PTSD Info & David Lee's PTSD Video
From Dr. Schween
PCMHI Coping with Trauma Manual Revised Jan 2017.docx (497.49 KB)
Anger Management
https://www.veterantraining.va.gov/apps/aims/resources/resources/videos.html
- SAMSHA Anger Management Workbook was developed for the original Anger Management course that AIMS is based upon. It provides more detailed information about anger management and opportunities to practice skills.
- Anger and irritability can affect your health and relationships. Make the Connection offers videos of Veterans sharing their experiences and a resource directory to help connect you to professional care.
- AfterDeployment.org is a comprehensive website with resources and information on a wide variety of topics that affect Veterans and their Families. The anger management section has access to assessments, workshops, videos, and a library.
National Center for PTSD
https://www.ptsd.va.gov/
David Lee's Video
http://www.interventionservicesinc.com/intervention-101/intervention-types/mental-health-intervention/ptsd-intervention/?_vsrefdom=ppc&gclid=CMjf5q_-xsECFfFzMgodFW0AIA
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The term "shell shock" came out of the First World War, followed by "combat fatigue" during World War II. For the first time, people began to understand that genuine mental illness could result from combat exposure. In the third edition of the Diagnostic and Statistical Manual of Mental Disorders published in 1980, PTSD was finally given its modern name and classified under anxiety disorders instead of mental disorders.
Although PTSD has now received official recognition, many old stigmas regarding "shell shock" and expectations for combat veterans still persist. The male-dominated and often extremely macho society of the military can make it difficult for combat veterans to admit that they may be suffering from an anxiety disorder.
It is now known that people who have experienced the trauma of combat often hold an implicit memory of the traumatic events (somatic memory) in their brains and bodies. This memory is often expressed in the symptomatology of PTSD - nightmares, flashbacks, startle responses, and dissociative behaviors.
According to the Rand Corporation and the Congressional Research Service, about one in three Vietnam veterans, one in 10 Gulf War veterans, 6 to 11 percent of Afghanistan War veterans, and 12 to 20 percent of Iraq War veterans have PTSD. For veterans who saw frequent combat, the numbers are even higher. Plus, the more tours you made and the more combat you experienced, the more likely it is that you’ll develop PTSD. (http://www.rand.org/content/dam/rand/pubs/monographs/2008/RAND_MG720.pdf) (http://www.fas.org/sgp/crs/natsec/RS22452.pdf)
According to the Congressional Research Service there are 138,000 service-members from Operation Iraqi Freedom and Operation Enduring Freedom with new Post-Traumatic Stress Disorder (PTSD) diagnoses in all services, 2000- June 2015. (http://www.fas.org/sgp/crs/natsec/RS22452.pdf)
People with PTSD frequently feel as if the traumatic event(s) is happening again. This is sometimes called a flashback, reliving experience, or ab-reaction. The person may have pictures stored in his/her head about the trauma, have recurrent nightmares, or may even experience hallucinations about the trauma. Intrusive symptoms sometimes cause people to lose touch with the “here and now” and react in ways that they did when the trauma originally occurred.
PTSD is challenging for a number of reasons. Because the symptoms are often delayed and may appear long after the traumatic event is over, many people don’t connect the way they are feeling with the event they experienced months or even years before.
The Groundhog Day Effect
Because combat losses occur in a place of trauma (a combat zone), the brain records the event in a much different manner. Following the losses, many soldiers must operate as usual and grieving would mean letting down the emotional shield necessary for the protection of self and others. As a result of the vigilant state of the brain during the loss, the brain replays the event over and over as if it is in the present. Because of this, especially as they get older, many combat veterans relive their own personal wounds or the deaths of their "blood brothers" on a daily or nightly basis. Consequently, moods are altered, and the result is often irritability, sadness, and a need to isolate.
Because many aging Vietnam veterans are at a stage in life where they are reflecting on the past and looking toward the future, a common perception is that they fear there is not enough time to do the things they want to do – in essence, that it is “too late.” Ironically, many Vietnam veterans who have coped with troubling PTSD-related symptoms for years are just now beginning to ask for help with symptoms such as anger and isolation.
Problems related to PTSD
- Anger, irritability and rage.
- Feeling nervous.
- Depression.
- Difficulty trusting others.
- Feeling guilt over acts committed or witnessed, the failure to prevent certain events, or merely having survived while others did not.
- Hyper-alertness and startle reactions.
- Having thoughts and memories that will not go away.
- Isolation and alienation from others.
- Loss of interest in pleasurable activities.
- Low tolerance to stress.
- Problems with authority.
- Nightmares.
- Substance abuse.
- Trouble sleeping.
- Anxiety.
