PSY 496
STRESS, TRAUMA AND THE PSYCHOLOGICAL EXPERIENCE OF COMBAT
SPRING 2014
MON-WED 1600-1715, GMCS-310
Heidi Kraft, Ph.D.
hkraftpsych@gmail.com
Course Description:
This course will focus on the vital human process of stress in the brain, body and behavior.
It will define stress, the stress response, and how stress is related to illness and disease. It
will chronicle different responses to stress, to include that of traumatic experiences and
how they affect us. Psychological diagnosis and treatment of trauma will be explored. The
second half of the course will discuss a specific stressor and (for some) traumatic
experience, the life-changing experience of combat. It will describe the history of the
American warrior, including veterans of the current long wars in Iraq and Afghanistan,
with emphasis on the emotional impact of war and its aftermath. The experience of
combat, including combat stress injuries, combat trauma, and post-trauma growth, will be
discussed.
Textbook:
Why Zebras Don’t Get Ulcers by Sapolsky
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Available in the bookstore or online (paperback)
Grading Format:
This class will involve a great deal of discussion. In addition, there will be movie and/or
readings assigned for certain class dates. There will be a midterm exam and a final exam.
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40%: Online assignments (viewing of four films and reading of one article, and
online submission of three answers)
** For each of these out of classroom assignments, there will be an online assignment to
complete. The assignment will be posted one week in advance to give students the chance
to view the film or complete the reading on their own timelines. The online assignment
questions will post to Blackboard Monday morning of the week they are due, and entry will
be closed at 6pm the Friday of that week. **
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30%: Midterm exam
30%: Final exam (not cumulative)
** Attendance is not mandatory nor will be taken. However, the tests may be heavily
influenced by in-class and online discussion points. **
Learning Objectives:
o Define stress, stress response, and explain why stress makes people sick
o Define the role stress plays in diseases of the cardiovascular, digestive,
immune, reproductive, endocrine systems
o Define psychological trauma
o Define PTSD and how it is diagnosed
o Describe treatments for PTSD
o Describe the evolution of the warrior through past American wars
o Describe the history of combat stress injuries and stigma
o Describe positive and negative emotional responses to combat experience
o Describe the military’s past and current efforts to intervene in combat
trauma in the field
o Discuss post-trauma growth
CALENDAR
Wed Jan 22
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Intro to course and each other
Review of syllabus
Breathing and meditation
Mon Jan 27
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What is stress?
Different types of stressors
Allostasis, stressors and stress responses
Why does stress make us sick?
Theories on positive and negative stress
Reading: Sapolsky Chapter 1
Wed Jan 29
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The two parts of the nervous system
Sympathetic and parasympathetic NS effect on the body
The cardiovascular stress response
Reading: Sapolsky, pages 20-23, 37-56
Mon Feb 3
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Stress and the digestive system
Irritable bowel syndrome
Ulcers
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Stress and the reproductive system
Reading: Sapolsky, pages 71-91, 120-143.
Wed Feb 5
OUT OF CLASS ASSIGNMENT:
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Watch: Stress: Portrait of a Killer (PBS documentary can be found online)
Answer 3 questions on Blackboard (due Friday 2/7 at 6pm)
Mon Feb 10
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Stress and the Immune System
Cancer, AIDS, other diseases
Reading: Sapolsky, pages 145-185
Wed Feb 12
Guest lecturer: Dr. Barbara McDonald
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Family stress and adaptation
Stress in children
Mon Feb 17
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Coping and Managing Stress
o SLEEP and Exercise
o Changing your thinking
o Social support
o Techniques!
Reading: Sapolsky, pages 385-418
Wed Feb 19
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Coping strategies
o PMR
o Mindfulness
o Hypnosis
Mon Feb 24
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Trauma
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o
o
o
Types of trauma
Subjective experience
Diagnostic criteria
New DSM-IV
Wed Feb 26
**OUT OF CLASS ASSIGNMENT:
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Watch Good Will Hunting
Answer 3 questions on Blackboard (due Friday 2/28 at 6pm)
Mon March 3
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Trauma
o
o
o
PTSD
o
o
Physiological experience of trauma in the brain
Cumulative effect
Coping strategies
What do we think it is?
