What PTSD looks like in veterans

Post-Traumatic Stress Disorder (PTSD) is a complex mental health condition that can develop after experiencing or witnessing a terrifying event. For veterans, this often stems from combat exposure, military sexual trauma (MST), or other life-threatening experiences during service. The symptoms can be pervasive and significantly impact a veteran's quality of life.

Core symptoms of PTSD in veterans typically fall into a few key categories:

Intrusion symptoms:

Recurrent nightmares: Vivid, disturbing dreams related to the traumatic events, often leading to disrupted sleep.
Flashbacks: Feeling or acting as if the traumatic event is happening again, often triggered by sights, sounds, smells, or even thoughts. These can be intensely disorienting and distressing.
Intrusive thoughts/memories: Unwanted, upsetting memories that pop into the mind unexpectedly.

Avoidance symptoms:

Avoidance of places or situations: Deliberately staying away from locations, people, or conversations that remind them of the traumatic events. This might include avoiding crowded public spaces, loud noises, or social gatherings.
Avoidance of thoughts or feelings: Actively trying to suppress or numb emotions and thoughts associated with the trauma, which can lead to emotional detachment.

Negative changes in thinking and mood:

Emotional numbness: Difficulty experiencing positive emotions, feeling detached from friends and family, or a general sense of emptiness.
Loss of interest in activities: No longer finding pleasure in hobbies or activities that were once enjoyable.
Negative beliefs about self or world: Feelings of guilt, shame, hopelessness, or a profound sense that the world is inherently dangerous.
Difficulty remembering aspects of the trauma: Gaps in memory related to the traumatic event.

Changes in arousal and reactivity:

Hypervigilance: Constantly being on guard, scanning the environment for threats, and feeling overly alert.
Being easily startled: An exaggerated startle response to sudden noises or movements.
Irritability or angry outbursts: Increased frustration, aggression, or difficulty controlling temper.
Difficulty sleeping: Insomnia or restless sleep due to racing thoughts or hyperarousal.
Concentration problems: Struggling to focus on tasks or follow conversations.

Consider the example of a veteran who served in a high-conflict zone. Years later, he finds himself avoiding crowded grocery stores, preferring to shop late at night or have groceries delivered. He constantly scans his surroundings, feels a jolt of panic at unexpected loud noises, and struggles to sleep through the night due to vivid nightmares. He often feels emotionally flat, finding it hard to connect with his wife and children, and experiences intense irritability, feeling perpetually on edge. These symptoms are a clear indication of PTSD, profoundly impacting his daily life and relationships, and signaling a need for specialized support.

Why many veterans avoid seeking help

Despite the prevalence of PTSD among veterans, many face significant barriers that prevent them from seeking the professional mental health support they desperately need. These barriers are deeply rooted in military culture, personal beliefs, and practical challenges.

Key reasons why many veterans avoid seeking help include:

Fear of stigma: A powerful fear of being perceived as "weak," "broken," or "crazy" by fellow service members, family, friends, or even within civilian society. This fear can be more potent than the fear of combat itself.
Belief that asking for help shows weakness: The military ethos often emphasizes self-reliance, toughness, and enduring hardship without complaint. This can lead to an ingrained belief that admitting to emotional struggles is a sign of personal failure.
Concerns about confidentiality: Veterans may worry that seeking mental health care could negatively impact their military career, security clearance, or future employment opportunities, leading to reluctance to disclose sensitive information.
Lack of awareness or misinterpretation of symptoms: Many veterans may not recognize their irritability, anger, social withdrawal, or physical complaints as symptoms of PTSD or depression, attributing them instead to "just being adjusted" or "normal" reactions to service.
Living far from VA facilities or therapists: For veterans in rural or underserved areas, geographical distance from VA hospitals, specialized trauma therapists, or convenient transportation can be a significant practical barrier.
Distrust of the system: Some veterans may harbor a general distrust of government institutions or the healthcare system due to past negative experiences or perceived bureaucratic hurdles.
Reluctance to revisit trauma: The idea of discussing painful, traumatic memories can be overwhelming and terrifying, leading to avoidance of therapy itself.
Feeling misunderstood: Veterans may feel that civilian therapists or friends cannot truly understand their unique experiences and the nuances of military life and combat.

