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Christian M. Alexander MS LMHC
Veterans Services Therapist
Valley Cities Counseling and Consultation
IntroductionGoals of presentationBe able to identify various types and signs of deployment stress
Understand the basics of treatment approaches
Know where to refer a veteran or family in need
Deployment Stress What are the various sources of deployment stress?
Not everyone who experiences combat stress develops PTSD
Combat Stress vs. ASD vs. PTSD
Resilience is the rule, not the exception
Most stress reactions dissipate after 1-3 months
In some people PTSD develops
TBI -MST –SU/A -PTSDTraumatic Brain Injury (TBI)
Military Sexual Trauma (MST)
Substance use/abuse
Combat Stress/Post-traumatic Stress Disorder (PTSD)
Resources?
Common Wartime Experiences The most common stressors reported by soldiers and
marines during the war included roadside bombs, length of deployment, handling human remains, killing an enemy, seeing dead or injured Americans, and being unable to stop a violent situation.
More than 90% of soldiers and Marines returning from Iraq reported encountering these stressors, with 12% of them reporting being wounded or injured.
Common Readjustment Issues- normal
reactions after being in a war zone
Feeling emotionally dead or constricted
Feeling detached or like you don’t fit in with others
Feeling as if in a daze
Frustration that others don’t understand
Feelings of guilt
Being irritable and intensely angry
Hyperawareness of surroundings and other people
Can’t get to sleep very easily or stay asleep
Nightmares or disturbing dreams
Poor concentration and memory problems
Battlemind vs. Home mind Buddies (cohesion) vs. Withdrawal Accountability vs. Controlling Targeted Aggression vs. Inappropriate Aggression Tactical Awareness vs. Hyper vigilance Lethally Armed vs.“Locked and Loaded” at Home Emotional Control vs. Anger/Detachment Mission Operational Security (OPSEC) vs.
Secretiveness Individual Responsibility vs. Guilt Non-Defensive (combat) Driving vs. Aggressive
Driving Discipline and Ordering vs. Conflict
Statistics Invisible Wounds of War: Rand Corporation (2008).
Survey of OIF and OEF service members and Veterans
14% PTSD
14% Depression
19% TBI
33% PTSD, depression or TBI
5% symptoms of all 3
Risks Isolation
Higher rates of unhealthy behaviors (smoking, overeating, unprotected sex)
Higher rates of physical health problems and mortality
Unemployment or impaired productivity
Substance Abuse
Homelessness
Domestic Violence
Suicide
Barriers to treatment
Military Trauma is complicated by the culture
Treatment is available, yet stigma is greater
Mission vs. Treatment
Multiple Tours
Constant wartime tempo
Consequences of Combat
Military Mental Health, VA Mental Health, and Civilian Mental Health
Stigma There is a perception among the troops that
seeking mental health care means you're weak or a coward and frankly, we in the military kind of foster that attitude”
“You're never going to have complete confidentiality in the military system, there is a big hole in the wall of confidentiality that will never close."
Col. Thomas Burke (US Army)
Family Impact and Stressors 40 % of those deployed have children
Children Frequently change schools
Isolated from extended family/friends
Frequent deployments
Anxiety for safety of parents
Marital conflict
Financial stressors
Be aware of children with parents in the military
PTSD6 Criteria for PTSD Diagnosis
Stressor- A threatening event accompanied by fear, helplessness or horror
Reexperiencing
Avoidance
Arousal
Duration (>1month)
Distress or Impairment
Some PTSD Facts Not everyone one who is deployed develops PTSD –15% to 32% Although many (41% -90%) have readjustment issues, these
usually resolve with help within a relatively short time 25-40% of those with PTSD recoverwithin the first year after
trauma exposure 30-50% of those with PTSD do not recover, even after many
years Intensity and frequency of traumatic stress exposure predicts
likelihoodof PTSD, as well as severityand duration Duration of symptoms is shorter for survivors who obtain
treatment (36 vs. 64+ months) Those needing treatment most usually have many reasons for
not obtaining help –usually out of fear of being seen as crazy or weak, or that the military will find out
Military Sexual Trauma The U.S. Department of Veterans Affairs (VA) defines
military sexual trauma (MST) as sexual harassment that is threatening or physical assault of a sexual nature. These traumas occur when a person is in the military.
MST can happen during war, peace, or training. It can be man-to-woman, woman-to-man, woman-to-woman, or man-to-man.
