Transcript 1st Sgt Academy PTSD Brief (Watson)

st
1
Sergeant’S Brief
LCDR Tenaya N. Watson, Ph.D.
U.S. Public Health Service
Licensed Clinical Psychologist
Maxwell AFB Mental Health Clinic, 42nd MDG
(Slides Adapted from Neysa Etienne, Psy.D. & Chad Morrow, Psy.D.)
RATIONALE FOR 1st SERGEANT
“…the most important enlisted person, give them the most
pay and I almost feel like making all Second Lieutenants
salute them. The ones I have worked with in the past and
many others, I would gladly give the first salute. The
First Sergeant is the Captain’s Chief of Staff. A poor one
will ruin a good troop no matter what kind of Captain
they have. And many a poor Captain has had his
reputation saved and his troop kept, or made good, by a
fine First Sergeant”
Colonel Charles A. Romeyn,
The Calvary Journal, July 1925
SIGNIFICANCE OF A SYMBOL
DIAMONDS
1st SERGEANT
UNBREAKABLE
LEADERSHIP STRENGTH
EXCELLENT OPTICAL CHARACTERISTICS
IDENTIFY AND HIGHLIGHT
FORMED UNDER PRESSURE/HEAT
SACRIFICES IN THE PROCESS
RESISTANT TO IMPURITIES/SCRATCHING
HIGHER CODE OF CONDUCT/ETHICS
HARD TOUGH MATERIAL
HANDLE TOUGH SITUATIONS
GOALS OF THIS BRIEF
ULTIMATE GOAL: HELP YOU DO YOUR JOB BY MAKING
AN INFORMED DECISION AS YOU SERVE YOUR AIRMAN
WE WILL COVER TWO PSYCHIATRIC CONDITIONS:
-Post-Traumatic Stress Disorder (PTSD)
-Suicide
-Interaction between the two
CRITICAL MATERIAL TO ADDRESS :
-Collateral Information
-Cause
-Symptoms
-Treatment
PROVIDE HIGH-YIELD RECOMMENDATIONS:
-Intervene
-Save Lives
-Empower Your Airman
WHAT IS PTSD???
PTSD IS AN ANXIETY DISORDER
-Emotion of Anxiety:
Feeling fear, terror, helplessness
-Physiological Manifestation
Changes in breathing, body temp, heart rate
PTSD is an EMOTIONAL REACTION to a Traumatic Event
-Definition of Traumatic Event
Actual threat to life or physical injury
Perceived threat to life or physical injury
Diagnostic concerns with PERCEPTION & EXPERIENCE
-Any experience is unique to individual perception
-Either direct experience or witness to event
-Subtlety of perceptions and witnessing can block 1st Sgt action
T: traumatic event
R: re-experience
A: avoidance
P: persistent arousal
Experienced
Actual
Witness
Threatened
Intense emotions
Fear
Helplessness
Horror
Persistently re-experienced (at least 1)
Distressing recollections
Dreams
Re-occurring
Psychological distress @ exposure
Physiological reactivity @ exposure
Avoidance of associated stimuli (at least 3)
Thoughts/feelings
Activities/people/places
Inability to recall
Diminished interest in significant activities
Detachment/estranged from others
Restricted range of affect (emotionally numb)
Foreshortened future
Increased arousal (at least 2)
Falling or staying asleep
Irritability/outbursts of anger
Difficulty concentrating
Hyper-vigilance
Exaggerated startle response
Longer than 30 days
Clinically significant distress
Impairments
Social
Occupational
Other
Sleep problems
Work “sucks”
Family problems
Apathy & Anhedonia
Absences
Sick call/medical appointments
Chronic Pain
ANGER
• CONSIDER CONTEXT (pre/post deployment)
ANGER
THE ULTIMATE EMOTION BLOCKER
THE ACCEPTABLE EMOTION
A BONDING EMOTION: Common Enemy
THE ANGER SOLUTION- WHY BLOCK?
