In this segment, I continue on from part 1’s focus on “evolved perspective” and “integrating experiences” to discussing how helping individuals understand deployment’s impact on the nervous system seems to be helpful in facilitating positive clinical outcomes. Lastly, I discuss an anecdotal observation and subsequent treatment addendum that has proved helpful in increasing patient “buy in” and adherence to sleep protocols while reducing complaints about sleep.
I will start this discussion by explaining the rationale for exploring nervous system functioning with individuals who have deployed. First, the goal is to normalize their experiences of dysfunction post-deployment. A second goal is to have them understand that there is a tangible reality (physiological) that explains their psychological and physiological reactivity to the post-deployment environment. A third goal is to have them understand that they can be more than passive “reactors” and that their physiological response can be recalibrated to more appropriately match the current environment. With this understanding, most individuals are relieved to hear that they are not “broken” and that their general psychophysiological disposition of hyperarousal is more of a biological response to the environment that is being used out of context (with the appropriate context being the deployed environment). In essence, the individual comes to understand that they have developed and continue to maintain a psychophysiological response, acquired in the deployed environment, that they continue to use post-deployment and consequently, must recognize when this is occurring and make a conscious effort to recalibrate their responses accordingly.
In discussing/describing nervous systems functioning, my intent is to be brief; I avoid information overload by staying away from a thorough and extensive biology lesson. I briefly mention that many aspects of our day to day functioning are controlled and/or managed by our autonomic nervous system (ANS) and quickly move on to a more detailed explanation of the ANS’s two subsystems (“One of which I’m sure you’ve heard of,” I say, completely ignoring the ANS's enteric nervous system). I explain that there is the sympathetic nervous system and the parasympathetic nervous system. I then go on to explain what each of these systems are responsible for maintaining; stating that they may have heard of the sympathetic nervous system through its more common colloquial name, “the fight or flight response.” I explain that the sympathetic nervous system prepares them mentally and physically “to take action” with an increase in heart rate, more sensitive visual and auditory acuity, and a mental state that is narrowly focused on the here and now. I explain that the parasympathetic nervous system “for the most part” does the opposite of what the sympathetic nervous system does and works to maintain a calm and tranquil state in which heart rate and blood pressure decreases, digestion works smoothly, and thoughts of what’s on TV tonight proliferate. I always ask the question, “Which system were you using most while downrange, you think?” The answer is always related to “the sympathetic nervous system.” I then go on to explain that that is an atypical use of the system and that the situation for our ancestors thousands of years ago was such that if they had not successful “fled” within 15 minutes to an hour, “they were probably being eaten.”
However, I explain, the system cannot be “broken” from overuse (such as when the individual deploys to a war zone and remains under a constant threat to life and limb for far greater than an hour). Several things can (and do) occur, I explain. Since it’s not being broken with overuse, the system gets stronger (like going to the gym everyday for 12 months). You are not consciously aware of this happening. Your attitudes, beliefs, and values related to your safety and security are changing, forever. It has become your preferred system (versus the previous preference for relaxation and tranquility). Post-deployment, the extensively conditioned (now dominate) sympathetic nervous system operates with efficiency within an inappropriate context (environment) causing distress for both the post-deployed individual and the environment. Individuals who have deployed seem to readily understand this explanation for poor post-deployment adjustment and show a greater willingness to “make a conscious effort” to correct there problematic sympathetic nervous system responses to more appropriate reflect the demands (or lack thereof) of their current environment.
With regard to complaints of sleep disturbance (an issue that seems to be universal amongst individuals who have deployed), I take the following psychoeducational approach as an adjunct to sleep protocols. In simple terms, I ensure that individuals who have deployed understand that sleep is a behavior and that we all develop routines, habits, and patterns of behavior that make us feel safe, comfortable, and/or simply reduce distress. I will ask the individual to describe their sleep habits (pattern) in the months and years prior to deploying for the first time. I then ask about, explore, and discuss their sleep routine while deployed. Generally, they will state that they were unable to set a sleep routine and describe a pattern of sleeping when and where they could (or as the mission allowed).
At this point, I point out that what seemed like no regular sleep routine became their NEW sleep pattern; a sleep pattern that was practiced and solidly integrated into their subconscious habits for as many months or years as they were deployed (with no reversal in between deployments). I point out that that “sleep when you can and expect to be disturbed at anytime” routine, is their sleep pattern. To emphasis the point, or to solidify the understanding, I ask, “How do you think this sleep pattern you have right now (that seems to be giving you so much trouble) would work out for you if l packed you up and sent you back downrange?” And the answer is almost always “just fine.” And then…, they get it. They understand that their sleep difficulties have an origin in deployment habits and routines and are able to dismiss the idea that “something is wrong with me.” At this point, I am better able to help them effectively start to change their sleep routine (i.e., pattern of sleep behaviors) with the understanding that they are trying to establish asleep habits and behaviors that reflect the current environment and decrease sleep behaviors that worked in the deployed setting.
Hopefully, this brief discussion of my experiences with using a psychoeducational approach has given you some insight into the advantages of having a similar discussion with your clients.