Can PTSD be healed, or is therapy just a band-aid, something that will simply help me cope?
For decades combat veterans seeking treatment to reduce their combat-related symptoms of post traumatic stress disorder (PTSD), have often been told by friends, family, and healthcare providers something to the effect of, “You’ll just have to learn to cope with it. You will have these symptoms for the rest of your life.”
MYTH: People should be able to move on with their lives after a traumatic event. Those who can’t cope are weak.
FACT: Many people who experience an traumatic combat event go through an adjustment period following the exposure. Most of these people are able to return to leading a normal life. However, the stress caused by combat trauma can affect all aspects of a person’s life including mental, emotional, and physical well-being. Research suggests that prolonged trauma may disrupt and alter brain chemistry.
Today, however, as a result of current brain research, the prognosis is positive, and many veterans experience a profound release of their symptoms. In fact, numerous researchers have found that time with peers, relaxation methods, distracting activity, proper diet and sleep all can help alleviate the symptoms of PTSD.
The most common treatment modalities for PTSD are cognitive therapy and veterans’ support groups. A reasonably new one is Somatic Experiencing.
Cognitive therapy (sometimes called cognitive behavioral therapy) is based on the concept that the way we think about things affects how we feel emotionally. It focuses on present thinking, behavior, and communication, rather than on past experiences, and is oriented toward problem solving. Often used to treat a broad range of problems including depression, anxiety, panic, fears, eating disorders, substance abuse, and PTSD, cognitive therapy can help veterans understand their symptoms, decrease their reactivity, and learn coping skills.
Group therapy (or a veterans’ support group - especially one made up of individuals with whom you were in combat with), offers camaraderie and an opportunity to openly share locked-up experiences with other veterans who truly understand and listen without judgment. The groups also validate the fact that symptomatic behavior – exaggerated startle response, nightmares, trust issues, emotional numbness, irritability, isolation, avoidance of crowds, and avoidance of social events – is a normal response to the untreated trauma caused by the combat experience. During confidential group sessions, domestic and other unresolved issues can be discussed without guilt or shame. For many veterans, listening to “brothers” in the group is the first time they have created an authentic kinship since combat. Statistics gathered by the United States Department of Veterans Affairs (VA) suggest that when compared to traditional talk therapy, veterans’ support groups are more effective. However, when the possibility of joining a vets’ support group is first discussed with a combat veteran, the response is almost always negative.
Another treatment that works pretty successfully with the nervous system following trauma is Somatic Experiencing. Created by Peter Levine, this treatment uses relaxation, breathing techniques, and imagery to create resolution within the nervous system. By using these techniques, veterans can learn to cope with stress, and bring resolution to their combat experience. More and more institutions and private therapists are making use of these and similar techniques to actually end the symptoms of trauma.
Keep in mind that several factors determine the degree of success that is experienced from the therapeutic process. These include the veteran’s determination to create changes in the way he or she copes with stressful triggers, willingness to trust the therapeutic process, and life experiences following combat. For some, there is much regret regarding relationships and lifestyle choices. Early background, current support and family system, and the specific experiences from combat are also factors that influence the outcome of therapy.
Ways you can personally calm your nervous system
1) Just as loud noises, certain smells, or the feel of sand in your clothes can instantly transport you back to the trauma of a combat zone, so too can sights, sounds, smells, and other sensory input quickly calm you down. The key is to find the sensory input that works for you.
Think back to your time on deployment: what brought you comfort at the end of the day? Perhaps it was looking at photos of your family? Or maybe it was the taste of candy in a care package from home, or listening to a favorite song, or smelling a certain brand of soap or cologne? Or maybe petting an animal works quickly to make you feel calm and centered?
Everyone responds to sensory input a little differently, so experiment to find what works best for you.
2) You may find it very difficult to relax at first. It’s common for veterans to be drawn to behaviors that pump up adrenaline. After being in a combat zone, that’s what feels normal. Without the rush, you feel strange or even dead inside. Things you may turn to for that familiar adrenaline rush include energy drinks, coffee, drugs, cigarettes, violent video games, and daredevil sports. If you recognize these urges for what they are, you can make better choices that will calm and care for your body and mind.
3) Find safe ways to blow off steam. Pound on a punching bag, pummel a pillow, go for a hard run, sing along to loud music, head to the gym for a vigorous workout, go somewhere private where you can scream at the top of your lungs, or vent in your journal or to someone you trust.
4) Deal with flashbacks, nightmares, and intrusive thoughts Flashbacks usually involve visual and auditory memories of combat or other trauma you experienced. It feels as if it’s happening all over again so it’s vital for you to accept and reassure yourself that your traumatic experience is not occurring in the present.
