Transcript of Military and Trauma Counseling: Treating the Mind, Body, and Spirit of Active Duty and Veterans Mark...
- Slide 1
- Slide 2
- Military and Trauma Counseling: Treating the Mind, Body, and
Spirit of Active Duty and Veterans Mark A. Stebnicki, Ph.D., LPC,
DCMHS, CRC, CCM Professor- Coordinator of Military and Trauma
Counseling Certificate Dept. of Addictions & Rehabilitation
East Carolina University stebnickim@ecu.edu
- Slide 3
- Military and Trauma Counseling Network
http://www.ecu.edu/cs-dhs/rehb/omtc.cfm
http://www.ecu.edu/cs-dhs/rehb/omtc.cfm Military and Trauma
Counseling on Facebook https://www.facebook.com/ECUMTCN
- Slide 4
- Military Statistics NC * North Carolina has deployed 50,886
troops to OIF/OEF since 9/11. * There are more than 750,000
veterans living in North Carolina. veterans living in North
Carolina. * There are 150,000 Active Duty North Carolina residents
Duty North Carolina residents * 35% of NC population comprise
Military * Bases: Fort Bragg; Camp Lejeune; Camp Geyger, New River
Air Station, Cherry Point, Seymour Johnson Dept. of Veterans
Affairs, 2012 3
- Slide 5
- MTC Certificate Program: Military Culture Courage Commitment
Loyalty Integrity DOD Military and Associated Terms
https://blackboard.ecu.edu/bbcswebdav/pid-6462558-dt-content-rid-
17376600_1/courses/REHB6375601201380/Dictionary%20of%20Military%20terms.pdf
DOD Military and Associated Terms
https://blackboard.ecu.edu/bbcswebdav/pid-6462558-dt-content-rid-
17376600_1/courses/REHB6375601201380/Dictionary%20of%20Military%20terms.pdf
https://blackboard.ecu.edu/bbcswebdav/pid-6462558-dt-content-rid-
17376600_1/courses/REHB6375601201380/Dictionary%20of%20Military%20terms.pdf
https://blackboard.ecu.edu/bbcswebdav/pid-6462558-dt-content-rid-
17376600_1/courses/REHB6375601201380/Dictionary%20of%20Military%20terms.pdf
Officer Rank Insignia
http://www.defense.gov/about/insignias/officers.aspx Officer Rank
Insignia http://www.defense.gov/about/insignias/officers.aspx
http://www.defense.gov/about/insignias/officers.aspx Enlisted Rank
Insignia http://www.defense.gov/about/insignias/enlisted.aspx
Enlisted Rank Insignia
http://www.defense.gov/about/insignias/enlisted.aspx
http://www.defense.gov/about/insignias/enlisted.aspx Military Unit
Size Military Unit Size
https://blackboard.ecu.edu/bbcswebdav/pid-6462569-dt-content-rid-17376721_1/courses/REHB6375601201380/Military%20Unit%20Size.pdf
Military Code of Conduct [punitive articles, NJP]
http://www.dtic.mil/whs/directives/corres/pdf/130021p.pdf
http://www.dtic.mil/whs/directives/corres/pdf/130021p.pdf
http://www.dtic.mil/whs/directives/corres/pdf/130021p.pdf
- Slide 6
- The Psychological Cost of War: Personal Testimonials of Trauma
and Resiliency I was only getting 2 hrs of sleep I was only getting
2 hrs of sleep Your head is always on a swivel Your head is always
on a swivel We were stuck at an FOB for 3 months of intense
fightingcommand would fly-in for a morale-boost theyd stay for an
hour-then leave We were stuck at an FOB for 3 months of intense
fightingcommand would fly-in for a morale-boost theyd stay for an
hour-then leave My Master Gunny Sergeant told me to do (xyz)I said
are you kidding me? My Master Gunny Sergeant told me to do (xyz)I
said are you kidding me? Ive seen my best buddy get burned alive
Ive seen my best buddy get burned alive %#@&*$# ragheads- you
just dont know whos going to take you out... %#@&*$# ragheads-
you just dont know whos going to take you out...
