The rocket attack happened when he was working out.

The gear soldiers usually wear to protect themselves in combat was stowed in his living quarters. Maj. Steve Herda and another North Dakota National Guard soldier received shrapnel wounds.

"My stuff was far enough away, there was no immediate way to get to it," he said. "The nearest first aid kit was 300 yards away."

He received shrapnel wounds to his lower left leg, left thigh and chin.

When he talks about the injury, it dredges up feelings that are hard to shake.

"I won't say I enjoy talking about it, but I feel free to relate my experience," Herda said. "I find after I'm done, I feel nervous."

The nervousness, anxiety and jitters are possibly because of post-traumatic stress disorder. The North Dakota National Guard and Medcenter One hosted a workshop on the disorder for clinical psychologists in the region this week.

The disorder occurs in some people after a traumatic event or a series of events that cause a high level of stress.

"Post-traumatic stress disorder symptoms are normal after experiencing something traumatic," Dr. Ann Rasmusson said. "Symptoms usually last six weeks to three months."

Rasmusson works for the Veterans Affairs as the medical director of the VA Post Traumatic Stress Disorder Center for the VAof Boston. She also is an associate professor at Boston University and a member of the National Center for PTSD. She led the training seminar at the Bohn Armory on Friday. She promoted a treatment plan that looks at changing the cognitive functions of the disorder.

For a smaller, but still large, segment of the population, the PTSD symptoms persist, she said. It can affect people who have been in combat, raped or assaulted, along with other traumatic or stressful events.

It took time and hindsight for Herda to realize he might be experiencing the disorder. His injury happened 14 months ago, but only in the last eight months has he started to realize he might be experiencing PTSD.

The symptoms can vary from person to person. Some people relive a traumatic event, while for others something triggers anxiety or anger.

Herda was at a British installation when it came under rocket attack. The personnel there followed British protocol to treat his injury. That meant assessment at a nearby hospital instead of evacuation to Germany.

It was difficult for him to be at the hospital in Iraq. He wanted to be with his fellow soldiers, and felt he let them down. After a week, he was transferred to Germany.

"At that time, there were more feelings of anxiety, because I was forced to leave my buddies," Herda said.

The injury sent him back to the United States. He went through recovery at Fort Carson in Colorado Springs, Colo. He didn't seek treatment for PTSD.

"In all fairness, I have to say no," he said. "My mindset was to get over it and go back."

There's been more of a need for psychologists to know how to treat someone with the disorder as more soldiers, like Herda, come back from Iraq and Afghanistan.

"The military tried to deny it for a long time," Rasmusson said. "Now, with the experience of Vietnam veterans, they're well aware of the problem."

Military culture also changed so that it was not punitive to the soldier to admit experiencing the disorder. Instead, soldiers are encouraged to seek out help so that they can resume their duties. The military has hired more psychologists to deal with the influx of people seeking treatment for PTSD. They also focused more on programs to help soldiers adjust to life outside the combat zone.

"… This workshop is the latest method we have employed," said Maj. Gen. David Sprynczynatyk, North Dakota National Guard adjutant general.

The North Dakota National Guard in Bismarck has three licensed social workers, a chaplain, a transition and re-entry coordinator and six outreach specialists to help returning soldiers and their families.

Herda was at Fort Carson for five months for rehabilitation. The first couple months he was back in the United States, he went through a re-entry program. While he spoke about his experience, he didn't seek out professional help in dealing with the emotional fallout. He has found other outlets.

"My brother is a psychiatrist," he said. "We talked many, many times."

He also spoke at a leadership symposium at the U.S. Air Force Academy about his experience, and when he returned to North Dakota, he visited the elementary class from South Dakota that adopted him while he was deployed.

"They had a lot of questions," Herda said about the class that sent him e-mails and letters.

He also receives help for coping with the post-traumatic stress through colleagues at work. He's the environmental officer for the joint force of the North Dakota National Guard. He has a work meeting every other week in which the chaplain attends. The chaplain always inquires how he's doing, Herda said.

The mindset of the Guard has changed to help its members with the disorder, Herda said. This shift in thought also is needed among the psychologists who treat the soldiers.

"Historically, it's been a debate if it's a chronic illness, but it's showing it's not," said Dr. Matt Doppler, a psychologist at Medcenter One. "So, that is encouraging."

It was once thought to be an untreatable disease. That's changed, with different treatment options.

"We're trying to get psychologists trained in the latest science-based treatment for PTSD," Doppler said.

It means there's hope that people with PTSD can be cured, so to speak., and no longer experience the symptoms. The approach is one that can be readily adapted to a psychologist's practice, he said.

Doppler and his colleagues who attended the workshop said they've seen more people with the disorder.

The approach Rasmusson taught at the seminar is one of two newer treatment methods for PTSD. Her's looks at changing though processes, while the other is prolonged exposure.

Rasmusson's approach is relatively quick. In 12 to 16 sessions, a person can be free of the symptoms, she said. More conventional treatment methods focus on coping skills, and in some cases medication to counteract symptoms, such as anxiety, insomnia or depression. Most of the sessions are an hour, but a few last longer.

Psychologists have the patient consider a series of questions, which gauges their perception compared to reality. For example, a person with the disorder may talk in absolutes, or start to feel the trauma-causing situation is more apt to happen that in reality.

Herda hopes he gets to a point he can talk about his experience without the anxiety, but he knows he might not.

"I have an uncle in Minot who is a World War II veteran," Herda said. "He doesn't talk about it. That's 60 years ago."

(Reach reporter Sara Kincaid at 250-8251 or sara.kincaid@bismarcktribune.com.)