War may be hell…
but home ain’t exactly heaven, either.
When a Soldier comes home from war,
he finds it hard…
…to listen to his son whine about being bored.
…to keep a straight face when
people complain about potholes.
…to be tolerant of people who complain
about the hassle of getting ready for work
…to be understanding when a coworker complains about a bad night’s
sleep
…to control his panic when his wife tells
him he needs to drive slower
…to be grateful that he fights for the
freedom of speech.
…to be silent when people pray to God
for a new car.
…to be compassionate when a
businessman expresses
a fear of flying.
…to not laugh when anxious
parents say they’re afraid to send
their kids off to summer camp.
…to not ridicule someone
who complains about hot weather.
…to control his rage when a colleague
gripes about his coffee being cold.
…to remain calm when his
daughter complains about
having to walk the dog.
…to be civil to people who complain about
their jobs.
…to just walk away when someone says
they only get two weeks of vacation a year.
…to be happy for a friend’s
new hot tub
…to be forgiving when someone says how
hard it is to have a new baby in the house.
…to not punch a wall when someone says
we should pull out immediately.
The only thing harder than
being a Soldier…
By: Danielle
“A Proud Army Wife”
is loving one.
A gentle reminder to
keep your life in perspective.
And when you meet one of our
returning Soldiers,
please remember what he’s been through
and show him
compassion and tolerance.
Thank you.
CPT Alison L. Crane, RN, MS
Mental Health Nurse Observer-Trainer
7302nd Medical Training Support Battalion
POST TRAUMATIC
STRESS DISORDER
(PTSD)
Beth Jeffries, PhD
PCT Supervisor
Jack C Montgomery Veterans Hospital
Muskogee, OK
What We’ll Cover
Post Traumatic Stress Disorder
(PTSD)
Traumatic Brain Injury (TBI)
Social Implications
Academic Implications
Occupational Implications
PTSD
Brief Overview
Experience of being exposed to an extreme traumatic
stressor falling outside of the typical human
experience or expectation
Response to this event involves intense fear,
helplessness or horror
Evidence of persistent re-experiencing of the event
Evidence of persistent avoidance behaviors related to
the trauma and generalized numbing of
responsiveness
Increased arousal
These symptoms must be present for more than 1
month
Create dysfunction in social, occupational, and other
important areas of functioning
Extreme Stressors
Some examples…
Military combat
Violent personal assault
Terrorist attack
Kidnapping
Natural or Manmade disasters
Diagnosed with life threatening illness
or injury
Personal Response
How the person responds is
important…
Amount of control the person feels in
the situation appears to be very
important for outcome
Social support, or lack of, impacts
symptoms
Avoidance is NOT helpful…
Symptoms of PTSD
Associated with Re-experiencing…
Intrusive thoughts of the event
Nightmares and sleep disturbance
Flashbacks
Intense psychological and
physiological distress when reminded
of the event
Symptoms continued…
Associated with Avoidance and Numbing…
Efforts to avoid reminders
Inability to recall important aspects of the
event
Withdrawal from favored activities and
interests
Strong feelings of detachment and/or
estrangement from others
Restricted range of affect (poker face)
Symptoms continued…
Associated with Arousal…
Irritability and outbursts of anger
Difficulty concentrating/often confused
with memory loss
Hypervigilance
Exaggerated startle response
Suicide
Feelings of hopelessness
Feelings of isolation/detachment
Depression and Loss
Guilt
Substance Abuse/Excessive Use
Coming home to family changes such as
divorce, loss of money, or deaths in the
family
Physical changes/disabilities resulting from
wartime experience
Suicide What to look for
Isolation
Substance abuse/excessive use
Depression
Giving possessions away
Threats of suicide/past attempts
Talking about lack of future/hopelessness
Family history should be considered
Lack of social support
Suicide National Hotline
It Takes the Courage and Strength of a
Warrior to Ask For Help
1-800-273-TALK (8255)
Press 1 for Veterans
www.suicidepreventiononlifeline.org
PTSD
Prevalence and Etiology
Estimated that 8% of total population
meets criteria as set forth by the
Diagnostic and Statistical Manual-IV
(DSM-IV)
Research indicates 30-40% of
persons exposed to trauma go on to
develop PTSD
Number may be higher in “real world”
Prevalence and Etiology cont…
No one group impacted more than
another
Childhood traumas may “prime”
individuals to develop PTSD after
subsequent traumas
Not considered an illness, but rather a
stress reaction
Long term, adrenal system impacted
and other physiological problems
Symptom Presentation
Withdrawal from family and friends
Inability to “get along” with others
Alcohol and substance abuse
Poor performance in home activities,
school and work
“Personality” changes, behavior
changes
Prognosis
Typically considered chronic, but
recovery/management realistic goal
Up and down pattern of symptoms
likely over a lifetime
Anxiety and depression features are
medication responsive
Early, intense cognitive behavioral
therapies are effective
Medications
SSRIs
TCAs
Sometimes, anti psychotics
Alpha blockers
Discourage use of sleep agents and
benzos consistently found to be
ineffective, at best, and possibly,
more harmful
Behavioral Treatments
Group Therapy – Therapy of Choice
Individual Therapy
Supportive Therapy
Cognitive Behavioral Therapy (CBT)
Cognitive Processing Therapy (CPT)
Prolonged Exposure Therapy (PET)
Family/Marriage Counseling
Support and Peer Groups
Evidence Based Psychotherapy
Cognitive Processing Therapy (CPT)
Prolonged Exposure (PE)
Cognitive Behavioral Therapy (CBT)
PHYSICAL INJURIES
Traumatic Brain Injury
Significant Issues
Physical Injuries
Loss of eyesight
Loss of limbs
Burns
Traumatic Brain Injury (TBI)
Soldiers are surviving injuries on the
battlefield that would have been fatal
in the past!
