Additional Content

1. Additional Content You might consider adding multimedia content to the PPT, which we did not do to maintain file size of this PPT. In particular: • DownloadAboutFace Previews: compilation of Veteran responses to key questions which overview symptoms and treatment experiences • DownloadWhiteboard Videos (Public): series of 5 animated whiteboard videos on PTSD and effective treatments • DownloadWhiteboard Video (Professional): animated whiteboard video for providers on best treatments for PTSD If you have questions or need more in-depth information for your presentation, contact: PTSDconsult@va.gov or rebecca.matteo@va.gov

2. Posttraumatic Stress Disorder Overview and Treatment Alex L. Alexander MS, ND, LMHC March 2017

3. Overview • What is a traumatic stressor or: trauma, traumatic event? • How common are trauma and PTSD? • What are the symptoms of PTSD? • Why do some people develop PTSD and others do not? • What problems co-occur with PTSD? • How is PTSD treated? • National Center for PTSD (NCPTSD) Resources for Trauma Survivors & Clinicians

4. What is traumatic stress? LIFE NAME OTHER STRESSFUL SITUATIONS IN DAILY LIFE

5. Trauma exposure is common.

6. Trauma types more likely to lead to PTSD?

7. How common is PTSD? Only 7% of people develop PTSD

8. Top traumas associated PTSD by gender?

9. What about repeated exposure to tragic events? Name as many news-media-reported events in the last 10 years as you can that were traumatic to hear about and process

10. 9/11, as an example of resiliency Conclusion? Trauma alone isn’t sufficient to ensure a longer term PTSD diagnosis

11. The role of trauma in PTSD People who usually experience very little anxiety, guilt, anger, alienation and other unpleasant emotions higher income education, strong social ties male gender Not only is trauma insufficient to trigger PTSD symptoms, it is also not necessary

12. Emotional triggers. Although by definition clinicians cannot diagnose PTSD in the absence of trauma, recent work suggests that the disorder’s telltale symptom pattern can emerge from stressors that do not involve bodily peril. DSM V

13. The emerging research In a 2005 study of 454 undergraduates, psychologist Sari Gold of Temple University and her colleagues revealed that students who had experienced nontraumatic stressors, such as serious illness in a loved one, divorce of their parents, relationship problems or imprisonment of someone close to them, reported even higher rates of PTSD symptoms than did students who had lived through bona fide trauma. Taken together, these findings call into question the long-standing belief that these symptoms are tied only to physical threat. PTSD symptoms can follow emotional upheavals

14. What is the criteria for diagnosis?

15. Directly experiencing a traumatic event Witnessing, in person, an event that happened to someone else Learning about the violent or unexpected death of a friend of family member Experiencing repeated or extreme exposure to aversive details of traumatic events Criterion A: Traumatic Event

16. Symptom Clusters

17. Symptom Clusters 2 Cont. • Intrusion (or re-experiencing, “flashbacks”) • Recurrent distressing dreams of the event or acting/feeling as if the event is happening again

18. Symptom Clusters 3 Cont. • Avoidance • Avoiding memories, thoughts, feelings, people, places or activities that are reminders of the event

19. Symptom Clusters 4 Cont. • Negative alterations in cognitions and mood • Diminished interest in activities, feeling detached, inability to feel positive emotions, negative emotions, distorted blame of self or others

20. Symptom Clusters 5 Cont. • Alterations in arousal and reactivity • Irritable behavior, outbursts of anger, reckless or self destructive behavior, problems concentrating, hypervigilance, exaggerated startle, sleep disturbance

21. Most people do not develop PTSD following trauma. US General population estimates from the National Comorbidity Survey - Replication

22. PTSD is a common consequence of war. About 15% of returning Post-9/11 (OEF/OIF) Veterans have PTSD. Hoge, et al., 2004

23. Recap: Why do some people get PTSD while others do not?

24. A closer look at Personal Factors

25. Two Categories of Traumatic Event

26. Best Recovery Environment

27. Comorbidity: PTSD often co-occurs with other problems. How can this data HARM people? Which came first?

28. Other Co-occurring Problems

29. How to Recognize PTSD in Patients https://www.ptsd.va.gov/professional/materials/videos/index.asp

30. Civilians and PTSD - It’s not just a veteran disorder https://youtu.be/SNVATLHBVhY

31. Diagnosing- The scales https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp Download the PTSD Checklist for DSM-5 (PCL-5): • PCL-5 (PDF) • PCL-5 with Criterion A (PDF) • PCL-5 with LEC-5 and Criterion A (PDF) • Using the PTSD Checklist for DSM-5 (PCL-5) (PDF)

