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Welcome to CombatCounselor Chronicle, an E-zine dedicated to giving you the most current, pertinent information on cognitive behavioral therapy (CBT) and mindfulness-based CBT available.

Chris Sorrentino, a.k.a CombatCounselor, is a leader and expert in cognitive behavioral therapy. He combines 30 years of experience in psychology with the discipline from having served as a U.S. Air Force officer for 20 years, 4 of those in combat zones, retiring as a lieutenant colonel in 2005.

The Leader in Military and Veteran Psychology ... Follow Me to Mental Health!

Wednesday, September 21, 2016

Get Of Your "But" And Live A Value Driven Life ... That's A Freakin' Order!

What if I told you that I have the key to controlling anxiety, or depression, or anger, or whatever might be ailing you, psychologically speaking?  What if I told you that after 30 years of searching, I finally figured it out, this “psychotherapy” business?  There are probably hundreds, if not thousands, of self-help psychology books out there, and they all claim to have “the answer”. What if I told you that controlling anxiety is not the answer to your troubles, but the problem?  What if I told you that the answer to controlling your anxiety is to give up the struggle and simply accept the anxiety?  Would you think I am crazy? Yes, probably. Would you be right? Well, maybe. But, what do you have to lose by reading a little further and finding out if what I am saying makes sense, then deciding if you want to keep reading and, possibly, changing your life forever? If you are looking for a quick fix, you have come to the wrong place. If you are looking for an exciting new way of living and are willing to do some work to get wherever you want to be, psychologically, this is the book for you. But first, a little background about me. 

I am a combat and disabled veteran, retired military officer, and licensed professional counselor with over 30 years of experience and education in clinical psychology and cognitive-behavioral therapy.  I was an Assistant Professor of Behavioral Sciences and Leadership and counselor at the United States Air Force Academy from 1988 to 1993 and  am author of the future New York Times Best Seller: You Think, You Are…Anxious: A Journey from Avoidance to Acceptance, the first installment in the You Think, You Are series.  I will bestow my knowledge and wisdom, a proprietary approach to cognitive-behavioral therapy known as Body-Mind-Behavior Therapy (BMBT), in the first of the series, which follows forthwith.

The earliest cognitive-behavioral therapists lived thousands of years ago and the origins of cognitive-behavioral psychology go back as far as Buddha (563-483 BC) who said, “We are what we think; we are shaped by our thoughts; we become what we think.” Actually, he said it in Chinese, because his English was not great.  Confucius (551-479 BC) also pointed out (in Chinese, of course) the importance of thoughts and mindfulness in behavior, when he said, “The more man meditates upon good thoughts, the better will be his world and the world at large.”  How about that!  Those two guys were pretty smart because, here we are two thousand five hundred years later and, we have only recently rediscovered the validity and usefulness of these profound statements.  

Wait a minute; did he say he was a future New York Times bestselling author?  Bestow his knowledge and wisdom?  What? Is he nuts?  Some might think so, but I prefer to think of myself as mildly eccentric.  But, think about what Buddha said for a minute: “We are what we think” (hence, the title of this book and series).  It is so true, but we take it for granted that sometimes, many times, in fact, that what our minds tell us is far from reality, yet the majority of the time we believe exactly what our thoughts tell us, even though our thoughts may not be, and probably are not, true.  Scientists say that we have as many as 50,000 thoughts a day. If we knew how accurate our memories actually are at remembering things correctly, we would be hesitant to believe anything that goes through our minds.  The mind is a very funny thing as we shall see as we progress in our “Journey from Avoidance to Acceptance”.

How many times have you been absolutely sure something was true, but it turned out not to be the case (or vice versa)? “I’m going to get really nervous during that upcoming presentation and forget what I’m supposed to say.”  “What an idiot I am.”  “Those people are laughing at me because I’m fat.”  Is what you think is reality or are they just thoughts?  What goes through your mind could possibly be true, you could get nervous, freeze, and forget what to say in front of a bunch of people, but it most likely would not happen, had you not given those doubts credibility in the first place.  Nevertheless, you believe the thoughts anyway, making yourself more nervous than you probably need to be, a self-fulfilling prophecy of sorts.  Because you think you will get nervous, you, in fact, become nervous which, in turn, negatively affects your performance, making you even more nervous. That is what we call “meta-cognition”, which can be defined as “thinking about thinking” (cognition originates from the Latin verb cognoscere, literally meaning "to know") or, in this case, getting nervous about getting nervous, and it is ruining your life! It is also an excellent example of a vicious cycle, a cycle which, if not interrupted or broken, can escalate out of control into severe anxiety or full-blown panic.

So what are you going to do about it?  Well, you can do nothing about it and be miserable for the rest of your life, or, you could try to sort things out on your own, maybe read a self-help book (like this one), or you can get some help from a professional counselor.  Cognitive behavioral therapy (CBT) is the most widely researched mode of psychotherapy and efficacious (that is scientist talk for “effective”), particularly when it comes to anxiety and depression.  But, what exactly is CBT?  Well, I am going to tell you, the way I understand it, and introduce you to my approach to cognitive behavioral therapy, what I call Body-Mind-Behavior Therapy or BMBT, for short.

BMBT is a cognitive behavioral approach, in that we focus on thoughts and behaviors, but is different to traditional CBT, in that with BMBT, we focus on changing the context of thought rather than the content. That might not make much sense right now, but I am going to explain it to you in simple English (not Chinese) and in “un-”scientific terms, but first we need to know how we got here . . . a little history perhaps.

