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TSR Training for Veterans. David A Fohrman, M.D. What is TSR Training?. Traumatic Stress Resiliency (TSR) Training is a program to teach you how to avoid getting PTSD Essential to Have Easy to learn Takes about 30 minutes. What is the Problem?.

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Tsr training for veterans

TSR Training for Veterans

David A Fohrman, M.D.

What is tsr training
What is TSR Training?

  • Traumatic Stress Resiliency (TSR) Training is a program to teach you how to avoid getting PTSD

    • Essential to Have

    • Easy to learn

      • Takes about 30 minutes

What is the problem
What is the Problem?

  • Veterans have a high risk for getting Post Traumatic Stress Disorder (PTSD)

    • Veterans also on active duty

      • In national guard or reserves

      • For example, approximately 30% of the OIF/OEF veterans have impaired due chronic PTSD symptoms

      • With each deployment, the number goes up

    • Veterans have a 90% of experiencing a non-military related traumatic event

      • These traumas can lead to PTSD

      • higher risk if already have PTSD, from combat or non-combat related experiences

      • had a traumatic brain injury (TBI)

What is the problem1
What is the Problem?

  • PTSD symptoms (such as flashbacks, nightmares, chronically feeling jumpy, irritable, angry, anxious or depressed) cause serious problems

    • at work, home, in life

      • Lose job, marriage, friends, interests, life (suicide)

  • PTSD can be very difficult to treat

    • especially chronic PTSD (having PTSD symptoms for more then six months)

What is the solution
What is the Solution?

  • Prevent PTSD before it develops

  • Diagnosis of PTSD

    • Wait at least 30 days after traumatic/stressful situation ends

      • In case of a deployment, time closer to 3-6 months

    • If symptoms resolve prior to this window, will not get PTSD

      • If you already have PTSD from prior deployments/non combat related traumatic situations, TSR training can still help

Tsr training
TSR Training

  • Helps avoid road blocks that keep your body from naturally recovering from the effects of traumatic events.

  • Two parts

    • #1: What is PTSD

    • #2 What are the six road blocks to recovery and how can we avoid getting them

What is ptsd
What is PTSD?

  • PTSD is biological problem

    • A disorder due to our brain’s creating abnormal trauma induced memories.

    • These memories cause you to experience almost all of the symptoms of the symptoms of PTSD

    • Intrusive recollections of trauma

    • Avoidance and numbing symptoms

    • Hypervigalence and hyperarousal symptoms

What is ptsd1
What is PTSD?

  • PTSD is a spiritual problem

    • A disorder due to the creation of abnormal trauma induced faulty beliefs

  • Traumatic events can cause people to lose previously held core beliefs

    • Core beliefs are things you believe to be true but don’t think about

      • Examples are when I go through a green light other drivers will obey the traffic signal and stop

      • When I really need help, people I trust will help me out.

  • As a result of trauma, people can become lose their self confidence, not trust other people, become very cynical, think everything is ‘worthless or meaningless’ and/or may lose previously held religious beliefs

What is ptsd2
What is PTSD?

  • PTSD is a disorder due to a failure to naturally recover from the effects of trauma

    • All traumatized people temporality have some symptoms of PTSD

  • People get PTSD when they are unable to naturally recover

    • They don’t recover because trauma creates six road blocks to recovery

    • Soldiers have not been taught how to avoid these roadblocks.

Six roadblocks to recovery
Six Roadblocks to Recovery

#1 – Can’t feel safe

#2 – Can’t relax

#3 – Emotionally isolate self

#4 – Unable to stay in optimal zone for recovery

#5 – Avoid talking about trauma

#6 – Unable to fix trauma created faulty beliefs

Six steps to recovery
Six Steps to Recovery

  • Use mnemonic: GROWTH

    • G – Go to a Safe place

    • R – Relax

    • O – Open Up

    • W – Wait until you are ready

    • T - Tell your story

    • H - Heal

G rowth g o to a safe place
GROWTH: Go to a Safe Place

  • Feelings safe means feeling both physically and psychologically safe

    • Physically safe – feel will not be unexpectedly hurt or killed

    • Psychologically safe – feel will not be taken advantage of while experiencing strong negative emotions

G rowth g o to a safe place1
GROWTH: Go to a safe place

  • Examples,

    • At home

    • With friends

    • Doing an activity you enjoy

      • If you are doing something you enjoy, you feel safe

      • Can use handout to help you figure out what is a safe place for you

Roadblock 1 don t feel safe
Roadblock #1: Don’t feel safe

  • Traumatic events can make us chronically feel unsafe

    • Like we might unexpectedly be in a life threatening situation

      • may sit with back against wall in restaurants

      • Avoid or really dislike crowds

    • For those that have never experienced this feeling

      • Like not having enough oxygen

        • Very hard to do anything other then try to feel safe

Avoid roadblock 1 don t feel safe
Avoid Roadblock #1: Don’t feel safe

  • Regain sense of safety after trauma.