- Slide 7
- The New Military: Not Your Fathers Military Combat Training
& Combat as an occupation: Combat Training & Combat as an
occupation: - Demands of killing - Avoidance of being killed -
Caring for the wounded - Witnessing death and injury - Frequent
geographic relocation - Separation from family and other support
systems - Being available 24/7/365
- Slide 8
- Challenges of OIF and OEF No clearly defined front line or Rear
or FOB Highly ambiguous environment Complex and changing missions
Long deployments Repeated deployments Environment is very
harsh
- Slide 9
- Operation Enduring Freedom (2001), Operation Iraqi Freedom
(2003), Operation New Dawn (2010) 50,000-100K + wounded 50,000-100K
+ wounded 6,825 + fatalities 6,825 + fatalities -Blast wounds / TBI
(13-24%) - Soft tissue/orthopedic injuries - Amputations - Burns -
Hearing loss - SCI
- Slide 10
- Exposure: OEF (AFG, 2001) OIF (2003) OND (2010) Mortar Mortar
Rocket Rocket Artillery Fire Artillery Fire Small Arms Fire Small
Arms Fire Multiple High-Intensity blast Multiple High-Intensity
blast Roadside bombs Roadside bombs IEDs IEDs Sniper Attack Sniper
Attack
- Slide 11
- MIL MH vs Community MH The Occupational MH Model of PTSD (Adler
& Castro, 2013) Community MH models based on Community MH
models based on - the unexpected - freezing, shutting down - person
as the victim Military acquired PTSD Military acquired PTSD
-adaptive and survive -adaptive (not maladaptive) response
-aggressive (not stress)!!
- Slide 12
- Occupational MH Model of PTSD Community MH model: Community MH
model: - Person experiences full range of symptoms - Many times
critical event is experienced by self Military acquired PTSD:
Military acquired PTSD: -Person most always experiences critical
event in small and large groups of others in their unit -full range
of symptoms may occur to a lesser degree of intensity during combat
training exercises -symptoms (i.e., hypervigilence) is
adaptive-esp. in combat
- Slide 13
- Suicide Ideation & Threats Number of suicide completions in
MIL- 2012 (N=349) have surpassed those who died in combat the
previsous year (N=295) Number of suicide completions in MIL- 2012
(N=349) have surpassed those who died in combat the previsous year
(N=295) Suicide on increase from 10.3%-16.1% (Marines); 19.3%
(Army) per 100k (2001-2008) Suicide on increase from 10.3%-16.1%
(Marines); 19.3% (Army) per 100k (2001-2008) Suicide Methods: 49%
Firearms (non-Mil issue); 21% Hanging; 19% Other; 11% Firearms (Mil
issue) Suicide Methods: 49% Firearms (non-Mil issue); 21% Hanging;
19% Other; 11% Firearms (Mil issue) Suicide is the 8 th leading
cause of death among adults in U.S.; the 2 nd leading cause of
death in adolescents#1 cause of death (2012) with military and vet
population. Suicide is the 8 th leading cause of death among adults
in U.S.; the 2 nd leading cause of death in adolescents#1 cause of
death (2012) with military and vet population. Suicide (inward
directed anger & depression) often coexists with homicide
(outwardly directed) Suicide (inward directed anger &
depression) often coexists with homicide (outwardly directed)
Suicide behavior include assessing risk factors of age,
medical/physical conditions, psychiatric conditions, intellectual
and emotional conflicts Suicide behavior include assessing risk
factors of age, medical/physical conditions, psychiatric
conditions, intellectual and emotional conflicts
- Slide 14
- Traditional Suicide Assessment: Community MH vs Military
Culture If the person answers yes to any of the following they are
considered high risk: Does the person communicate an intent? [MIL-
emotional detachment] Does the person communicate an intent? [MIL-
emotional detachment] Have they devised a specific detailed plan ?
[MIL- access to weapons] Have they devised a specific detailed plan
? [MIL- access to weapons] Person has no friends, family, or
support system? [MIL- departure leads to isolation, disconnect from
battle-buddies little structure in life, decreased meaning and
purpose, typically unemployment] Person has no friends, family, or
support system? [MIL- departure leads to isolation, disconnect from
battle-buddies little structure in life, decreased meaning and
purpose, typically unemployment] Is there a concrete life stressor
(death of spouse, girl/boy friend, family, friends, pet, facing
legal issues such as incarceration, has a medical physical
condition, or life-threatening illness, mental health condition)
[MIL IS family death surrounds our Family] Is there a concrete life
stressor (death of spouse, girl/boy friend, family, friends, pet,
facing legal issues such as incarceration, has a medical physical
condition, or life-threatening illness, mental health condition)
[MIL IS family death surrounds our Family] Has person had past
attempts? Has person had past attempts? Is the person a male? Is
the person a male? Is the individual on an anti-anxiety or
anti-depressant? Is the individual on an anti-anxiety or
anti-depressant?