Behavior therapy got its start in the 1920s and 1930s, but really took off in the 50s when Joseph Wolpe designed a method called systematic desensitization.  In the late 1950s and early 1960s, Albert Ellis and Aaron Beck began what we call cognitive therapy today, a therapy where negative automatic thoughts (aka NATS – like those annoying little buggers that swarm around your head on a hot summer day and drive you nuts, but spelled slightly differently) are analyzed, challenged, and tested. Because their methods contained behavioral elements as well (exposure, activity scheduling, and so on), the therapy has commonly become known as cognitive behavioral therapy or CBT for short.  In the 1980s, along came the "third wave" (as Steven Hayes and others have called it) of cognitive behavioral therapy.  Dr. Marsha Linehan developed a therapy called Dialectical Behavior Therapy (DBT) for the treatment of borderline personality disorder at the University of Washington and Steven Hayes developed what is now known as Acceptance and Commitment Therapy (ACT - pronounced like the word, not as an acronym) at the University of Nevada in Reno.  Both DBT and ACT incorporate "mindfulness" and "acceptance" into CBT, hence the tag "third wave" which has become associated with these evolutionary and revolutionary new treatments.  MBMT (BMBT??)incorporates the best of CBT, DBT, and ACT into a powerful, yet extremely simple package, a package that is deceptively basic and drastically different than anything you have ever tried before.  Are you getting excited yet?

Well, don’t get too excited just yet because here is the bad news. People in general, and Americans in particular, spend a lot of time (and money) being anxious and depressed.  According to the National Institute of Mental Health (NIMH), some 40 million American adults, 18 percent (nearly two (2) out of every ten (10) people), suffer from an anxiety disorder in any given year.  The anxiety disorders include specific phobias (like acrophobia – fear of heights – accounting for 8.7%), social anxiety disorder (fear of people and being evaluated – public speaking anxiety is an example - 6.8%), post-traumatic stress disorder (PTSD – a devastating disorder, resulting from a severe trauma – making up another 3.5%), generalized anxiety disorder (excessive worry - 3.1%), panic disorder (strong, urgent anxiety attacks that come out of the blue - 2.7%), obsessive-compulsive disorder (or OCD – hoarding, excessive checking, or fear of contamination are examples - 1%), and, finally, agoraphobia (fear of open spaces – more accurately, the fear of having a panic attack when away from home - often found with panic disorder -  coming in at .8%).  If that were not bad enough, another 9.5 percent of the U.S. population, age 18 and older, (nearly one out of every ten people), has a mood disorder, like depression or bi-polar disorder, in any given year according to the NIMH.  These disorders (illnesses, problems…pick a label) cost millions, if not billions, of dollars each year in therapy, visits to general practitioners, medications (can you say Zoloft?), and lost productivity, including missing work.

Now for the good news.  The anxiety and mood disorders we have been talking about can be treated quite effectively with CBT, DBT, ACT or, in this case, BMBT.  As a matter of fact, the vast majority (nine out of ten) of the "well-established" empirically supported treatments (according to the American Psychiatric Association) for the anxiety and mood disorders are cognitive-behavioral.  In simple terms, CBT works very well for many problems, anxiety and depression in particular.  Over the next several chapters, I will be describing BMBT in much more depth, taking a lot of the mystery out of psychotherapy and dispelling many of the myths that surround it.  If you have seen the show Obsessed on A&E, a show about OCD and CBT, you have a very rough, and I do mean very rough, idea of how cognitive-behavioral therapy works, at least for people with OCD.  I will now give you a brief glimpse of what is to come in upcoming chapters.

I will start by providing a historical overview of where cognitive behavioral therapy has been, and where it is going, looking at some of the philosophies and theories behind cognitive  behavioral therapy as it has evolved and how it exists today. I will briefly discuss B.F. Skinner, Albert Ellis, Aaron Beck, Marsha Linehan, Steven Hayes and the tremendous contributions these incredibly talented individuals have made over the past half-century as well as the theories behind their successes. It is important to know where you have been, at times, to have an idea of where you are going, and the people I mentioned, and their theories, are at the forefront of psychotherapy today. Notice I did not say “cognitive behavioral” psychotherapy, I said “psychotherapy” in general, because the cognitive behavioral therapies are the most studied, effective, and widely used of all therapies in existence.
I will then elaborate on mindfulness and acceptance, both of which are the key to successful treatment, particularly for anxiety.  Mindfulness has been integrated into cognitive behavioral therapy by asking clients to focus on the here-and-now, using techniques derived from Zen Buddhism.  Mindfulness is not a spiritual process in the sense that it is associated with any particular religion (as it is used in DBT, ACT, and BMBT anyway ???), it is a state of mind which allows the client to maintain contact with the present, allowing him or her to accept thoughts, memories, and emotions as they are, without judgment.  This is a powerful method of reducing anxiety and other painful psychological problems, and is something I strongly encourage my clients to try.  Personally, I find no conflict between mindfulness, acceptance, and my faith, but that is a judgment you will have to make for yourself.  Cognitive behavioral therapy can work quite well without the mindfulness component, but I believe you will be short-changing yourself if you ignore it. You can find a series of mindfulness exercises on the accompanying CD, along with several other resources we will be talking about later, making this an extremely user-friendly experience and complete package, one-stop shopping for your psyche, if you will.
Next is “dialectical” thinking, the cornerstone of Linehan’s DBT and a philosophy I embrace in BMBT.  The dialectical philosophy is too complex to explain here, but basically entails looking at things in terms of shades of “grey”, getting away from “black and white” or “dichotomous” (all or nothing) thinking many of us tend to gravitate toward.  The primary dialectic Linehan teaches is “acceptance versus change”, where the therapist accepts the client (and the client accepts her/himself) as he/she is in the here-and-now, validating any problems and struggles, while pushing him/herself to change for the better.  It is not the therapist that challenges thoughts or makes the decisions, it is you, the client (or reader), that makes the decisions, with expert assistance from a professional counselor, or in this case,  my book.