One effective technique is to state to yourself (either out loud or in your head) the reality that while you feel as if the trauma is currently happening, you can look around and recognize that you’re safe. Here’s a simple script you can use when you awaken from a nightmare or start to experience a flashback or intrusive thought:
“I am feeling [panicked, overwhelmed, etc.] because I am remembering [traumatic event], but as I look around I can see that the event isn’t happening right now and I’m not actually in danger.”
5) Ground yourself during a flashback.
- Move around vigorously (run in place, jump up and down, etc.); rub your hands together; shake your head.
- Splash cold water on your face; grip a piece of ice; touch or grab on to a safe object; pinch yourself; play with worry beads or a stress ball.
- Smell something that links you to the present (coffee, mouthwash, your wife’s perfume) or a scent that has good memories.
- Suck on a strong mint or chew a piece of gum; bite into something tart or spicy; drink a glass of cold water or juice.
- Enlist help: Teach a trusted friend or family member about grounding and why you need to use it. If someone you trust understands when grounding is useful, they can remind you to use it (and do it with you) if you are starting to lose touch with the present. For example, they might say, “I think you might want to do some grounding now... can you describe what you are wearing? What am I wearing? Where are we right now?”
6) Deal with irritability, anger and rage:
- Before reacting, take a time out to cool off and think.
- Walk away from the situation.
- Exercise every day - exercise reduces tension and relieves stress.
- If you blow up at family or friends, find time to talk to them and explain what happened and what you are doing to cope with it.
7) Difficulty falling - or staying - asleep:
- Keep a regular bedtime schedule and routine.
- Avoid heavy exercise for a few hours before bed.
- Use your bed only for sex and sleeping.
- Don't use alcohol, tobacco, and caffeine - these hurt your ability to sleep.
- Don't lie there in bed thinking or worrying. If you can't sleep, get up and do something quiet like drinking herbal tea, or warm milk. Read a book or do something else quietly.
Some good drugs to combat PTSD
By Jonathan Shay, M.D., Ph.D. Staff Psychiatrist, Boston VA Outpatient Clinic
Published at: http://www.sidran.org/resources/for-survivors-and-loved-ones/about-medications-for-combat-ptsd/
"Everything I say here is my point of view, and carries no claim of special authority. Also, what I say here is no way complete. I have left out many important subjects, such as drug interactions, what medical conditions forbid the use of a given drug, overdoses and toxicity, and most specific side-effects. --- No medicine can cure combat PTSD by itself. However, healing can never mean a return to 17-year old innocence. Healing means building a good human life with others—a life that a veteran can embrace as his own."
–Serotonin reuptake inhibitors: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), etc.
The main effect of fluoxetine on combat vets with PTSD whom I’ve worked with is to allow them more time to think before they act, particularly in anger. It does this without sedation or cutting a man off from himself or the world. The duration of anger, once aroused, is also shorter. Greater self-mastery of anger leads to an increase in self-respect and relief from a sense of humiliation. Most men feel humiliated after they go off on people in situations they really would not have, if they had had the freedom to choose. In addition to this, fluoxetine may have a direct anti-depressant effect in combat PTSD. Fluoxetine effects on self-control and rage may take many weeks to kick in, although I’ve seen it as soon as a week.
Fluoxetine is practically useless as a drug to overdose on, if the goal is suicide. All anti-depressants have been known to give long-time depressed people the energy to kill themselves, and fluoxetine is no different. Many combat veterans go through brief periods of intense despair during the first few months that they are feeling generally better, more alive, and are coming out of their bunkers. Support from other veterans, family, therapists is especially important during those times—nobody should try to go through it alone, or have to. Someone trying to go through it alone might try to kill himself during one of these times of despair. Remember that this is no special risk with fluoxetine, but is a risk when anyone recovers from severe depression. Several vets I’ve treated have had bouts of despair like this, but none has ever tried to kill himself during one, because support and therapy are built into the program I’m a part of. The much-publicized claim that Prozac has special powers make a previously non-suicidal person violently suicidal is without good foundation. Fluoxetine does have side effects, which not everyone can stand, and it doesn’t work for everyone. A full discussion of side-effects, some of which depend on the dose and others not, would be too long for this summary.
Fluoxetine is the first drug of its type to be released for use. Other drugs in the same family have now come along, sertraline (Zoloft) and paroxetine (Paxil). They have been tried by many combat vets around the country, and from what I hear they are not a lot different than fluoxetine as far as main and side-effects. In the relatively limited number of men I have treated with paroxetine and sertraline, this has been what I have heard from them. Paroxetine has a 24 hour half-life and no active metabolites [what the body turns the parent drug into], so if the actions of the drug are otherwise identical to fluoxetine, it will be a superior drug from a safety point of view, because it doesn’t hang around in the body so long. But on the down side, paroxetine may be expected to (and is reported to) have a withdrawal syndrome because it leaves the body so fast.
