Combat Stress Reaction Treatment and Why It Works

When we first came home from Iraq, we landed in New Jersey. We remained on base for a couple of weeks to get “acclimated back to the civilian world.” I was laying on a soft bed in the barracks. I hardly slept because we were either drinking, partying, or just restless to get home.

Then came the time for our de-brief with the VA. I’ll never forget what we were told. “If you tell us you’re having a hard time please let us know, so we can hold you for evaluation.” Now all of us looked at each other and thought the same thing. Hell no, I’m not being held on base while everyone else goes home!

One soldier did disclose that he had issues and they ended up holding him for six months. They put him to work doing various details with the rear detachment platoon. Rear detachment is mostly made of up soldiers who couldn’t deploy for whatever reason. Some of them fabricated an injury so they wouldn’t deploy. I am guessing that it did not help my fellow soldier to be included in that platoon.

As the days, months, and years went on, my rage kept growing. It became really bad because I would not remember what got me mad. I would feel it build and then I’d snap. The problem was, I wouldn’t remember what finally set me off. I punched holes in walls, thrown chairs, and tables around.

I was in a bad place.

Fast forward a little bit. I started hitting the gym hard. I got into powerlifting. I fell in love with it. I felt it release all the aggression I ever held. Over the years, I got better and better, mostly through proper therapy and lifting. I found that lifting kept my demons tired and at bay. I was wondering, what was it about lifting that truly helped me?

I was doing some research online and found Samantha Case PsyD, Clinical Psychologist and founder of Combat Stress Reaction Training. Her gym is called Raw Performance in Los Alamitos, CA which is managed by Jason Shelton, her husband, and William Ha also the third owner who is the strength and conditioning coach. She combines powerlifting with therapy for combat veterans. My interest grew and I asked her some questions.

What is your overall mission?

“Funny that you would use that word. I see a mission as a job, there is something that needs to get done. If this was the question, I would answer it by providing psychotherapy to Combat Veterans on a one-to-one basis. I do not see what I do as a mission. I see it as my purpose. I conceptualized the gym and psychotherapy four years ago and we opened doors in 2019, my practice is housed inside the same square footage. My purpose is to help Combat Veterans transition into civilian life at any capacity that I am allowed to.”

Explain the link between psychotherapy and lifting/exercising.

“There is not a unique link between psychotherapy and powerlifting. It is not lifting and exercises. It is the execution of the movements that are the key component. When you squat, bench, or deadlift, you need to be intentional and focused. You are paying close attention to engaging muscles, moving with precision and confidence. When you are in the sport of powerlifting you are honing your form and your attention every time you push weight around.

Yes, you can go in and do the movements at the gym without intention, pushing and pulling as much weight around as your body can tolerate but that’s not the point. The link between the style of psychotherapy that I do, and powerlifting is that the more intentional the movements are the more progress is felt and seen.

Let me circle back around. Our emotions, thinking, and behaviors are driven by the biochemistry of the body. Traumatic events can create trauma and possibly PTSD. Now triggers to trauma create an increase in noradrenaline, adrenaline, and cortisol which in a traumatized body will remain in the system for at least 30 hours.

An increase in noradrenaline creates – increased anger and agitation, hostility, reduced empathy, and assertiveness.

An increase in adrenaline creates – fear, anxiety, desire to withdraw, difficulty with focus and attention.

An increase in cortisol – reduces dopamine, serotonin, reduced reality checking, reduces logic and reasoning.

Now what I am attempting to do, is that when memories or emotions are recalled during psychotherapy and there are the hormonal dump and dis-regulation = anger, irritation, all the previous feelings and rewire the neuropathways with exercise.

By using intentional and heavy movements the body can metabolize those hormones quicker and the body is better able to self-regulate. The Veteran experiences this firsthand and can regain the knowledge that they are in full control of themselves and the snowball effect of therapy and powerlifting is started. Now please remember that it does not need to be powerlifting, (add another example, intentional loading or priming for your body, like a weapon).

It can be any form of exercise that the individual enjoys which will accelerate the body’s ability to process the hormonal dump after they are triggered.

What does CSRT stand for and why did you come up with that name?

“Combat Stress Reaction – Treatment. The diagnosis and terminology for PTSD came about in the 1980s, PTSD has been called various things. The term Combat Stress Reaction was coined in World War II in response to combat, other terms that have been used are “battle fatigue,” “combat fatigue,” and “shell shock.” I wanted a name for my practice that was not just my name. I also wanted something that was within the realm of what I was doing Combat Stress Reaction Treatment at least lets you know that the focus is with combat and it does not have my name plastered all over it, it’s not really my personality.`

Any success?