    • Practice gradual exposure technique

      • When something makes us feel afraid one of two things happen

        • We freak out, panic, feel horrified, helpless, etc.

        • We stay in control; with time, anxiety will go away

          • Each time we stay in control will feel less and less anxious



G r owth r elax

  • May think of one goal for relaxation:

    • ‘de-stress’

  • Two Goals:

    • 1. contain excessive emotion

    • 2. regain a sense of being in control

Roadblock 2 can t relax
Roadblock #2: Can’t relax

  • Traumatic events can make it hard to relax

    • Chronically activate fight or flight response

      • Feel anxious nervous, increase heart rate, blood pressure, dilate pupils

      • Can’t relax while fighting or running away!

    • Trauma are events where things are “out of control”

      • Can chronically feel this way

Avoid roadblock 2 can t relax
Avoid Roadblock #2: Can’t relax

  • Relax after trauma by having relaxation techniques that work for you

    • Can use breathing technique, described in handout

    • Use any other technique that works

      • Literally hundreds of books in library, book stores

    • Can use tapping technique to make flashbacks go away

  • Make sure you can feel in control “again” after trauma

    • Figure out what you enjoy doing

      • Hobby, sport, work, being a parent,

      • Do this in “easy way” after trauma to help you feel in control again.

        Can use relaxation techniques to help with prolonged exposure

Gr o wth o pen up
GROWTH: Open up

  • Collectively, we can emotionally deal with what we can not deal with alone

    • True both in military and civilian settings

      • Enemies that are emotionally resilient are very difficult to beat

        • Examples are soldiers during war of Independence

    • True psychologically and biologically!

Roadblock 3 emotionally isolate self
Roadblock #3: Emotionally Isolate Self

  • Traumatic events are situations were people close to us can be hurt or killed.

    • When this happens there is a natural tendency to emotionally pull back

      • For a limited period of time

    • Like having a rubber band snap on ones fingers

      • More cautious next time

  • Problem: people choose to constantly isolate self

    • minimize emotional contacts

Avoid roadblock 3 emotionally isolate self
Avoid Roadblock #3:Emotionally Isolate self

  • Use handout: Suggestions for Opening Up

    • First talk about Easy Topics

    • Then talk about more difficult topics

  • Talk about the what, where, when, how for each topic

Gro w th w ait until you are ready
GROWTH: Wait until you are ready

  • Wait until you are ready

    • You need to be in your “optimal zone for recovery” before continuing

    • If you are below your optimal zone – your brain will not process memories

      • This happens when you drink alcohol, use drugs or actively avoid thinking about the trauma

    • If you are above your optimal zone, you will not re-process your abnormal trauma induced memorieswhich will make it harder to fix them in the future

Avoid roadblock 4 can t fix abnormal trauma memories
Avoid Roadblock #4: Can’t fix abnormal trauma memories

  • When your ready to recover, make you’re you are in your “optimal zone for natural recovery”

    • Some people are ready to start recovering a day or two after the event, others wait weeks or a couple of months

  • Use the handout: Optimal Zone for Recovery” to make sure your brain is biologically in the right place before you talk about the trauma with someone else.

    • Doing this will increase the speed in which your brain will fix it’s abnormal trauma induced memories

Handout your optimal zone for recovery
Handout Your optimal Zone for Recovery

Grow t h t ell your story
GROWTH: Tell your story

  • The best way to recover from the effects of trauma is to talk about it

  • Name for this: Natural Debriefing

  • Teaches you how to naturally debrief

    • Something we do often do after a stressful day

      • We talk to a spouse/significant other or a loved one

      • Talking doesn’t change ‘what happened”

        • Still, we feel better

  • In case of trauma

    • Talking also helps brain re-process trauma created abnormal memories

    • Easier said then done

      • We don’t practice talking about trauma

    • Trauma usually a rare event

      • Something people keep to themselves

  • Roadblock 5 avoid talking about trauma
    Roadblock #5: Avoid Talking about trauma

    • Traumatic events bring up:

      • very strong emotions like horror, helplessness, intense fear, anger, shame, guilt

      • Thoughts, beliefs about ourselves, others or the world that are very distressing

        • “It was my fault”

        • “I can’t trust anyone because of what happened’

  • Natural not to want to talk about, let alone think about, these things

  • Avoid roadblock 5 avoid talking about trauma
    Avoid Roadblock #5: Avoid talking about trauma

    • Practice by:

      • First thinking of something that bothers you

        • if have a hard time, think of a time when you “over reacted’ to something – for example, became angry for little or no reason

        • think about something that irritates you; bothers you only a little

      • write down, in outline form, what happened

  • use handout: Tell your story for an example

    • tell this story to someone else

      • if feel overwhelming emotion, stop

      • main thing is the process

      • does not matter how long you speak as long as you stay emotionally in control

  • Session 6 h eal
    Session #6: Heal

    Healing occurs when your past traumas no longer holds you back from living your live the fullest

    • Healing occurs in two ways: Biologically, Spiritually

      • Biologically

        • reprocess abnormal trauma induced memories

      • Spiritually

        • Fix any trauma induced faulty beliefs

    Heal biologically
    Heal Biologically

    • Process abnormal trauma induced memories

      • Stop uncontrolled reactivation of event, flashbacks, etc.

