Stress Zones, Online Faculty, & PTSD

Preliminary Survey, 2009

Fred Stielow, Ph.D.

John D. Moore, Ph.D.

Carol Passman, Ph.D.

Philip McNair, U.S. Army (ret)

Meet the Panel

• Introduction: Dr. Fred Stielow

• Defining & Exploring PTSD: Dr. John Moore

• AMU Faculty Survey Results: Dr. Carol

Passman

• Thoughts & Discussion: COL Phil McNair

Professors:I wanted to thank you for your assistance during my enrollment at AMU … You really showed me how great a professor you can be during times when education is taking a back seat. I recently completed, what was once a fast-burning run through life… In Dec 08 as I was diagnosed with PTSD. Since returning from my 8 month tour in Iraq in Dec 07…. Without complaint you stepped in and helped me complete my entire academic plan … I greatly appreciate your extreme display of concern and understanding while enrolled in your class. I did not expect the support I received; yet it has gotten me where I am today.

Excerpted Student Comment, 09/2009

Introduction• Memoriam: Andrew Baggs, Ph.D., USN (ret)• Frequency study of faculty awareness of

students in high stress areas and dangerous events

• Follow-up/Implications for further study- Can study in online universities while in high stress zones ameliorate the subsequent onset of PTSD?- Or facilitate reintegration into society?- Given onset of GI-Bill students in traditional schools, do online instructors have PTSD practices to share?- How do the frameworks of online and land-based universities differ in terms of students with PTSD?

John D. Moore, Ph.D.

Defining and Exploring PTSD

in an

Online Educational Environment

• The Syndrome • Diagnostic Criterion• Impact on the Student• Impact on the Educator

A. PTSD in Broader Context

• PTSD is the acronym for Post-Traumatic Stress Disorder

• PTSD is a qualified psychiatric condition that appears in the Diagnostic and Statistical Manual of Mental Disorders

• PTSD is different than a person experiencing normal “Stress”

What is PTSD?

Easily Startled

Irritable

IncreasedSubstance

Use

Hyper

Unable to fall asleep

Angry Outbursts

Problems With Focus

PTSD = Increased Agitation

Posttraumatic Stress DisorderDSM IV Diagnostics

Criterion A. The person has been exposed to a traumatic event in which both of the following were present:

1. Person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others

2. Person's response involved intense fear, helplessness, or horror.

PTSD—DSM IV Diagnostics, Continued, 1

Criterion B. The traumatic event is persistently re-experienced in one (or more) of the following:

1. recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.

2. recurrent distressing dreams of the event. acting or feeling as if the traumatic event were recurring (a sense of reliving the experience, illusions, hallucinations & dissociative flash-back episodes, including those that occur awakening or intoxicated).

3. intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

4. physiological reactivity on exposure to internal or externalcues that symbolize or resemble an aspect of traumatic event

PTSD—DSM IV Diagnostics, Continued, 2

Criterion C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not

present before the trauma), as indicated by three (or more): 1. efforts to avoid thoughts, feelings, or conversations associated with

the trauma 2. efforts to avoid activities, places, or people that arouse recollections

of the trauma 3. inability to recall an important aspect of the trauma 4. markedly diminished interest or participation in significant activities 5. feeling of detachment or estrangement from others 6. restricted range of affect (e.g., unable to have loving feelings) 7. sense of a foreshortened future (e.g., does not expect to have a

career, marriage, children, or a normal life span)

PTSD—DSM IV Diagnostics, Continued, 3

Criterion D: “Hyperarousal responses" (two or more of the

following) 1. difficulty falling or staying asleep

2. irritability or outbursts of anger

3. difficulty concentrating

4. Hypervigilance

5. exaggerated startle response

Criterion E: Duration of more than one month

Criterion F: Distress or impairment to functioning

B. Psychological Pathways

Impact of PTSD

Impact of PTSD on E-Educators

Vicarious Trauma

11

22

33

Loved Ones

• Anxiety• Fear• Uncertainty• Anger• Helplessness• Depression • Fidelity Concerns• Financial Worry

IMPACT OF PTSD ON LEARNERS

The PTSD Learner

• Anxiety• Fear• Guilt• Anger• Helplessness• Depression• Fidelity Concerns• Financial Worry

Extra Responsibilities

New Family Roles Routines Disrupted

Lack of Contact

Feeling Helpless Worried about Future

TitleFamily

Experience

PTSD WHEEL OF STRESS

PTSD = FAMILY IN CRISIS

PTSDStudent

LovedOnes

Children

CRISIS CRISIS CRISIS

How does PTSD Impact E-educators?

Online Institution

E-Educators

Vicarious Trauma

Confusion/Distraction

Student Outbursts

Student Outbursts

Students who may be living with PTSD can sometimes present as irritable, uncooperative or disengaged in the classroom.

Using the psychological concept of displacement, students will sometimes “rage” against a faculty member or other student in moments of high stress, anxiety or depression.

Confusion for E-faculty

When a students discloses that he or she has been through a traumatic event or perhaps previously diagnosed with PTSD, this can sometimes cause confusion for the e-educator.