There are four primary factors involved in mental health (or mental disorders), factors that can become a “vicious cycle” when they get out of whack and left unattended. The four factors I am talking about are physiology (BODY -biochemical imbalances, diet, sleep, exercise), cognition (MIND – like those nasty, annoying NATS), behavior (BEHAVIOR - smoking, overeating, drinking), and affect (or emotions, a combination of BODY, MIND, and BEHAVIOR).  If any one of these domains becomes unstable, it can throw the whole system out of balance, resulting in anxiety, depression, or some other psychological problem. 

Figure 1
As a matter of fact, the logo on the front and back covers (Figure 1), which I created for my practice in Kansas City, includes the Greek letter "psi", representing psychology, and the circular blue arrows surrounding the symbol represent the physiological (BODY), cognitive (MIND), behavioral (BEHAVIOR), and emotional (BODY + MIND + BEHAVIOR) components of the human psyche.  As I alluded to earlier, those four components constantly interact to make you sad or anxious, a “vicious cycle”, or happy and serene, what I like to call a “precious cycle”.  I will address each of these factors separately, and in detail, so you understand how they can affect you and what you can do to help them work in harmony.

Life skills are skills that make it easier to navigate life, even when anxious or depressed, and are skills everyone can benefit from understanding and practicing.  We already mentioned one of them and that is mindfulness.  The others are distress tolerance (stuff you can do when things get rough), interpersonal effectiveness (how to get along with others and stand up for yourself at the same time), and emotional regulation (tools you can use to feel less stressed).  These really are very simple tools, but you will be surprised by how easy it is to forget how to use them when you are feeling stressed, anxious, or worried. I will explain how to recognize and use these tools, when appropriate, to help you be more effective in life and content in the present moment.

I will then address the biggest threat to mental health in general, and the crux of the anxiety disorders: avoidance.  Avoidance takes many forms, but some of the most common are smoking, overeating, excessive drinking, drug abuse, and sexual (and other) addictions (can you say video games???).  But are those not behaviors (you are probably asking yourself)?  Yes, they are behaviors, avoidant behaviors, because they help you avoid the things that are really bothering you, like those nasty NATs that are contributing to your anxiety and/or depression.  You can, and do, also avoid thoughts, physical sensations, emotions, and other “internal” behaviors.  In short, avoiding what you are afraid of, or find distressing is what causes and perpetuates anxiety (and depression). 

Now that we have a solid foundation, the real work begins! I will next take you through a series of steps (chapters) using experiential techniques and exercises while explaining the intent of those techniques and exercises in simple terms, something Steven Hayes would probably argue against doing, but that I believe is essential when dealing with intelligent, thoughtful human beings.

We will first review all of the things you have tried, to control anxiety over the years, but have obviously failed at, or you would not be reading this book. As I mentioned earlier, control is the problem, not the solution. It seems somewhat counterintuitive and it is, because, again, as I told you earlier, my approach is unlike anything else you have tried before. What you have been doing does not work, so how about taking a radically different approach? What some might call “thinking outside the box”.

We will then determine how you view yourself and offer some alternatives, giving you a solid foundation on which we can build a totally same you. Same? Not new? That is correct. There is nothing wrong with you, nothing broken. You have simply learned to think the way you do, the way that makes you anxious, and you can learn to think in a way that does not make you anxious.

Next, we will try some things that will give you a new perspective on anxiety and emotions. You will experience a new way of thinking about your thoughts, sensations, behaviors, and emotions, focusing on the context rather than the content, a deceptively complex, yet simple alternative to the way you have been doing it for so long.

The next step in the process will be to look very hard at your values.  Not the values you think you should have because your mother or partner wants you to be a certain way, but the values that are important to you.  To put it simply, those which would be important to you if you knew that nobody else would know what those values are.  Once you determine your true values, and I am not talking about hardware, setting specific goals based on those values and committed actions, is the obvious next step.  By having a clear guide, goals that are based on your values, and making a commitment to yourself (and others if you wish) to live your life every day in accordance with your values, you will find it much easier to face and conquer the fears which have become so debilitating and disabling.

In the final chapter, I will pull it all together, giving you step-by-step assistance in implementing this new way of living, along with some possible pitfalls, those things we therapists call “relapse prevention”.  I will also explain what a typical session and course of treatment might look like for those of you who decide to seek assistance from a trained professional. 

Body-Mind-Behavior Therapy and cognitive behavioral therapy are really very simple and straightforward, and all we as therapists do is teach you and coach you along until you know how to help yourself.  If you listen intently, are motivated to change and face your fears, and work collaboratively with your therapist, you too can live a long, happy, and fulfilling life. 

Finally, I will explain everything you ever wanted to know about psychotherapists, but were afraid to ask. Do you know the difference between a psychologist, a life coach, a licensed professional counselor, a spiritual healer, and a psychiatrist?  Well, if you do not know, and are planning on seeking treatment at some point, it could be the most important information you ever learned.  The differences are HUGE and the cost to you could be enormous, not only in terms of money thrown out the window, but in your emotional well-being as well. 

Are you ready to start your journey from avoidance to acceptance? Well hold onto your seat, because here we go....

