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Recognizing the “Invisible Wounds”

Male military service memberIt's estimated that one in three veterans returning from the Iraq and Afghanistan conflicts will experience combat–stress (also known as Post Traumatic Stress) or a Traumatic Brain Injury (TBI). The signature, "invisible wounds" of these wars are complex and many of the symptoms are the same.

The Home Base Program has a team of clinicians who are skilled, compassionate and experienced with the complexities of diagnosing and successfully treating these "invisible wounds" or war.

Combat and Deployment-related Stress

Coming home is challenging for every service member, veteran—and family member. Research shows that the repeated deployments of the past ten years have made all military service members more vulnerable to combat stress. So you are not alone. Most people return from war, and with time and support from family and friends, readjust. But everyone is different. How do you know when things are going in the wrong direction, and when you or someone you care about needs some help?

Watch this video of two Iraq War veterans, Home Base Veteran Outreach Coordinator, Nicholas Dutter, and Bunker Hill Community College student, Bill Peters, talk about making a decision to get help for combat stress. Combat stress, post traumatic stress, or PTSD. No matter what you call it, it is your body’s normal reaction to a terrifying, troubling or traumatic physical or emotional event.

Sleeping Difficulties Are Extremely Common

If you were deployed to Iraq or Afghanistan or another war theater, you learned to get by on very little sleep, and always remain alert. When you come home, you may have trouble falling asleep or have your sleep interrupted by nightmares. During the day, some people experience disturbing flash backs of a traumatic event as if it were happening in real time. If you or a loved one is still having sleep trouble after being home for a few months, that is a sign you may need help.

Thoughts and Emotions Can Feel Overwhelming

You may feel as if you are always on alert, jumpy and easily startled. You may have difficulty concentrating at school or at work. You might start to avoid crowds, public places, even family gatherings or any situation that makes you feel anxious. You may be anxious, irritable or quick tempered with family or friends. Some people get angry or very impatient with family members over little things like decision-making. After all, when you are in combat, decisions are made quickly without discussion. It’s a big adjustment to stay calm when your teenager is arguing about using the car or your six-year old is refusing to brush his teeth before school.

Intense feelings of guilt or fear are common—but so is the opposite extreme. You may feel numb, and find that it's hard to trust others, or enjoy all the people and life activities you once did.

Take Our Online Self-Assessment

To see if you or someone you love has symptoms of combat or deployment-related stress, take our short self- assessment.

Treatment Works

First brought to public attention by war veterans and once referred to as "shell shock" or "battle fatigue,” combat and deployment-related stress is nothing new. Hundreds of thousands of service members and veterans struggle with the stigma associated with seeking help for the emotional stress and trauma of their battlefield experiences.

Psychological anxiety and distress may not be as obvious as the physical wounds of war, but the “invisible wounds of war” are just as painful and deep. The good news is, treatment works, and it will dramatically improve the quality of your life. People recover—especially if they get help early. The Red Sox Foundation and Massachusetts General Hospital Home Base Program is fortunate to have a team of clinicians who are skilled, compassionate and experienced with the complexities of diagnosing and successfully treating these "invisible wounds" of war.

To schedule a confidential appointment at the Home Base Clinic for further evaluation, contact us at 617-724-5202 or

Are you in crisis? If you or a family member is in crisis or facing an emergency, go to the nearest emergency room or call the Veterans Crisis Line at 1-800-273-TALK (8255).

Virtual Reality Exposure Therapy at Home Base

virtual reality therapyHome Base began offering Virtual Reality Exposure (VRE) therapy as a treatment option for Iraq and Afghanistan veterans at the Home Base outpatient clinic in Boston in May 2013. This tool is available for veterans receiving Prolonged Exposure (PE) therapy, a well established evidence-based cognitive behavioral therapy for PTSD. Home Base is at the cutting edge of integrating VRE therapy directly into clinical care options for veterans diagnosed with PTSD. This is another effort to remove barriers to care for veterans.

Avoidance is a core symptom of PTSD and, as a result, some veterans may not recall painful or emotional memories. VRE therapy works by helping the veteran call forth traumatic memories, a critical component of PE. The clinician programs the virtual environment (including sights, sounds, and smells) to resemble the context in which the trauma occurred in order to enhance memory of traumatic events in the course of treatment.

Home Base has a designated VRE therapy room at the outpatient clinic for veteran patients and their doctor. Through a fitted head-mounted display (including view screen and headset), the veteran can experience a 3D digital world capable of mimicking vehicle rumble sounds, the smell of burning trash and explosives, the concussion of IEDs, a cityscape with narrow streets and alleys, and the inside of a humvee. The veteran may also carry a plastic, life-like military rifle that is connected to the computer. 

VRE therapy is a treatment approach used to treat posttraumatic stress disorder (PTSD). VR technology for clinical use and VRE therapy have been in existence since the 1990s and have been applied to a variety of anxiety disorders. It has demonstrated success in treating PTSD symptoms in some patients and has become a standard accepted treatment by the Anxiety and Depression Association of America.