- Slide 15
- Exposure to Combat 56% of all active duty reported combat
exposure (High= 23%; Mod= 21%; Low= 12%) 56% of all active duty
reported combat exposure (High= 23%; Mod= 21%; Low= 12%) Personnel
exposed to high level combat were identified as heavy drinkers
(10%) and use of prescription drugs (34%) Personnel exposed to high
level combat were identified as heavy drinkers (10%) and use of
prescription drugs (34%) Personnel exposed to high level combat
with TBI reported binge drinking (39%); 45% prescription overuse
Personnel exposed to high level combat with TBI reported binge
drinking (39%); 45% prescription overuse Personnel exposed to high
level combat with TBI reported depression (23%); anxiety (43%);
suicide ideation (10%); self- inflicted injury (13%); high risk
taking (18%); high levels of anger (18%); low affect (16%); and
suicide attempts (2%) Personnel exposed to high level combat with
TBI reported depression (23%); anxiety (43%); suicide ideation
(10%); self- inflicted injury (13%); high risk taking (18%); high
levels of anger (18%); low affect (16%); and suicide attempts (2%)
http://www.murray.senate.gov/public/_cache/files/889efd07-2475-40ee-b3b0-508947957a0f/final-2011-hrb-active-duty-
survey-report.pdf
http://www.murray.senate.gov/public/_cache/files/889efd07-2475-40ee-b3b0-508947957a0f/final-2011-hrb-active-duty-
survey-report.pdf
http://www.murray.senate.gov/public/_cache/files/889efd07-2475-40ee-b3b0-508947957a0f/final-2011-hrb-active-duty-
survey-report.pdf
http://www.murray.senate.gov/public/_cache/files/889efd07-2475-40ee-b3b0-508947957a0f/final-2011-hrb-active-duty-
survey-report.pdf
- Slide 16
- Characteristics of OEF, OIF, OND At least 19% (30-60%?) of
active duty men/women returning from Iraq - Afghanistan will be
dx:PTSD. At least 19% (30-60%?) of active duty men/women returning
from Iraq - Afghanistan will be dx:PTSD. 26-39% of all military met
positive screen for PTSS (gen. pop= 12%). 26-39% of all military
met positive screen for PTSS (gen. pop= 12%). Strong r between
being shot at, handling dead bodies, knowing someone who was
killed, or killing the enemy and developing PTSD. Strong r between
being shot at, handling dead bodies, knowing someone who was
killed, or killing the enemy and developing PTSD.
- Slide 17
- Characteristics of OEF, OIF, OND 32% + screen for depression;
25% + alcohol abuse; 33% met criteria for addiction. 32% + screen
for depression; 25% + alcohol abuse; 33% met criteria for
addiction. Only 38%-45% report receiving help for mental Only
38%-45% report receiving help for mental health services within a
year. health services within a year. 25% come home with a medical
health problem & co-morbid physical injuries (TBI, SCI, blast
wounds, soft tissue orthopedic injuries, burns, hearing loss,
amputations) doubles the risk for mental health problems. 25% come
home with a medical health problem & co-morbid physical
injuries (TBI, SCI, blast wounds, soft tissue orthopedic injuries,
burns, hearing loss, amputations) doubles the risk for mental
health problems. Women comprise 14% of deployed forces, more than
ever before- creating multiple traumas. Women comprise 14% of
deployed forces, more than ever before- creating multiple traumas.
Multiple deployment (Marines avg. 7 mos; Army 12 mos; 15) Multiple
deployment (Marines avg. 7 mos; Army 12 mos; 15)
- Slide 18
- Research: PTSD (PSS) is a Significant Predictor of Current and
Future Medical & Psychosocial Adjustment Men & Women (post
deployment), have more frequent number of visits to their
healthcare provider than those w/o PSS. Increased onset of
cardiovascular, gastrointestinal, dermatological, and
musculoskeletal conditions. Increased onset of cardiovascular,
gastrointestinal, dermatological, and musculoskeletal conditions.
Increased onset of cardiovascular, gastrointestinal, endocrine,
vision, hearing, dermatological, and musculoskeletal, and chronic
pain conditions. Increased onset of cardiovascular,
gastrointestinal, endocrine, vision, hearing, dermatological, and
musculoskeletal, and chronic pain conditions. Mortality has
declined due to advances in body armor and battlefield medicine BUT
28% sustained TBI primarily closed head and blast wound TBI.