Friday, August 19, 2016

The Stigma Killing American Heroes by C.T. Sorrentino

This article was originally published in De Oppresso Liber Magazine in January 2013 and is being republished here after recent publicized VA shortfalls to highlight the dilemma still facing our military and veterans ...


On average, one military member and 18 Veterans commit suicide each day, and post-traumatic stress disorder (PTSD) is a significant factor in many of those deaths. The negative stigma surrounding PTSD and military mental health treatment exist partly because the brave men and women who make up our military are hesitant to seek mental health treatment from military practitioners. Our young men and women in the military are returning from deployments having experienced horrifying events, either directly or as an observer. PTSD incidence is reported to be as high as 20 to 30 percent of our military returning from recent combat. Until military and civilian leaders understand the connection and impact the negative military mental health stigma has on our force's mental health and morale, these needless deaths will continue. The negative stigmas regarding PTSD and Veterans are perpetuated by the media. As long as these stigmas are perpetuated in the media, young heroes, our military and veteran men and women, will continue to die. We need a positive dialogue started in this country, educating the public, our elected officials, and military leaders, about the problems in military and Veteran mental health treatment and figure out a way to fix them soon! We also need leaders willing to give our men and women in uniform the confidentiality they need when seeking treatment for their problems, be it PTSD, depressions or anxiety. We need leaders who are going to do the right thing and end the negative stigmas against PTSD and seeking mental health treatment in the military … now, today, before one more American hero dies by their own hand!

