PTSD: Reclaiming Control By: Robert ‘Bob’ Cuyler, PhD Psychologist and Trauma Expert
Iran Conflict Continued
The past five years has brought the world conflicts with massive civilian impact in Gaza/ Israel, Ukraine, and Iran, not to mention other counties like Sudan, Ethiopia, and Nigeria which receive less notice. A quick scan of Youtube uncovers coverage of raw video of civilian casualties, sometimes factual and sometimes political in nature.
Last month we addressed the some of the consequences of the current campaign, so this month we’ll expand. At this writing, we do not have boots on the ground and our casualties, while tragic, are thankfully limited given the scope of the engagement. First, the concept of delayed onset PTSD. I first became aware of this early in my career working with elderly veterans. The coverage of a number of 50-year anniversaries (D-Day, Hiroshima, Battle of the Bulge, and others) had surprising impact on these men, many of whom had functioned very well throughout their adulthood. As the concept of PTSD was not in place at conclusion of their service, it was unclear how many of these gentlemen would have qualified for a diagnosis at the time. What was clear that media coverage of these events was triggering, particularly in the form of nightmares. What we know now about delayed onset PTSD is that prior exposure to traumatic events can set the stage for the onset of full PTSD. One way of thinking about this is that neurobiological changes in response to trauma can set the stage for delayed reactions. Risk factors like social isolation, family or work stress, economic uncertainty can bring individuals ‘to the brink’ of key PTSD symptoms such as nightmares and hypervigilance, only to be pushed over the edge by current event triggers like the Iran conflict. Next, the impact on civilians. It’s too easy to think of military trauma exposure as confined to combat between formal adversaries, our soldiers against theirs. The changing nature of war since WWII has increasingly involved asymmetric warfare, with unclear battle lines, military targets intermingled with civilians (think Gaza), and deliberate targeting of civilians and civilian infrastructure (think Ukraine). Prior exposure to such conditions (think Iraq and Afghanistan) can push veterans to the brink, both for those whose PTSD symptoms are either improved or intermittent and for those who made transition to post-service life without overt symptoms. 30
SanDiegoVeteransMagazine.com / May 2026
Veterans who encountered significant civilian casualties during their service often have components of moral injury, which has been defined as experiences that violate or disrupt one’s concept of right and wrong. Moral injury often overlaps and complicates the symptoms of PTSD. In our era of social media overload, seeking information about the Iran conflict can trigger the algorithms pushing constant triggering content. What to do? Take a break from the news cycle. Find positive involvement with family, friends and community, which can serve as reminder of the good that remains in our troubled world. Seek help, no matter now long ago a trauma exposure occurred, if your nightmares, irritability, or hypervigilance start to take over. We can all pray for an end to this conflict that will leave the earth a more peaceful and secure place.
Dr. Cuyler is chief clinical officer of Freespira, an FDA-cleared non-medication treatment that helps people with panic and PTSD manage their symptoms by learning how to regulate their breathing. www.freespira.com