Mortality has declined due to advances in body armor and
battlefield medicine BUT 28% sustained TBI primarily closed head
and blast wound TBI. Four variables were positively associated with
re-entry: being an officer; having a consistently clear
understanding of the missions while in the service; being a college
graduate; and, for post-9/11 veterans but not for those of other
eras, attending religious services frequently. Four variables were
positively associated with re-entry: being an officer; having a
consistently clear understanding of the missions while in the
service; being a college graduate; and, for post-9/11 veterans but
not for those of other eras, attending religious services
frequently.
- Slide 19
- Overall Problems in Medical/Psychosocial Adjustment Multiple
reconstructive surgeries require not just one adjustment to
disability- rather there are multiple re-adjustments. Reliance on
medical equipment/tech RFC leads to permanent disabling conditions
TBI, PTSD, SUDs, Chronic pain Significant vocational/career
impairments.
- Slide 20
- Veterans Vocational & Career Obstacles #1 Disability (Pew-
44% acquired MH/Phy) #1 Disability (Pew- 44% acquired MH/Phy) #2
Lack of Civilian job experience and transferable skills to other
occupations. #2 Lack of Civilian job experience and transferable
skills to other occupations. #3 Policies that hinder licensing,
certifications, and other skills that transfer to civ jobs. #3
Policies that hinder licensing, certifications, and other skills
that transfer to civ jobs. Jobless rate all Vets about 7% (Nov
2013) Jobless rate all Vets about 7% (Nov 2013) Unemployment NC
Guard = 19% (Nov. 13) Unemployment NC Guard = 19% (Nov. 13) Gulf
War II vets have 28% unemployment Gulf War II vets have 28%
unemployment
- Slide 21
- The Stigma of Counseling: Reducing Barriers to MH Tx (Mental
Health Advisory Team, 2011) Service men/women report: difficulty in
getting time off for an appt. and dont know where to go for help
Service men/women report: difficulty in getting time off for an
appt. and dont know where to go for help 29% reported embarrassment
29% reported embarrassment 38% reported mental health counseling
would harm their career 38% reported mental health counseling would
harm their career 42% reported their units would lose confidence in
them 42% reported their units would lose confidence in them 50%
report they would be seen as weak 50% report they would be seen as
weak Others could loose security clearance Others could loose
security clearance
http://www.murray.senate.gov/public/_cache/files/889efd07-2475-40ee-b3b0-
508947957a0f/final-2011-hrb-active-duty-survey-report.pdf DoD
Health-related Behavioral Survey.2011
http://www.murray.senate.gov/public/_cache/files/889efd07-2475-40ee-b3b0-
508947957a0f/final-2011-hrb-active-duty-survey-report.pdf
http://www.murray.senate.gov/public/_cache/files/889efd07-2475-40ee-b3b0-
508947957a0f/final-2011-hrb-active-duty-survey-report.pdf
http://www.murray.senate.gov/public/_cache/files/889efd07-2475-40ee-b3b0-
508947957a0f/final-2011-hrb-active-duty-survey-report.pdf
- Slide 22
- Intake Assessment - What is your MOS? What is your RATE (for
Navy) -Where did you do your basic training? -What advanced
training do you have? -Any experiences that you remember that
caused negative or disturbing memories? -Have you talked to anyone
about these experiences? -Are you (were you married) during your
service or when deployed? -Do you (have you ever used) the VA?
-Were you in a combat zone/combat space? FOB? -Ever surrounded by
the enemy? Blown up? Under fire? -See death of any member of your
unit or others you know?
- Slide 23
- PTSD & Other Measures Personal Interview & Observations
CAPS Life Events Checklist (LEC) Primary Care PTSD Screen (PC-PTSD)
Combat Exposure Scale (CES) BDI-II ASI- 5 th ed.
