Combat Trauma and Post-Traumatic Stress Disorder can have both physical and mental health related implications that interfere with aspects of daily life from work and leisure to sleep and social relationships, making the return to civilian life difficult for many servicemembers and veterans. In addition, symptoms of combat trauma may also ease for a time, only to worsen again when the servicemember or veteran is exposed to a triggering event or a change in medical status that removes access to previous coping mechanisms. Whether you work exclusively with service members or veterans, or work in a civilian setting and have veterans on caseload, it is important for occupational therapists to understand how to appropriately address combat trauma.

Combat trauma is multifaceted and intervention requires a multifaceted approach.
As occupational therapy practitioners we are trained to view individuals holistically, as individuals with not only a physical body, but also a mind and a spirit. When addressing combat trauma, we must take the same treatment approach. Combat trauma causes wounds that can be physical, mental, and spiritual in nature, and as such, we must consider and address all three of these aspects in our intervention approach. The specific logistics of how you can address all three aspects will vary based on both your professional setting and situation, as well as the individual beliefs and values of the veteran or servicemember you are working with, but whatever your specific circumstances, be sure that you are either addressing or encouraging the veteran or servicemember to consider these three aspects of their individuality when working towards recovery.

Combat trauma can be linked to physical symptoms.
When viewing individuals holistically, it is also important to recognize the link between combat trauma and physical symptoms. In some cases, the exposure to combat may have resulted in physical injury such a back pain, traumatic brain injuries, or even loss of limbs. Exacerbation of the pain associated with these physical injuries, then, may serve as a reminder of the combat trauma experience and lead to exacerbation of the mental health symptoms. As the mental health related symptoms worsen with this ever present reminder, this may in turn lead to a worsening of the physical pain symptoms, causing the cycle to continue. The positive side to this interconnectedness, however, is that when these two types of symptoms are so closely linked, intervention that focuses on reducing pain, can in turn lessen the severity of the mental health symptoms, which can then further reduce the pain symptoms.

Each experience of combat trauma is unique.
It is also important to remember that although servicemembers or veterans may share common combat trauma experiences and even symptoms, each individual is unique and has their own unique experience before, during, and after the combat experience that influence their response to the situation, and therefore each approach to intervention must be customized uniquely to them and their identified concerns. Not all servicemembers and veterans will be impacted in the same way by a combat experience, nor will they exhibit the same symptoms or respond in the same way to treatment. It is important for us, as occupational therapists, to remember to personalize and customize the treatment approach to meet each individual’s specific needs and concerns.

Combat trauma affects more than just the service member.
While a service member or veteran may be the only one in their family who physically experiences combat, they are not the only member in their family who is impacted by the combat trauma. Combat trauma affects the entire family. When a veteran or servicemember withdraws from close relationships, that can include withdrawing from the relationships with their spouse, children, and other family members; an inability to work and earn and income can impact the other individuals who depend on that income for their livelihoods; and nightmares and insomnia can impact the spouse who shares a bed with the servicemember or veteran. Regardless of the ways in which others are impacted, it is critical to recognize that they are impacted and to identify their concerns as well as the concerns of the servicemember or veteran when developing a plan of care and intervention approach.

Combat experience isn’t exclusively negative.
We often focus on the negative impacts of the combat experience, but it is important to remember that, as with any experience, life lessons can be learned and character traits can be developed within the combat experience. As a result, we as occupational therapists need to remember that we aren’t “fixing” the combat trauma related concerns identified so that the servicemember or veteran and their family can return to how life was before. Rather, our goal should be to assist them in optimizing function and maximizing quality of life within the new life they find themselves in. And that means embracing the new skills, lessons, and traits learned during combat while moving forward into life within the civilian sector.

Our training as occupational therapists uniquely prepares and qualifies us to address the combat trauma needs and concerns of servicemembers and veterans, but it is still important for us to increase not only our knowledge of combat trauma, but also our understanding of the military and veteran community in order to more effectively provide occupational therapy interventions to meet the needs we are asked to address. If you are interested in learning more about addressing combat trauma, below is a list of related reading and resources.

Additional Combat Trauma related reading and resources:
The Combat Trauma Healing Manual by Chris Adsit
Down Range – to Iraq and Back by Bridget C. Cantrell, Ph.D, and Chuck Dean
National Center for PTSD
REBOOT Combat Recovery
The Return: A Field Manual for Life After Combat by David J. Danelo
When War Comes Home by Chris Adsit, Rahnella Adsit, and Marshele Carter Waddell