ANGER BLOCK
(-) Emotions
Uncertainty/Confusion
Disappointment/Distress
ANGER BLOCK
(+) Emotions
Happiness
Fondness
Worry/Frustration
EQUALS WEAKNESS
Closeness
AVOIDS LOSS
HOW DOES IT DEVELOP???
PTSD IS A LEARNED BEHAVIOR
HOW IS THIS BEHAVIOR LEARNED?
UCS----------------------------------------UCR
(Food)
(Salivation)
CS------------------------------------------ CR
(Bell)
(Salivation)
UCS---------------------------------------- UCR
(IED Blast)
(Anxiety)
CS-------------------------------------------CR
(Environment)
(Anxiety)
Why does IT LASTS???
BEHAVIOR
Do Something
Do Something
Do Something
Do Something
CONSEQUENCE
Lose something good
Get rid of something bad
Get something good
Get something bad
FUTURE
Do it less
Do it more
Do it more
Do it less
RECOMMENDATION
INFLUENCE OF 1st SHIRT???
Acknowledge their courage
Communicate validation of symptoms
Share your story if appropriate
Offer to facilitate a clinic appointment
Remain non-judgmental of experience
Attempt to collaborate the next step
Treatment obstacles
1. Avoidance of trauma-related material
• Triggers
• Feelings
• Activities
• Thoughts
• Images
• Situations
2. The presence of inaccurate thoughts/beliefs
• “The world is unpredictably dangerous”
• “I am unable to cope”
PROLONGED EXPOSURE
 > 60 research studies support efficacy
 Inadequate evidence supporting
medications as effective treatments
 Early evidence suggests physical
symptoms will not improve if PTSD is
not adequately addressed first
 Two parts of exposure
• Imaginal: in the head
• In Vivo: in the environment
Exposure
 Prolonged Exposure
Maladaptive Cognitions
 Cognitive Processing Therapy
 National Prevalence = 8%
 Trauma Victims = 20-30%
 Vietnam Veterans = 30%
 Persian Gulf War I Veterans = 10%
 Soldiers returning from OIF:
 Report one or more PTSD symptoms: 22%
 PTSD Diagnosis: 12%
 Latest Research: All Branches
• 15-17% PTSD
• 25% psychological difficulties
Anyone in Theatre
Trauma exposure
• High risk Groups
• History of trauma exposure
Airmen exposed to trauma will recover
• Data indicates 60% / 40% Split
Data is mixed on timing of treatment
PTSD symptoms & Health
Positive for PTSD symptoms
 Have twice as many medical visits
 Miss twice as many work days
PTSD & depression
PTSD & depression account for physical
symptoms more than mTBI











SECURITY FORCES
EOD
OSI
Intel
Medics
Transport (helicopters)
Unmanned Air Planes
Combat Controller
JET
Multiple deployments
Longer deployments
 Amongst all Airmen deployed in support of OEF/OIF:
 Report one or more PTSD symptoms: 1.9%
 PTSD Diagnosis: 0.35%
 Amongst all Airmen deployed on JET missions in support of
OEF/OIF:
 Report one or more PTSD symptoms: 4.7%
 PTSD Diagnosis: 1%
 AF PTSD discharges increased tenfold since 2001
 From 10 discharges in 2001 to 110 in 2007
 Direct communication
 Ambiguity fuels the fire
 Normalize
 Provide Personal examples (disclose appropriately)
 Support : Constructive Behaviors
 Help-seeking behavior
Time off for appointments
 Healthy living
Eating, sleeping, exercise
Group activities versus isolation
 Discourage: Destructive Behaviors
 Drinking
 Drugs
 Avoidance of responsibility
Full-blown PTSD is a low base phenomena
PTSD can be effectively treated
PTSD is not a remitting disorder
1st Sgt’s play a significant role
Consistency/follow-through
Consult with Clinic Providers
LCDR Tenaya N. Watson, Ph.D.
U.S. Public Health Service
Licensed Clinical Psychologist
Maxwell AFB MHC
Commercial: 334-953-5430
DSN: 493-5430
[email protected]