32. Treatment Options

33. How can PTSD be treated?

34. Evidence-based Pharmacological Treatments • First line medications • Selective Serotonin Reuptake Inhibitors (SSRIs) • E.g., paroxetine (Paxil), sertraline (Zoloft) • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) • E.g., venlafaxine (Effexor) • Warning: Benzodiazepines (e.g., Xanax, Valium, Klonopin) • Limited efficacy • Increased safety concerns • Not recommended for PTSD

35. Evidence-based Psychotherapy Treatments • First line psychotherapies Cognitive Behavioral Therapy (CBT): build new cognitive skills and engage in new behaviors, or change existing ones • Prolonged Exposure (PE): In PE you confront situations you have been avoiding until distress decreases. • Cognitive Processing Therapy (CPT): In CPT you examine and challenge thoughts about the trauma until you can change the way you feel.

36. CBT • CBT works with our thoughts, feelings and behaviors. CBT therapists understand that by changing the way we think and act in the here-and-now, we can affect the way we feel. CBT can also be applied longitudinally to explore the origin of beliefs, rules and assumptions which shape an individual's world-view: this knowledge can then be used to drive change in the present. There are evidence-based CBT models (and associated treatment protocols) for a wide range of range of disorders, but CBT can also be used to formulate (conceptualize) cases individually.

37. Psychology Tools • https://psychologytools.com/ptsd.html • Free • Easy • Lots of Handouts • Evidence Based

38. Cognitive Behavioral Therapy (CBT) Works

39. Evidence-based Psychotherapy Treatments Cont. • Other VA/DoD Clinical Practice Guideline first line psychotherapies include: • Stress Inoculation Training (SIT): By teaching coping skills, SIT can help you find new ways to deal with PTSD symptoms. These skills can also help you manage other stressful situations or event in your life. • Eye Movement Desensitization and Reprocessing (EMDR): EMDR helps you process upsetting memories, thoughts, and feelings related to trauma. In EMDR, you’ll pay attention to a back-and-forth movement or sound while you think about the upsetting memory long enough for it to become less distressing.

40. EFT- Emotional Freedom Technique • https://youtu.be/IWu3rSEddZI • Based loosely on acupuncture points • Meditation and mindfullness “Even though I have this (___), I truly and completely love and accept myself.” Check in before with 1 - 10 scale Check in after

41. Resources and Tools for Professionals

42. PTSDconsult@va.gov www.ptsd.va.gov/consult (866) 948-7880

43. WWW.PTSD.VA.GOV • About the Consultants • Experienced senior psychologists, psychiatrists, social workers, pharmacists, and other health professionals who treat Veterans with PTSD • Available to consult on everything from your toughest cases to general PTSD questions Ask about: • Evidence-based treatment • Medications • Clinical management • Resources • Assessment • Referrals • Collaborating with VA on Veterans’ care • Developing a PTSD treatment program Available Resources - www.ptsd.va.gov/consult • PTSD-related publications • PTSD and trauma assessment and screening tools • Mobile apps, and more • Free continuing education • Videos, educational handouts, and manuals

44. Monthly one-hour webinar for providers Free continuing education credits Register and sign up for notifications at www.ptsd.va.gov/consult PTSD Consultation Program Lecture Series PAST TOPICS HAVE INCLUDED

45. NCPTSD offers well over 50 hours of web-based courses for professionals. All courses are free. Most offer continuing education for multiple disciplines. Continuing Education Courses Available to Anyone For VA Staff

46. NCPTSD works to bring the most current research on trauma and PTSD to professionals. Each of our publications are free e-subscriptions. Trauma and PTSD: Stay Up-To-Date

47. PTSD Awareness in Health Care Settings • PTSD Awareness is a 15-minute video that shares the stories of three Veterans being seen at VA for PTSD care. • Models strategies to improve interactions in health care settings with Veterans who have PTSD and trauma histories. • A Facilitator Guide is also available for those offering a training to medical staff.

48. PTSD Assessment • We provide information on a variety of measures assessing trauma and PTSD. • We also offer online courses about best practices. • Most NCPTSD authored measures are available for direct download by qualified mental health professionals on our website.

49. Animated Whiteboard Videos • NCPTSD created a series of whiteboards, including one for professionals about PTSD and effective treatments. • Short (~3 minute), engaging videos that are easily shared via email or Facebook.

50. AboutFace