Transcript Post Traumatic Stress Disorder & Traumatic Brain Disorders

James Vaughns, MS, LPC, CCS, MAC, CACII
Windsor Primous, Intern
-DSM-IV DefinitionAfter a trauma (the experience, threat, or witnessing
of physical harm, e.g., rape, hurricane), the person
who has each of the following key symptoms for over
a month, and they result in decreased ability to
function (e.g., work, social life): Intrusion
(flashbacks, nightmares); Avoidance (not wanting to
talk about it or remember.
The symptoms could start after the traumatic event, months or
years later. These symptoms are different from those that last for
weeks, that cause you great stress or interference.
Bad memories of the traumatic event. You may feel like you are
going through the event again. This is called flash backs.
Sometimes the triggers are smells, sounds, etc.
Feeling keyed up (hyper arousal) on alert , looking for danger.
Know a hyper arousal , it may cause sudden anger or being
irritable.
Having a hard time sleeping and trouble concentrating.
Men and Sexual Trauma
10% of men suffer from the results of a sexual trauma.
Boys are more likely than girls to be sexually abused by
strangers (authority figure).
Boys and men who have been sexually assaulted are more
likely to suffer from PTSD, anxiety disorder and depression.
(Sonkin & Walker, 1998)
Female Veteran
This study suggests that there may be a link between
PTDS and sexual trauma.
1 in 5 women veteran who seek healthcare services from
the VA reported PTSD as a result of sexual trauma.
These women were 8 times more likely to be diagnosed
with PTSD as compared to women who did not report
these experiences.
Men who were sexually abused report with a diagnosis of
PTSD as compared to than those who do not. (Munsey,
2009).
Emotional
Depression
Self-blame
Guilt
Shame
Suicidal thoughts
Anger****
Aggressive behavior****
Drugs and Alcohol abuse
Physical
Sweating
Pounding heart
Rapid breathing
Feeling edgy
Trouble sleeping
Medical problem gets worst
Anger is usually a central feature of a survivor's
response to trauma because it is a core component
of the survival response in humans.
Anger helps people cope with life's adversities by
providing them with increased energy to persist in
the face of obstacles.
Uncontrolled, anger can lead to a continued sense
of being out of control of oneself and can create
multiple problems in the personal lives of those
who suffer from PTSD.
One theory of anger and trauma suggests that
high levels of anger are related to a natural
survival instinct.
Automatic responses of irritability and anger in
individuals with PTSD can create serious
problems in the workplace and in family life. It
can also affect the individuals' feelings about
themselves and their roles in society.
*“The compulsion to use despite negative
consequences” (e.g., legal, physical, social,
psychological). Note that neither amount of use nor
physical dependence define substance abuse.
DSM-IV term is “substance use disorder”, with
substance abuse a milder form, and substance
dependence more severe.
Rates: 35% for men; 18% for women
It is a treatable disorder and “a Brain Disease” (not a
moral weakness)
Rates: of clients in substance abuse treatment 12% 34% have current PTSD. For women, rates are 33%59%
For women, typically a history of sexual or physical
childhood trauma; for men, combat or crime.
Drugs: No one drug of choice, but PTSD is
associated with severe drug use like (cocaine,
opioids); “self-medication” in 2out of 3 cases (i.e.,
PTSD first, then substance abuse).
Other life problems are common: Axis 1 D/O,
personality D/O, interpersonal and medical
problems, inpatient admissions, low compliance
with aftercare, homelessness, domestic violence.
PTSD does not go away with abstinence from
substances; and PTSD symptoms are widely
reported to become worse with initial abstinence.
Separate treatment systems(mental health Versus
substance abuse)
Fragile treatment alliances and multiple
crisis are common occurrences.
Treatments are helpful for either d/o alone
may be problematic if someone has both
disorders,(exposure, twelve step groups,
benzodiazepines). Also, some messages in
substance abuse treatment maybe
problematic: “hitting bottom, confrontation”.
Fear for your safety and always feel on guard
Be very startled when someone surprises you
Feeling numb: Find it hard to express your feelings
You may not have positive or loving feelings toward
other people and may stay away from relationships
You may not be interested in activities that you use to
enjoy
You may forget parts of your traumatic event or may
not talk about it
1. Diversity Issues: In the US, rates of PTSD do not differ by
race (Kessler et al.,1995.
2. Substance Abuse: Hispanics & African Americans have
lower rates than Caucasians; Native Americans have higher
rates than Caucasians. Rates of abuse increase with
acculturation. Some cultures have protective factors
(religion, kinship).