- Slide 24
- Spiritual and Religious Values We are all spiritual beings
traveling through time having a human experience The most important
question to humankind is where we came from before we were born and
where we will be going to after we pass-on Making sense of combat,
death, catastrophic injury is a spiritual question- not CBT Q
- Slide 25
- Deployment Cycle Treatment Options Pre-deployment Deployment
Post Deployment Re-deployment Reintegration Sustainment
- Slide 26
- Family Issues (or if the Army wanted men to have a wife -they
would issue one) Primary caregiver may neglect own mental-physical-
spiritual wellness Family/spouse misinterprets absence of spouse as
(they dont love me-putting work before family) and resents role of
single mother-father Family/spouse experiences loss & grief of
deployed service member- communication may not occur for weeks or
months- deployed location cannot be disclosed Family structure and
roles are significantly altered and routines disrupted during
deployment
https://blackboard.ecu.edu/bbcswebdav/pid-6462562-dt-content-rid-
17376703_1/courses/REHB6375601201380/Facts%20for%20Families%20in%20the%20Military.pdf
- Slide 27
- Sexual Assault in the Military
https://www.youtube.com/watch?v=Scsb5
uB1Z7Yhttps://www.youtube.com/watch?v=Scsb5 uB1Z7Y [NBC Today Show-
Rape in the Military] https://www.youtube.com/watch?v=Scsb5 uB1Z7Y
https://www.youtube.com/watch?v=Wl2BN
eLi5c0https://www.youtube.com/watch?v=Wl2BN eLi5c0 [Deborah
Slagboam- MST] https://www.youtube.com/watch?v=Wl2BN eLi5c0
- Slide 28
- Modern Military Family 2 million + have served 2 million + have
served 47,000-70,000 LGBTs (RAND Corp.; UCLA School of Law)
47,000-70,000 LGBTs (RAND Corp.; UCLA School of Law) DADT Fact
Sheet
https://blackboard.ecu.edu/bbcswebdav/pid-7621821-dt-content-rid-
32857248_1/courses/REHB6375601201530/Quick_Reference_Guide_Repeal_of_DADT_APPROVED.pdf
DADT Fact Sheet
https://blackboard.ecu.edu/bbcswebdav/pid-7621821-dt-content-rid-
32857248_1/courses/REHB6375601201530/Quick_Reference_Guide_Repeal_of_DADT_APPROVED.pdf
https://blackboard.ecu.edu/bbcswebdav/pid-7621821-dt-content-rid-
32857248_1/courses/REHB6375601201530/Quick_Reference_Guide_Repeal_of_DADT_APPROVED.pdf
https://blackboard.ecu.edu/bbcswebdav/pid-7621821-dt-content-rid-
32857248_1/courses/REHB6375601201530/Quick_Reference_Guide_Repeal_of_DADT_APPROVED.pdf
1.2 million children have at least one active duty parent 1.2
million children have at least one active duty parent 75% of these
children experienced at least one parent deployed 75% of these
children experienced at least one parent deployed 55% of troops are
married 55% of troops are married 50% report negative affects on
the psychological health of partners and children 50% report
negative affects on the psychological health of partners and
children Intimate partner (intense arguments, emotional/behavioral
dysregulation, physical/sexual violence) violence widespread- much
attributed to PTSD, TBI, SIDs Intimate partner (intense arguments,
emotional/behavioral dysregulation, physical/sexual violence)
violence widespread- much attributed to PTSD, TBI, SIDs
- Slide 29
- LGB Military, Partners & Family As a group LGB military
experiences health disparities and poor health outcomes. As a group
LGB military experiences health disparities and poor health
outcomes. GLMA, 2006; MPFC, 2011 report only 45% LGB come-out to
physician; self-disclosure may create negative reaction, fears of
retribution, rank, promotions, career. GLMA, 2006; MPFC, 2011
report only 45% LGB come-out to physician; self-disclosure may
create negative reaction, fears of retribution, rank, promotions,
career. There is an invisibility and isolation that exists for LGB
serve members, partners, & familymoreso for transgender service
personnel There is an invisibility and isolation that exists for
LGB serve members, partners, & familymoreso for transgender
service personnel
- Slide 30
- DADT 2010 Dont Ask, Dont Tell Repeal Act, 2010 which took
effect Sept. 2011 allows LGB to serve- NOT transgender individuals.
Dont Ask, Dont Tell Repeal Act, 2010 which took effect Sept. 2011
allows LGB to serve- NOT transgender individuals. Former Defense
Secretary Chuck Hagel every qualified American should be allowed to
serve; AMPA, 2015 U.S. Army reviewing policies on transgender;
Defense Secretary Ash Carter (Feb. 24, 2015) transgender
individuals should be allowed to serve [supported by Pres. Obama]
Former Defense Secretary Chuck Hagel every qualified American
should be allowed to serve; AMPA, 2015 U.S. Army reviewing policies
on transgender; Defense Secretary Ash Carter (Feb. 24, 2015)
transgender individuals should be allowed to serve [supported by
Pres. Obama] Military IS hypermasculine, heterosexual environment
where women and minority groups have a much different experience.
Military IS hypermasculine, heterosexual environment where women
and minority groups have a much different experience.
