The Psychological Toughness of Veterans in Therapy

“Let’s do this!” This is the statement made to me by an Army veteran and psychotherapy client of mine when I asked if he was ready to directly process his past trauma using the tools of Eye Movement Desensitization and Reprocessing (EMDR), the trauma-focused type of intervention he requested. Since then, this comment has become a constant reminder to me about veterans because it epitomizes the psychological toughness veterans regularly exhibit when they are invited to explore thoughts, feelings, and body sensations related to their past trauma.

While a few studies suggest that the “emotional toughness” classically associated with veterans may inhibit therapeutic progress, vis-à-vis the suppression of emotions, my clinical experience points in a different direction. I’ve noticed a silver lining to such a “show-no-weakness” frame of mind. When I am able to help veterans focus their well-developed conquering attitude onto the therapeutic task-at-hand, it can often draw out a strong sense of their personal resilience in the face of challenge.

In the case of the Army veteran, his stout-hearted readiness to face the images associated with his trauma allowed him to directly follow me into a part of his mind where various unprocessed memories were stored; then, it equipped him with the willingness to remain in his emotional discomfort until I could help him process through the distressing memories.

I have not witnessed this type of psychological hardiness in my 20 years of clinical practice with mostly non-military clients. Is this a coincidence? Probably not. The fact that the veterans I’ve worked with seem to show up better equipped to process through trauma appears to be a by-product of their military training. That said, perhaps helping veterans work through their past trauma can be enhanced by helping them continue to cultivate the unique qualities of their psychological toughness, a strength they may not consider to be an asset for therapy and healing old wounds.


Written by Tony Madril


New guidelines for the treatment of PTSD

New guidelines for the treatment of PTSD: A panel of experts from VA and the Department of Defense developed the latest guideline for managing PTSD and acute stress disorder.
Read more in the PTSD Monthly Update:…/bulletins/1abae94

Free Mindfulness-Based Cognitive Therapy Training for Veterans in Los Angeles, CA.

Know of someone who may benefit from learning practical tools to successful manage symptoms of PTSD, depression, and anxiety? Join other veterans for this free training on August 19th from 10 – 11:30 a.m.  Learn more:

Islands of Peace

People with Post-Traumatic Stress Disorder (PTSD) often struggle with distressing thoughts, feelings, and body sensations, which seem to happen unexpectedly and may become so unmanageable that a person may not able to complete his or her scheduled tasks-for-the-day. Such distressing symptoms may respond to calming down the nervous system by finding and stepping into “islands of peace.” An island of peace is anywhere you can go within your physical locale that is quiet and still, or quieter and more still than your present surroundings. Great if you can find a nearby park; if you cannot, consider moving to an empty room or corner in the building where you can sit quietly for a couple of minutes–even sitting in your car and counting your breaths may be exactly what you need to generate a moment of inner-peace.

A moment of inner–peace that may lead to another…and, then, another. In a relatively short period of time, you may discover your distress slowly starting to shift. Perhaps you may feel a little more well; just enough to take another step toward balancing an unsettled mind and body. Where are your islands of peace?

Written by Tony Madril

Mindfulness-Based Cognitive Therapy Shows Promise for Veterans with PTSD

A 2013 collaborative study conducted by the University of Michigan Health System and the VA Ann Arbor Healthcare System shows that veterans with Post-Traumatic Stress Disorder (PTSD) who completed an 8-week Mindfulness-Based Cognitive Therapy (MBCT) group showed significant reduction in PTSD symptoms as compared to veterans who underwent behavioral health “treatment-as-normal.” In fact, 73 percent of veterans in the MBCT group showed significant improvement compared to 33 percent in the treatment-as-usual group. The study was published in Depression and Anxiety.

MBCT is a research-based type of psychotherapy that helps clients work through troublesome emotions using skills from mindfulness meditation and cognitive talk therapy to increase awareness of thoughts and emotions.