By C.T. Sorrentino, LtCol, USAF (Ret) 
On average, one military member and 18 Veterans commit suicide each day, and post-traumatic stress disorder (PTSD) is a significant factor in many of those deaths. We as a nation waste billions on political campaigns, needless government spending, and personal luxuries each year, while many of our nation's heroes go jobless, homeless, and with inadequate mental health treatment, while almost 7,000 of them choose to end their lives ... that is correct, nearly 7,000 MILITARY AND VETERANS COMMIT SUICIDE EVERY YEAR!
Being a Veteran of multiple combat operations over my 20-year career in the Air Force and a licensed professional counselor, practicing psychotherapy and treating military, Veterans, and “civilians” (everybody else) with anxiety disorders, including PTSD, and depression for nearly 30 years, I have a unique insight into the military, combat, and the effects both can have on the human psyche. 
PTSD has been around as long as humans have been exposed to trauma, and as long as there has been war, having been called many things over the centuries, including exhaustion, railway spine, stress syndrome,  shell shock, battle fatigue, combat  fatigue, traumatic war neurosis, and, most recently, post-traumatic stress disorder or PTSD for short.  
Combat stress reactions appeared as early as the 6th century BC when the Greek historian Herodotus reported one of the first descriptions of a PTSD-like incident:
During the Battle of Marathon in 490 B.C., an Athenian soldier who had suffered no combat injuries, became permanently blind after witnessing the death of a fellow soldier.  
A more accurate diagnosis of this reaction would be “conversion disorder” rather than PTSD, but it is an indication of the dramatic impact a traumatic event can have on a human being nonetheless. 
Many people think only of combat when they think of PTSD, but there are many causes, traumatic experiences, that can lead to PTSD symptoms, including accidents, physical and sexual assault/abuse, terrorism, as well as many others.  According to Department of Veteran Affairs (VA) estimates, seventy percent of the population will experience a trauma extreme enough to qualify for a PTSD diagnosis over the lifespan.  Oddly enough, also according to the VA, only 6.8% of all Americans will develop PTSD during their lifetimes, or roughly 10% of those experiencing a trauma.  Recent Veterans of the Iraq and Afghanistan Wars, on the other hand, suffer an incidence rate of 13.8%, nearly twice that of the general population.
PTSD is a medical diagnosis as defined by the Diagnostic and Statistical Manual, 4th Edition, Text Revision (DSM-IV-TR, APA, 2000) and the symptoms of PTSD include 1) hyper-arousal (exaggerated startle response, difficulty sleeping or staying asleep); 2) avoidance (avoiding things previously enjoyed or that remind the individual of the trauma); and 3) re-experiencing (flashbacks, nightmares or night terrors, daydreaming about the trauma).  An individual must experience a trauma so severe that the individual experienced extreme fear, helplessness or horror and the threat of death or serious injury in addition to all of the three symptom areas listed above (more than one symptom are required for diagnosis in two of those areas) in order to be officially diagnosed by a licensed clinician with “PTSD”.
Ignorance and bureaucratic processes, having needed changing for decades, if not centuries, are the cause of this stigma killing our young American heroes.  A stigma, because the brave men and women who make up our military are hesitant to seek mental health treatment from military practitioners.  They are hesitant and afraid, and rightly so, because their careers and/or security clearances could be at stake if they seek treatment from a military provider. 
I served in the Air Force for over 20 years, retiring in 2005 as a lieutenant colonel, and experienced the stigma firsthand. I would not and did not seek help for post-deployment anxiety and depression until AFTER I pinned-on my silver oak leaf and knew I would be retiring (meaning "they" could not hurt me). I spent four years in four different combat zones during my career, including "boots on the ground" in the Middle East one month before 9/11 and during the first year of Operation ENDURING FREEDOM, and the stresses of combat took their toll, although not enough to receive a PTSD diagnosis, thankfully.
I recently returned from Fort Riley, Kansas, home of the 1st Infantry Division, better known as "The Big Red One", where I provided counseling to soldiers returning from Afghanistan and Iraq. Two of the battalions I worked with suffered high numbers of casualties, with several killed in action (KIA) and many more wounded in action (WIA). Dozens of brave young men and women received purple hearts, having lost limbs and suffering other wounds, many invisible to the naked eye.
Not all wounds are visible, with traumatic brain injury (TBI) and Post-Traumatic Stress Disorder (PTSD) making up the majority of injuries to those returning home, many times caused or hastened by experiencing the effects of an improvised explosive device (IED), the current weapon of choice of Taliban and Al Qaeda terrorists. When a young man loses his leg, he is considered a hero, and rightly so. But when a man or woman "loses his or her mind", either through physical damage to the brain, as is the case in TBI, or emotional damage, as we see in those who have experienced severe trauma in combat, those coming home with PTSD, they are portrayed as weak or as malingerers by their comrades, or worse, the officers responsible for their health, safety, and well-being.
Looking down on or thinking less of those who seek help for mental health issues has been a problem in the military for centuries, but is also a problem in our modern, technologically advanced, contemporary culture here in the United States and elsewhere.  Ignorance in regard to psychotherapy and counseling is nothing new, and few people are enlightened enough to understand that it is a sign of strength, not weakness, to seek help or treatment from a qualified, licensed clinician, be it a psychologist, psychiatrist, licensed professional counselor, or licensed social worker. 
Unfortunately, there are many unqualified and unscrupulous individuals taking advantage of people weakened by emotional stress and the turmoil of modern life, and they have given psychotherapy a bad name. Therefore, it is no wonder that an uneducated and psychotherapy-ignorant public, so desperately in need of professional treatment, misunderstand and fear the many highly qualified, licensed, certified clinicians, helping and saving lives every day. 
Our young men and women in the military are returning from deployments having experienced horrifying events, either directly or as an observer. There are estimates that as many as 50 percent of those returning from combat come home suffering from a mental health issue of one kind or another. PTSD incidence is reported to be as high as 20 to 30 percent of our military returning from recent combat. Yet many, if not most, do not seek treatment because they are afraid that doing so will damage their careers.
I have seen it firsthand in my own career, in my private practice and non-profit, and with soldiers recently returning from Iraq and Afghanistan. Their leaders, who can be squad and platoon leaders (enlisted) or company, battalion, brigade, and division commanders (officers), do not understand the devastation TBI and PTSD can cause in a person's life. Many of these individuals, both the so-called leaders and the individual suffering from a mental health issue, simply refuse to acknowledge the pain and suffering, maintaining the ridiculous macho bravado and reputation of a "real soldier" or "real man" who does not ask for help. These young men and women may even have a caring and compassionate chain-of-command currently, but do not know whether the beliefs and attitudes of their "next" unit's leadership will be as flexible and understanding.  
Because mental (behavioral) health treatment in the military is not confidential and becomes a permanent part of an individual's medical record, any psychological treatment received, becomes a matter of record for future leaders to hold against an individual or a reason to deny a coveted security clearance. It is no wonder young soldiers, airmen, sailors, and Marines are afraid to step forward for treatment, and no wonder that suicide rates among military members has skyrocketed.
Until military and civilian leaders understand the connection and impact the negative military mental health stigma has on our force's mental health and morale, these needless deaths will continue. When you are anxious, depressed, sleep-deprived, and suicidal with nowhere to turn, the options are limited, particularly when you are a brave, skilled marksman with easy access to lethal weapons.
There is no reason military members cannot have the same rights and protections as the average citizen when it comes to confidentiality in psychotherapy. What does the military have to gain except complete, 100 percent control over their people, by allowing confidential communications between therapist and client in the military? The same restrictions which apply to confidentiality in the private sector could also apply in the military: danger to self or others; child, spouse, elder abuse; and criminal behavior would still need to be reported. Threats to National security and good order and discipline are two military-specific areas that may need to be added to those limits of confidentiality, and I do not believe anyone would argue against that.  Nevertheless, military members would then know that anything else they say would remain confidential, allowing them to open-up, develop a trusting relationship with their therapist, and get the help they so desperately need and deserve.