In brick and mortar institutions, there is often an ability to refer the student to a student counseling center. This is generally not the case for online institutions, leaving the e-educator asking the question:

What can I do to help?

Vicarious Trauma (aka: secondary trauma) occurs whenever a person is exposed to a first hand account of a traumatic event by another person. An example of this might be a faculty member being told by a student that he or she was involved in a life threatening incident. Over the course of time, these kinds of repeated exposures to secondary trauma can have a negative impact on the individual.

Vicarious Trauma

EACH TIME A FACULTY MEMBER IS EXPOSED TO PAINFUL MATERIAL THAT FACULTY

MEMBER EXPERIENCES VICARIOUS TRAUMA

Fatigue

Irritable

IncreasedSubstance

Use

Burnout

Sleep Problems

FeelingDrained

Problems With Focus

Vicarious Trauma

Vicarious Trauma

Faculty Awareness of Students in High Stress Situations & Events

Survey Overview

Carol Passman, Ph.D.

Survey Background

• Run Dates: Aug 18th – Sep 8th, 2009 • Subjects: APUS (American Military

University & American Public University) Faculty

• Response Rate: 465 of 845 = 55% response rate

A. Faculty Demographics

Response Count Percent

Less than a year ago 57 12.3%

1-3 years ago 159 34.2%

Over 3 years ago 249 53.5%

Online Teaching Experience

Other Experience/Areas Served*

Response Count Percent

The military (active duty or reserves) 175 37.6%

Emergency management professions (e.g., firemen, police, paramedic) 75 16.1%

Non-Emergency management, Non-military 229 49.2%

**Other 166 35.7%

* Multiple responses allowed ** Other category included CIA, Civilian Military Employee, DEA, Government Contractor, Homeland Security, Defense Analyst, Military Spouse, TSA…

Involvement in Dangerous Situations

Response Count Percent

War zones (e.g., bombings, fire-fights) 115 24.7%

Emergency management situations 157 33.8%

None of the above 174 37.4%

Other (please specify) 117 25.2%

B. Awareness of Students in High Stress Settings

N/A Rarely Sometimes Never

You became aware of one or more of your students serving in war zones.

1.4% (6) 4.5% (19) 91.0% (385) 3.1% (13)

You became aware of one or more of your students in emergency management positions.

3.6% (15) 14.9% (62) 68.3% (285) 13.2% (55)

You became aware of one or more of your students in other physically dangerous fields.

10.3% (44) 16.2% (69) 57.5% (245) 16.0% (68)

Timing of Awareness

Before the class started

During the class

After the class was over

You became aware of one or more of your students serving in war zones.

8.7% (38) 91.1% (397) 0.2% (1)

You became aware of one or more of your students in emergency management positions.

6.9% (26) 92.6% (351) 0.5% (2)

You became aware of one or more of your students in other physically dangerous fields.

7.9% (28) 91.2% (322) 0.8% (3)

How Did Faculty Become Aware of High Stress Occupational Settings

Response Count Percent

Student comments about self during introductions as part of starting the course. 391 84.1%

Student comments about self in classroom Discussion Groups. 281 60.4%

Student comments emailed to you about self or other students in the class. 305 65.6%

A student's telephone conversation with you. 65 14.0%

Separate class exercises that are visible only by the instructor. 34 7.3%

Other (please specify) 15 3.2%

C. Awareness of Students in Dangerous Encounters

N/A Rarely Sometimes Never

You became aware of one or more of your students in physically dangerous war-zone situations (bombings, fire fights).

3.7% (16)

16.7% (72) 67.4% (291) 12.3%

(53)

You became aware of one or more of your students taking part in emergency management situations.

5.4% (23)

22.0% (93) 56.7% (240) 15.8%

(67)

You became aware of one or more of your students being in other physically dangerous situations.

15.0% (63)

19.7% (83) 45.8% (193) 19.5%

(82)

Timing of Awareness of Dangerous Encounters

Before the class started

During the class

After the class was over

You became aware of one or more of your students in physically dangerous war-zone situations (bombings, fire fights).

6.5% (25) 93.2% (358) 0.3% (1)

You became aware of one or more of your students taking part in emergency management situations.

4.4% (15) 95.3% (328) 0.3% (1)

You became aware of one or more of your students being in other physically dangerous situations.

5.8% (17) 93.5% (274) 0.7% (2)

D. Faculty/Student Interactions

Student comment to faculty on dangerous situations

Response Count Percent

No/Not Applicable 85 18.3%

Rarely 114 24.6%

Sometimes 220 47.4%

Often 45 9.7%

Student in-class discussions on such situationsResponse Count Percent

No/Not Applicable 151 32.6%

Rarely 162 35.0%

Sometimes 128 27.6%

Often 22 4.8%

Summary - Phil McNair

• But first – 2 brief anecdotes• What we know:

- Some percentage of students have PTSD- PTSD can affect student behavior

• What we don’t:- Who those students are- What online faculty are supposed to do- The impact of online learning on students with PTSD

Thoughts? Comments?

We welcome your input as we think about the implications of this for further study and research. Want to join us?

Fred Stielow: fstielow@apus.eduPhil McNair: pmcnair@apus.edu