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Treating PTSD: Natural Disasters, Sexual Abuse & Combat
PTSD continuing education addiction counselor CEUs

Section 21
Client Exercise: Distinguishing Grief and Anger

CEU Question 21 | CE Test | Table of Contents | PTSD
Counselor CEUs, Psychologist CEs, Social Worker CEUs, MFT CEUs, Nurse CEUs

If you have served in the military, especially if you have participated in or seen combat, any unresolved grief and anger connected to your war experiences will likely greatly contribute to the persistence of your PTSD symptoms or other readjustment problems. However, because of the military environment, and the nature of military training and war, your grief and rage may be strongly interconnected.

In order to promote your healing, you need to separate your grief and other feelings from your anger. At this point, review your journal entries under the categories of anger and loss, and write about the following questions:

1. Have you listed all your angers and losses?
2. In your list of angers, did you include anger regarding your loss of innocence or loss of belief or principles? Did you list any loss of faith in the military as an institution, in certain military officers or practices, or in your country?
3. In what instances during combat or afterwards, was your anger or rage a cover-up for grief?
4. How did you deal with grief during your military experience? Did you ever deal with grief by acting on your anger?
5. How did others in your unit deal with their grief? Was their grief ever expressed through aggressive acts?
6. How have you dealt with your grief since your military experience? Have you used anger to cope with grief? If so, how?
7. How do you feel about how you dealt with your grief during combat? How do you feel about how you have dealt with it since then?
8. In your life today, are there instances where you express your unresolved grief and sadness from the war as anger or rage? What are those instances?

Reviewing Triggers
Because of the magnitude of the horror you experienced during your war experience, the list of triggers you compiled takes on added significance. Wars of all sorts are going on nearly continuously in our world. Furthermore, war is a common theme for popular films and television programs. Therefore you cannot help but be given frequent reminders of your war experiences.

Review the list of triggers you compiled and take some time to answer the following questions in your journal:
1. Toward which of these war-related reminders have you become immune? Toward which do you still react?
2. What measures have you taken to protect yourself from such triggers?
3. What is the price you pay for such protection?
4. Do you have any choice but to protect yourself this way? If you feel you have no choice but to avoid certain situations, do you have difficulty accepting this limitation? What would be required for you to accept this part of yourself?

Consider the fact that if you are a combat veteran, you have been trained to react with aggression and anger to provocation. A trigger in your environment today, even if it does not pose a threat, may be sufficient provocation to cause you to respond with anger and aggression. Equally likely is that you respond with a shutdown of emotion or with attempts to remove yourself physically or distance yourself emotionally from the individuals or situations that trigger you.
Because your potential for violence is greater than that of civilians, due to your training and military experiences, you need to take particularly good care of yourself in terms of managing trigger situations. This means there may be situations you need to avoid except under emergency conditions.

You may need to be especially watchful not only of situations that enrage you, but those that cause you intense pain and grief as well. React­ing with uncontrollable or unwanted aggression is painful, but equally painful is being emotionally shut down. Either way, you may feel you have failed in certain important relationships or on the job. This feeling of failure may be especially heightened if, in your case, part of your war trauma was feeling that you failed your unit, your commanding officer, or your own military standards.
- Matsakis PhD, Aphrodite; I Can’t Get Over It: A Handbook for Trauma Survivors; New Harbinger Publications, Inc: California; 1992

Personal Reflection Exercise #7
The preceding section contained information about distinguishing grief and anger.  Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Captari, L. E., Riggs, S. A., & Stephen, K. (2021). Attachment processes following traumatic loss: A mediation model examining identity distress, shattered assumptions, prolonged grief, and posttraumatic growth. Psychological Trauma: Theory, Research, Practice, and Policy, 13(1), 94–103.

Chang, C., Kaczkurkin, A. N., McLean, C. P., & Foa, E. B. (2018). Emotion regulation is associated with PTSD and depression among female adolescent survivors of childhood sexual abuse. Psychological Trauma: Theory, Research, Practice, and Policy, 10(3), 319–326.

Christ, N. M., Contractor, A. A., Wang, X., & Elhai, J. D. (2020). The mediating effect of rumination between posttraumatic stress disorder symptoms and anger reactions. Psychological Trauma: Theory, Research, Practice, and Policy, 12(6), 619–626.

Online Continuing Education QUESTION 21
According to Matsakis, what are the two most likely reactions of a combat veteran to one of their triggers? Record the letter of the correct answer the CE Test.

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Treating PTSD: Natural Disasters, Sexual Abuse & Combat

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