- Slide 31
- The New TBI: The Signature Injury of OEF-OIF-OND
- Slide 32
- Mild Traumatic BI Mild TBI- 85% of all TBIs BUT 52% of mTBI dx:
PTSD!!! Mild TBI- 85% of all TBIs BUT 52% of mTBI dx: PTSD!!!
Altered state of consciousness-brief loss up to 30 minutes loss of
consciousness. Altered state of consciousness-brief loss up to 30
minutes loss of consciousness. Glasgow rating of 13-15 or higher.
Glasgow rating of 13-15 or higher. Person feels stunned &
disoriented, has reduced concentration, focus, loss of memory
immediately before-after, learning new tasks. Person feels stunned
& disoriented, has reduced concentration, focus, loss of memory
immediately before-after, learning new tasks. Many go untreated
until Postconsussion Syndrome appears- headache, vertigo, tinnitus,
sleep disturbance, depression, irritability, reduced attention
span/memory. Many go untreated until Postconsussion Syndrome
appears- headache, vertigo, tinnitus, sleep disturbance,
depression, irritability, reduced attention span/memory. After 3
mos post-injury 78% have persistent headaches; 59% have memory
problems; 34% unable to R-T-W. After 3 mos post-injury 78% have
persistent headaches; 59% have memory problems; 34% unable to
R-T-W.
- Slide 33
- Closed/Open vs Blast Injuries and Battlefield Medicine Initial
shock wave from a high-intensity-explosive detonation or blast,
resulting from supersonic blast-wind or blast-wave of inhalations
of dust, smoke, carbon monoxide, other chemicals, burns from hot
gasses or secondary fires, and crushing injuries from structural
collapse. Initial shock wave from a high-intensity-explosive
detonation or blast, resulting from supersonic blast-wind or
blast-wave of inhalations of dust, smoke, carbon monoxide, other
chemicals, burns from hot gasses or secondary fires, and crushing
injuries from structural collapse. Consequence: penetrating and
thermal trauma, soft tissue, orthopedic injuries due to person
thrown against fixed objects, falling, vehicle crash, penetrating
injury from blast projectiles. Consequence: penetrating and thermal
trauma, soft tissue, orthopedic injuries due to person thrown
against fixed objects, falling, vehicle crash, penetrating injury
from blast projectiles. Classification of Blast Injuries: Primary:
rapid changes in atmospheric pressure caused by blast wave.
Primary: rapid changes in atmospheric pressure caused by blast
wave. Secondary: objects accelerate by energy of explosion causing
blunt or penetrating ballistic trauma. Secondary: objects
accelerate by energy of explosion causing blunt or penetrating
ballistic trauma. Tertiary: injuries resulting from persons body
being thrown by expanding gasses, high winds, penetrating injuries
from blast projectiles and soft tissue, orthopedic wounds.
Tertiary: injuries resulting from persons body being thrown by
expanding gasses, high winds, penetrating injuries from blast
projectiles and soft tissue, orthopedic wounds.
- Slide 34
- Cognitive Consequences of BI Memory Attention &
Concentration Self-awareness Problem-solving & Decision-making
Information Processing Concept Formation Judgment, Reasoning and
Insight
- Slide 35
- Personality Affect Personality Changes Anger Irritability
Nonconformance to Social Norms Loss of Self- esteem Apathy
Depression
- Slide 36
- Impact that Stress & Traumatic Stress Have on Emotions and
Illness
- Slide 37
- Peripheral/ANS: Sympathetic-Parasympathetic Nervous System
- Slide 38
- Pathways to Traumatic Memories Object Recognition (Neural
pathways-what- when-where-how-why?) Consciousness (Cognitions,
thoughts, symbols, feelings, emotions, purpose, meaning) Activating
Event Seeing, Hearing, Smelling, Tasting, Touching,
Physical-sensory, Balance Working Memory (Here & Now or Past
)
- Slide 39
- Stress and Post Traumatic Stress Excessive, recurrent, and
intense emotional arousal of an unhealthy nature results in stress
and disease; Excessive, recurrent, and intense emotional arousal of
an unhealthy nature results in stress and disease; Repeated
reactivation of our perceptual-cognitive- affective response that
is unhealthy in nature; Repeated reactivation of our
perceptual-cognitive- affective response that is unhealthy in
nature; Stored unhealthy thoughts, perceptions, and emotions,
become a worn neural pathway which leaves an imprint on our
cognitive unconscious and causes a mind-body interaction. Stored
unhealthy thoughts, perceptions, and emotions, become a worn neural
pathway which leaves an imprint on our cognitive unconscious and
causes a mind-body interaction.