The Joint Chiefs of Staff (JCS), Service Secretaries, Secretary of Defense, and President of the United States are going to have to "do the right thing" and end the negative stigma associated with military mental health care by allowing the limited confidentiality described above to be implemented across the military. It will take several years for our military men and women to trust the system and routinely seek treatment for the problems caused by the rigors and stress of military service, but WE MUST START SOMEWHERE, WE MUST START TODAY! Our American heroes deserve no less!
The negative stigmas regarding PTSD and Veterans are perpetuated by the media. The film, television, and print (hardcopy and online) industries are at least partial contributors to Veteran joblessness, homelessness, and, ultimately, suicide. With unemployment rates for Veterans hovering at least five percent higher than non-Veterans, we must ask ourselves why.
Because non-Veterans, not having had the opportunity to serve in the military, do not understand the our culture, and rightfully so.  What they also do not understand is that the trash the media is spewing about Veterans and Veterans with PTSD or TBI is that we are dangerous!  Veterans, particularly those with PTSD, are regularly portrayed in films, television series, TV news, magazines, newspapers, and blogs as being aggressive and threatening at the very least and homicidal maniacs on the other end of the continuum.  Veterans “are nuts” and about to blow our corks at the drop of a hat and go off on innocent civilians, possibly whipping out an automatic weapon and killing dozens, as was the case in the spring of 2012 when an Army Staff Sergeant killed 17 Afghanis after multiple deployments, TBI, and PTSD, having seen his buddy’s leg blown off just the day before.
Recently having read an article entitled: "IS GETTING HELP A CAREER KILLER?" in a large weekly military magazine, I noticed that in a little more than one page, the author managed to hinder any progress we have made in recent years toward reducing the negative stigma.  The article highlighted why airmen and other military members need to be afraid, very afraid, of seeking mental health treatment, or even worse, talking about it! 
The article’s author wrote about an Air Force NCO (non-commissioned officer) who had sought help for alcohol abuse and depression, and educated other airmen, telling them about his battle with alcohol (which he is currently winning, by the way) and other mental health issues. His supervisor, an obvious Neanderthal, virtually ended this airman's career by making statements about his alcoholism in his enlisted performance report (EPR) and marked his rating down, both career-ending behaviors. The NCO in question, a master sergeant (E-7), appealed his "referral" EPR to his superiors and the Inspector General, but was unsuccessful. Not surprising and not promoted!
Most everyone in the Air Force, Army, Navy, and Marines have heard plenty of horror stories like the one described above and now have one more...a page and a half's worth in national weekly military publication.  As long as these stigmas are perpetuated in the media, young heroes, our military and veteran men and women, will continue to die. For the first time in recorded history, more people are dying by suicide in the military than are being killed in combat! 
The space taken up by that particular article could have been better utilized by providing accurate information about the PTSD and the associated stigma(s), identifying what the implications of the stigma(s) are (e.g. suicides), and analyzing realistic proposals regarding what we can do about them. We need a positive dialogue started in this country, educating the public, our elected officials, and military leaders, about the problems in military and Veteran mental health treatment and figure out a way to fix them...soon!
The stigma surrounding Veterans has affected my own life as well. Having had a disappointing experience in the private sector, I returned to a local state university on the Post-9/11 GI Bill to become a school counselor. After 4 semesters and 27 units completed with a 4.0 GPA, being inducted into the Phi Kappa Phi National Honor Society in April 2011, I was called into a meeting with my advisor, a woman of color I had only met on three other occasions.  I thought that she was going to congratulate me on my honor, but that could not have been further from the truth.
When I entered the room for the meeting, my advisor was seated with another professor I had never seen before.  The mood in the room and the tone of the conversation quickly enlightened me that I was not there for a “pat on the back”.  My advisor stated that she felt that I was “aggressive and threatening” and that if it “didn’t stop”, my “status in the program would be in jeopardy”.  Having always treated fellow students, professors, and administrators with nothing but dignity and respect, I was flabbergasted!  I asked her for some concrete examples of my “aggressive and threatening behavior”, but all she could come-up with was “it’s a perception, that’s all, a perception”.
After the meeting, I filed a complaint with the university’s Office of Affirmative Action based on the fact that she threatened my status in the program based on a false “perception” of me being “aggressive and threatening”.  All Veterans, anyone who would fight for their country and sometimes have to kill our enemies, must be “aggressive and threatening”, right?  I filed the complaint in May 2011 and the Head of the Office of Affirmative Action only harassed and insulted me, accusing me of being bigoted and racist!  The Deputy Chancellor for Diversity then refused to investigate my complaint.  I filed an appeal with the President of the University of Missouri in August 2011 and was immediately promised a response from “general counsel”, but I still have not received that response.  Because of the aggressive, threatening, and intimidating environment that was created, I have not returned to complete the three courses required to complete my Educational Specialist (EdS) degree and become licensed as a school counselor.
When will all of this insanity stop?  When will the population, our elected officials, government agencies, even our very own Departments of Defense and Veterans Affairs and military comrades, end these negative stigmas?  Stigmas against Veterans in general, and those unfortunate enough to return with PTSD and other debilitating mental health conditions, must be addressed now!
The answer to many of our problems, including how we perceive and treat PTSD, is to clarify our core values, then act on them. It sounds extremely simple, and it is. The primary problem with our world, nation, military, and selves is an alienation from our core values or not having defined any in the first place.  It appears as though people, in general, have become extremely self-centered in recent time. It seems to be all about ME...ME...ME…how is this or that going to affect me?  Guess what folks, there are other people in the world and last time I checked, the world did not revolve around any single person or group.  
Values are signposts, directions, not something that can be attained like a goal. Without values, you cannot form goals and if you have neither values nor goals, how can you possibly act in any other way than impulsively...selfishly?  Therein lies the problem.  With no values, no direction, people will react emotionally when confronted with a situation, and because self-preservation is an innate human condition, that reaction will normally be of a selfish nature.
We must clearly define and understand our values if we are going to succeed as a human race. Our men and women in uniform must memorize their service’s Core Values, which, in the Air Force, are: 1) Integrity; 2) Excellence; and 3) Service before self, but do they really understand what they mean as they apply to behavior, to combat? If you clearly understand what your core values are, when confronted with a situation, difficult or otherwise, you can confidently act in accordance with those values, without even thinking...REACTION! Know your values cold, react appropriately and selflessly when required.  Values lie at the core of my therapy for PTSD and other mental health problems, and this is a cursory explanation at best, so I will go on to discuss the processes in-depth in future articles about my proprietary treatment to anxiety, including PTSD, depression, and other problems: Body-Mind-Behavior Therapy (BMBT).
Our world, our society, and our military are in the state they are in because we have no direction, no values, and no real leaders leading us, teaching us, or acting as role models, mentors, for positive core values. Our leaders are perpetuating the negative stigmas I have been discussing here because many continue to reinforce and condone them, doing nothing about them.  It should be rather obvious, but people comfortable seeking and receiving mental health care are far less likely to resort to suicide than those who are chastised and ridiculed for doing so. 
The Army recently threw $1.5 million at a study to determine how to reduce the suicide rate in the military.  We do not need to waste millions on research to know how to stop suicide or end these harmful stigmas, we need leaders who are going to stand-up and say “enough is enough!”  We need leaders who will give our men and women in uniform the confidentiality they need when seeking treatment for their problems.  We need leaders who will not condone the harassment and peer pressure keeping our men and women in uniform from seeking the mental health treatment they so desperately need and deserve.  We need leaders who are going to do the right thing and end the negative stigmas against PTSD and seeking mental health treatment in the military … now, today, before one more American hero dies by his or her own hand! 