Did you know?

  • VRE therapy is safe. In VRE therapy, the clinician is always present for the full session, guiding the veteran through different scenarios tailored to his or her personal trauma. The clinician has the ability to work with the veteran throughout the treatment, with sensitivity to the veteran’s reactions and can adjust the experience to reduce or increase its intensity in a therapeutic manner.

  • A team of Home Base clinicians is trained to offer VRE therapy. Home Base clinicians were trained by Barbara Rothbaum, PhD, a professor in the Department of Psychiatry and Behavioral Sciences and director of the Trauma and Anxiety Recovery Program at Emory University School of Medicine.

  • Not all veterans treated at Home Base receive VRE therapy. Home Base clinicians decide who is appropriate based on careful assessment and patient preference. 
Read an article on VRE therapy at Home Base featured in the Boston Globe.  

      Traumatic Brain Injury

      A Traumatic Brain Injury (TBI) occurs when a person has had a head injury or a concussion during military combat, and felt dazed, confused, had “their bell rung”, or been knocked unconscious. TBI is a complicated injury which can range from mild to severe. It can affect your thinking, memory, personality and emotions. It is an "invisible wound of war."  It is a physical injury to the brain caused by a sudden force. Watch this news story from WGBH which features the story of one Iraq veteran, our Veteran Outreach Coordinator Bob Davis and our Home Base TBI specialist Dr. Ross Zafonte.

      How is TBI caused?

      For military service members, a brain injury can result from the force associated with a blast or explosion. But that’s not all. TBIs can also be caused by falls, motor vehicle accidents, getting in a fight or being assaulted, or any sudden blow to the head. The force may cause the brain to jolt backward and forward, hitting the skull and causing damage to the internal lining, tissues and blood vessels of the brain. This damage can result in internal bleeding, bruising or swelling of the brain.

      How do I know if I have a TBI?

      Many of the signs of TBI and combat stress (Post Traumatic Stress) are the same, so the two conditions are hard to tell apart. These symptoms include:

      • Sleep disturbances
      • Headaches
      • Fatigue
      • Dizziness
      • Trouble with balance
      • Trouble concentrating

      TBI can range from mild to severe, depending on the cause of the injury. Most people who experience a mild TBI can recover completely with rest. Others who experience a severe TBI or multiple concussions will need medical treatment.  

      Any brain injury, whether it’s mild, moderate, or severe, can:

      • Temporarily or permanently weaken your physical abilities, including motor function
      • Impair your ability to think, concentrate, and reason clearly
      • Affect your memory
      • Affect your senses, including touch, taste and smell
      • Interfere with your emotions and behavior
      • Impede language and communication abilities

      What do I do if I have a TBI?

      It is important for you or anyone who may have a TBI to be evaluated by a clinician at the earliest possible opportunity.

      To schedule a confidential appointment for further evaluation at the Home Base Clinic, contact us at 617-724-5202 or

      Are you in crisis? If you or a family member is in crisis or facing an emergency, go to the nearest emergency room or call the Veterans Crisis Line at 1-800-273-TALK (8255).

      Home Base Senior Advisor General Fred Franks (ret), Dr. Ross Zafonte and Home Base Director Dr. John Parrish had the honor and privilege of accompanying General Peter Chiarelli, Vice Chief of Staff of the US Army and his team to Afghanistan

      Improving Care for TBI

      In July 2011, Home Base Honorary Board Member General (Ret) Frederick M. Franks, Jr., Dr. Ross Zafonte and Home Base Executive Director Dr. John Parrish had the honor and privilege of accompanying General (Ret) Peter Chiarelli, who was then Vice Chief of Staff of the US Army and his team to Afghanistan. They saw first–hand the extraordinary commitment under General Chiarelli’s leadership, that the military has made to identifying and treating the “invisible wounds of war”—post traumatic stress (PTSD) and traumatic brain injury (TBI)—in theatre.

      The team visited the Army’s Restoration and Recovery Centers, and saw that the Army is working to build a new culture of concussion awareness. Soldiers who have been knocked unconscious are screened for TBI, then spend a few days recovering and rebuilding from their concussion. The military has also made a massive effort to educate our troops about the "invisible wounds of war," and to reduce the stigma of seeking care. Service members are repeatedly told that combat stress symptoms are a normal reaction to abnormal circumstances. If the symptoms don’t go away, the responsible thing to do is get help. But, most important, they are told that people get better. No part of the Army message treats our soldiers as victims. It’s about protecting our valuable assets as a nation—and building hope.

      As our service members return home to their families, it is critical that the civilian community recognize that the "invisible wounds of war" are very real, and will be with our young service members and their families for a long time to come. Home Base is working to create a strong mental health safety net for our returning veterans and their families to serve those who have served and sacrificed for us.