“I have had some very clear successes in which individuals worked through a specific event and have kept in touch letting me know how their lives are going. Of course, I do have some people that I have worked with who stopped coming after a major event was processed in therapy or something outside of therapy happened, or that I messed up and they left.

When measuring if I have had successes I do feel that I have attained this. Please note that I have made mistakes, I wish that I could speak to some people who reached out and that I unintentionally did not help and make it right. I hope to have an opportunity one day to provide something that they needed that I could not see. When someone stops coming in or stops making contact, I do not assume that they are being ‘non-compliant’ or ‘not-ready for therapy’ I see it as something that I could have done differently, I trace my steps back to see where I slipped.

I have worked with too many men who have committed suicide, I know their names and the anniversaries of their deaths. I mourn them quietly and to myself and vow to do right by them. I measure my success as information that is passed from one Veteran to another. I do not need to be given credit, as long as that information helps that is all I am striving for.”

For those that I have not done right by I wish that they would reach out one day, or that they tried someone else and that treatment worked out for them.

Psych is an interesting world. There is no broken bone to be fixed, no growth to be removed. Trauma is not simple and it is not visible, a trauma implies that an event of such magnitude occurred that it shifted the way that your body and mind now perceive the world. This is not something that should be taken lightly. When a trauma specialist works with an individual it can be one of the most intimate and vulnerable relationships this person can have. The relationship will fluctuate in levels of contact, weekly, monthly, or whatever is needed.

Why do you feel better after a heavy workout?

The concept of strength building to reduce the severity of symptoms of PTSD is that the stronger the individual feels and is, the less powerful the symptoms of PTSD are. For instance, when you got back from deployment, you went to bed and fell asleep and laughed at the thought that someone would try to break into your house. You knew and had no questions about your potential to cause damage.

Now, joints hurt, injuries have settled in and muscles have started to wither into a soft pillowy silhouette. If that guy is going to break into your house, could you hear them? Could you physically take them down? Would they be younger, stronger, and faster than you? You hope that you could protect your home, but you second guess yourself.

By incorporating going to the gym, putting some weight on your back, working on the fundamentals of squats, bench, deadlifts, and combat training starts to kick back in. The muscle memory is still there from the service. Now there is no doubt that if that guy comes into your house, that you can again cause some damage. This is one simple example, there are many more, but for now, it’s the hook. Your homework is to find a therapist, put the work in, go to the gym, work hard, and intentionally. You got this.

After my interview with her, I started to think, she is 100% on point. She put words into what I feel and do feel while I put chalk on my hands and start to lift. My intent and resolve are met in the House of Iron. My will is tested, my demons are occupied by the need to challenge myself.

As I grip the barbell, I focus on my body, focus every muscle fiber, and breathe as I prepare to lift. My mind flashes with prior battles, radio calls, screams of the innocent, and I lift with all my resolve. My will and resolve are forged by the fire within. Lifting helps me channel it and learn to focus it. Samantha can help you learn to do that, as I’m still learning.

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This first appeared in The Havok Journal on February 8, 2021.

Ayman Kafel is the founder and owner of Hybrid Wolf Blue Line Strategies, LLC. A veteran-owned training and consulting company for Law Enforcement officers and agencies. He combines his military and law enforcement experience to bring much-needed cutting-edge training to the law enforcement profession. 

Ayman is not only an active police officer but also a law enforcement instructor and has taught across the East Coast of the United States. He offers a wide variety of training, such as advanced patrol tactics, mechanical breaching courses, designated marksman, and Human Performance under duress. 

In addition, Ayman is an Army Combat Veteran who was deployed during Operation Iraqi Freedom in 2005. He became a police officer in 2007 after 8 years of service in the Army

Ayman has seen the ugliness of war and evil in the world. He survived two civil wars prior to immigrating to the United States in the late eighties.

His current position is the commander of his department’s Problem-Oriented Policing Unit. He leads a team of investigators that employs unconventional methods and Special Forces philosophy in achieving specific objectives in the communities he serves. These unconventional methods range from winning hearts and minds to specific strategic law enforcement actions to arrest and prosecute those who are the root cause of various crimes.

To reach Ayman, feel free to email him at hwbluelinestrategies@gmail.com

As the Voice of the Veteran Community, The Havok Journal seeks to publish a variety of perspectives on a number of sensitive subjects. Unless specifically noted otherwise, nothing we publish is an official point of view of The Havok Journal or any part of the U.S. government.