B0038M1ADS EBOK (29 page)

The next step is to "inoculate" yourself to the distressing trigger in a
similar way the doctor would inoculate you if you had an allergy to beesby gradually increasing your level of exposure (or "dose") to whatever
causes you distress, in this case, the crowded mall. The inoculation exercise involves going to the mall on a number of occasions to gradually build
up your "immunity" so you react less strongly to it.

Assume the crowded mall generally causes a "9" level of distress, but if
you sit or stand in a less-crowded area close to an exit, you can keep your
distress level down to a "6" or a 'T'; if you sit in your car in the parking lot,
the level is only a "3" or a "4."

Start by driving to the mall and sitting in the parking lot. If this causes
you a lot of distress, then this is a good place to start. If this causes minimal
or no distress, then walk into the mall to an area that is less crowded and
near an exit, where you feel noticeable distress but not to the level where
it's through the roof. The idea is to pick a place that causes you noticeable
distress, but not at a "10" level (perhaps a "5," "6", or "7").

Once you've picked your location, your mission is to sit there
patiently without leaving, notice your level of anxiety, and allow your
body to learn that this location isn't as threatening or dangerous as it
feels. What will happen is that the level of anxiety will likely increase initially, reaching a peak after several minutes. You might start to sweat or
feel your heart pound. Anxiety can sometimes make you feel like there's
something physically wrong with you, or like you're about to go crazy.
You'll probably have a strong urge to leave right away.

Your mission, however, is not to leave, but to stay at that location until
your anxiety level starts to naturally subside, which usually happens after
several more minutes. If necessary, consider yourself on guard duty: You've been ordered to monitor this location, and retreat isn't an option for the
duration of your assignment.

It's important not to let yourself get distracted in any way; stay focused.
For example, don't talk on your cell phone, text, or check messages on
your BlackBerry. Don't read, don't eat, don't try to control your breathing;
just sit there and do nothing except remain aware of where you are, what's
going on around you, and your level of anxiety. If it's easier to do this when
you have a friend or family member with you, then ask them to be with you
but to not talk or distract you.

After a while the body learns that this place isn't as threatening as you
first perceived it to be, and the level of anxiety will gradually diminish.
The goal isn't to actively do anything to change your anxiety level, but to
allow your body to learn by itself that a high level of anxiety is no longer
necessary. All you have to do is understand the process and not respond as
the anxiety increases by leaving; after a while the anxiety level will start to
subside. After the anxiety subsides to about half the level it was at its peak,
then the exercise is over and you can get up and leave. This generally takes
anywhere between twenty and thirty minutes.

It's crucial to stay there when your anxiety is at its highest point and
you're feeling the greatest urge to leave. If you leave at that moment, you'll
feel immediate relief, but you'll also reinforce the avoidance (retreating)
behavior and actually train your combat reflexes to think that this location in
the mall (and similar locations) are very high threats. That will make things
worse. What you want to do is train your body's reflexes that this part of the
mall is not a high threat, and that there's no need to maintain such a high
level of anxiety there. Wait until your anxiety level subsides before leaving.

If after about thirty minutes your anxiety is still "through the roof" and
isn't showing any signs of diminishing, then consider practicing the deep
breaths and wide relaxed focused meditation to calm your reflexes down
(Chapter 5, skills 5 and 6). Give it about five to ten more minutes for your
body to adjust to the location and to learn that it doesn't have to maintain
the high level of anxiety any longer.

After you've done this once, the next step is to set a schedule where
you repeat this exercise as many times as necessary (for example, every other day for a couple of weeks), until going to this location is no longer a
big deal. Then pick another location that still causes distress, like a morecrowded area, and repeat the process. If it was helpful to have a friend with
you initially, then later on, practice doing the exercise when your friend is
in another part of the mall, or not with you.

The only objective is a reduction in your level of anxiety. This exercise isn't intended to change what you like or dislike. It won't make you
enjoy things that you find annoying or you know you won't ever enjoy
doing. For instance, you may be the kind of person who hated going to
malls even before your deployment. This exercise isn't going to change
that. After doing this exercise you'll still find the mall aggravating and
will continue to dislike being there. But you also won't be triggered
so strongly or have panic attacks as a result of visiting a mall, and this
allows you to go on occasion, to tolerate it for the sake of your spouse,
friends, kids, or just because you need a new pair of jeans and want to
go shopping for yourself.

If you find that after about thirty to forty minutes, your anxiety or
distress level hasn't diminished as expected, or is increasing, then your
current assignment is finished, and you can relinquish your position. But
don't surrender. Try to find another location that produces less anxiety
and come back the next day and work on it again. The point is to experiment with this so that your body becomes trained to react less strongly to
common triggers and you retreat from things less often.

Other Examples

You can experiment with this technique for any situation that triggers
strong reactions. For example, if you can't stand waiting in lines, make a
habit of selecting the longest line everywhere you go until standing in line
becomes just an annoying but not a threatening activity. You still won't like
standing in line, but you'll be able to do it. If you don't like bridges, find
a bridge that's safe to walk across and gradually confront it-for example,
by standing at one end of it for twenty to thirty minutes, until your anxiety
subsides, and then returning every other day and repeating this same exercise until you can move onto it and eventually cross it. If you react strongly to overpasses or trash on the side of the road, and avoid certain roads
because of this, find ways to confront these things so that you can gradually
resume driving on those roads. As soon as you can do the activity without
getting a strong reaction, you're done with the exercise.