Traumatic Brain Injury (TBI)
Closed or Open Wound
Loss of consciousness
Dizzy
Headache
Memory loss
Nausea
Suicidal risk
TBI, cont.
Can be difficult to distinguish from PTSD,
many symptoms are similar
Behavioral changes
Attention deficits, Concentration problems
Impulsive behaviors/Acting out
“Nervous” energy
Depression, withdrawal, suicidal ideations
Not always visually apparent
TBI Treatment
Psychological Testing from a trained
Neuropsychologist is recommended
Medical tests such as CAT scans and
MRIs may be warranted
Assessment of pre-morbid functioning
is recommended
TBI, cont
Head injuries may impede a person’s
ability to function in all spheres, including
academic
Ability to concentrate
Socialize appropriately
Focus of attention
Memory
Retention
“Personality” changes
Impulsivity
HOW DO ALL THESE INJURIES
IMPACT THE RETURNING
SOLDIER IN HIS “LIFE”
AND
HOW DO THEY IMPACT THE
“REST OF US”
Social Functioning
Big Changes
Withdrawal / Isolation
Impulsive
Aggressive / Acting out
Short Attention Span
Self Focused / “Selfish” / Childlike
Regression
Angry
Controlling
Family and Friends
Isolates from others, even at home
May be “uninvolved”
May be “overly involved”
Detachment
“Clingy-ness”
Routines are disrupted
Roles are altered
What Might Help
Give self and family time to adjust
Create a routine
Communicate, communicate, communicate
Set aside “alone” time
Set aside “family” time
Monitor and minimize substance use
Seek VA (or other) services to assist with
adjustment issues
Understand that both of you have changed
in some ways
Academic
Big Changes
Loss of Concentration / Distractable
Inability to sit still
“Speaks out” in class
Disorganized
Easily Frustrated / “Slow” to learn
What Might Help
Set aside study times that are brief
and consistent/daily
Consider testing in separate room
and/or extended time
Use a study partner
Practice going outside your comfort
zone in simple, small ways to start
Occupational
Big Changes
Not Dependable or Reliable
Frustrates Easily
Loss of Concentration
Difficulty Getting Along with
Supervisors and Co-workers
Frequent Mistakes
Over Controlling -or- Appears to “not
care”
What Might Help
Consider employment options
carefully
Practice going outside your comfort
zone in small ways
Use relaxation and visualization
techniques
Improve surroundings in small but
meaningful ways
Where and How to Get Help
Veterans Administration (VA)
Services
DoD and VA collaboration to inform
veterans about our services
Orientations and PTSD Screen in
Primary Care
Easy access and flexible hours
Outpatient/Inpatient/Crisis services
PTSD Clinical Team (PCT)
Specialized team focused on
treatment and care of veterans with
PTSD
Psychiatrists, psychologists, social
workers and administrative personnel
available for comprehensive, team
approach
Group Therapy
Treatment of Choice
3 Stage Program
Core group – 3 months/education focus
Action group – 3 month/process focus
Maintenance group – 1 yr/support focus
Intense focus groups
CPT groups
Individual Therapy
Supportive and Cognitive
CPT
PET
Marriage/Crisis/Family
Importance of family involvement is
stressed
Who Needs a Referral?
Identifying the need is the biggest
step
The individual may avoid the problem
by
Self medicating with substances
Withdrawing from activities and “life”
Using anger
Performance may suffer
Who can and should be referred to
VA?
Any member of the National Guard or
Reserves, or other affiliation with our
Armed Forces
Any veteran of our Armed Forces
Of the above, anyone who requests a
referral
Who Do I Call for Assistance?
Contact the business office at
Jack C Montgomery VA Hospital
Muskogee, OK
(918) 577-3000 / (888) 397-8387
Contact the Behavioral Medicine Clinic
Muskogee 918-577-3699
Tulsa 918-610-2000
Beth Jeffries, PhD Program Director/Supervisor
PCT
918-610-2000
918-577-3699
Ernest C Childress VA Tulsa
Jack C Montgomery VA Muskogee
Operation Enduring Freedom
(OEF)
Operation Iraqi Freedom (OIF)
Nanette Waller, MSW
OEF/OIF Program Director
Jack C Montgomery VA Hospital
Muskogee, OK 74401
918-577-4150
Oklahoma City Area VA
For admissions in person, go to the
2nd floor of Building 3 and request an
information packet.
For telephone information, or to have
a packet sent to your home, please
contact Cheryl Bays, LCSW at
(405) 270-0501, extension 5367
**A copy of your DD214 is required.
Operation Enduring Freedom
(OEF)
Operation Iraqi Freedom (OIF)
Steven Scruggs, PhD
OEF/OIF Program Director
Veterans Administration Hospital
Oklahoma City, OK
(405) 270-0501
QUESTIONS???
THANK
YOU
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post traumatic stress disorder (ptsd)