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Authors: Charles W. Hoge M.D.

BOOK: B0038M1ADS EBOK
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Sometimes after coming home, warriors lose their ability to concentrate or focus when their body sets off alarm signals, like a pounding heart.
In combat, you know exactly what to do when your anxiety ramps up. Back
home, when the anxiety warning bells go off it can be more difficult because
you don't have a series of combat tasks or procedures to fall back on.

Most warriors are already in the habit of monitoring their environment for threats, but may not be in the habit of monitoring their own
internal perceptions of threat. The physiological reactions scale is one
tool for self-monitoring reactivity and anxiety, and if you find it helpful,
keep track of where you fall on average throughout the day. Over the
course of any day your level of alertness, attention, muscle tension, and
heart rate will fluctuate, but on average you should not remain at the
highest levels for too long. Obviously, during combat it's normal to be at
the highest end of all of these scales, and it can be very difficult to wind
down after combat missions.

Exercises will be presented in this and other chapters to help you
modulate anxiety and physiological reactions. However, if you're experiencing a "10" on most or all of the physiological reactions day after day,
then your body is acting like there's high danger or threat 24/7, just as it
did in the war zone. This is a sign that you probably need to see someone
for help. Being on high alert for a long time takes a tremendous amount
of energy. Sleep is disrupted, and as discussed in the last chapter, poor
sleep leads to being more revved up and irritable. There may be a strong
urge to try to calm the body down with alcohol or other substances, but
this just makes things worse. If the body stays on high alert for weeks or
months, then it can become very difficult to reset, and over time this can
lead to more chronic health problems, such as high blood pressure, cardiovascular disease, and memory difficulties.

In summary, the objective here is to develop an ability to be aware
of how your body registers danger signals, and what sensations you can
expect when you're revved up or when you perceive high threat or danger.

SKILL 2: LEARN TO PAY ATTENTION TO YOUR FEELINGS
AND EMOTIONS

This skill involves learning to pay attention to your emotions and being
aware of how many different emotions you may be feeling and how they
fluctuate, shift, and change. Emotions are always changing in response
to all the information coming in through our senses. Take a look at the
following scale that includes common emotions and feelings, and mark
how you feel right now. Make photocopies of this scale and paste them
into your notebook, or refer to it to keep track of how you're feeling over
time. There are no right or wrong answers. All emotions are equally valid.
Learn to recognize them, whatever they are, and pay attention to how they
change. You can experience various emotions over the course of a day and
different emotions in the same moment. After stressful events, you can
look back at what emotions you experienced at that time and how they
changed after that. Be aware of your level of anger, and the fact that anger
is often connected with other emotions; look deeper than anger to see
what other emotions may be present.

The terms feeling and emotion are used interchangeably in this book.
Some therapists distinguish between these two terms, with feeling representing a more internal process, and emotion being the outward manifestation
of the feeling, but for our purposes, they mean the same thing. Additionally, there are no "positive" or "negative" emotions. Emotions are emotions.
Only the behaviors that stem from them are "positive" or "negative."

Feelings/Emotions Scale

Ask yourself, "How am I feeling right now?"or"How have I been
feeling overall today?" (circle the best answer)

Keep track of how your feelings change throughout each day. If your
body is physiologically revved up a lot of the time, then the predominant emotion is likely to be anger. However, there are probably other
emotions present along with the anger, and exploring them will help to
reduce the effects of anger.

Feelings are fluid; they change and shift. For example, someone may
be feeling lonely and depressed, but then suddenly feel happy when a
friend calls. Sadness can change to amusement with humor, and laughter
is one of the best coping strategies for difficult times. It's also perfectly reasonable to feel more than one emotion at the same time, even opposites,
like happiness and gratitude along with grief and sadness. The point is to
become attuned to the wide range of emotions you may be experiencing.

Special attention needs to be given to the emotion labeled "Detached/
Numb" on the chart. Feeling numb, detached, or not having emotions is
also an emotion, or at least an emotional state, and one that often goes
along with anger. Like anger, numbness and detachment can mask (or
cover up) other emotions. If you register high on feeling numb, then pay
attention to what other feelings may be underneath, like sadness, loneliness, or grief. Acknowledge your emotions and don't shut anything out.

