Post Traumatic Stress Disorder and Traumatic Brain Disorder

1. Post Traumatic Stress Disorder and Traumatic Brain Disorder James Vaughns, MS, LPC, CCS, MAC, CACII Windsor Primous, Intern

2. What is Post Traumatic Stress Disorder (PTSD)? -DSM-IV Definition- After 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.

3. Symptoms of PTSD 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.

4. Traumatic Events 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)

5. Traumatic Events 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).

6. Common Problems After The Traumatic Event 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

7. AngerA Common Response to Trauma • 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.

8. Anger (cont’d) • 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.

9. Substance Abuse • *“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)

10. The Link Between PTSD and Substance Abuse • 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).

11. Treatment Issues • 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)

12. Treatment Issues (cont’d) • 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”.

13. Treatment (concerns) • 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

14. Other Concerns Diversity Issues: In the US, rates of PTSD do not differ by race (Kessler et al.,1995. 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). 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.

15. Recommended Treatment Strategies • 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

16. The Seeking Safety Treatment • 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

17. Key Principles of Seeking Safety • 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

18. 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

19. Treatment (cont’d) • 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 medical-necessary treatment. • Cognitive Rehabilitation • Critical therapy • Available to active duty • Not accessible to medical retirees under TRICARE

20. Vocational Rehabilitation • 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

21. Home and Community-Based Treatment • 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.

22. Assistance for Family Caregivers • 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.

23. Traumatic Brain Injury (TBI) • 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.

24. Understanding Traumatic Brain Injury Talking Behaving Walking and other physical activities Seeing and/or hearing Learning 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

25. Understanding Traumatic Brain Injury (cont’d) • 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.

26. Symptoms of TBI • Memory loss • Concentration and attention problems • Slow learning • Difficulty with planning and reasoning • Poor judgment • Depression • Anxiety • Impulsivity • Aggression • Thoughts of suicide

27. TBI Assistance • 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**

28. Suggestions • 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.

29. 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!

30. References • 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

31. Thank You For Your Time!Questions, please call James A. Vaughns 478-225-6192- Office478-225-6291- Fax