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Support for Families during COVID-19

Support for veteran families

During COVID-19

Are you a family member of a veteran, looking for help and advice on how best to offer them support?

This web page has been designed to provide information about how to support a veteran you care for as well as your own wellbeing related to the COVID-19 situation. During this strange and difficult time, it might be increasingly challenging to know how best to support a veteran you live with who has mental health difficulties such as post-traumatic stress disorder (PTSD). But you probably already have a good deal of expertise and the tools below are meant as suggestions or add-ons to your existing knowledge and experience.

What is PTSD?

PTSD is a mental health problem caused by very stressful, frightening or distressing events. The symptoms of PTSD are divided into four symptom clusters:

 

Re-experiencing Avoidance Arousal Negative changes and mood.
  • Intrusive, thoughts, images, memories
  • Nightmares
  • Flashbacks
  • Psychological reactions to reminders  
  • Physiological (bodily) reactions to reminders
  • Avoiding:
  • Things remind us of the trauma Thinking about the trauma
  • Exaggerated startle response
  • Poor concentration & / or memory
  • Poor sleep
  • Hypervigilance
  • Anger / irritability
  • Strong negative thoughts / feelings about the trauma, yourself, others the world in general
  • Guilt / shame
  • Feeling cut off from others
  • Inability to experience positive emotions

 

It is important to note that: PTSD is a normal reaction to an abnormal experience.

Many veterans have experienced traumatic experiences, some they may have shared with you, others they may have locked away in order to protect you from the emotional burden they carry.

Some of these memories are easily triggered, they feel threatening in the moment, often focus on the worst part of an experience, are difficult to put into words, are intrusive, often leaving the veteran feeling stuck or frozen and they might not have a clear start, middle or end.

Individuals with PTSD are often on high alert. Have you noticed them always looking around? Always nervous and on edge? Will only sit with their backs to the wall? These are just a few of the ways this mental health condition might be seen.

How to support a veteran you care about during COVID-19

Government restrictions intended to keep us all safe can be difficult for us all but being a veteran with PTSD under these circumstances can be particularly challenging. Therefore, it is important to know how you can support the veteran you care for during these difficult times. One of the main psychological techniques that can have a direct impact on calming down the body’s stress response is Grounding.

 

 

What is Grounding and why is it helpful: 

Grounding is a term used to describe being present and connected with the here and now, it can help us feel more in control and not taken over by events that happened in the past. When experiencing intrusions or flashbacks, veterans may start to feel disconnected from themselves, their bodies or the present moment, which is incredibly distressing. Using grounding techniques can reduce the intensity and length of an intrusion or flashback. These techniques may also be useful when waking from a nightmare or to help manage strong emotions, such as anger. 
 

Grounding techniques work on all our senses, and here are some examples of ways to use a sense to ground someone back into the present. You can use these to support your loved one if you recognise that they are ‘spinning out’: 

Smell 

  • Pleasant perfume 
  • Vicks inhaler  

Taste 

  • Mindfully sucking a mint 

Touch/ feel 

  • Holding object (stone, ball, beads) 
  • Textured surfaces 

Sound 

  • Calming environment sounds (water, sea) 
  • Music 

Sight 

  • Looking at a familiar/ calming picture 
  • Examining an object in detail   

Grounding can be a useful tool if a veteran dissociates. Dissociation is when veterans have flashbacks to their trauma. You may often see them reliving the experience, losing perception of time, date and even where they are. 

If you experience a veteran dissociating:   

  • Speak calmly using their name and continue to talk to them  
  • Reassure them they are safe 
  • Reassure them of where they are and of the time 
  • Use a grounding strategy already agreed and familiar with 
  • As they return to the here and now, be warm and matter of fact. Use short sentences (no more than15 words) 
  • Suggest movement like stamping feet hard on the ground or jumping on the spot.  Taking a brisk walk or doing heavy work like cleaning or raking are other options.   
  • Use the 5, 4, 3, 2, 1 grounding strategy to reconnect with the five senses:  

What are ...

  • 5 things you can see 
  • 4 things you can touch 
  • 3 things you can hear 
  • 2 things you can smell 
  • 1 thing you can taste 

These are just suggestions – it might be there is something else that works for the veteran you care about that’s not in the list and that’s fine.   

Low mood and depression

Many veterans with PTSD also experience other difficulties such as low mood and depression. With the current situation, this might be increased, and might cause a veteran to have a lack of interest in leaving bed, being around the family, staying in contact with friends/ family over the phone, or going out for daily exercise.

Research has consistently showed us that the most effective way of overcoming depression is through changing your behaviours. It is okay to feel low, many of us do, and emotion is not as easily changed. However, behaviour is easier to change. One helpful approach is to make a list of tasks for the day with the veteran you care about so they have something to work through.