3. It is important to respect cultural differences and tailor
treatment to be sensitive to historical prejudices. Also,
terms such as “trauma, PTSD and substance abuse” may be
interpreted differently based on culture.
Treat both disorders at the same time, also clients prefer
this mode of treatment(One Stop Shopping)
Decide how to treat PTSD in context of active substance
abuse.
OPTIONS:
Type 1: Focus on “present only”(coping skills, psycho education,
educate about symptoms) {safest approach, widely
recommended}
Type 2: Focus on past only(tell trauma story){high risk; works
for some clients} Type 3:Focus on both past/present
A present-focused therapy to help clients (male &
female) attain safety from PTSD and substance abuse.
25 topics that can be conducted in any order:
Interpersonal topics
Cognitive topics
Behavioral topics
Other topics
Designed for flexible use
Safety
Integrated
A focus on ideals
4 content areas
Attention to therapist processes
Additional features: Trauma details not part of group
therapy
Identify meaning of substance use in context of PTSD
Optimistic, help clients obtain more treatment
Inhibition
Impulsivity
Aggression
Sexual Deviation
Passive; Indifference
Paranoia
Irritability
Improvement tends not to
occur after 2 years.
No established drug
treatment for affective
disorder, anxiety or
psychosis
Psychotherapy
Behavioral modification
Poor outcomes after TBI shorten length of stays in
both inpatient medical setting payers points to
lack of sufficient evidence-based research as a
primary reason for coverage denial of medicalnecessary treatment.
Cognitive Rehabilitation
Critical therapy
Available to active duty
Not accessible to medical retirees under TRICARE
Vocational rehabilitation is available for service
members diagnosed with PTSD, TBI, and other
related illnesses
VA treats employment as a goal of rehabilitation
VA declares many retirees ineligible for
vocational rehabilitation
Department of Defense and the Department of
Veterans Affairs has improved the quality and
speed of care for service members and veterans
with TBI.
Access to local and specialized treatment
remains limited.
H.R. 667 & S.262 Traumatic Brain
Injury Family Caregivers Personal
Attendant Training, Certification and
Compensation Program makes respite
care available to caregivers of persons
with cognitive disabilities as physical
disabilities.
TBI is a blow or jolt to the head that can
temporarily or permanently diminish a person’s
physical abilities, impairs cognitive skills, and
interfere with emotional and behavioral well
being.
TBI outcomes depend on the location and the
extent of the neurological damage; ranges good
recovery to death.
A traumatic brain injury can change how a person
acts, moves, and thinks. It can cause changes in the
brain, such as:
Thinking and reasoning
Understanding words
Remembering things
Paying attention
Solving problems
Thinking abstractly
Talking
Behaving
Walking and other physical
activities
Seeing and/or hearing
Learning
The term TBI is not for a person who is born
with a brain injury. It not a term for a brain
injuries that happen during birth.
Personnel who are exposed to loud noise,
like a loud cannon or a bomb/grenade going
off around you. Prolonged exposed can cause
this TBI affect.
Memory loss
Concentration and attention problems
Slow learning
Difficulty with planning and reasoning
Poor judgment
Depression
Anxiety
Impulsivity
Aggression
Thoughts of suicide
It is very important that returning soldiers, airman,
marines and navy members get thoroughly checked
out before returning to society.
Everyone who is returning wants to get home as
soon as possible and when asked will deny any
problems, especially those of a psychological
nature.
**YOU ARE NOT INSANE IF YOU ASK FOR HELP**
GET CHECKED OUT BEFORE YOU GO HOME!
Make sure you tell doctors everything you think or feel may
be wrong with you.
Get a copy of your medical and dental records.
Get copies of every evaluation you participated in on purpose
or accidentally.
Medical records seem to get lost or burned in fires, or other
catastrophes.
You will need these records if and when your service time is
questioned.
Lastly, when you do need them, never, ever, give the VA your
original medical records; copies only, and keep your records
in a safe place.
Post-traumatic stress disorder and traumatic brain
injuries are serious and should be taken seriously.
Get help!
We do care and support you;
All of America supports you!
Munsey, Christopher. (2009, September) Women
and War, Monitor Staff, Monitor on Psychology,
Volume 40, N0.8.
Sonkin, Danial J., Walker, Lenore E. A. (1998)
Wounded Boys, Heroic Men: A Mann’s guide to
Recovering from child abuse