The example of driving brings up the fact that in certain situations, it
may be difficult, impractical, or inappropriate to actually do the exercise
in vivo (in real life). For instance, it may be unsafe to stop your car and
get out and stand under an overpass or examine trash on the side of the
road (you wouldn't want to anyway). Instead, you can use visualization
in a safe place like your home. For example, if overpasses or trash cause
you to change course or react like there may be an IED threat, visualize
yourself driving on a road where there are overpasses or trash. If your
anxiety level goes up from imagining this, then you can practice inoculating yourself to these images through repeatedly visualizing this and
holding the visualization long enough for the anxiety to subside. You can
combine this with the relaxation breathing ("deep breaths from low in
your abdomen") or meditation. It's a way of preparing yourself for going
out and doing it in real life.

As another example, if you have difficulty with airplane travel, close
your eyes and imagine everything that has to do with taking a trip that
involves flying. In particular, imagine making the reservations, packing
for the trip, traveling to the airport, checking in, going through security,
boarding the plane, taking your seat, taking off, in-flight service, moving
about the cabin, turbulence, and then descending and landing. Imagine
these things in as much detail as possible. Notice which steps in this visualization produce the most anxiety; then practice "inoculating" yourself to
your own visualizations by repeatedly doing this exercise until your anxiety
subsides. Start with the first step in the sequence, moving on to the next
only when your anxiety level has diminished. In the event that the anxiety
doesn't subside, practice breathing from deep in your lower abdomen and
add muscle relaxation and/or meditation until you can visualize doing
these things without anxiety. You can also "inoculate" yourself by learning
more about flying from a book or the Internet. Then you can add an invivo component, such as going to a museum that has airplanes, watching planes at an airport, and then ultimately boarding a plane to take a trip,
initially with a friend, and later on, alone.

The inoculation procedure can be applied to various situations,
and you can experiment with it until you get the desired result. The
bottom line is to face the things that cause you to feel anxiety or distress, and directly counter the urge to avoid these things. Over time,
your reactivity to certain types of situations will improve. This is a path
to fearlessness.

Sensitivity to Ethnicity

A delicate topic, but one that needs to be discussed, is that some veterans from OIF/OEF and Gulf War 1 find that they react strongly to any
person who appears to be of Middle Eastern ethnicity (or Vietnamese
ethnicity for Vietnam veterans) because they remind them of an enemy
combatant. If you're one of these warriors, then you're going to have to
find some way to address this. I've recommended to warriors to actually
go to places where there are Middle Eastern (or Vietnamese) people,
such as a restaurant that serves that type of food, and to remain there
until the anxiety level subsides. Bring a buddy if you want, and make sure
that you check any anger you may feel at the door and avoid all alcohol.
Enjoy the food, drink some of the local coffee or tea, enjoy the belly
dancers (not likely to be found at a Vietnamese restaurant), speak with
the people, and show respect.

Although this may seem like a crazy thing to do (particularly if you
don't like Middle Eastern or Vietnamese food), it's not as crazy as it seems,
because you don't want to live your life reacting to someone's mannerisms
or the color of their skin. The idea is to train your body not to react simply
because a person's skin color is similar to that of the enemies you encountered during deployment. Just because your body reacts to reminders of
your war-zone experiences doesn't mean that you have to remain a slave
to these reminders forever. In other words, create exercises that involve
facing the very thing that causes the greatest levels of distress or anxiety so
that your automatic reflexes become reconditioned.

SKILL 2: DEALING WITH THE "STUPID STUFF" PEOPLE DO

This is a big topic, and the above example of going into a Middle Eastern
restaurant is a perfect segue to this. Warriors frequently report problems
dealing with people and intolerance to the "stupid stuff' that people do.
Many warriors find themselves getting triggered during encounters with
people, and situations that provoke anger can sometimes end up in a fullblown flashback or physical altercation.

This skill involves developing an understanding of the importance of
control in combat, and how this can affect your reactions to people after
returning home. Warriors learn to completely depend on their team members, respect the chain of command, take orders from no one unless that
person is in their immediate chain of command, and maintain a high level
of suspicion of anyone who isn't part of their unit.

There are good reasons for this perspective. In many operational environments, including the wars in Iraq, Afghanistan, and Vietnam, allies and
enemies could be indistinguishable unless they were pointing a weapon at
you. They may have worn the same clothes and exhibited the same cultural
mannerisms. Local military or security personnel working right alongside
you may have been serving as the "eyes and ears" of the enemy.

I remember walking into a dining facility (DFAC) in Mosul in 2004
during a busy lunchtime and suddenly feeling a sense of unease because
all of the tables where the Iraqi National Guard soldiers usually sat at the
far end of the DFAC were empty. As soon as I noticed this, a rocket landed,
and then two more landed in succession, fortunately falling just shy of the
DFAC and buffered by blast walls and vehicles in the parking lot. Naturally, the assumption of every U.S. service member there was that the Iraqi
soldiers had been tipped off to a possible attack but hadn't warned their
U.S. counterparts-an assumption that may not have been correct, but
nevertheless seemed logical given the circumstances. (This facility was hit
a few weeks later by a suicide bomber.)