Who Gets MST? Among veterans using VA health care, about:
23 out of 100 women (23%) reported sexual assault when in the military
55 out of 100 women (55%) and 38 out of 100 men (38%) have experienced sexual harassment when in the military
Even though military sexual trauma is far more common in women, over half of all veterans with MST are men.
Treatments That Work- PTSD Anxiety management or stress inoculation training
(SIT)
Cognitive therapy (CT, CPT)
Exposure therapy (PE)
As primary intervention
Combined with SIT or CT
EMDR
Antidepressants, Anti-Anxiety Medication, and Prazocin
Anxiety Management A set of techniques that helps patients learn to manage
their anxiety
Relaxation training
Controlled breathing
Positive self-talk and guided imagery
Social skills training
Distraction techniques (e.g., thought stopping)
Cognitive Therapy A set of techniques that help patients change their
negative, unrealistic cognitions by:
Identifying dysfunctional, unrealistic, or unhelpful cognitions (thoughts and beliefs)
Challenging these cognitions
Replacing these cognitions with more functional, realistic, or helpful cognitions
Exposure Therapy A set of techniques designed to help patients confront
their feared objects, situations, memories, and images (e.g., systematic desensitization, prolonged exposure [PE], flooding).
EMDR Access trauma images and memories
Evaluate their aversive qualities
Generate alternative cognitive appraisal
Focus on the alternative
Sets of lateral eye movements while focusing on response
Substance Use and Abuse 7.1 % of veterans report substance use disorder in the
past year
Problems with alcohol and nicotine abuse are most prevalent
At greatest risk are deployed personnel with combat exposures, as they are more apt to engage in new-onset heavy weekly drinking, binge drinking, as well as smoking initiation and relapse.
Traumatic Brain Injury- Definition A traumatic brain injury (TBI) is caused by a blow or
jolt or a penetrating injury that disrupts normal brain function.
Not all blows or jolts to the head result in TBI
Direct blow is not needed to have TBI (whiplash effect)
Severity ranges from mild to severe with different implications for each
Implications of TBI-Physical Decreased Stamina, fatigue
Headaches
Dizziness or balance problems
Sensitivity to light and noise
Weakness of limbs
Implications of TBI: Cognitive Slowed processing of information
Problems with attention/concentration
Less efficient at learning and remembering new information
Executive functioning (reasoning, problem solving, planning, etc)
Implications of TBI: Behavioral/Emotional Irritability
Personality Changes
Impulsivity
Emotional de-regulation
Aggression
Depression, Anxiety
Relationship and family problems
Management of TBI There are no medical treatments to address underlying
cause
Importance of early recognition/education of patient and family
Treatment must be individualized and can include Inpatient programs
Day treatment
Individual and family therapy
Vocational Rehabilitation
Physical and occupational therapy
How You Can Help Honor those Veterans you encounter in and outside
church
Recognize signs of combat stress injury
Educate people about military/veterans issues
Community partnerships- knowing what’s available
Provide support to individual and families
Know where to refer individuals who need assistance
Give the expectation of resiliency and recovery
Resources- Federal PSHCS –American Lake and Seattle VA Medical Centers: 800-329-8387 or 206-764-2636 Spokane VA Medical Center: 509-434-7000 Walla Walla Medical Center: 888-687-8863 Vet Centers: Seattle Vet Center 206-553-2706 Everett Vet Center425-502-0617 Tacoma Vet Center253-565-7038 Portland Vet Center503-273-5370 Spokane Vet Center509-444-8387 Bellingham Vet Center360-733-9226 Yakima Vet Center509-457-2736
County/State Resources King County Veterans may apply for assistance by
contacting the King County Veterans Program at 206-296-7656
WDVA Contractors 1-800-562-2308
33 Private Contractors throughout Washington Statewww.dva.wa.gov
Program can provide services to active, guard, reserves, and their families for readjustment counseling. Can also provide consultations for schools and employers
Readings and Websites After the War Zone, Slone & Friedman
The Sandbox, G.B. Trudeau
www.ncptsd.gov (better for clinicians)
www.BattleMind.org
www.MilitaryOneSource.com
www.ArmyOne Source.gov
www.DVA.WA.gov
www.milspecvets.com
For More Information Christy M. Alexander M.S., LMHC
Therapist, Veterans Services
Valley Cities Counseling and Consultation
Phone –253-632-9746
Email –[email protected]