War may be hell… but home ain’t exactly heaven, either.

1. War may be hell… but home ain’t exactly heaven, either. When a Soldier comes home from war, he finds it hard…

2. …to listen to his son whine about being bored.

3. …to keep a straight face when people complain about potholes.

4. …to be tolerant of people who complain about the hassle of getting ready for work

5. …to be understanding when a co-worker complains about a bad night’s sleep

6. …to control his panic when his wife tells him he needs to drive slower

7. …to be grateful that he fights for the freedom of speech.

8. …to be silent when people pray to God for a new car.

9. …to be compassionate when a businessman expresses a fear of flying.

10. …to not laugh when anxious parents say they’re afraid to send their kids off to summer camp.

11. …to not ridicule someone who complains about hot weather.

12. …to control his rage when a colleague gripes about his coffee being cold.

13. …to remain calm when his daughter complains about having to walk the dog.

14. …to be civil to people who complain about their jobs.

15. …to just walk away when someone says they only get two weeks of vacation a year.

16. …to be happy for a friend’s new hot tub

17. …to be forgiving when someone says how hard it is to have a new baby in the house.

18. …to not punch a wall when someone says we should pull out immediately.

19. The only thing harder than being a Soldier… By: Danielle “A Proud Army Wife”

20. is loving one.

21. A gentle reminder to keep your life in perspective. And when you meet one of our returning Soldiers, please remember what he’s been through and show him compassion and tolerance. Thank you. CPT Alison L. Crane, RN, MS Mental Health Nurse Observer-Trainer 7302nd Medical Training Support Battalion

22. POST TRAUMATIC STRESS DISORDER(PTSD) Beth Jeffries, PhD PCT Supervisor Jack C Montgomery Veterans Hospital Muskogee, OK

23. What We’ll Cover • Post Traumatic Stress Disorder (PTSD) • Traumatic Brain Injury (TBI) • Social Implications • Academic Implications • Occupational Implications

24. PTSD

25. Brief Overview • Experience of being exposed to an extreme traumatic stressor falling outside of the typical human experience or expectation • Response to this event involves intense fear, helplessness or horror • Evidence of persistent re-experiencing of the event • Evidence of persistent avoidance behaviors related to the trauma and generalized numbing of responsiveness • Increased arousal • These symptoms must be present for more than 1 month • Create dysfunction in social, occupational, and other important areas of functioning

26. Extreme Stressors Some examples… • Military combat • Violent personal assault • Terrorist attack • Kidnapping • Natural or Manmade disasters • Diagnosed with life threatening illness or injury

27. Personal Response How the person responds is important… • Amount of control the person feels in the situation appears to be very important for outcome • Social support, or lack of, impacts symptoms • Avoidance is NOT helpful…

28. Symptoms of PTSD Associated with Re-experiencing… • Intrusive thoughts of the event • Nightmares and sleep disturbance • Flashbacks • Intense psychological and physiological distress when reminded of the event

29. Symptoms continued… Associated with Avoidance and Numbing… • Efforts to avoid reminders • Inability to recall important aspects of the event • Withdrawal from favored activities and interests • Strong feelings of detachment and/or estrangement from others • Restricted range of affect (poker face)

30. Symptoms continued… Associated with Arousal… • Irritability and outbursts of anger • Difficulty concentrating/often confused with memory loss • Hypervigilance • Exaggerated startle response

31. Suicide • Feelings of hopelessness • Feelings of isolation/detachment • Depression and Loss • Guilt • Substance Abuse/Excessive Use • Coming home to family changes such as divorce, loss of money, or deaths in the family • Physical changes/disabilities resulting from wartime experience

32. Suicide What to look for • Isolation • Substance abuse/excessive use • Depression • Giving possessions away • Threats of suicide/past attempts • Talking about lack of future/hopelessness • Family history should be considered • Lack of social support

33. Suicide National Hotline It Takes the Courage and Strength of a Warrior to Ask For Help 1-800-273-TALK (8255) Press 1 for Veterans www.suicidepreventiononlifeline.org

34. PTSD Prevalence and Etiology • Estimated that 8% of total population meets criteria as set forth by the Diagnostic and Statistical Manual-IV (DSM-IV) • Research indicates 30-40% of persons exposed to trauma go on to develop PTSD • Number may be higher in “real world”

35. Prevalence and Etiology cont… • No one group impacted more than another • Childhood traumas may “prime” individuals to develop PTSD after subsequent traumas • Not considered an illness, but rather a stress reaction • Long term, adrenal system impacted and other physiological problems

36. Symptom Presentation • Withdrawal from family and friends • Inability to “get along” with others • Alcohol and substance abuse • Poor performance in home activities, school and work • “Personality” changes, behavior changes

37. Prognosis • Typically considered chronic, but recovery/management realistic goal • Up and down pattern of symptoms likely over a lifetime • Anxiety and depression features are medication responsive • Early, intense cognitive behavioral therapies are effective

38. Medications • SSRIs • TCAs • Sometimes, anti psychotics • Alpha blockers • Discourage use of sleep agents and benzos consistently found to be ineffective, at best, and possibly, more harmful

39. Behavioral Treatments • Group Therapy – Therapy of Choice • Individual Therapy • Supportive Therapy • Cognitive Behavioral Therapy (CBT) • Cognitive Processing Therapy (CPT) • Prolonged Exposure Therapy (PET) • Family/Marriage Counseling • Support and Peer Groups

40. Evidence Based Psychotherapy • Cognitive Processing Therapy (CPT) • Prolonged Exposure (PE) • Cognitive Behavioral Therapy (CBT)

41. PHYSICAL INJURIESTraumatic Brain Injury

42. Significant Issues • Physical Injuries • Loss of eyesight • Loss of limbs • Burns • Traumatic Brain Injury (TBI) Soldiers are surviving injuries on the battlefield that would have been fatal in the past!

43. Traumatic Brain Injury (TBI) • Closed or Open Wound • Loss of consciousness • Dizzy • Headache • Memory loss • Nausea • Suicidal risk

44. TBI, cont. • Can be difficult to distinguish from PTSD, many symptoms are similar • Behavioral changes • Attention deficits, Concentration problems • Impulsive behaviors/Acting out • “Nervous” energy • Depression, withdrawal, suicidal ideations • Not always visually apparent

45. TBI Treatment • Psychological Testing from a trained Neuropsychologist is recommended • Medical tests such as CAT scans and MRIs may be warranted • Assessment of pre-morbid functioning is recommended

46. TBI, cont • Head injuries may impede a person’s ability to function in all spheres, including academic • Ability to concentrate • Socialize appropriately • Focus of attention • Memory • Retention • “Personality” changes • Impulsivity

47. HOW DO ALL THESE INJURIES IMPACT THE RETURNING SOLDIER IN HIS “LIFE” AND HOW DO THEY IMPACT THE “REST OF US”

48. Social Functioning

49. Big Changes • Withdrawal / Isolation • Impulsive • Aggressive / Acting out • Short Attention Span • Self Focused / “Selfish” / Childlike • Regression • Angry • Controlling

50. Family and Friends • Isolates from others, even at home • May be “uninvolved” • May be “overly involved” • Detachment • “Clingy-ness” • Routines are disrupted • Roles are altered