Here are some suggestions for this:

  1. Make time to devise a plan together.
  2. Support the veteran to highlight key activities that lift their mood.
  3. Help him or her break down activities into manageable steps – set achievable goals.
  4. Schedule a range of activities. Enjoyment is key but scheduling some chores as well is important. Getting those out of the way will feel good and free up some time for things that really matter.
  5. Celebrate small achievements/ goals together.

Anger during lockdown  

A veteran might normally reflect their emotions through anger, irritability and/ or frustration. However, anger might be hiding other emotions such as guilt, shame, fear, feeling weak and feeling overwhelmed. Living alongside someone who expresses anger frequently might leave you feeling like you are:  

  • Walking on eggshells  
  • Unsure how to help  
  • Struggling to deal with when your partner’s anger goes from flash to bang  
  • Becoming more passive in the relationship  
  • Thinking at times there is no communication at all 
  • Feeling like others do not understand  

There are several reasons as to why anger might occur, however, these reasons might have changed or increased while in lockdown, for example: 

  • Loss of work 
  • Frustration at people who are not following the government lockdown guidelines 
  • Being indoors much more, with no distractions 
  • Close proximity with family members  
  • Increased alcohol abuse 
  • More frequent noises as people are around more 

To help, try to speak to them to understand their feelings. Try to develop a shared understanding of the early warning signs for anger such as tension in the body, or heat rising, etc. Ask a veteran “what does it feel like when you get angry? And which of these come first, and what are the first three warning signs? Tell me what to look for”. By recognising early warning signs, you can help a veteran communicate what might trigger his anger. You might also want to ask, “what do you need when you are angry?”.

For many veterans, they need time and space before they can then reflect on the situation and have a conversation.  

Communication

When you are together with a veteran and recognise the early warning signs, you can focus on how to express your feelings positively, caringly and assertively. Especially during lockdown, we all must be extra mindful of each other, and certain words or tones might be triggering. Using the I-script might be helpful to start a difficult conversation:  

The I- Script  

A simple formula for how to express something assertively to someone: 

  • When… (Describe the event or behaviour and try to do this as factually as possible) 
  • Then I… (Explain how this practically affects you) 
  • I Feel… (Describe your feelings as calmly and clearly as possible) 
  • I`d like… (Describe how you would like to see this resolved. You might have to negotiate a bit at this point.) 

Note: Avoid starting sentences with the word “you” … Also, try to replace the word “but” with the word “and”.  

 

What to do when there is no communication at all? 

Explore if there are other ways to signal feelings in the house. This could be through using words on the fridge, emojis, etc.  

Use the I-script to tell a veteran how you feel. 

Compassionate self-statements can help you manage this situation. You may, for example, say to yourself: ‘I have done nothing wrong; this is a result of the illness; I am not to blame’.  

It can also help to have a plan or toolbox of ways to help soothe yourself and how you can distract yourself when anger affects a veteran. 

 

How to support yourself during COVID-19 when living with a veteran with PTSD 

All the techniques described above are useful tools you can try yourself. Grounding and activity scheduling are ways to help you manage lockdown better. Some key tips are to: 

  • Exercise 
  • Talk to someone 
  • Challenge unhelpful thoughts 
  • Prioritise some time for your own wellbeing 
  • Relaxation/ mindfulness 
  • Allow yourself some positivity  
  • Break tasks down  
  • Ask others for help if required 

Recognise your legitimate rights:  

  • You have the right to put yourself first sometimes 
  • You have the right to your opinions and convictions 
  • You have the right to your experience even if it’s different from others  
  • You have the right to ask for help, emotional support or anything you need even if you don’t always get it 
  • You have the right to say no. Saying no does not make you selfish 
  • You have the right not to justify yourself to others 
  • You have the right to sometimes inconvenience or disappoint others  
  • Looking after yourself doesn’t make you selfish 

 

There are several resources available for carers of veterans that can support you with mental health needs and other needs – these are listed below: 

  1. Your GP  
  2. The NHS Improving Access to Psychological Therapies (IAPT) programme (find details local to you on the NHS website)  
  3. Combat Stress 24-hour Helpline (0800 138 1619) 
  4. Samaritans (116 123) 
  5. The Ripple Pond - a charity that supports the adult family members of veterans (0333 900 1028) 
  6. SAFFA (0800 731 4880) 
  7. Help for Heroes Band of Sisters (01980 844280) 
  8. Walking with the wounded (carers need to be referred through the NHS Veterans Mental Health Transition, Intervention and Liaison (TIL) Service)  

 

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Is there someone I can call and talk to?

Our 24/7 free Helpline remains open, so please do not hesitate to call if you need someone to talk to or any guidance during this difficult time.

Combat Stress 24/7 Free Helpline 0800 138 1619.

If you require more urgent help, either yourself or a member of your family, please contact your GP or call 111.

You can also contact the Samaritans on 116 123