–Buspirone (Buspar)
This anti-anxiety drug works differently from the benzodiazepines (like Valium). Like anti-depressants it takes a few weeks to kick in. It takes effect gradually, like the tide coming in. It usually has few side-effects and may help some people with intrusive thoughts and nightmares. Buspirone has no street value and is almost useless as a suicide pill. I am not aware of other drugs in this family coming along, but I hope there will be. I have recently read the report of a colleague who works with combat veterans that the best results with buspirone come at doses above 60mg/day. I do not yet have enough personal experience with patients who have tried this, to confirm or deny this report.
–Beta-blockers: propranolol (Inderal), nadolol (Corgard), atenolol (Tenormin), etc.
This family of drugs breaks the mind-body-mind vicious cycle in rage reactions, by blocking the body effects of adrenalin. For example, if someone at work says something offensive about Vietnam vets, the words start the mind working into rage. The rage starts in the mind—but within a second the body responds with adrenalin, which makes the gut burn, the heart pound, the muscles tense. These body changes send loud messages back up to the mind. For some veterans, the roar of the body drowns out all thought and shuts out everything else coming in. When adrenalin is roaring, it’s impossible for most people to think clearly and to take in non-combat possibilities in the situation. This is the mind-body-mind vicious cycle that beta-blockers break up. By blocking the adrenalin effect on the body they prevent the roar of the body from drowning out all thought and choice about what you really want. “Is it really in my interests to rip this guy’s lungs out? Is it really what I want to do?” When adrenalin is roaring these questions sometimes cannot be heard.
Some vets feel that these medications weaken them, because they associate being pumped up with adrenalin with their personal strength. When someone is over-medicated on these drugs (which started life as blood pressure meds) he is weaker because his blood pressure is too unstable, but this is usually not a problem with a correct dose. Tolerance does not develop to the anti-adrenalin effects of these drugs. Massive overdoses of a beta-blocker can be fatal, by dropping the blood pressure and slowing the heart to the point that the brain is not getting enough blood flow.
–Low-dose lithium
Some respected practitioners of PTSD pharmacotherapy speak highly of lithium to help veterans maintain their self-control when they are angry. This means doses of about 600mg/day, far less than is usually needed to treat bipolar affective disorder (manic-depressive disorder), and does not imply that the doctor recommending this thinks that the veteran is manic-depressive.
I agree that this can help some veterans, but I have found fluoxetine to be more reliable. It is also safer, in that lithium is readily fatal in a large overdose. For a veteran who cannot tolerate fluoxetine and whose life has been blighted by explosive violence, low-dose lithium may be a good thing to try. [no blood tests because of low dose]
Join a existing group or create one yourself to help wounded service-members and their family (http://lotsahelpinghands.com/)
PTSD Linked to Dementia in Later Life (http://www.vietnow.com/ptsd-linked-to-dementia-in-later-life/)
Between 10 and 20% of Iraq and Afghanistan veterans have suffered a traumatic brain injury (TBI). Possible consequences of this internal injury include anger, suicidal thoughts, and changes in personality.
Sources
1 Carden, Michael J., Sgt. 1st Class. “Army Works to Expand Combat Stress Detection,” American Forces Press Service. Published July 22, 2010.
2 Combat Stress for Medical Providers [PDF 2.3 MB], Deployment Health Clinical Center, Department of Defense. Published August 2006.
3 Implementation of Adjudicative Guidelines for Determining Eligibility for Access to Classified Information [PDF 1.1 MB], Department of Defense. Published August 30, 2006.
4 Haire, Tamara. “Financial Problems or PTSD Need Not Affect Security Clearance,” Army News Service. Published July 8, 2009.
5 Miles, Donna. “Gates Works to Reduce Mental Health Stigma,” American Forces Press Service. Published May 1, 2008.
6 “TBI and PTSD Quick Facts [PDF 28.7 KB],” Deployment Health Clinical Center, Department of Defense. Last accessed June 19, 2014.
7 Pueschel, Matt. “Combat Exposure Raises PTSD, Smoking, Alcohol Abuse Risks,” Force Health Protection & Readiness, Department of Defense. Published May 22, 2009.
8 “What is PTSD?,” National Center for PTSD, Department of Veterans Affairs. Last accessed June 19, 2014.
9 “Nightmares & PTSD,” National Center for PTSD, Department of Veterans Affairs. Last accessed June 19, 2014.
10 Stress & Trauma, Fact Sheets: A Normal Reaction to an Abnormal Situation, Deployment Health Clinical Center, Department of Defense.