What other situations have you experienced that dealt with stress?
Ditto: As a Security Forces member, I was part of a first-responder team for Hurricane Katrina in 2005. We helped evacuate 30,000 people from the Superdome in New Orleans. I literally stared trauma, death and sheer chaos in the face. My team returned after 14 very long days/nights, and we were told to just go home – with no debrief.
I was confused by my ensuing emotional response, without understanding why these feelings were overtaking my ability to process information. I’ve lost several close friends to suicide.
Fast-forward in my career, I find it a lot easier to connect with my patients because I’ve navigated the darker paths in life. With support of SFS command, I conduct weekly visits/walk-arounds with intent of focusing on prevention. The past two and a half years with the Defenders, my family, have been rewarding and effective.
What advice do you give people who are stressed or have been traumatized?
Ditto: You have to get ahead of it and recognize the symptoms before the severity and duration increase. Everyone will process emotions differently, so just be mindful of your capacity. Just because you experience a normal reaction to an abnormal situation doesn't mean you are "broken" or "crazy" – just be patient with yourself and activate your support system.
What are some healthy, productive things people can do?
Ditto: Find someone to confide in and process your feelings. Being able to talk about what you are feeling can be like releasing a pressure valve to avoid combustion. If the standard social circle isn't meeting your needs, reach out to any mental health provider. We offer BHOP, or the Behavioral Health Optimization Program, as a first stop within the Family Health Clinics.
After any traumatic on-base event, we automatically activate the Disaster Mental Health Team. A wonderful feature of DMH, if imminent safety concerns are not present, is that nothing is documented. Someone can talk about whatever occurred, and nothing goes on the record.
Who are some of your best partners in assisting people dealing with stress and trauma?
Ditto: We work closely with the Chaplain Corps, Military Family Life Consultants and Military OneSource. We also count on our four-legged friends, the Pet Therapy dogs, as a great resource. For civilians, there is the Employee Assistance Program.
What physical outlets or pursuits can help?
Ditto: People work through things in different ways – some people like to run or go to the gym, some prefer yoga or hiking. Activate what has helped you in the past. There is no need to "reinvent the wheel" if something works. Avoid increased substance use because it's merely a band-aid, and the trajectory is not ideal.
Can you talk more about the ADAPT approach?
Ditto: People can do a self-referral to ADAPT if they feel they have been drinking too much alcohol; however, if they meet diagnostic criteria for having a substance use disorder, command is notified to ensure appropriate treatment recommendations are completed. This is not punitive.
Trust me, as prior SF, you could not tell me treatment was positive due to fear of arming restrictions, but the perspective I have now demonstrates the “get ahead of it” approach.
Whenever someone doesn’t self-identify, there is potential for an alcohol-related incident (i.e., a DUI, intimate partner violence or a physical injury). This prompts the two other types of referrals: command or medical, which are reactive versus proactive.
How can people reinforce their feelings of safety and security?
Ditto: It comes down to patience, self-care and challenging negative cognitions. If a person overgeneralizes their feelings to assume the world is always unsafe based on an isolated or infrequent incident, they will experience difficulties with daily functioning. Unexpected things will always arise, but this does not mean the world is always unsafe.
It’s normal to question safety when incidents go against the “just world” concept – meaning the perception that good things happen to good people, and bad things happen to bad people. The world is not perfect or just. Perfection is not realistic.
Any final thoughts on coping skills?
Ditto: It's important for people who have been through something to realize that an emotional reaction is expected. In fact, it is completely adaptive to have all kinds of emotions following during/after an event.
“Fight, flight or freeze” is a very real concept, so if you need to cry, then cry – release the pressure valve. It’s also healthy to set boundaries for yourself in how much information you consume. Don’t allow yourself to consume third-party information that reinforces uneasy feelings.