5 Insights in Working with PTSD
The Russian-Ukrainian war is already being compared to the Second World War in terms of the scale and intensity of the fighting. The missile war being waged on the territory of Ukraine is the biggest in the history of mankind. All this is a totally traumatic experience for the Ukrainian people and society. Some commentators have suggested that all Ukrainians, without exception, now suffer from PTSD. However, Ukrainian psychotherapists have their own insights into the state of society. And their professional experience since 2014, after the annexation of Crimea and the start of the anti-terrorist operation, and especially since the full-scale invasion in 2022, is unique and incomparable even to their colleagues in Israel.
Olha Yevlanova, a Ukrainian trauma-focused cognitive behavioural therapy trainer and psychotherapist, shared her vision of the psychological state of Ukrainians.
After a traumatic experience, there are two ways to move towards PTSD or post-traumatic growth. Ukrainians choose the second path.
“We can already talk about this growth consistently, based on our history, because since 2014 our society and our specialists – psychologists, psychotherapists – have matured and learned to distinguish the signs of a post-traumatic reaction from PTSD, and that a person can grow and integrate their traumatic experience into their life biography, become wiser.
Growing is when a person is not ashamed of not having a limb, continues to lead an active life and knows that he/she is so valuable. Or a person who has led an active life is now retrained and has the opportunity to adapt to the outside world and is supported by society, can be realised in a different speciality. Now we are facing a huge task, but we are working, we are not left alone to face the challenges of war, many people already know that all our reactions are natural in an abnormal situation of war.”
Ukraine – all of it – has been under threat for more than a year and a half. In 2014-2015, next to the war zone, next to the occupation, the rest of the territory was safe to recover and rest, there was no threat. Now the people are facing a completely different challenge, and that is the main difference.
Traumatic guilt, or survivor's syndrome, requires specialist support.
“As a practicing psychologist I do not distinguish such a concept as survivor syndrome. This is one of the concepts that describes traumatic feelings of guilt, even when something happens in a peaceful life, such as a car accident. Ukrainians are human beings like everyone else on earth, and we react in the same way as everyone else. You don't always need support to experience grief or loss. However, if a person is fixated on feelings of guilt, negative thoughts or a catastrophic moment for more than a month, cognitive behavioural therapy (CBT) or the EMDR approach has been scientifically proven to help. If it is PTSD, we use the trauma-focused CBT protocol.”
Trauma should not talk about itself if it has not yet been transformed into a conscious experience, an autobiography.
“Traumatic events become part of growth when they are over. When we talk about small episodes, for example missiles or drones being shot down near my house, I can talk about it after the air raid siren has gone off, if I don't have a very emotional or physical reaction. If I have not dealt with it myself, I cannot talk about it. Then testifying doesn't work as therapy, that's for sure – then testifying can be re-traumatising.”
Ukrainian psychologists and psychotherapists are currently doing a lot of work with victims of war crimes. When a person testifies, it is imperative that he or she is safe and in understandable circumstances. Similarly, when working with the wounded, it is necessary to see adequate physical reactions, the ability to analyse, and a plan of action should be clear, for example, how rehabilitation will take place, when a prosthesis will be fitted, and so on.
It is necessary to transform our own traumatic experience – but where we have the strength, where there will be caution, warmth, and trust.
“When we go through a traumatic experience, we will have bodily reactions for the first month, and it may seem impossible to cope with it. You need to give yourself time for the wound to heal, connect with others who are like you, seek support from those who can relate, and not violate the boundaries of others. The important question is “How are you?” and “I'm here if you need me”, a warm connection.”
Experience transformation tools are individual therapy and trauma is not dealt with in groups due to safety precautions.
A person can naturally integrate traumatic experiences into his or her autobiography, as most Ukrainian artists do, by acknowledging rather than freezing their pain and understanding their own war traumas. Painters literally paint their memories and feelings, poets write poetry, and documentary filmmakers capture reality on video. Fictional formats require distance, but they too are emerging. This is the case, for example, with the play Green Corridors, which is being staged by several Kyiv theatres. Olha Yevlanova herself is a script consultant for the feature film Nodokasa, which is supported by the Ukrainian Cultural Foundation.
Ukrainian specialists have a unique experience, both supporting others and experiencing traumatic events in the midst of war.
“Our supervisors from other countries are surprised and say they have no idea how we work. For example, when we talked to trauma-focused therapists from the US in 2015 who shared their experience of 9/11, they had a very dosed workload, 2-3 hours a week, recovery, supervision, and they had so much support from society and the state that they could cope with it. Our challenge is a more rapid burnout due to difficult and dangerous working conditions, painful emotional stress, but at the same time we have learned to pay attention to this and to pay a lot of attention to clarity, humanity and trust within the team in our projects to ensure recovery. The team has been working in this format for over a year. So, we have something to share, the main thing is to live, to win and to keep the warmth of human relations.”
“Unfortunately, the twenty-first century shows that humanity still needs to evolve into a ‘compassionate/empathetic person’,” says psychologist Olha Yevlanova.
Over the past 9 years, Ukrainian specialists have gained a wide range of experience travelling to the de-occupied regions to provide advice and work with people who have been captured and are under fire. The working conditions there can be terrible and exhausting. In 2014-2015, the Ukrainians made intensive use of the experience of their colleagues from Israel and the United States, and now they have their own specialists with a lot of practical work. The number of injuries is high.
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There are currently more than three dozen military conflicts going on around the world. Hundreds of people are caught up in horrific events that threaten their physical health and destroy their mental health. The insights gained by specialists during the largest war on the European continent in Ukraine can be an important contribution to the development of assistance schemes for people suffering from PTSD around the world.