- Slide 40
- So Why Dont All Those Exposed-Die from Stress? We all differ as
to the: We all differ as to the:-pattern - frequency
-exposure-magnitude/intensity -immune competence & resistance
..of how we turn-on our own stress response
- Slide 41
- Complex Grief Reaction Preoccupation with the deceased.
Disbelief about the death. Pain in the same area as the deceased.
Envious of others. Memories are upsetting. Lonely most of the time.
Avoid reminders of the death. Bitter about the death. Death is
unacceptable. Difficulty trusting others. Feeling life is empty.
Difficulty caring about others. Longing for the person. Feeling
stunned or dazed. Hear the voice of the person who died. Feel it is
unfair to live when this person died. Drawn to places and things
associated with the deceased. See the person who died. Anger about
the death.
- Slide 42
- The New PTSD-Typically Complex PTSD TBIDepression Suicide
Ideation SUD Chronic Illness & Physical Disability Sleep
Disorders
- Slide 43
- The New PTSD: DSM V Classification- Trauma and Stressor-Related
Disorder (Not under Anxiety Disorders in DSM-IV) 313.89 (F94.1):
Reactive Attachment Disorder 313.89 (F94.2): Disinhibited Social
Engagement Disorder 309.81 (F43.10): PTSD 308.3 (F43.0): Acute
Stress Disorder
- Slide 44
- 309.81 PTSD: A Review of DSM-V A. Exposure to actual or
threatened death, serious injury, or sexual violence in one or more
of the following ways: (experiencing, witnessing, learning about,
experiencing repeated or extreme exposure to aversive details of
event(s)- NOT electronic media) B. Presence of one or more of the
following intrusion symptoms associated with traumatic
event(s)-beginning after the trauma (recurrent, involuntary,
intrusive distressing memoires, distressing dreams, dissociative
reaction which individual feels or acts as if the trauma were
occurring (e.g., flashback), intense prolonged psychological
distress of internal or external cues that symbolize or resemble
trauma event) C. Persistent avoidance of stimuli associate with the
traumatic event(s) beginning after the traumatic event as evidenced
by one or both: (avoidance of distressing memories, thoughts,
feelings closely associated with trauma; avoidance of external
[people, places, conversations, activities, objects,
situations)
- Slide 45
- 309.81 PTSD: A Review of DSM-V D. Negative alterations in
cognitions and mood associated with trauma, beginning or worsening
after trauma has occurred as evidenced by two or more (inability to
remember important aspects of trauma due to dissociative amnesia
[not due to TBI, alcohol/drugs] persistent and exaggerated negative
beliefs of self and others; distorted cognitions; negative
emotional state; diminished interest or participation; feelings of
detachment or estrangement from other; persistent inability to
experience positive emotions- happiness, satisfaction, or loving
feelings) E. Marked alterations in arousal and reactivity
associated with traumatic event beginning or worsening after trauma
as evidenced by two or more (irritable behavior, recklessness or
self-destructive behavior, hypervigilance, exaggerated startle
response, problems w/concentration, sleep disturbance)
- Slide 46
- 309.81 PTSD: A Review of DSM-V F. Duration of disturbance
(Criteria B, C, D, E) more than 1 month. G. Disturbance causes
clinically significant distress or impairment in social,
occupational, or other important areas of functioning. H.
Disturbance is not attributable to the physiological effects of a
substance or another medical condition. Specify whether: 1.
Depersonalization (detached) or 2. Derealization (unreality)
- Slide 47
- Psychosocial Aspects of Suicide in Military Life: DoD Suicide
Outreach
http://www.suicideoutreach.org/Docs/Reports/DSPO_2012_Annual_Report_MARCH_2013_FINAL.pdf
http://www.suicideoutreach.org/Docs/Reports/DSPO_2012_Annual_Report_MARCH_2013_FINAL.pdf
Major depression is the #1 cause of suicide followed by PTSD and
substance abuse disorders. Major depression is the #1 cause of
suicide followed by PTSD and substance abuse disorders. The
grieving process is different for those in the Military: - Death
surrounds us - Prolonged intrusive images - Survivor guilt,
constant reminders of self-blame
- Slide 48
- Holistic Approach to Transition Services From Active Duty to
Civilian Life Dx: and treatment of mental health disorders. Dx: and
treatment of mental health disorders. Psychosocial counseling.
Psychosocial counseling. Family and/or relationship counseling.
