PTSD: National Center for PTSD
Provider Guide to Addressing Veterans' Reactions to Current Events in Ukraine
Provider Guide to Addressing Veterans' Reactions to Current Events in Ukraine
Veterans may experience a range of challenging emotions related to the events in Ukraine. Events there can be a powerful reminder of Veterans' own military experiences.
Common Reactions
Some common reactions include frustration, sadness, helplessness and grief. Veterans may also feel angry or betrayed. They may worry that the events in Ukraine could lead to another world-wide conflict or that they may be called back to service. Reactions can also be experienced as more general upset that they do not necessarily attribute to events in Ukraine.
Those with mental health conditions like depression, anxiety, or posttraumatic stress disorder (PTSD) may experience increases in symptoms. Some may cope through avoidant strategies like drinking more, using substances, or isolating. Veterans may also experience more military and homecoming memories and more trouble sleeping. Some may become preoccupied with danger or feel like they need to prepare for the worst. In response, they may become overly protective, vigilant, or guarded so that they can avoid being shocked by, or unprepared, for what may happen in the future.
Feeling distress is a normal reaction to negative events, especially ones that feel personal. However, for some Veterans, these reactions may be overwhelming, continue for an extended period, or negatively affect functioning to the extent that intervention is indicated. Below are strategies to understand Veterans' reactions and help them through this challenging time.
Check In with Veterans
It is helpful to ask questions to recognize what each Veteran is thinking and feeling. Veterans may differ in their reactions—some feeling angry, some feeling sad, even some feeling relieved—so start from a place of no assumptions about what the Veteran is thinking or feeling.
- Begin the conversation broadly: "There has been much media coverage and national conversation on what is happening in Ukraine. Would you like to spend some time today on your reactions to what is happening?"
- Normalize reactions to events in Ukraine and begin a conversation focused on emotional reactions: "Many people have been experiencing strong feelings about the events in Ukraine. I wanted to check in and see how you have been doing during these very stressful times. How have you been feeling?"
- As a way to begin the conversation, you can ask if the Veteran is engaging in these conversations elsewhere and about their support system (or lack thereof): "Have you been having conversations about your reaction to the invasion of Ukraine with others? In what ways have the conversations been helpful? Are there ways in which the conversations have been less helpful?"
- Another option is to tie the discussion in with the Veteran's treatment: "The news about the events in Ukraine can impact mental health in many ways. I'm wondering if you noticed changes in how you are feeling? Is this something you want to spend time working on today?"
This interaction with you may be the Veteran's first or only opportunity to express thoughts and emotions. Give them (and yourself) room to reflect on their reactions. Take your time with the conversation, allow the Veteran to add to their narrative. Allow the Veteran the opportunity to experience emotions. Reflect back to the Veteran what you hear to make sure you understand their reaction. The Veteran's reaction may change over time, so consider checking in over multiple appointments.
Respond to Veterans' Needs
Help Veterans identify and explore unhelpful cognitions
Ask Veterans what upsetting thoughts they are having related to the events in Ukraine. It can be valuable to help a Veteran recognize and reframe any unhelpful cognitions. What is happening in Ukraine is terrible but often thoughts can be restructured to be more balanced and less catastrophic. For example, they may be thinking, "The events in Ukraine are going to lead to World War III," or, "No one is safe." Providers can have a collaborative discussion to help Veterans come to less extreme and less painful conclusions. For example, asking, "How safe are you here?" The ultimate goal is for the Veteran to come up with a more balanced, less distressing thought such as, "My family is currently safe in the United States."
Some Veterans may find meaning by supporting Ukrainian refugees. Veterans can look for opportunities to volunteer or make a donation.
Encourage Veterans to engage in activities they find meaningful
Encouraging Veterans to engage in activities they find meaningful can help them focus on their lives in the present and can help to reduce distress. Explore what matters most to Veterans across the many domains in which they function, which may include as an individual, a family member, a parent, or a community member. Once Veterans identify important values, providers can help them set realistic short- and long-term goals consistent with these values and help them plan concrete activities to work toward these goals. These activities will not change the past or the things the Veteran cannot control, but they can help the Veteran feel like life is meaningful and reduce distress.
Encourage positive coping
It is important to assess the Veterans' coping strategies (adaptive and maladaptive), current resources and supports, and ongoing stressors. How might existing strategies be applied in this current situation? Are they as helpful in times of crisis? Are there ways they could be adapted to meet current needs? Social support, including spending time with people who understand what the Veteran is going through, can be particularly important in buffering stress. Make a plan with the Veteran about how to put their positive coping strategies into action to help them manage their negative reactions. Teach the Veteran a positive coming skill or share a coping self-help mobile app.
Conclusion
The events in Ukraine may serve as a traumatic reminder for many Veterans and service members of their own military experiences. Veterans will differ in their reactions and needs, and these may change over time. Asking questions, listening, and responding to the individual needs of each Veteran will help them through this challenging time. Providers are further encouraged to be aware of their own reactions to world events. Take time and space to process and reach out to colleagues, friends, and family for support as needed.
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