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Preparing for potential PTSD triggers after PBS Vietnam War documentary
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PBS is currently airing a 10-part documentary on the Vietnam War, titled “The Vietnam War,” produced by Ken Burns and Lynn Novick.
It has been speculated that the documentary may trigger traumatic memories for some Vietnam War veterans and cause an increase in individuals seeking treatment for PTSD.
Healio.com/Psychiatry spoke with experts to explore the potential impact of the documentary and how clinicians can prepare for it.
Impact
According to Elizabeth Goetter, PhD, director of the outpatient clinic at Home Base, Massachusetts General Hospital, although media, and in particular documentaries, that provide first-hand accounts of war can be very distressing and disturbing to some viewers, documentary exposure alone does not lead to PTSD.
“However, for people who already have PTSD, the content of documentaries may lead to an increase in symptoms, including nightmares, intrusive memories, difficulty sleeping, feelings of guilt and sadness, and irritability,” Goetter told Healio.com/Psychiatry.
Elspeth Cameron Ritchie, MD, MPH, a forensic psychiatrist who retired from the Army in 2010, echoed this sentiment and offered some additional perspective.
“I’ve been seeing a number of veterans in their 70s who have ... had a recent increase in PTSD symptoms, and it is confusing to them,” she said in an interview. “I believe it is partly related to the 50th anniversary of the Tet Offensive, which occurs next summer; this was a very difficult and painful event. It may also be related to these veterans now being in their 70s, starting to age, maybe not working anymore or losing a spouse, so having less structure in their lives.”
With that in mind, it is very possible that the documentary may trigger PTSD symptoms, according to Ritchie.
How to prepare
Goetter recommended psychiatrists and other mental health professionals familiarize themselves with symptoms of PTSD and common comorbid conditions, including depression and substance use disorders.
“For older adults, like many Vietnam veterans with PTSD, mental health providers should also be aware of the potential co-occurring medical and cognitive concerns that may impact an individual's symptoms,” she said. “Providers should also be aware of the toll chronic PTSD can take on individuals and their families.”
Clinicians with little experience treating PTSD should be aware of evidence-based psychosocial treatments for PTSD, including prolonged exposure therapy and cognitive processing therapy.
Further, psychiatrists can be particularly helpful in managing sleep impairments “by promoting sleep restoration, which enhances the effects of psychotherapy,” Goetter said.
For psychiatrists familiar with PTSD, Ritchie recommended increasing awareness of the disorder, its presentations and symptoms as well as the potential impact of the documentary.
“Know that the film is out there and is likely to trigger people,” she said.
For veterans presenting with recently surfaced PTSD symptoms, Ritchie recommended simply reassuring them that experiencing these symptoms is normal.
“It doesn’t mean you’re going crazy because you’re suddenly thinking of things you haven’t thought of for 50 years,” she said. “Rather, it is common to have triggers. Just telling veterans that these experiences are common will often be very reassuring.”
In addition, Ritchie often instructs her patients to utilize breathing techniques, a treatment approach that is simple, cost effective and has no side effects, according to Ritchie.
“I will usually be very concrete and recommend that they take 10 deep breaths through the nose three times a day,” she said. “[They should] practice this, so if they do have anxiety or flashbacks they are able to resort to something they know how to do well.”
Further, Ritchie encouraged exercise, yoga and meditation for PTSD symptoms.
Selective serotonin reuptake inhibitors may be useful for some, but ensure individuals are aware of potential side effects, particularly sexual ones, according to Ritchie.
Another facet to consider is that Vietnam War veterans may not be the only individuals affected by the documentary.
“I know when ‘Black Hawk Down’ was released it triggered Vietnam veterans,” Ritchie said. “When 9/11 happened and we went to war, it triggered Vietnam veterans. It may well be not just Vietnam veterans [who are affected], but veterans from many conflicts and possibly their families as well.”
Home Base
Home Base, a private-sector clinic conducted in partnership with the Red Sox Foundation and Massachusetts General Hospital, may be a useful resource for veterans and their families.
The clinic is “devoted to healing the invisible wounds for veterans, service members and their families through clinical care, wellness, education and research,” regardless of ability to pay or discharge status, Goetter said.
The Home Base Training Institute, which is available online for free in the United States, operates on the goal of educating first responders, health care professionals and community members on how to identify veterans and military families experiencing “the invisible wounds of war and to help them overcome the stigma of seeking care,” Goetter said. – by Amanda Oldt
Disclosures: Goetter reports no relevant financial disclosures. Ritchie reports that her comments do not represent the U.S. Department of Veterans Affairs.
For more information:
To access Home Base, visit www.homebase.org.