Key Words: anxiety, depression, disorder, help4vetsptsd, hero, heroes, killing, leaders, media, military, post-traumatic, ptsd, stigma, stigmas, stress, suicide, values, veterans, vets

Copyright 2011-2016 - 3rd Wave Publishing and CombatCounselor - All Rights Reserved

Wednesday, August 17, 2016

CombatCounselor's Thought of the Day

I saw a beautiful butterfly, then became one, spreading my wings, taking flight. Fear is my friend, not my enemy. The sky is the limit. 

© 2016 - C.T. Sorrentino and 3rd Wave Media Group, LLC - All Rights Reserved

Monday, August 15, 2016

CombatCounselor Describes War-Induced Stress On Kansas City TV Station KMBC

An experienced combat veteran, retired Air Force lieutenant colonel, and expert in working with military and veterans with post-traumatic stress disorder (PTSD), Chris Sorrentino, a licensed professional counselor, Executive Director of Kansas City Cognitive-Behavioral Therapy, and President of Help4VetsPTSD, a non-profit dedicated to military and veterans with PTSD, discusses combat stress with ABC News affiliate:

Sorrentino went on to describe his sorrow for the families of the 16 Afghanis allegedly killed by a US solider and for the soldier's family.  "My heart and prayers go out to the families of the victims, the soldier, and the Afghani people for their unimaginable losses" Sorrentino told Maria Antonia via Skype this afternoon.  LtCol Sorrentino happened to be out of the area at the time, working with re-deploying soldiers at an undisclosed location.

"The military is a microcosm of American society", Sorrentino added, stating: "and the extremely unfortunate events that occurred in Panjwai district, a rural suburb of Kandahar and a traditional Taliban stronghold, are not at all indicative of the behavior of our brave, dedicated, selfless military personnel and should be considered an isolated event". Our deployed military are heroes and this incident should not reflect negatively on them in any way.  It is understandable and warranted for the Afghan people to be horrified and upset about the attack, just as many American are, and justice will be served as the soldier's fate is determined in a court of law.

The facts have yet to be determined, but Sorrentino concluded "the negative stigma attached to mental health treatment in the military has existed for decades and will not, unfortunately, end anytime soon".  "If the attacks were related to combat-related stress or other psychological issues, an environment more conducive to military members seeking treatment, rather than fearing reprisal or loss of a security clearance, could have potentially mitigated this threat ".  LtCol Sorrentino asked President Obama to "end the negative stigma associated with military mental health care" in a question and answer session after January's State of the Union Address.  Unfortunately, Obama ignored Colonel Sorrentino's pleas and failed to respond to his question.

Title: CombatCounselor Describes War-Induced Stress On Kansas City TV Station KMBC

Key Words:  KMBC, TV, Kansas City, MO, MIsouri, combatcounselor, combat, counselor, war, induced, stress, PTSD. PTS, trauma, disorder, television, 

Social Dystrophy™: Are Technology or Values to Blame?

Would "Social Dystrophy" be an appropriate term for the lack of social skills endemic in today's population? I came up with the term “social dystrophy” while exercising at the YMCA last week, having experienced more then the usual number of rude and obnoxious people that day. I cannot take credit for coining it because somebody already created a website,, having apparently had similar experiences with humans.

According to, “dystrophy” can be defined as “faulty or inadequate development” faulty or inadequate nutrition or development”. Dystrophy would then imply that there were some social skills in the first place, which may not necessarily be the case and may eliminate the term as an appropriate label for what we are experiencing. I may be generalizing, and I know there are many pitfalls in that and there are many socially adept people out there, young and old, but the problem seems to be getting worse and worse with the advent of new communication technologies (being invented almost daily). Let me elaborate and provide some poignant examples as well as potential solutions.

I was at the market the other day looking for my rewards card before placing my items on the conveyor (there was no line when I arrived and few customers in sight). Before I had a chance to hand my card to the cashier, some middle aged guy rushes up and starts putting his shopping items on the conveyor. As they whizzed past me on their way to the cashier, I looked back and politely asked "would it be OK if I continued to put my items on the conveyor and finish checkout?" while the cashier looked on in dismay. The man, who was accompanied by his teenage son, glared at me defiantly and stated "I didn't turn the conveyor on!" Really? Is that an answer or any kind of excuse for being rude and in such a hurry that you cannot wait until I complete a simple task? Dumbfounded by his ridiculous answer, I politely asked if he would remove his things so I could continue with my shopping, but his reply cannot can be repeated here, cursing and insisting that I was being rude simply because I wanted to continue my shopping without having to move his out of the way. Let me just say that the situation deteriorated from there with the man using profanity and insulting my character…what an excellent role model for his teenage son!

Then there are the people at the gym who turn the fans around the cardiovascular equipment on without bothering to ask the people who have been there for some time, and do not like the fan blowing on us, if we would mind if they “turned the fan on”. How difficult would it be to say, “excuse me, can I turn this on? Too difficult, obviously, for a social misfit who does not care about anybody but him or herself or does not have the social skills or training to communicate with other humans.

Still at the gym, there are the people, usually young, who barge past us in the locker room on their way to a locker they just cannot live without. Many times there are areas of the locker room totally empty and available, but they NEED THAT locker, cannot wait a few minutes until we are done, or do not have the skills or inclination to say "excuse me". Is that really so difficult?

