisms that individual victims adopt. This phase relies heavily on the patients recollection of events and cooperation with the psychologist.
The second phase involves an analysis of the coping mechanisms and the impact that they have on the victims everyday existence. The third phase of recovery involves psychoeducation and acceptance of the traumatic events, while the fourth phase requires the patient to reorganize his or her life positively in order to reduce negative influences and increase chances of progress. Lastly, the patient undergoes re-evaluation to ensure the success of any strategies implemented to mitigate the effects of the trauma. The main challenge for this model is the establishment of trust between a victim and psychologist, as mistrust forms one of the core characteristics of combat trauma.
The second model the Eye Movement Desensitization and Processing (EMDP), focuses on identifying traumatic events and desensitizing triggers as part of the process to resolve the victims distress. Unlike the cognitive processing therapy model, EMDP takes a clinical approach in its intervention and treatment procedure. Some of the key features in this model include evaluation of past memories, identification of present disturbances, and formulation of future actions with the aim of replacing negative thoughts, emotions, and behavior with positive ones (Currier, Holland, Jones, & Sheu, 2014).
A unique concept to this model that is often absent in most other models is the use of external stimulus to identify triggers. Such stimuli include physical movements such as eye movements and tapping of the hands. This model is appropriate for combat trauma due to the characteristic mistrust and unwillingness to communicate feelings directly that most victims experience during therapy. Although the intervention and treatment processes do no establish trust as a mandatory requirement for combat trauma victims, the ability to regenerate feelings and behavior makes up for the vacuum (Davidson & Parker, 2001).
The therapy process takes six to eight stages depending on the psychologist, with the first one being prepared for the therapy through psychoeducation and relaxation exercises. The second phase entails an assessment process. The items for assessment include the origin of negative self-beliefs and the intensity of disturbance that the beliefs cause to the victim. In addition, at this stage, the psychologist and the victim work on generating a set of positive beliefs that may alter the current perspectives of the victim on his or her life. The third stage in the treatment process carries the most attention, as desensitization occurs at this point.
The desensitization process involves the reduction of disturbances originating from traumatic memories (Oren, 2012, p.200). During the fourth stage installation, the psychologist assists the victim in developing positive beliefs to replace the negative ones. This aspect may occur concurrently with the fifth stage the body scan, which is aimed at addressing any physical attributes that cause symptoms of trauma.
According to Soderberg (2006), the sixth stage involves finding closure whereby the victim reconciles and accepts the traumatic events and agrees to embrace calmness while proceeding with the rest of his or her life. The last stage involves a re-evaluation of the progress that the victim makes over a specific period in order to measure the success of therapy and consider different approaches where necessary (Courtois & Ford, 2009).
The main advantage that this model exhibit is the comprehensive nature of the entire recovery process. Division of the process into manageable stages depending on the victims progress makes it possible for the psychologist to change his or her approach towards the intervention early enough during treatment. However, the process is heavily reliant on the psychologists counsel, which does the patient no good in terms of taking charge of his or her own recovery.
The method is also extensive, and it may take more time than other models, albeit with better results, usually with long-term results (Kenny, 2014). The model also takes into consideration the view that some symptoms of combat trauma do not appear until later stages of therapy.
Some of the factors that limit the ability of combat trauma victims include lack of financial capabilities, stigma from members of society, feelings of shame, confusion, and mistrust. In most cases, victims prefer discrete methods that allow them to express their feelings without compromising confidentiality (Valdez & Lilly, 2014). Both methods described above provide such confidentiality and are thus most appropriate for combat trauma intervention and treatment. In some cases, a psychologist may use both methods in tandem as opposed to their separate application.
References
Baldwin, D. (2013). Primitive Mechanisms of Trauma Response: An evolutionary perspective on trauma-related disorders. Neuroscience and Biobehavioral Reviews, 37(8), 1549-1566.
Courtois, C., & Ford, J. (2009). Treating Complex Traumatic Stress Disorders: An Evidence- based Guide. New York, NY: The Guilford Press.
Currier, J., Holland, M., Jones, W., & Sheu, S. (2014). Involvement in abusive violence among Vietnam veterans: Direct and indirect association with substance use problems and suicidality. Psychological Trauma: Theory, Research, Practice and Policy, 6(1), 73-82.
Davidson, P., & Parker, K. (2001). Eye movement desensitization and reprocessing (EMDR): a meta-analysis. Journal of Consulting and Clinical Psychology, 69(2), 30516.
Kenny, M. (2014). Review of the child survivor: Healing, developmental trauma, and dissociation. Psychological Trauma: Theory, Research, Practice and Policy, 6(1), 97-99.
Oren, E. (2012). EMDR Therapy; An Overview of its Development and Mechanisms of Action. European Review of Applications in Psychology, 62, 197203.
Soderberg, M. (2006). EMDR and the Energy Therapies Psychoanalytic Perspectives. Clinical Social Work Journal, 34(2), 241242.
Valdez, E., & Lilly, M. (2014). Biological Sex, gender role and criterion A2: Rethinking the gender gap in PTSD. Psychological Trauma: Theory, Research, Practice and Policy, 6(1), 34-40.
Ahmed, S. (2007). Post-traumatic Stress Disorder, resilience and vulnerability. Advances in Psychiatric Treatment 13, 369-375.
Barrett, L. (2006). Are Emotions Natural Kinds? Perspectives on Psychological Science, 1(1), 200-223.
Bracha, S. (2004). Freeze, flight, fight, fright, faint: Adaptationist perspectives on the acute stress response spectrum. CNS Spectrum, 9(9), 679-685.
Courtois, C. (2004). Complex Trauma, Complex Reactions: Assessment and treatment.Psychotherapy: Theory, practice, training, 41(4), 412-425.
Courtois, C., & Ford, J. (2009). Treating Complex Traumatic Stress Disorders: An Evidence- based Guide. New York, NY: The Guilford Press.
Johnson, S. (2011). Emotionally focused Couple Therapy with Trauma Survivors. New York, NY: Guilford Press.
Schechter, D., & Willheimer, E. (2009). Disturbances of Attachment and Parental Psychopathology in Early Childhood. Child and Adolescent Psychiatric Clinics of North America, 18(3), 665-685.
Wood, D. (2012). Iraq, Afghanistan War Veterans Struggles with Combat Trauma. Web.
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