Dealing with homecoming stress Published Nov. 29, 2006 By Master Sgt. Collen McGee 433rd Airlift Wing LACKLAND AIR FORCE BASE, Texas -- Editor's note: Names of those who consented to interview about issues they are facing have been withheld to protect their right to privacy. The two Airmen who spoke about their stresses and how they are dealing with them, are referred to in this article as Airman One and Airman Two. Just about anyone who's ever deployed to a war zone deals with some stress in conjunction with the deployment or upon returning home. Sometimes it goes away on its own in time. Sometimes it doesn't. "In many ways, readjustment stress can be considered a normal reaction to abnormal events," said Dr. Jennifer Wood, a licensed psychologist with the Harlington Texas Veteran's Administration Outpatient Clinic. "Given that combat exposure is not typically part of American life, it's logical that most service men and women would have some reaction to their combat experience." Reservists may face even more stress issues because upon returning home, they are no longer surrounded by people on the job who can identify with the deployed experience. "As a civilian predominantly, you aren't in the military constantly and not constantly in a military mindset," said Airman One, who has deployed repeatedly. "Even though you practice (train), you have no concept until you go over there." One of the most difficult things Airman One dealt with was the rapid shift in mindset from security to absolute vulnerability. "Within two or three days, suddenly you are dealing with the worst trauma ever," said Airman One. "(You are dealing with) a significant change to sudden chaos in this place, the loss of the security of having wife and family around to a chaotic fragmented system." The second Airman who spoke about this shift in mindset related it to the return from deployment. Airman Two described having to make fast decisions while deployed, based on available information, and knowing those decisions could impact life. Then, coming home and learning to deal again with decisions that to her should be quick, easy and not that important. But to her boyfriend, those decisions are vital parts of his daily routine. For both Airmen, coming home after going through a high pressure deployment was like being suddenly ejected from a mental pressure cooker back into the old version of normal without letting the steam dissipate. For each, their minds were still in the battlefield mode and each reported similar issues with things that were typical in life on the home front. Each of them talked about difficulties with crowds, confrontational personalities, sounds and smells. Both commented on the inability of friends and family to identify with the things they were going through because none of them had any similar experiences. Airman Two admitted that the crowd at the recent Lackland Airfest was tough for her to deal with. She confessed to a desire to avoid work when it intersected with the crowd. Withdrawing from uncomfortable situations is a normal reaction for anyone. Fortunately, providers now have an arsenal of effective strategies and treatments to assist with readjustment concerns, according to Dr. Wood. One technique that has proven effective in lessening the impact of the lingering trauma is all about confronting the experiences. "The normal thing is for people to talk to their buddies," said Dr. (Maj.) William Isler, Chief of Clinical Health Psychology at Wilford Hall. "The reminiscing part is useful - the retelling of the story." Dr. Isler said that the Veterans of Foreign Wars, American Legion and organizations like these served that purpose in the past by putting people with like experiences together. For today's war zone veterans, there are more resources available and more is known about coping strategies for those suffering from Post Traumatic Stress. "We know, in PTSD treatment, it isn't the avoidance (that helps), it's the retelling, writing it down, adding more descriptors," said Dr. Isler. "(Use) audio tape - tell your story and listen to it to lessen the effective significance that the brain places on it. Desensitizing - the actual mechanism is something everybody uses all the time." Dr. Isler explained that by continuing to tell the story about their experiences, the experience looses the ability to cause distress. Dr. Isler, who also served in Iraq, recommends getting help before feelings of post traumatic stress become Post Traumatic Stress Disorder. But many people fear taking the step to seek mental health assistance for fear that they will be labeled. "There are real risks to career," said Dr. Isler. "But it (the risk of career impact) is less than five percent (of those seen by a military provider) and those are mostly the ones that wait until they are already having problems." Dr. Isler explained that if a person seeks immediate readjustment help, before serious issues arise due to avoidance, then normally they can get the help they need without adverse impact and, "Usually, there is no engagement with the command at all." But Reservists, no longer on military orders, don't always seek active-duty services. But there are services available to those who need them. And getting help for readjustment issues doesn't mean you are mentally unstable. But if ignored, stress issues can become physical health issues that can cause weight loss, loss of sleep and even hypertension. Physicians are also more apt to recognize warning signs of PTSD as more is learned about it. "It is more accepted now; you are not going to get dinged having it (PTSD)," said Dr. (Lt. Col.) William Bailey a physician with the 433rd Aerospace Medicine Squadron and a cardiologist. Although Col. Bailey does say there are medications that prohibit continued Reserve participation, there are ways to treat readjustment issues and PTSD that don't require medication. "Within the South Texas Veterans Health Care System, several teams of providers have been established specifically to address the needs of returning Operation Enduring Freedom and Operation Iraqi freedom veterans," said Dr. Wood. "There is a system available," said Dr. Bailey. "Seek it and work with and involve loved ones ASAP. Find VA (Veteran's Administration) clinics in general within the VA system for group sessions where you talk things out about feelings and changes. If it is mild, go immediately to join a group to talk not short term but long term. Then go regularly for maintenance every 3-6 months. For severe stuff immediately go to the VA with your spouse and ask for help. Make your spouse a part of your care." Dr. Isler. Agrees that a spouse, significant partner or family members should be involved is the readjustment process. "Schedule time on the couch and talk daily," recommends Dr. Isler. "Slow down enough where you specifically talk about the readjustment. (Ask) are we getting along? - have an agenda if possible." If you don't know if you need help, Dr. Isler recommends listening openly to comments from those around you. "Listen to your friends," said Dr. Isler. "If they are continually saying things like 'you're on edge' or 'lighten up' - maybe it is worth listening to them." "It is always easy to slip through the cracks if you want to," said Dr. Isler who said the Air Force follows up on previously deployed members at 3-, 6- and 12 -month intervals. The fact is, diagnosing PTSD or traumatic stress is based entirely on the honesty of the person being interviewed. "It is, therefore, vital that individuals discuss their concerns openly and honestly with their providers," said Dr. Wood. Both Airman One and Two actively sought help with readjustment issues and tools to assist with post traumatic stress. Help is available. For more resources and information on PTSD or readjustment stress check out the web sites and resources listed below. Veteran's Administration The VA Medical Center system's specialized PTSD clinics and programs can provide to eligible veterans educational information and diagnostic evaluations concerning PTSD. The Readjustment Counseling Service's community-based Vet Centers provide information and diagnostic evaluations concerning PTSD to any veteran who served in a war zone or in a military conflict (such as in Panama, Grenada, or Somalia). There are no co-payments or charges of any kind for Vet Center confidential services. Please call 1-800-905-4675. PTSD and stress-related information Military Onesource provides guides for deployment and homecoming for Airmen and family members http://militaryonesource.com Veteran's Administration National Center for PTSD provides sections on various types of stress related issues and a Frequently Asked Question section about PTSD - http://www.ncptsd.va.gov/ Deployment Health Clinical Center provides fact sheets and resources for clinicians and military members http://www.pdhealth.mil/ Air Force Crossroads provides information for Airmen and families http://www.afcrossroads.com/ National Institute of Mental Health pamphlet on PTSD http://www.nimh.nih.gov/publicat/nimhptsd.cfm