    • Stop excessive fight or flight activation

      • Stop startle reaction, irritability, hypervigalence

    Heal biologically1
    Heal Biologically

    • Fill out the PTSD symptom checklist, any symptom you have more then ‘rarely’ is a positive response

      • If you have any positive response, use the GROWTH technique to help make these symptoms go away.

      • If you still have symptoms for more then two months after using these techniques, get additional help!

        • PTSD can be very difficult to treat!

    Heal spiritually
    Heal Spiritually

    • Trauma causes us to lose things important to us

      • Both concrete/specific and beliefs

    • This causes us to:

      • disconnect with ourselves

        • “live in your head” and become excessively stoic

      • disconnect with others

        • Emotionally as well as physically

      • disconnect with our beliefs/ideals

        • Start questions basic/or long held secular and/or religious beliefs

    Heal reconnect to yourself
    Heal – reconnect to yourself

    • Identify if you are disconnected

      • Difficulty experiencing/expressing intense emotions

      • Experience unexplained medical problems

    • Heal by being able to experience emotions without getting overwhelmed

      • By body sensations

      • Thoughts

    • Recover from unexplained/stress induced medical problems

      • Especially gastrointestinal, headaches, other unexplained aches and pains

      • Sexual dysfunction

        • Need to be able to express intimacy and aggression

    Heal reconnect to others
    Heal – reconnect to others

    • Identify if you are disconnected

      • Physically isolating oneself

      • Emotionally isolating oneself/avoiding emotional intimacy

        • Honestly/behavior will tell you if this is an issue

          • What would an ‘fly on the wall’ say you are doing

    • Often held back in emotionally reconnecting because of our trauma induced beliefs

    Heal reconnect to your beliefs

    Before being traumatized

    (1) I am in control of my life

    (2) I am competent.

    (3)I can reach my goals

    (4) What I think, feel, say and do effects other people

    (5)I can control how I spend my time

    (6) I am usually pretty healthy person

    After being traumatized

    (1)My life is out of control

    (2)I am basically incompetent.

    (3) I can’t accomplish what I set out to do

    (4)My actions, thoughts, and feelings do not affect any one but me

    (5) I can not take control of how I spend my time

    (6) I am usually sick

    Heal -reconnect to your beliefs

    Handout - Identify if you have trauma induced beliefs

    Heal re connect to your beliefs
    Heal re-connect to your beliefs

    • Use questioning of beliefs as an opportunity to growth

      • Other cultures view trauma as a rite of passage

      • Opportunity to grow

    • Researchers have a name of this: Post Traumatic Growth

      • As a result of living through a potentially life threatening event, people often report they now

        • ‘try to live each day to the fullest’

        • ‘do things (like hobbies, going on vacations, etc.) that they had put off doing before’

        • ‘feel that their life is more meaningful’

        • ‘are closer to their friends and family’

          Pragmatically – emphasize decision to prioritize “connecting”

    Change your actions change your life
    Change your actions, change your life

    • Use OIA acronym.

      • Observe

      • Imagine

      • Act

  • Observe for situations where you are doing thing that result in you being more emotionally distant from people you are close to

    • examples: spouse tries to talk to you, you pretend not to hear him/her

    • first identify situation retrospectively, then Use OIA acronym.

      • Observe

      • Imagine

      • Act

  • Observe for situations where you are doing thing that result in you being more emotionally distant from people you are close to

    • examples: spouse tries to talk to you, you pretend not to hear him/her

    • first identify situation retrospectively, then

  • Imagine

    • Imagine – how you would act if you wanted to emotionally connect

      • example – spouse talks to you, you listen

        • Use active listening skills

        • We all have them, but don’t always use them

      • Identify at what stage of moral development client is – speak to them at that level

      • Practice scenarios that could happen


    • Act as if you want to emotionally and physically connect

    • This may or may not be connected to your current beliefs

    • May be an ‘act of faith’

      • Faith means different things

      • This is secular

        • Refers to acting in a way you hope (or wish) were true even though you may not belief it’s true

    • Act first, and your beliefs will follow

    Final points
    Final points

    • Trauma happens!

      • PTSD and other long term post trauma problems don’t have too

  • Can use GROWTH to help you and your loved ones recovery from the psychological effects of deployment.

  • G - Go to a safe place

    • R - Relax

    • O - Open up

    • W -Wait until you are ready

    • T - Tell your story

    • H - Heal

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