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1 st Sergeant’s Brief

1 st Sergeant’s Brief. LCDR Tenaya N. Watson, Ph.D. U.S. Public Health Service Licensed Clinical Psychologist Maxwell AFB Mental Health Clinic, 42 nd MDG (Slides Adapted from Neysa Etienne, Psy.D. & Chad Morrow, Psy.D.). RATIONALE FOR 1st SERGEANT.

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1 st Sergeant’s Brief

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  1. 1st 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.)

  2. 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

  3. SIGNIFICANCE OF A SYMBOL

  4. 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

  5. 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

  6. HOW PTSD IS DIAGNOSED T: traumatic event R: re-experience A: avoidance P: persistent arousal

  7. T: Trauma • Experienced • Actual • Witness • Threatened • Intense emotions • Fear • Helplessness • Horror

  8. R: Re-experience • Persistently re-experienced (at least 1) • Distressing recollections • Dreams • Re-occurring • Psychological distress @ exposure • Physiological reactivity @ exposure

  9. A: Avoidance • 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

  10. P: Persistent Arousal • Increased arousal (at least 2) • Falling or staying asleep • Irritability/outbursts of anger • Difficulty concentrating • Hyper-vigilance • Exaggerated startle response

  11. MEETING CRITERIA • Longer than 30 days • Clinically significant distress • Impairments • Social • Occupational • Other

  12. HOW DOES IT LOOK??? • Sleep problems • Work “sucks” • Family problems • Apathy & Anhedonia • Absences • Sick call/medical appointments • Chronic Pain • ANGER • CONSIDER CONTEXT (pre/post deployment)

  13. ANGER • THE ULTIMATE EMOTION BLOCKER • THE ACCEPTABLE EMOTION • A BONDING EMOTION: Common Enemy • THE ANGER SOLUTION- WHY BLOCK?

  14. 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)

  15. Why does IT LASTS???

  16. RECOMMENDATION

  17. 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

  18. Treatment obstacles • Avoidance of trauma-related material • Triggers • Feelings • Activities • Thoughts • Images • Situations • The presence of inaccurate thoughts/beliefs • “The world is unpredictably dangerous” • “I am unable to cope”

  19. Treatments • 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

  20. Why it works • Exposure • Prolonged Exposure • Maladaptive Cognitions • Cognitive Processing Therapy

  21. HOW COMMON IS PTSD??? 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

  22. WHO IS AT RISK??? • 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

  23. impact of deployment • 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

  24. High Risk Populations SECURITY FORCES EOD OSI Intel Medics Transport (helicopters) Unmanned Air Planes Combat Controller JET Multiple deployments Longer deployments

  25. OEF/OIF & PTSD in AF 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

  26. Discharges by AFSC

  27. Role of 1st Sgt • 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

  28. Final Thoughts 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

  29. Contact Info LCDR Tenaya N. Watson, Ph.D. U.S. Public Health Service Licensed Clinical Psychologist Maxwell AFB MHC Commercial: 334-953-5430 DSN: 493-5430 tenaya.watson@maxwell.af.mil

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