Family and/or relationship counseling. Vocational evaluation,
career, Ed. assessment. Vocational evaluation, career, Ed.
assessment. Medical and healthcare services. Medical and healthcare
services. Medical supply and assistive technology. Medical supply
and assistive technology. Allied health services. Allied health
services.
- Slide 49
- The tragedy of life is not death; itself but what dies inside
of us as we live -Norman Cousins
- Slide 50
- Post-Traumatic Growth: A Journey into Healing (Calhoun &
Tedeschi) 1. Strength: a sense of self-efficacy, coping,
resiliency, thriving. 2. New Possibilities: new meaning, purpose,
positive future-oriented attitude, with crisis comes opportunity.
3. Relationships: deeper appreciation of relationships with family,
friends, intimates 4. Appreciation of Life: sense that one has been
given a second chance at life which should not be wasted, less time
at work more with family members, dont sweat the small stuff,
overall- a significant shift in priorities. 5. Spirituality: a
renewed sense of religious-spiritual strength, knowing God through
adversity, trauma-experiences may have been a gift to bring them
closer to God.
- Slide 51
- The Resiliency Advantage Dr. Al Siebert 1. Making conscious
choices in life. 2. Power of Positive Thinking. 3. Take
responsibility. 4. Internal locus of control. 5. Self motivate
yourself. 6. Dont fear trying-out new things. 7. Take control of
your life. 8. Practice positive approaches to life.
- Slide 52
- Green Zone Training: Transitioning from Base to Campus Location
recognized by veterans - service members as a Safe Place.
- Slide 53
- Transition Difficulties May have difficulty relating to
classmates (Campus Life, College Student Culture, Age-related
differences, Marriage, Dep.) May find loud noises to be disturbing
May be anxious with structure, assignments, changes in the
classroom May have excessive absences May have symptoms of trauma
from military experiences Post-911 G.I. Bill/Montgomery Bill
- Slide 54
- Transition Strengths Veterans/ Servicemembers transitioning out
of the military onto college campuses bring a unique perspective
Veterans/ Servicemembers transitioning out of the military onto
college campuses bring a unique perspective Military training Life
experience Established Identity A more worldly view Skills taught
in the military help Skills taught in the military help students to
be successful students to be successful Leadership Motivation Time
Management Work Ethic Stress Management 53
- Slide 55
- Treatment Programs-Provider Resources Defense Centers for
Excellence for Psychological Health & BI
http://www.dcoe.mil/blog/13-
10-30/Benefits_of_Mindfulness_Push-ups_for_the_Brain.aspx
http://www.dcoe.mil/blog/13-
10-30/Benefits_of_Mindfulness_Push-ups_for_the_Brain.aspxhttp://www.dcoe.mil/blog/13-
10-30/Benefits_of_Mindfulness_Push-ups_for_the_Brain.aspx Tricare
Provider Handbook
https://blackboard.ecu.edu/bbcswebdav/pid-7503897-dt-content-rid-
31972644_1/courses/REHB6375601201530/REHB6375601201530_ImportedContent_201501
05024914/TriCare%20Provider%20Handbook.pdf
https://blackboard.ecu.edu/bbcswebdav/pid-7503897-dt-content-rid-
31972644_1/courses/REHB6375601201530/REHB6375601201530_ImportedContent_201501
05024914/TriCare%20Provider%20Handbook.pdf Military Deployment
Guide
https://blackboard.ecu.edu/bbcswebdav/pid-7522387-dt-content-rid-
32000897_1/courses/REHB6375601201530/DeploymentGuide.pdf
https://blackboard.ecu.edu/bbcswebdav/pid-7522387-dt-content-rid-
32000897_1/courses/REHB6375601201530/DeploymentGuide.pdf Soldiers
Resiliency Guide
https://blackboard.ecu.edu/bbcswebdav/pid-7503838-dt-content-rid-
31972449_1/courses/REHB6375601201530/REHB6375601201530_ImportedContent_201501
05024914/ARNG.Leaders%20Guide%20to%20Resilience.pdf
https://blackboard.ecu.edu/bbcswebdav/pid-7503838-dt-content-rid-
31972449_1/courses/REHB6375601201530/REHB6375601201530_ImportedContent_201501
05024914/ARNG.Leaders%20Guide%20to%20Resilience.pdf Real
Warriors-Real Battles- Real Strength
http://www.realwarriors.net/taxonomy/term/13 Veterans Employment
Toolkit http://www.va.gov/vetsinworkplace/