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 co-worker 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 someonewho 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, MSMental 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 combatViolent personal assaultTerrorist attackKidnappingNatural or Manmade disastersDiagnosed 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 hopelessnessFeelings of isolation/detachmentDepression and LossGuiltSubstance Abuse/Excessive UseComing home to family changes such as divorce, loss of money, or deaths in the familyPhysical 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 anotherChildhood traumas may “prime” individuals to develop PTSD after subsequent traumasNot considered an illness, but rather a stress reactionLong 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 TherapySupportive 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 INJURIESTraumatic Brain Injury

Significant Issues

Physical InjuriesLoss 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 WoundLoss 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 / IsolationImpulsiveAggressive / Acting outShort Attention SpanSelf Focused / “Selfish” / ChildlikeRegressionAngryControlling

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 adjustCreate a routineCommunicate, communicate, communicateSet aside “alone” timeSet aside “family” timeMonitor and minimize substance useSeek VA (or other) services to assist with adjustment issuesUnderstand 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 ProgramCore 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/FamilyImportance 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 918-577-3699Tulsa 918-610-2000

Beth Jeffries, PhD Program Director/Supervisor PCT

918-610-2000 Ernest C Childress VA Tulsa918-577-3699 Jack C Montgomery VA Muskogee

Operation Enduring Freedom (OEF)

Operation Iraqi Freedom (OIF)

Nanette Waller, MSWOEF/OIF Program Director

Jack C Montgomery VA HospitalMuskogee, 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, PhDOEF/OIF Program Director

Veterans Administration HospitalOklahoma City, OK

(405) 270-0501

QUESTIONS???

THANK

YOU