–      Download the article on MBCT and Veterans with PTSD

–      Attend a free, skills-based workshop on MBCT for Veterans: On August 19, 2017, I will be facilitating a free, skills-based MBCT workshop for Veterans and their families from 10 a.m. to 12 p.m. in Los Angeles, CA. Save the date!

Trauma’s Silver Lining

Is there anything to gain from having experienced trauma? Is there any helpful way to relate to the emotional distress that lingers after the event?

The concept of “post-traumatic growth” offers hope! Post-traumatic growth is a relatively new concept in the field of behavioral health, which purports that distressing–even harmful–events can lead to positive outcomes; lending credibility to the phrase: “What doesn’t kill me makes me stronger.” For example, a military veteran who lost a friend in battle demonstrates post-traumatic growth by becoming a peer counselor to other combat veterans.

The following are three questions you can ask yourself to determine whether the very thing you would have rather avoided has unexpectedly made you stronger and more resourceful:

  1. Has my past trauma changed my priorities about what’s important in life?
  2. Has my past trauma led to the creation of a new path for my life?
  3. Do I know better that I can handle difficult situations?

If you answered “yes” to any of these questions you may consider that, although you cannot change the past, you can use the present moment to consider how you are positively transforming the way you approach the challenges of life.

Written by Tony Madril


Exercising Choice

ChoiceSaying “no” when you would typically say “yes.”

Replying: “Let me think about it” instead of immediately making a decision.

Leaving a stressful situation for a few minutes to find your center.

These are all examples of choices you can make to promote your well-being when feeling cornered by circumstance. Choosing to place your needs first can have profoundly positive effects in your life; it loosens old patterns that don’t serve us anymore.

What choices can you exercise to take better care of you?

Compassion Over Entanglement

How Mindfulness Can Help Ease Difficult Relationships
Research is starting to examine the benefits of mindfulness as a tool to promote healthy relationships. In addition to reducing stress, studies now suggest that mindfulness can increase our empathy toward others. Developing empathy for others through the practice of mindfulness can prepare us to look “beneath the surface” of what we think about the people in our lives whose actions seem to challenge us every-step-of-the-way. It can help us make better decisions when triggered by emotion and construct another way of seeing things during times of interpersonal conflict. Would you like to know more?
 In what follows, I’ve outlined three mindful steps you can take to make a radical shift in the way you currently manage difficult relationships. You might say the three steps are a practical tools you can use to make your life a little easier:


Step One: Pause and practice
Several studies examining the benefits of mindfulness strongly suggest that mindfulness promotes stress reduction. When we’re less stressed we are better able to perceive difficult behaviors in others as “challenges” rather than “threats.” In other words, practicing mindfulness in the presence of potential conflict helps to calm the areas of our brain responsible for triggering “fight, flight, or freeze” responses and, therefore, helps us maintain our connection with the more rational parts of our brain that promote good judgement. One practical tool to practice mindfulness in difficult moments is the practice of shifting your focus away from conflict and onto the physical sensations of the breath. One way to do this is to say to yourself with every breath: Inhale one, exhale one…inhale two, exhale two, and so on.


 Step Two: Explore your hunches about the person’s underlying needs.Before responding to irrational behavior from others, it may be helpful to pause and ask yourself: How likely is it that this person’s behavior is really about me? If we’re honest, we’ll likely discover that, most of the time, it isn’t. Barring the presence of mental illness, people’s challenging behaviors (E.g. blaming, complaining, shouting) are often a reflection of unmet needs: psychological states of being that undermine personal growth and a sense of emotional security. For example, the person at the office who makes undermining comments at someone else’s good idea may have an underlying need to feel recognized and competent within the group. Like an iceberg, underlying needs exist “beneath the surface” and are psychological explanations for what often drives difficult behavior.
 That said; when facing irrational behavior from others–in addition to asking yourself the question: “How likely is it that this person’s behavior is really about me?”–it may also help to ask: “What are these behaviors really signifying?” “What’s likely beneath the surface?” and “How can I best respond knowing that this is probably more about this person’s underlying need than anything I’ve done?”