Then there is the guy in his BMW that lays on his horn when I have the nerve to continue in the lane that I was traveling in after leaving a stop light. If he had not been too busy talking on his cellphone, he would have been cognizant of which lane was his and where he should have been driving. Instead, he thinks I am the moron when in fact he should have been ticketed for an illegal lane change, aggressive driving, and disturbing the peace.

I could go on and on and experience numerous instances like those above DAILY! Really? Daily? Yes, DAILY! Well, why is this happening daily and why does it seem to be getting worse as time goes on? In this reporter’s opinion, technology and a lack of clear core values are at the root of the problem.

Technology has grown so quickly and become so engrained in our culture, our lives, that we “think” we cannot live without it. How many times have you seen a car swerving all over the road, only to catch up to the driver and find them chatting or texting on their cellphone? If you live in any metropolitan area, or anywhere else for that matter, you see it all the time. Everywhere you go people young and old are talking on the phone or texting their friends about some inane subject, completely oblivious to what is happening around them or considering what affect their behavior may have on others. They simply do not care! It has gotten to such an extreme that people are texting the person standing next to them or in the same room! C’mon folks, is it really that demanding or difficult to look someone in the eye, open your mouth, and emit the words it takes so long to “thumb” on your smartphone (a misnomer).

The ability of humans to communicate is slowly deteriorating because of technology. Whether it is cellphones or computers, the internet or email, laptops or iPads – you name it – technology has made us (yes, I am not immune) not only more productive, but lazy! Before cellphones, computers, and the internet became commonplace, which was not all that long ago, people waited until they returned home to call a friend or even write a letter which may have taken several days to arrive once posted, and everybody seemed to be a lot happier, a lot less stressed than we are today. If technology and human behavior continue at this pace, the ability to communicate verbally, face to face, making eye contact and the whole shebang, is going to become a thing of the past. It is quickly becoming clear, particularly in the younger generations who have grown up with these technologies, that human communication is deteriorating rapidly and we should all be very concerned about that dilemma.

Finally, I believe it is a loss of focus on or undefined core values that can account for much of the self-centered behavior we see daily. The world in general and our country specifically, politically, corporately and personally, has lost touch with what is important to us – our values. I see it day in and day out in my practice, when I ask a client to tell me what they value, they look at me like I have a penis growing out of my forehead. “My values? What do you mean exactly?” When I explain what values are, they routinely come up with “my family” or “my job”, still not quite grasping the concept.

Values, according to Encarta Dictionary, are “the accepted principles or standards of a person or group”. They define what we are about and, if clear and well defined, help us act in a moral, ethical, or legal way when presented with novel or familiar situations. That sounds pretty important! But few people can tell me what their values are and that is pretty scary. It is no wonder that people are running around thinking of little but themselves when they have no moral, ethical, or legal map to help get where they are going. That is why the world and our nation are in crisis, financial and otherwise, at this moment and it is also why people do not care about anybody but themselves.

Put down the phone, clarify your values (what is important to you), look people in the eye when you speak to them, treat people with dignity and respect, and act on your values...even if you are having a bad day, or are anxious or selfless, not selfish and the world will be a better place to live.

More on values in a future post…

Key Words: social, dystrophy, values, value, core, inept, incompetent, CombatCounselor, combat, counselor, psychology, therapy, CBT, ignorant, ignorance, SocialDystrophy, technology, phone, text

Friday, February 26, 2016


                                                                         December 27, 2012
Dear Governor Nixon,

How could you ignore my pleas for help after the University of Missouri-Kansas City REFUSED to investigate my legitimate complaints of attack, harassment, discrimination, and retaliation?  How can a state institution disobey the law and not be held accountable? President Owens promised me an answer to my appeal in August of last year and I have only heard from the representative of the new president recently after filing an appeal with the US Department of Education.
I am a disabled Vet and refuse to return to the hostile and intimidating environment, and the program in which I have a 4.0 GPA, nominated by UMKC and inducted into the Phi Kappa Phi National Honor Society for excellence in education and outstanding citizenship.

I am a retired military officer and cannot believe that UMKC and MU ARE NOT HELD ACCOUNTABLE for their immoral, unethical, illegal behavior! You, Senators McCaskill and Blunt, the Missouri Department of Higher Education, Missouri Attorney General, the media, and dozens of lawyers, including the ACLU have ignored me...why? How can a public institution refuse to investigate legitimate complaints, ruining a Veteran's career in school counseling and wasting 2 years of my life and GI Bill eligibility...2 years, over $39,000 in VA and personal funds, and a salary of $48,000 a year!
If I did not have a case, the university would have told me to shut-up and get lost long ago, so instead they do not say a word, hoping that I will go away.

Initiation of the statute of limitations (180 days) has not begun because I was promised an answer from President Owens and still have not received it...which is further retaliation!

Do the right thing Jay ... GROW A PAIR and stand-up for and protect a constituent. Being white and male, nobody gives a crap about me, including lawyers who told me "sorry, there is not enough in it for me", turning me away even though they admit I have an excellent case and only because they are greedy bastards.

There must be one person in this state, this nation, with the integrity to DO THE RIGHT THING and help me get justice...holding THE UNIVERSITY OF MISSOURI ACCOUNTABLE FOR THEIR ACTIONS! Is that too much to ask Jay? Have some integrity and hold my attackers and the University of Missouri accountable for their actions AND lack thereof.


Chris Sorrentino, LtCol, USAF (Ret)