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By: Marla Knox, MA CTRS
Balboa Warrior Athlete Program
Naval Medical Center San Diego
PTSD is a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape.

People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person's daily life.
  • One in 5 veterans of the Iraq and Afghanistan wars grapple with PTSD (National Center for PTSD)
  • Over 300,000 veterans have developed PTSD or depression  (Rand Corporation Study)
  • Effects of PTSD ripple across the lifetime  or generations
  • Effects patient, their family and loved  ones
  • Invisibly Wounded
  • Can be a dual diagnoses with TBI, ortho impairment or amputation
Behaviors May Include:
  • Inability to function in social or family life, employment
  • Isolation
  • Depression
  • Hyper- vigilance       
  • Impatience
  • Anxiety/Fight or Flight
  • Aggression/Anger/Outbursts
  • Emotional Detachment
  • Lack of Trust
  • Sense Of Entitlement
  • Fear of Crowded Areas
  • Reaction to Loud Noises/Startle Reflex
  • Flashbacks/Night Terrors
  • Feelings of Guilt/Survivor Guilt
  • Alcohol & Substance Abuse
  • Inability to enjoy activities they once enjoyed
  • Failure to show up for activities


  • Increase Socialization Opportunities/Build Relationships
  • Community Reintegration
  • Increase Comfort Level of Patients Working with Civilians
  • Learn New Recreation, Sports or Fitness Activities
  • Relearn/reconnect old skills/previous activities
  • Provide participant with new community resources
  • Increase endurance and overall fitness
  • Find Meaning in Life
  • Decrease stress and anxiety
  • Help them to "get their happy back"


  • Activities that promote reintegration
  • Activities that promote self expression
    • writing, music , acting, painting
  • Outdoor Activities:
    • skiing, snow boarding, fishing, surfing, hunting, biking, kayaking, canoeing
  • Extreme  Sports:
    • skydiving, white water rafting, mountain biking, etc.
  • Activities that promote relaxation :
    • yoga, tai chi, mediation
  • Have adequate trained staff/volunteers on how to work with this population
  • Do involve family member(s) and/or  friends when appropriate (in activities, or utilize as a source of information)
  • Build genuine rapport with your participant
  • Consider offering activity for OEF/OIF combat injured only
  • Listen to them and observe their behavior (do they appear comfortable? Do they appear anxious)
  • Anticipate reactions to their environments
  • Give them space, time out when needed
  • Work with their therapist to align goals
  • Let them know that at any time they feel uncomfortable that they can take a break
  • Encourage them to contact you via phone call, email, or text when they cannot make it to activity
  • Let them know they are welcome to come back at any time
  • Make your activity challenging and fun
  • Do a small group feedback following each training session
  • Over instruct
  • Ask them questions about their combat experience
  • Say the wrong things or inappropriate statements i.e. talk about the war, your personal opinions, politics, etc.
  • Take their behavior personally
  • Walk up behind them
  • Put them in situations or environments that could trigger negative behavior
  • Over encourage them to try the activity when they don’t feel comfortable
  • Encourage them to observe an activity if they don’t want to participate. Sometimes it is best to observe.
  • Think you know what  is best for them
  • Push them when they feel uncomfortable
  • Say " I know how you feel"
  • Don’t tell them to  "suck it up"
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