 Step Three: See the person as an innocent child or try to see aspects of yourself in him/her.
Now that you understand the concept of underlying needs, this step asks that you put this knowledge into practice. After you’ve considered the possible needs underlying the other person’s irrational behavior, try to imagine what he/she must have looked like as an innocent child whose legitimate needs were never met. Perhaps they might resemble the child in this picture: If you find this too difficult to do, try to see aspects of yourself in the other person. To help you do this, you might ask yourself the following questions:
– Have I ever been in a similar situation as this person? If so, how did I feel?
– Have I ever felt angry, afraid, or ashamed?
– Have I ever acted irrationally when upset?


 It is much harder to judge someone when we discover pieces of ourselves reflected back in the experience of the other person who, like us, is imperfect; has endured the palpable pains of life, and is ultimately vulnerable to suffering, sickness, and death–just like us. Although it is sometimes necessary to sever relationships with people who are “toxic,” there are some relationships from which we simply cannot walk away–relationships that we need to meet our goals whatever those may be. In these cases, it may be very helpful to introduce a bit of mindfulness into the relationship. Mindfulness is not magic, but it may ultimately help you make a radical shift in the way you perceive the other person and the situation. And, this can make all the difference!


Written by Tony Madril

Leaning Into Anxiety

How often have you felt anxious about “not knowing” what the future holds? Having a sense of powerlessness over what will happen next is perhaps one of the most anxiety-provoking situations we can face in an ever-changing world.
Since we cannot control what the future may bring, it may be helpful to focus on what we can manage: Namely, how we respond to anxiety.
We have choices.
We can eat a half-gallon tub of ice cream.
We can drink a bottle of wine, or we can teach ourselves how to “lean into” it.
Here is simple instructions for practicing ‘leaning into’ anxiety…
  1. Find a place where you will not be disturbed for a few moments.
  2. Take a couple of deeper than normal breaths.
  3. Visualize yourself sitting in a room filled with white clouds, clouds that make it impossible to see more than couple of inches in any direction.
  4. Stay with the image for a few moments or minutes.
Perhaps many of our discomforts can be resolved by integrating anxiety into our daily lives-instead of trying to push it away, again and again.
–Tony Madril

Let Out Some Poison!

letoutsome poisonOur body often acts as a barometer for internal emotional “pressure.” When powerful emotions like fear and anxiety become intense within the body, it can manifest itself as physical symptoms like muscle tension in the shoulders and face; other signs may be an increased heart rate and perspiration. These are classic signs that the body’s “fight-flight-freeze” system has been activated and stress hormones like cortisol and adrenaline have been released into the blood stream.
It would be easy to blame the “evil stress hormones” for our discomfort and call it “poison.” But consider instead the distress that is created by becoming immobilized by not knowing how to release this type of mind-body tension as the real problem.
What then can be done? Is there a ready antidote to counteract this type of poisoning?
What if, when this distressing thoughts and emotions occur, we take the following three steps:

Stop what you are doing and take a couple of deeper-than-normal breaths.
Try to identify the thoughts you are experiencing (E.g. “I’m thinking that I may not find a job and become homeless”), the emotions (E.g. fear, anxiety) and the body sensations (E.g. muscle tension in the jaw and temples).
Call a friend and tell them what you are thinking, feeling, and sensing in the body related to a distressing situation.
I call this practice: “letting out some poison” because it provides an immediate outlet for distressing thoughts, feelings, and body sensations and counteracts the sense of powerlessness that can accompany ‘not knowing’ what to do with action-oriented steps to improve the situation. You might find that after doing this exercise your mind and body returns to a state of rest; the muscles in the body lengthen and relax, and the mind returns to a general state of wellbeing.
The next time you find yourself in a distressing situation, you might try letting out some poison!
–Tony Madril