Post-Traumatic Stress Disorder

1. Post-Traumatic Stress Disorder CPT David Boyer, Division Psychologist

2. Plan of Action Symptoms Prevalence Causes Prevention Treatment Leadership Issues

3. Symptoms of PTSD Person experienced, witnessed, or was confronted with event that involved threat of death or serious injury. And The person�s response involved intense fear, helplessness, or horror.

4. Symptoms of PTSD -Re-experiencing: flashbacks, nightmares, re-living, intrusive thoughts -Avoidance: avoiding thoughts and feelings, avoiding memories, memory problems, detachment -Arousal: sleep probs, anger, concentration, startle, vigilance

5. Symptoms of PTSD From a biologic perspective, the body�s failure to return to its pre-traumatic state differentiates PTSD from a simple fear response. In a normal fear response, the immediate sympathetic discharge activates the �fight-or-flight� reaction. Increases in both catecholamines and cortisol occur relative to the severity of the stressor. Cortisol release stimulated by corticotropin-releasing factor via the hypothalamic-pituitary-adrenal (HPA) axis acts in a negative feedback loop to suppress sympathetic activation and cause further release of cortisol.

6. Symptoms of PTSD PTSD is a hyper-activation of the sympathetic nervous system The symptoms of PTSD are generally ADAPTIVE in combat zones but are MALADAPTIVE back home

7. Symptoms of PTSD Associated Features Marital Problems Alcohol/Drug Abuse Violence Desperation

8. Prevalence of PTSD North et al. (1999) Examined effects of Oklahoma City bombing 45% of those directly affected met criteria for PTSD 6 months after the event

9. Prevalence of PTSD Kang et al. (2003) 15,000 Gulf War veterans compared to 15,000 Non-Gulf veterans Gulf War veterans 3 times more likely to develop PTSD symptoms

10. Prevalence of PTSD

11. Causes of PTSD There is no good predictor of who might develop symptoms. Higher rates of PTSD in: Individuals with poor social support Depression in first-degree relatives Previous trauma More combat exposure Other psychiatric conditions Females

12. Prevention of PTSD Before Traumatic Events Hard, realistic training Physical training Stress Management Education about operational stress Good leadership Informal assessment Formal screening

13. Prevention of PTSD Immediately after Traumatic Event Critical Incident Stress Debriefing Operational Debriefing Good leadership Stress Management

14. Treatment of PTSD The important thing is to recognize the symptoms in yourself and your fellow soldiers Alcohol abuse Sleep problems Marital problems Emotional changes

15. Treatment of PTSD Initial treatment should be: B � Brief I � Immediate C � Centrality E � Expectancy P � Proximity S - Simplicity

16. Treatment of PTSD Medical Treatment Anti-depressant medications especially effective at addressing Avoidance Numbing Re-experiencing Hyper-arousal Alcohol consumption in co-morbid alcoholics

17. Treatment of PTSD Psychological Treatments Cognitive-behavioral therapy: most effective at addressing guilt, avoidance, emotional changes Best conducted in group format Can be done with self-help books: �The PTSD Workbook�

18. Treatment of PTSD Grinage (1994): Reviewed studies of effectiveness of therapy Positive end-state= 50% reduced sxs Approximately 1/3 of patients achieved end-state in 10 sessions

19. Treatment of PTSD Informal treatment: Debriefing/Defusing in workgroups Support Groups

20. Treatment of PTSD The difficulty with treatment in military settings is the barriers inherent in our line of work Stigma: crazy, malingering, weak Career: mental health=death

21. Perceived Stigma of Mental Health Care DIVSURG: There remains a significant stigmatization barrier to mental health care. In order for Soldiers to properly be prepared for combat, leaders must recognize that Soldiers are best served by early intervention to increase the rate of return to duty. Fostering a climate that recognizes that mental health wounds are just as real as fractured bones or gunshot wounds AND as treatable will reduce the stigma, promote better coping skills, and avoid future combat stress casualties.DIVSURG: There remains a significant stigmatization barrier to mental health care. In order for Soldiers to properly be prepared for combat, leaders must recognize that Soldiers are best served by early intervention to increase the rate of return to duty. Fostering a climate that recognizes that mental health wounds are just as real as fractured bones or gunshot wounds AND as treatable will reduce the stigma, promote better coping skills, and avoid future combat stress casualties.

22. Treatment of PTSD Special aviation-related issues: Flight status Often mental health is viewed as a death to a career Informal assessment/treatment Typical coping style of aviators Repression and denial Aviators need to be allowed to cope in their own way

23. Leadership Issues Whether you �believe� in PTSD or not, there is no argument that a certain percentage of soldiers will experience problems and become casualties of their experience May occur either emotionally or behaviorally

24. Leadership Issues Traumatic stress reactions are common, but often become less frequent or distressing as time passes, even without treatment. Approximately 5-8% of soldiers who see combat will develop life long PTS symptoms. FEW will seek or get help until they cannot cope. Veterans with PTSD often worry that they are going crazy.� This is not true.� They are experiencing a set of common symptoms and problems that are connected with trauma.� Soldiers are concerned that any revealing of their troubles will result in actions against them or will damage their reputation/career. Leaders must communicate and assure soldiers in their command that this is NOT the case.

25. Bottom-Line Approx 1/5 of soldiers in the 101st are likely to be suffering Treatment is effective and available Aviation represents a �special case� We need to work to provide help and avoid the stigma associated with mental health

26. Recommendations Prevention PTSD education Screening Barriers to care MH teams to each BCT Army OneSource Aeromed Psychology program? Informal treatment methods

27. Helpful Resources Your Unit Chaplain/Physician Division Mental Health: 798-8682 Adult behavior health (BACH): 798-8802 Army One Source 1 800 464-8107 National Center for PTSD: Http://www.Ncptsd.Org/