These concerns are entirely valid and reflect the unique context of military service and reintegration. However, it is vital to reassure veterans that these challenges do not have to be insurmountable barriers to recovery. Effective, confidential, and specialized support is available, and overcoming these barriers is a powerful step toward healing.

How online therapy addresses these challenges

Online therapy offers compelling solutions that directly address many of the significant barriers veterans face when seeking mental health support. Its inherent design often aligns well with the needs and preferences of the veteran community.

Here’s how online therapy directly addresses these challenges:

Unparalleled privacy and discretion: Online therapy sessions can be conducted from the comfort and security of a veteran's own home or any private location. This eliminates the need to visit a physical office, reducing the fear of being seen or recognized, thereby alleviating a major source of stigma and confidentiality concerns.
Eliminates travel barriers: For veterans living in rural areas or those with mobility issues, online therapy completely removes the need for long commutes to VA facilities or private practices. This accessibility ensures that geographical location is no longer a deterrent to receiving timely and consistent care.
Increased choice of therapists: Online platforms connect veterans with a vast network of licensed mental health professionals across different states or even nationally. This expanded choice means veterans can more easily find therapists who explicitly specialize in trauma, PTSD, and, crucially, those with specific military experience or who are veterans themselves. Finding a therapist who "gets it" can significantly enhance the therapeutic alliance.
Comfort of a familiar environment: Engaging in therapy from a familiar and controlled environment can help veterans feel more at ease and less hyper-aroused. This sense of safety can facilitate greater openness and deeper engagement in the often-challenging work of trauma processing.
Flexible scheduling: Online therapy typically offers more flexible appointment times, including evenings or weekends, making it easier for veterans to fit sessions around work, family commitments, or personal responsibilities without added stress.
Messaging between sessions: Many online therapy platforms provide the option for secure messaging between scheduled video sessions. This can offer a continuous line of support, allowing veterans to reach out with questions, share insights, or process emotions as they arise, providing extra reassurance and continuity of care.
Gradual engagement: For veterans who are highly guarded or reluctant to open up immediately, the online format can sometimes feel less intimidating initially, allowing them to ease into the therapeutic relationship at their own pace.

By leveraging technology, online therapy makes highly specialized and confidential mental health care more accessible and tailored to the unique circumstances of veterans, fostering a more comfortable and effective healing environment.

Evidence-based treatments for PTSD

For veterans struggling with PTSD, engaging in evidence-based therapies is crucial for effective healing. These are therapeutic approaches that have been rigorously tested and proven to be effective through extensive scientific research. Importantly, these highly effective methods have been successfully adapted and delivered in online settings, ensuring veterans can receive top-tier care from anywhere.

The most commonly used and effective therapies for PTSD include:

Cognitive processing therapy (CPT):

How it works: CPT helps individuals understand how traumatic experiences have altered their thoughts and beliefs about themselves, others, and the world. It focuses on identifying "stuck points"—unhelpful thoughts or beliefs that prevent recovery (e.g., "I'm a bad person," "The world is completely unsafe"). The therapist guides the veteran to reframe these thoughts into more balanced and accurate perspectives, challenging cognitive distortions and promoting emotional processing of the trauma's meaning.
Online adaptation: CPT is very well-suited for online delivery, utilizing shared digital worksheets, text-based assignments, and structured verbal processing via video calls.

Prolonged exposure (PE) therapy:

How it works: PE therapy involves gradually and systematically exposing the veteran to trauma-related memories, feelings, and situations that they have been avoiding. This can involve "in-vivo" exposure (gradually facing real-life situations like crowded places) and "imaginal" exposure (repeatedly recounting the traumatic memory in detail). The goal is to help the veteran process the trauma, reduce avoidance behaviors, and learn that these memories or situations are not actually dangerous, thereby reducing the associated anxiety.
Online adaptation: Online PE can effectively guide veterans through imaginal exposure via video. For in-vivo exposure, the therapist can provide detailed instructions and support for real-world practice, with the veteran reporting back or even utilizing features like shared screen views for specific tasks.