What does society think it is?
Wed March 5
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PTSD
o
o
o
Definition (DSM-V)
Operational definition
Functional impairment due to symptoms:
 Types of sxs
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Co-morbidities
Mon March 10
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PTSD
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Treatment
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Wed March 12
Prolonged Exposure
CPT
Other promising tx modalities
MIDTERM EXAM in CLASS
Mon March 17
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History of the Warrior
o What is a warrior?
 Words we use to describe them
 Words they use to describe themselves
 Why do people choose this path?
o
The experience of the US Soldier, Sailor, Marine through our wars
 Training/ deployment time
 Country support/involvement
 The warrior paradox
Wed March 19
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The concept of combat stress
 Early definitions/descriptions/conceptualization
 Evolution through conflicts
 Combat stress injury
Warriors through the ages
The Illiad – still applies today
Why we fight
Mon March 24
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The experience of combat
o Physical preparation/ physical toll
o Emotional toll
 Reality of taking a life/knowing someone is trying to kill you
 “On Combat” and “On Killing” by Grossman
 Are certain people predisposed to be able to kill if needed? Can
it be trained?
 What is the difference between these people and criminal
killers?
o Response to combat situations: positive
 Positive/affirming/life-changing moments
 Intensity/adrenaline
 Friendships/loyalty/comradery
 Simplicity/meaning/feeling of contribution to something
Wed March 26
**OUT OF CLASS ASSIGNMENT:
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Watch: Either The Hurt Locker or Lone Survivor
Answer 3 questions online (due Friday 3/28)
NO CLASS Mon March 31 – Spring Break
NO CLASS Wed April 2 – Spring Break
Mon April 7
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The experience of combat (cont)
o Response to combat situations: negative
 Four types of combat stress injury
 Resilience
 Combat stress injury: who develops it?
 Factors that influence who will develop CSI
 Fear, exhaustion, the elements, horror and guilt, hate
o
Aftermath of trauma in the combat zone - stigma
Wed April 9
** OUT OF CLASS ASSIGNMENT: WATCH Cover Me (documentary sponsored by the
Semper Fi Fund) (You Tube)
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Answer 3 questions on Blackboard (due Friday 4/11)
Mon April 14
o
Combat trauma and PTSD
o Definition of trauma (DSM-V)
 Specific combat scenarios
 Infantry, CASEVAC
 Medical, Convoys
 EOD, Mortuary Affairs
o Why combat is different from other traumatic situations
Wed April 16
 Case Studies
Mon April 21
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Co-morbidity with traumatic brain injury and physical injury
o Development of combat stress injury symptoms
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Typical course of sxs and military response/plan in the field
PIES principal for tx of acute combat trauma
Acute sxs and intervention
Group intervention
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History of CISD for first responders
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Current military strategy for “After Action Debriefing”
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Role of peer intervention/ Marine OSCAR extenders
Wed April 23
** ONLINE ASSIGNMENT
o
READ: WSJ article on “Comradeship as Treatment” by Michael Phillips –
ON BLACKBOARD, questions due Fri, 4/25
Mon April 28
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Post-Traumatic growth and recovery
o Resilience
o Meaning and growth after trauma
 Emotional recovery/Spiritual growth
 Friendships and family relationships
 Rehabilitation
o Case study
Wed April 30
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Wrap up, review, student feedback, Q and A
Mon May 12
FINAL EXAM 1530 – 1730
About the Instructor
Heidi Kraft received her Ph.D. in clinical psychology from the UCSD/SDSU Joint Doctoral
Program in Clinical Psychology. She completed medical internship at Duke University
Medical Center, and joined the Navy in 1996. In 2004, she deployed to Iraq with a USMC
surgical company. RULE NUMBER TWO is a memoir of that experience. She left active duty
in 2005, and now serves as a contractor for Navy medicine and an adjunct professor at
SDSU. She currently treats PTSD patients, and provides invited talks on combat stress,
stigma and caring for the caregiver.