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Building Safety by Building on Resilience

Like others who have experienced intense and threatening experiences, veterans with post-deployment stress effects are always at risk of having even harmless words and events retrieve vivid, painful experiences and trigger powerful chemical reactions. Many can also dissociate or “shut down” when their bodies sense that these powerful chemical reactions are on the way. And for those with co-occurring substance use disorders, their post-trauma effects may constitute ready triggers for binges or return to use of addictive substances.

Herman (1992) identified the development of safety as the first stage of recovery from trauma. Even if your time with the veteran is limited, and safety is the only element you have time to address, helping veterans build safety into their lives can be a huge contribution to their well being.

One way to approach issues of safety is to remember some of the elements that are critical in developing and maintaining human resilience in the face of stress (see Resilience and Vulnerability to Traumatic Stress). Here are some examples:

  • Balance is the essence of the human stress and survival system’s work, and an important element of safety in recovery from trauma. Though that balance has been disrupted by the experience of war, you can help veterans learn conscious techniques for putting their stress systems back in balance.
    • They can learn to notice when their sympathetic fight-or-flight chemicals are rising and “put on the brake” by pulling back, invoking soothing images or affirmations, or temporarily leaving the situation.
    • They can learn to notice when they are shutting down and their parasympathetic systems are taking over, determine if this is happening because they feel unsafe, and take stock of other resources and safety measures that can help them.

  • The ability to separate past from present is an important function that helps the hippocampus inform the amygdala and keep it under control. Even if that ability has been severely compromised by trauma, you can help veterans learn to:
    • Become observers of their own situations and reactions
    • Ask themselves questions that will help them distinguish past from present experiences
    • Practice techniques that will help ground them in the “here and now”

  • A sense of control over one’s destiny is one of the qualities associated with stronger resilience to war-zone stress (Herman, 1992). Although people with strong post-deployment stress effects may feel a decided lack of control over even their basic moods and reactions, you can find many large and small ways of helping them regain a sense of control. A few examples are:
    • Establishing non-verbal “stop” signals they can use when the conversation becomes too intense
    • Letting them make informed choices about therapeutic techniques and the focus of therapy
    • Teaching them about the nature of stress reactions, so these reactions become more predictable
    • Providing and directing them to community-based and web-based resources
    • Teaching them techniques for controlling their stress reactions, and giving them chances to practice these skills
    • Providing information about self-care options they can use, like the ones listed on this web site (Click here for Ideas for Recovery, Re-Balancing, and Self-Care)

  • Attuned, responsive face-to-face communication is essential to the development of resilience in the human brain (Schore, 2001) and equally important in the development of safety in and through the therapeutic relationship. Simply listening and making genuine and responsive eye contact can help build safety and promote recovery (Scaer et al., 2008; Gaty, 2008a).

  • Collaboration is an important element of resilience to trauma (Herman, 1992) and an important skill in maintaining emotional safety in the therapeutic relationship, and in the world. By being thoroughly collaborative, you can model and teach collaboration and provide a laboratory for its practice.

  • Strong bonds with fellow Service Members are important protective factors overseas and equally important in building safety in recovery. If veterans are not in touch with other Iraq/Afghanistan veterans in their community, anything you can do to help them find these connections will be important to their emotional safety and well being.

  • A sense of meaning and purpose is an important element of resilience and an equally important element of recovery. Although you cannot force or create this meaning for the veteran, you can be a witness to and appreciator of his or her own sense of meaning and purpose as they emerge in the therapeutic process. This focus activates the prefrontal cortex and allows it to exert its calming influence on the amygdala.

  • Hope: A sense of hope and optimism can be a powerful component of resilience and treatment effectiveness (Hubble, Duncan, and Miller, 1999) and an equally powerful element in creating a sense of basic safety. You can foster hope in many ways, including:
    • Taking care not to judge, stigmatize, or “pathologize” their war-zone experiences or post-deployment stress reactions, either through your reactions or the words you use to describe conditions and options
    • Providing information about the success of the approaches you use and encouraging contact with other veterans who have overcome similar post-deployment stress effects
    • Letting the individual veteran choose treatment practices that he or she believes in, something that automatically raises the level of hope and trust in the success of the therapeutic process
    • While not diminishing their challenges in any way, encouraging veterans to make and continue to add to an “appreciation list” or a “gratitude list,” in which they can note anything and everything that inspires even trace amounts of appreciation or gratitude in them; In many ways, gratitude is to the past what hope is to the future, and it can serve as a sort of “pump primer” for hope

Next: Avoiding Iatrogenic Effects

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The material on all of the Clinical Pages is taken directly from the draft version of Finding Balance After the War Zone:  Considerations in the Treatment of Post-Deployment Stress Effects, a manual under development for the Great Lakes Addiction Technology Transfer Center and Human Priorities.  This draft is copyright © 2008, Pamela Woll.  Reprint permission is universally granted, but attribution is requested.
Click here for References and Other Resources.
Click here to link to a PDF file of the current version of the clinician’s manual draft.
Click here to link to a PDF file of the accompanying booklet for veterans.

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