Trauma triggers could come from a sudden loud noise.
They could arise from the act of facing away from the door in a restaurant.
They could even come from Virtual reality SHARP training and SHARP escape rooms.
Not all “triggers”, or stimuli that induce a trauma response, are obvious. Not all warrant a leader’s effort to minimize their effects. However, in some cases triggers can be reduced or eliminated through simple and worthwhile measures. Teammates who perceive they have a measure of control over their environment are less likely to be triggered. Leaders who are mindful of trauma responses and take reasonable measures to minimize unnecessary triggers will foster teams that can perform at their best.
At one end of the spectrum, some service members experience PTSD symptoms under which they cannot and will not function effectively on a timeline that the military should accommodate. Commanders and physicians typically share in making such a determination. At the other end, many service members experience only minor adverse effects in their work performance. The difficulty for leaders lies in the gray middle.
Step 1. Know that you have trauma victims in your formation.
Trauma victims pervade the force, with vastly different reactions to, and effects of, their traumatic experiences. Three of the most prevalent categories of stressors giving rise to post-traumatic stress disorder (PTSD) include combat- and deployment-related events, military sexual trauma, and pre-service trauma.
The prevalence of PTSD across these categories is discussed below.
A. Combat Exposure
A 2014 literature review found that an estimated 7.1 percent of service members deployed to Afghanistan experienced “probable” PTSD, as well as 12.9 percent of those deployed to Iraq. A different study also found that men who report combat as their worst trauma are more likely to have lifetime PTSD, delayed PTSD symptoms onset, and unresolved PTSD symptoms than men reporting other traumas as their worst experience. Soldiers with multiple combat deployments also have a higher risk of PTSD.
Although combat veterans comprise a steadily decreasing portion of the active component, they remain a sizable group. One important takeaway for leaders in this area is that similar combat exposures may affect individuals in vastly different ways, and to varying degrees. Another takeaway is that the onset of symptoms may be delayed for months, or even years after a combat experience.
B. Military Sexual Trauma
Despite massive effort and resource utilization, precise tracking of military sexual assault and sexual harassment remains elusive. For example, in Fiscal Year 2020, service members filed 6,290 reports of in-service sexual assault. However, this figure only denotes the number of tracked reports, and likely omits many instances of sexual harassment that still fall under the VA’s definition of military sexual trauma.
Leader awareness in this realm extends not only to sexual assault survivors, but to the many victims of sexual harassment within the ranks. One study found that, although women deployed to OEF/OIF were less likely to experience combat than men, they were more likely to report sexual harassment, and equally likely to report symptoms consistent with probable PTSD. A qualitative study also noted that “survivors often describe sexual harassment in the military setting as pervasive, threatening, and inescapable.” This “inescapable” sexual harassment can extend to garrison life as well.
Last, leaders should understand that sexual assault and harassment affects both women and men. Although women are comparatively more likely to experience sexual assault or harassment in the military, almost one-fifth of the above-mentioned 6,290 reports were filed by men.
C. Pre-Service Trauma
Adverse childhood experiences, or ACEs, are associated with several adult health problems, risk behaviors, and socioeconomic challenges. ACEs include potentially traumatic events such as physical, emotional, or sexual abuse; witnessing violence in the home; or growing up in a household with substance abuse. Childhood adversity also has a strong correlation with suicide in the military. A 2012 study found that experienced childhood trauma was present in 43.4% of suicide cases and 64.7% of suicide attempt cases.
One study notes that, “in the all-volunteer era, men with military service had a higher prevalence of ACEs than men without military service,” including nearly twice the odds of reporting forced sex before the age of 18 years. The same study noted higher prevalence of physical abuse, exposure to domestic violence, and emotional abuse among women with military service than among those without military service.
Collectively, these studies demonstrate that childhood trauma has a strong presence and effect on many military service members.
Step 2. Understand how prior trauma may be affecting your subordinates.
Common symptoms of PTSD include intrusive thoughts, dreams, or perceptions; avoidance of stimuli associated with the traumatic event; negative alterations in mood; hypervigilance; paranoia; and reckless or self-destructive behavior.
In addition to baseline symptoms associated with PTSD, long-term anxiety and avoidance patterns can lead to other negative health outcomes. For example, decreased physical and cognitive function, impaired short-term memory, reduced sleep quality, major depressive disorder, and weakened immune systems may follow PTSD symptoms. These in turn make those suffering from PTSD increasingly likely to reach a point of professional burnout.
Finally, assessing the need for PTSD-reducing measures and implementing them comes down to building trusting relationships among the team. When subordinates trust their leadership, they are more likely to be open about their backgrounds and needs. In turn, leaders who know their soldiers well can better recognize when soldiers are processing their trauma well, or merely coping.
Step 3. Create predictable pathways for increased autonomy.
A 2018 study found that “ongoing experiences of uncontrollability may heighten psychological vulnerabilities implicated in PTSD.” Stated differently, service members who experience PTSD may be more susceptible to the deleterious effects of a perceived lack of control than those without PTSD. This is true not only relative to the general population, but also when compared with patients diagnosed with generalized anxiety disorder. All of this means that facilitating perceived control is of particular importance when leading PTSD populations.
The gold standard in clinical psychotherapeutic PTSD treatments reflect this principle. Most find roots in establishing and maintaining safety and control. This entails forming clear structures and boundaries, and facilitating a patient’s active collaboration in the treatment process.
Military leaders are not clinical psychologists, but can still allow subordinates to achieve a sense of control in several ways. Incentivized late work calls, work-from-home windows, and leaves of absence to pursue quasi-professional passion projects all fall within this category.
More broadly, however, leaders should seek to delegate actual authority and control. This may be achieved by offering a reduced emphasis on specified tasks, and more on desired end states. For example, a leader might implement a target fitness test score to be achieved on a future date, but eliminate mandatory physical training inputs to achieve that score. For PTSD victims who value control, leaders might see added effort and commitment by emphasizing end state rather than inputs.
In Conclusion
The realities of military service— a business that regularly deals in life and death, are that unpleasant experiences may be ubiquitous. Shared strife and misery can bring teams together, and often stand at the core of effective training environments. The important question for leaders often becomes how to maximize collective growth against adverse health effects.
Some service members experience adverse effects of trauma incurred as a direct result of their selfless service and sacrifice. Others suffer for different reasons. Most retain the potential to add value to their organization. Ultimately, leaders seeking to effectively utilize and develop their PTSD populations must not only be self-aware, but also trauma-informed.
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