There are times when it's necessary to shut emotions out and not
acknowledge them. Combat veterans in particular understand this because
in order to do an effective job on the battlefield, they have to keep their
emotions in check. Spouses and partners also do this when their warriors
are deployed so they're not overcome with fear or worry. However, if emotions aren't acknowledged, they have a tendency to push their way to the
surface or act on the warrior's subconscious, leading to behavior the warrior
may later regret. Because some emotions can be overwhelming at times, it's
natural to want to lock them up and throw away the key. But this doesn't
make them go away; they'll usually find other less healthy ways to express
themselves. The place to begin is to acknowledge them. If they're overwhelming, try to lighten your burden by expressing them to a friend, pastor,
therapist, spouse, or anyone you trust who'll listen without judgment.

It's important to understand the connection between physiological
reactions, anxiety, anger, and fear. Fear is deeper and more difficult to identify. You may feel revved up, anxious, or angry, but unaware that fear exists
underneath. In combat, warriors use fear as a "sixth" sense, but also learn to
suppress it and keep it under control through training. Anger helps with this.
Controlling fear is an important part of what it means to be a warrior.

If you marked high on the line "Afraid/Scared," you've demonstrated
your ability to tune in to fear. If you marked this low, but marked high on
"Anxious/Stressed," "Irritable/Angry," or "Worried," then check if there's
fear as well. If it's present, then ask yourself, "What am I afraid of?"

If yes, what am I afraid of?

The answer is sometimes surprising. For example, fear of embarrassment, fear of being ostracized, or fear of being in a place where it's difficult to escape are prominent fears, often associated with panic or anxiety.
Fear of being alone (connected to fear of being vulnerable) is deep-seated,
and can make us act in crazy and paradoxical ways (for example, pushing
people away we love, or ending a relationship because we're afraid that the
other person will leave us). Fear of death is another.

Regarding fear, there is nothing specific that you need to do, other
than become aware of it and recognize what you're afraid of. Fear can
also exist with other feelings, such as being "Depressed." Fear drives a lot
of behaviors, and awareness of this can help to create space between reactions and behaviors, which ties in to the next skill.

There are places on the Feelings/Emotions form to write in other
emotions. Write down some additional words to describe how you feel.
The list is long. Here are some examples: awe, anticipation, surprise, disappointment, apprehension, contempt, desire, longing, envy, lust, relief,
apologetic, suffering, sympathy, empathy, compassion, vulnerable, caring,
courage, wonder, gratitude, modesty, embarrassment, horror, relaxation,
respect, appreciation, indifference, hate, hope, despair, pity, insult, outrage, calm, brave, ambivalent, stunned, confused, etc., etc. This is the
human condition.

This skill is meant to help you get comfortable with your emotions and
to give them room to express themselves. Emotions can coexist with one
another. Some emotions can be more powerful than others. Subsequent
chapters on narration, dealing with situations and people, and acceptance
will add more depth to this subject.

SKILL 3: CREATE SPACE BETWEEN YOUR REACTIONS TO
STRESSFUL EVENTS AND BEHAVIORS

An event or situation, like getting stuck in traffic, may lead to frustration,
anger, increased alertness to danger, and a rapid heart rate. These are all
internal processes. At this point, the warrior can either step back and not
let the reactions build further or can get increasingly agitated; in other
words, there are options here. The warrior may not be able to prevent how
they react or feel initially, but has options for what to do based on those
reactions. In First Sergeant Schindler's experience, he did this through
always reminding himself to keep the frequency of his reaction low, the
intensity mild, and the duration short. This is like counting to ten-common advice given for controlling responses to anger.

Obviously, if agitation continues to climb to the point of rage and running someone off the road, then this is no longer an internal process.
External responses, actions, or behaviors have consequences, like getting
arrested. The skill here is very simple, knowing that you have options in
how you respond to your internal physiological reactions and feelings. You
can get more agitated and run someone off the road, or you can accept
the situation and live with it.

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