The Development and Experience of Combat‐Related PTSD: A Demand for Neurofeedback as an Effective Form of Treatment

Posttraumatic stress disorder (PTSD) in veterans differs when compared with the isolated, traumatic incidents that civilians experience (Carmichael, 2009; Tanielian, 2009; Wilson, 2009). Generally, PTSD is classified as an anxiety disorder that develops after an individual is exposed to or witnesses another individual experiencing a life-threatening situation and responds with intense fear, helplessness, or horror (Foa, Keane, & Friedman, 2000; National Institutes of Health [NIH], 2010). Combat-related PTSD, formerly known as "battle fatigue" (Solomon, Weisenberg, Schwarzwald, & Mikulincer, 1988, p. 365) or "shell shock" (Mosse, 2000, p. 101), refers to experiencing posttraumatic stress as a result of exposure to trauma on a battlefield or in a war zone. Distinctions of combat-related PTSD include not only the type of trauma experienced but also the course of its development, how it is experienced (Alford, Mahone, & Fielstein, 1988; Eisenhart, 1975; Tanielian, 2009), and psychosocial barriers to treatment (Hoge, Auchterlonie, & Milliken, 2006; Sullivan, 2012; Tanielian, 2009; Wright et al., 2009). Unfortunately, these components of combat-related PTSD are not always acknowledged. Counselors should be cognizant of these differences to effectively tailor and deliver services to veterans. Combat-related PTSD is a condition unique to the military and occurs more frequently than the PTSD experienced by the general public (NIH, 2010; Richardson, Frueh, & Acierno, 2010). Between 12% and 30% of war fighters returning from deployment in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) experience combat-related PTSD (Hoge et al., 2006; Richardson et al., 2010; Tanielian, 2009). Identifying distinctions about the condition is necessary for counselors to specialize interventions and provide effective treatment (Carmichael, 2009; Duffy, 2000; Hammond, 2007; Othmer & Othmer, 2009; Peniston & Kulkosky, 1991; Tanielian, 2009; Walker, 2009; Wilson, 2009). Unfortunately, because of psychosocial barriers involving stigmatization and consequences related to a mental health diagnosis, less than half of veterans experiencing combat-related PTSD symptoms actually report difficulties (Hoge et al., 2006; Hoyt & Candy, 2011; Kim, Britt, Klocko, Riviere, & Adler, 2011; McFarling, D'Angelo, Drain, Gibbs, & Rae Olmstead, 2011; Sullivan, 2012; Tanielian, 2009; Wright et al., 2009), which further reinforces the need for an innovative and evidence-based treatment (Creamer & Forbes, 2004). Of particular interest is that war fighters are groomed to function with a heightened level of physiological arousal to survive in a combat environment (Alford et al., 1988; Eisenhart, 1975). Upon returning home, however, they are often not retrained to decrease this heightened state of physiological arousal, which, along with a duty to fight and protect, is neither necessary nor appropriate in a civilian environment where warfare is nonexistent (Othmer & Othmer, 2009; Peniston, Marrinan, Deming, & Kulkosky, 1993). In addition, war fighters are taught the necessity to suppress any emotional arousal to effectively make sound decisions during warfare (Alford et al., 1988; Eisenhart, 1975; Mosse, 2000; Solomon et al., 1988). Continuing to suppress these feelings, however, may hinder treatment (Alford et al., 1988). Because of the nature of combat-related PTSD, counselors must incorporate psychophysiological parameters to be effective (Hopper, Frewen, van der Kolk, & Lanius, 2007; Johnston, Boehm, Healy, Goebel, & Linden, 2010; Othmer & Othmer, 2009). For example, by viewing electroencephalographic frequencies, practitioners are now capable of identifying any dysregulation in the client's central nervous system that contributes to psychopathologies (Brosschot, Gerin, & Thayer, 2006; Hammond, 2007; Raymond, Varney, Parkinson, & Gruzelier, 2005; Walker, 2009; Wilson, 2009). …