The Link Between PTSD, Support, and Exercise in Military Veterans – Triathlete

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Photo: Getty Images, Heidi Carcella
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Kevin*, a 37-year-old former officer in the US Army, believes that training for triathlons saved his life not once, but twice. “I don’t remember thinking to myself, ‘Drinking is going to help me get to sleep tonight,’ but I was doing it every night anyway,” he said, reflecting on the months when he first began to experience symptoms of PTSD. He explained that drinking culture was just a part of life in the military and whiskey became the remedy of choice for his insomnia and nightmares. “If I hadn’t found swimming, biking, and running, I’d probably be pretty sick right now—if I was still alive.”
Triathlon came to his rescue a second time as he has transitioned out of military service and into civilian life, all while struggling with his mental health as a result of past trauma. He has stayed away from relationships and isn’t close to his family, but training feels like something to cling to. “I can maybe keep going if I have this,” he said over a Zoom call, gesturing to the triathlon bike hanging on a wall behind him. He has good days and bad days, he said, but never feels healed. When asked what would happen if he had to stop training, he could only shake his head.
The experience of trauma and PTSD is a pressing health concern for the entire U.S. population, but particularly in military veterans, where recent estimates of the prevalence of PTSD are as high as 20%. A meta-analysis of the physical health issues associated with PTSD published in the Journal of Anxiety Disorders notes that the symptoms and complications are wide-ranging, affecting every part of the body and mind as the brain struggles to adapt to stress and repeated memories of that stress.
The military has psychotherapeutic treatment services in place to support service members, but some vets have found that getting in daily exercise is one of the quickest and most effective ways of getting relief from PTSD symptoms like depression, anxiety, and insomnia. A recent literature review that summarized findings from research studies on the benefits of exercise for PTSD found that exercise had multiple benefits, including enhanced cognitive function, reduced reactivity to sensory stimuli, improved socialization, and reduced systemic inflammation. It’s clear that training helps, but is it enough?
Arielle Thibodeaux, a psychotherapist and US Army veteran, acknowledges that certain aspects of triathlon training feel especially comfortable for military service members, like adhering to a schedule, being goal-oriented, and pushing hard physically. “People get really attracted to these types of things because it’s such a similar experience. It can be good for them to mimic that.” However, she also explains that vets tend to turn that focus on a goal into tunnel vision and rigidity. Moderation goes by the wayside as vets get into “mission mode” and convince themselves that they must meet the objective, no matter what. This mindset is taught from the first day of boot camp and can influence behavior even in civilian life. “Part of the Army ethos is ‘never accept defeat and never quit,’” she explains while holding up a dog tag stamped with the “Warrior Ethos” that she received during her first week of training. “It’s pretty hard to forget that.”
Daphne*, a Marine Corps veteran, was diagnosed with PTSD at the tail end of her deployment and began running half-marathons every day to control mounting anxiety. For a while, she believed that she’d found a cure because her post-run high made her feel optimistic and more in control. She put more and more pressure on herself to keep up the workouts, often extending runs as symptoms like anxiety, depression, and insomnia increased. “I was so excited to get back to the U.S., so I could add swimming and biking. I was determined to do a triathlon that summer because I wanted to turn the bad into something good.” Daphne had to stop training when she injured her hip and things went downhill quickly after that. Unable to work out or follow through on her triathlon goals, she fell apart. “Last year, I ended up having suicidal thoughts and I ended up hospitalized for a week. It was the lowest moment in my life.”
This situation may be more common than we think. Athlete-veterans like Daphne are more likely to have underlying physical injuries from the wear and tear of service that may eventually limit or completely inhibit their ability to train. A recent literature review in Military Medicine indicates that soldiers are routinely put through extreme physical and mental stress during training operations, therefore it may be harder for them to notice when they are hurt because they have been trained to ignore pain and other somatic sensations until the operation is complete. Worse, Thibodeaux says that service members tend to be quite hard on themselves when they do experience physical injury. 
“They have a hard time saying, ‘I have this knee injury, but that’s not who I am as a person nor does it mean anything about me.’ They tend to say, ‘I’m broken. I’m weak because I can’t do this thing anymore’. They see it as a personal failure.”
Arielle Thibodeaux advocates using a diversified treatment plan that does not rely on just training for management, “Having multiple things in your life to fill the cup and guide you through the healing process is helpful.” She hopes that psychotherapy is part of the plan, but notes that it may not be right for everyone. Other options can be meditation and mindfulness, Cognitive Behavioral Therapy (CBT), having a good support network of friends and family, connecting to veterans organizations, and seeking substance abuse support when necessary. Even having a basic understanding of overall health principles like good nutrition, hydration, and sleep hygiene can go a long way toward managing symptoms. In this way, the person is never left without resources, never forced to keep training when it’s unhealthy, and never left thinking that their sport is their survival.
For veterans who enjoy endurance sports, Thibodeaux believes that they can use their mission-based thought process to approach training in a way that will protect their mental health. “When there is a mission in the military, we work on different courses of action and try to mitigate risk. Veterans are not used to thinking this way about personal things, but when they get out of the military, their new mission is themselves.” Using this strategy, athletes can manage their expectations, even preparing for the highs and lows of training, a DNF, or other unfavorable outcomes. Instead of falling apart, using substances, or engaging in self-harm behaviors, the athlete can get prepared to use one of their alternative coping tools. 
It’s important to remember that there is no way to tell how well a person is managing mental illness just by looking at them. Just because someone “looks” like a healthy athlete or a strong soldier doesn’t mean that they are not struggling internally. Thibodeaux says that whether or not the person is able to participate in triathlon training, they may still experience debilitating symptoms. She suggests watching out for red flags like irritability, nightmares, poor sleep, increased alcohol intake, and suicidal ideation. When these behaviors creep in, it may be time to ask for help. In their new mission for wellbeing, it may be the most courageous thing a veteran can do. 
*Names have been changed to protect privacy.
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