Eye movement desensitization and reprocessing (EMDR) therapy:

How it works: EMDR is a unique therapy that helps individuals process distressing memories and reduce their emotional impact. It involves recalling a traumatic memory while simultaneously engaging in bilateral stimulation (e.g., guided eye movements, alternating auditory tones, or tactile tapping). This process is thought to help the brain reprocess the memory in a way that reduces its emotional charge and integrates it more adaptively.
Online adaptation: Online EMDR therapists use digital tools to facilitate bilateral stimulation effectively, such as visual prompts on the screen, audio tones through headphones, or self-tapping instructions, allowing the therapy to be conducted just as effectively as in person.

These evidence-based treatments, when delivered by experienced and trauma-informed online therapists, provide veterans with the most effective pathways to process their trauma, regulate their emotions, and regain control over their lives.

How to get started

Taking the first step toward seeking help for PTSD can feel daunting, but online therapy offers a structured and accessible path forward. Remember, starting doesn’t mean committing long-term; it’s about exploring your options and finding what feels right for you. Here’s a step-by-step guide to help you get started:

1. Look for platforms with therapists experienced in PTSD and veteran care
Prioritize online therapy platforms or individual therapists who specialize in PTSD, trauma-informed care, and have experience working with veterans or military populations. Look for credentials such as EMDR (Eye Movement Desensitization and Reprocessing) certification, Cognitive Processing Therapy (CPT) training, or Prolonged Exposure (PE) therapy expertise. Many online platforms allow you to filter therapists by these specializations, ensuring that you can find someone who understands the unique challenges that veterans face.

2. Research therapy approaches that work for PTSD
Online therapy platforms usually offer a range of therapeutic approaches. It’s helpful to understand which ones are most effective for PTSD. Approaches such as Cognitive Behavioral Therapy (CBT), CPT, PE, and EMDR are well-researched and have proven to be highly effective in treating trauma-related conditions. By knowing what each therapy involves, you can make a more informed decision about which treatment might work best for you.

3. Prepare for an introductory call or consultation
Many therapists offer brief, no-cost consultations. This is a great opportunity to gauge whether a particular therapist is the right fit for you. During this call, you can ask questions like:

• "Have you worked with veterans before?"

• "What is your experience with treating PTSD?"

• "How do you incorporate military culture into your approach to therapy?"

• "What are the logistics for online therapy sessions—how do you ensure confidentiality?"

• "What should I expect during the first few sessions?"

4. Assess the connection with your therapist
A strong therapeutic relationship is key to successful treatment. During the initial call or session, assess whether you feel comfortable with the therapist. Do you feel heard and respected? Are they empathetic and non-judgmental? A good connection will help build trust and ensure that you’re able to open up about your experiences, which is essential in PTSD therapy.

5. Schedule your first session without pressure to commit long-term
Think of the first session as an exploratory step. You’re not obligated to commit long-term if it doesn’t feel like the right fit. The goal is to take that first step toward healing, get a sense of how therapy works, and evaluate if this therapist and their approach are aligned with your needs. Therapy is a personal journey, and it’s important to feel comfortable and supported.

6. Create a private, secure space for your therapy sessions
Ensure that your therapy sessions are confidential and that you feel comfortable. Set up a quiet, private space where you won’t be disturbed during your sessions. Test your internet connection, camera, and microphone ahead of time to ensure everything runs smoothly. If possible, use headphones to enhance audio quality and protect your privacy. A stable, private environment will help you feel more at ease during the session.

7. Be patient with the process
PTSD recovery is a gradual journey, and it’s important to be patient with yourself. Therapy may bring up difficult emotions, and progress can take time. The key is consistency, and it’s important to stay committed to the process, even when it feels challenging. Keep an open mind and be kind to yourself as you work through the therapeutic process.

Conclusion

Starting therapy is a courageous first step toward healing. Online therapy offers a convenient, flexible, and private way to receive the support you need. By finding a therapist with expertise in PTSD, preparing for your sessions, and fostering a strong connection with your therapist, you can begin your journey toward recovery. PTSD is treatable, and with the right support, you can regain control over your life and start moving toward emotional and mental well-being. Taking that first step is a powerful act of self-care—one that will serve you well in the long run.