Mental Health Performance - How PTSD Affects Tactical Athletes & Veterans
About the Author
Ben Foodman is a licensed psychotherapist & performance specialist. He owns his private practice located in Charlotte North Carolina where he specializes in working with athletes to help them overcome mental blocks (the yips), PTSD, ADD / ADHD and achieve flow states through the techniques of Brainspotting & Neurofeedback. If you are interested in services, use the link here! Enjoy the article below!
Introduction: Veterans, PTSD & Mental Healthcare
Many veterans face complex issues that affect their lives in significant ways compared to civilians. One common issue that many veterans face is how to effectively deal with Post-Traumatic Stress Disorder (PTSD). There are many misconceptions that both the general public and mental health clinicians have pertaining to PTSD and veterans. For instance, there is often an immediate assumption that the trauma veterans exhibit originates from their time in service. While there are many veterans who have sustained psychological trauma during their service, in my practice I have found that there is usually some form of trauma that precedes the individual’s military service. This is crucial to understand because these common misconceptions can lead to ineffective mental health treatment interventions.
Because this previously mentioned misconception along with all of the other misunderstandings are so common, I felt it was important to discuss how veterans should evaluate their PTSD when they are searching for a mental health provider. For this Training Report I want to take the time to explore the science of PTSD from a neuropsychological perspective, and explain the importance of why trauma needs to be thoroughly explored throughout one’s life. I will then discuss why traditional brief intervention therapy and other ‘evidence-based’ therapy approaches can be highly ineffective. Finally, I will explore what types of therapy interventions I believe veterans should try to utilize. Let’s first begin by exploring the neuroscience of PTSD.
Part I. Veterans, PTSD & Neuroscience
I have talked extensively about trauma in previous Training Reports, but I believe it is important to review the science behind post-traumatic stress disorder. The human brain has evolved overtime to help us accomplish amazing things, but many of the original structures that still remain with us continue to impact our lives in ways that we are now just beginning to understand. There are three main areas that we should be primarily concerned with: the brainstem; the limbic system; & the prefrontal cortex. The brainstem and limbic system are referred to as subcortical brain structures and are primarily involved with primitive responses such as the following: basic bodily functions; messaging between the brain and body; fear, freeze, fight or flight response; threat and reward response. The prefrontal cortex is considered to be a newer structure that is involved with higher order brain functions such as abstract thinking, working memory, and executive functions. Over time these modes of thinking have helped us succeed in different ways.
Despite all of these different functions, the human brain has one primary protocol that takes precedent over all other procedures. This protocol is ensuring that the host survives. This is important to understand because this protocol is primarily controlled by the subcortical brain structures we previously mentioned. As we are taking information in through visual processing, our subcortical brain structures are the first way-point by which the information is assessed. If the information being processed exceeds an individual’s stress threshold, the brain will activate either the fear, freeze, fight or flight response within an individual. Interestingly, once the stress event has ended, depending on the severity of the moment the brain will potentially log the event as a type of memory ‘bookmark’ and will attach a body sensation (e.g. panic attack symptoms) in order to remind the host that this memory must be processed. So how do mental health professionals usually attempt to help veterans with this bookmark?
Part II. Only Trauma-Informed Care Works
The vast majority of mental health clinicians utilize treatment interventions such as trauma-focused cognitive behavioral therapy, traditional cognitive behavioral therapy, motivational interviewing and other interventions when working with veterans. There is no doubt that there are many individuals who have had success when engaged in these types of therapies. Unfortunately, there is also a substantial amount of individuals who have had poor treatment outcomes with these interventions. Part of the reason for this is because these types of therapies regularly exclude the somatic experience of trauma, and have technical protocols that are primarily focused on engaging the prefrontal cortex exclusively. For instance, cognitive behavioral therapy focuses on addressing distorted thinking and frequently utilizes reality testing to help bring to the client’s awareness both to the distorted thoughts and confronting those thoughts with what is ‘really happening’.
But as previously mentioned, the subcortical brain structures that are involved with trauma processing are heavily involved with the somatic component of trauma and not necessarily logic based processing. The body is in an alarm state and requires a different type of language processing input (experiencing psychosomatic experiences in a safe space). The other problem with neocortex exclusive focused therapy is that usually the clinical assessment process rarely takes an inventory of an individual’s past experiences. For instance, many clinicians may make an assumption that a veteran’s trauma is a direct result from their service, when in fact their trauma may be a result from an event that occurred earlier in their life prior to their time in the military. For instance previous traumas that occurred during early childhood will require a different and usually longer approach compared to adults with no childhood trauma. Now that we have covered the limitations of brief intervention treatment, let’s explore more effective mental health treatment options.
Part III. Brainspotting, EMDR & Treating PTSD
There are many somatic based treatment interventions that have shown promising results when working with veterans who are dealing with PTSD. There is even new research emerging on the potential benefits of psychedelics. I have written about this in previous Training Reports which I encourage you to read. In my clinical opinion, when helping veterans who are dealing with PTSD I strongly believe in a dual treatment approach that utilizes a combination of psychodynamic psychotherapy and either Brainspotting or EMDR. EMDR was originally developed by Dr. Francine Shapiro and is referred to by some clinicians as a closed treatment model, meaning that the clinician guides the client through specific eye movements while the client is processing traumatic memories and psychosomatic symptoms. Brainspotting is what is referred to as an open model where both the client and clinician look for relevant eye reflexes associated with both the traumatic memory and psychosomatic symptoms.
Both EMDR and Brainspotting have been shown to have very promising treatment outcomes with patients. EMDR has a plethora of excellent research that supports its’ treatment efficacy, and while there is not as much research on Brainspotting, this is in large part due to this treatment model being so new within the mental health treatment sphere. Whatever types of treatment outcomes veterans choose to utilize, I strongly encourage them to make sure that there is a combination of both psychodynamic psychotherapy and somatic treatment interventions. I also strongly encourage veterans who are interested in learning more about these treatment approaches read the following books: The Body Keeps The Score by Dr. Bessel van der Kolk and Brainspotting: The Revolutionary New Therapy for Rapid and Effective Change by Dr. David Grand.
ONE MORE IMPORTANT MESSAGE…
I recognize that there are many different types of approaches veterans can utilize to treat PTSD. Whether you decide to talk with a therapist, family, or friends, please find whatever outlet you can to process these issues rather than remain silent. I recently came across this interview that I found incredibly powerful and if you have the time to watch it, I would strongly encourage anyone who is feeling isolated by their history of trauma to hear from someone who discovered the importance of psychologically processing with those that could help them on their journey towards self-healing and closure.
Note To Reader:
If you are an athlete reading this segment of the TRAINING REPORT, hopefully this content was helpful! I put the Training Report together because I felt like many of the discussions on issues such as the Yips/mental blocks, strength training & other subject matter on athlete performance concepts were really missing the mark on these ideas (e.g. how trauma is the direct cause of the Yips). If you are interested in learning more, make sure to subscribe below for when I put out new content on issues related to sport psychology & athlete performance! Also, if you are looking to work with a mental performance specialist, you are in the right place! USE THIS LINK to reach out to me to see if my services are the right fit for your goals!
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