PTSD Support to Improve Quality of Life

1. PTSD Support to Improve Quality of Life Ann Cornell, PsyD Kim Schmidt, PhD, LCSW, LMFT Gary Warner, PhD

2. MEANINGIN LIFE W O R K S O C I A L Physical Cognitive Emotional FINANCIAL RECREATIONAL From Ruff, 2007

3. PTSD Influence on Functioning • Presence of Intrusion Symptoms: memories, dreams, dissociations] • Persistent Avoidance of trauma-related stimuli: thoughts, feelings, people, places, things • Negative Alterations in cognitions/mood: mistrust, misattributions, guilt/anger/shame, detachment, low positive emotions • Marked alterations in arousal and reactivity: irritability, reckless, hypervigilance, startle, concentration, sleep

4. Effects on Role Functioning • Cognitive • Distractibility • Memory concerns • Heightened focus on Safety • crowds/situations • Low threshold for incompetence of others

5. Clinical Presentation Overlapping Symptoms TBI PTSD Poor Concentration Memory Impairment Insomnia Depression Anxiety Irritability Flashbacks Headaches Nightmares Dizziness

6. Functional Neuroanatomy of PTSD MEDIAL PFC & Ant Cingulate HIPPOCAMPUS AMYGDALA From Vasterling

7. FOG OF WAR Deployment experience itself linked with cognitive deficits when controlling for depression, ptsdand tbi Deployment Health Study, Vasterling, et al, JAMA, 2006)

8. Prevalence of Chronic Pain, PTSD and TBI in a PNS clinic sample Chronic Pain N=277 81.5% PTSD N=232 68.2% 16.5% 2.9% 10.3% 42.1% 12.6% 6.8% TBI N=227 66.8% 5.3% N = 340 Lew et al., (2009). Prevalence of Chronic Pain, Posttraumatic Stress Disorder and Post-concussive Symptoms in OEF/OIF Veterans: The Polytrauma Clinical Triad. Journal of Rehabilitation Research and Development, 46, 697-702.

9. Effects of Sleep Deprivation Decreased alertness; daytime sleepiness Neurocognitive changes Increased errors; decreased performance Impaired motor skills Mood changes; irritability Dangers to health –cardiac, obesity, inflammation, immune Negative impact on behavioral demeanor

10. INSOMNIA Substance Use Depression System Issues Post-Deployment Syndrome

11. Effective PTSD Treatments • Staged, stepped model of care • Stabilization/Safety: risk reduction, basic coping strategies of relaxation/grounding. Medication. Sleep. • Trauma focus: Empirically validated treatments include Cognitive Processing Therapy and Prolonged Exposure • Reconnection with family, work, other life roles

12. Interpersonal Factors in PTSD • Evaluation and treatment within individual context • Treatment planning is multidisciplinary and targets most troubling symptoms • As humans, we are social beings • The experience of trauma has potential to shatter beliefs about: the self, others, and the world • Quality of Life and Quality of Relationship (Monson & Fredman)

13. Natural Disasters vs. ‘Betrayal’ Trauma • Trauma and relationship • Natural disasters • Experiences in community • Betrayal trauma • Persons and/or institutions we depend on… (Freyd)

14. Social Support • Risk factors for PTSD • Facing the dragon • Humanity and attachment • Healing within relational context • Relationships matter (Brewin, Andrews, & Valentine)

15. The Nature of Relational Distress • Factors in relational distress • Diffuse physiological hyper-arousal Fight-Flight-Freeze • Rigid, negative patterns of interaction • Rigid and negative patterns • Pursue-Withdraw* • Blame-Defend • Accuse-Defend • Attack-Attack • Withdraw-Withdraw** • *Most common; **Most troubling (Gottman,; Johnson)

16. Understanding Context • Understanding, Openness, & Discovery: • PTSD symptoms influence relationships and relational dynamics influence PTSD symptoms • See symptoms as signals of distress • Remember that ‘listen’ is a verb • Remember your strengths & resiliency • Ask for help; it is a sign of strength • Remember: Healing from trauma often happens in relationship (National Center for PTSD)

17. Being Open… • Period of readjustment and every reentry from deployment differs • Recognize the ‘honeymoon’ period • Take time to reacquaint • Take time to renegotiate roles & responsibilities • All feelings matter • Finding balance in sharing • Notice growth and change • Slow down-notice where we get stuck • Learn about triggers • Choose safe coping first, last, & always • Notice red flags and reach for help (National Center for PTSD)

18. Religious Groups • Medical • Providers • Mental Health • Providers • Community • Supports • Colleagues • Friends • Extended Family • Partner/ • Spouse National Resources Local Resources • Service • Member • Parents • Siblings • Pets • Children • Pets VA Other

19. Children (National Center for PTSD)

20. Helping Children Adapt • Provide extra attention, care and physical closeness • Understand that children may be angry • Provide an accepting environment for children to talk about how they feel • Tell children their feelings are normal • Maintain routines and plan for upcoming events • Provide age appropriate information about PTSD (National Center for PTSD)

21. PTSD & Family • Sympathy • Negative Feelings • Avoidance • Depression • Anger and Guilt • Health Problems (National Center for PTSD)

22. What Can Family Members Do? • Learn about PTSD • Get support • Connect with local and national resources • Be aware of your own emotional reactions • Maintain healthy habits, activities, and relationships • Seek professional help • Take care of yourself (National Center for PTSD)

23. Support Network • Identify strengths and weaknesses in your support network • Seek additional resources and supports • Work on improving and strengthening your relationships • Stay informed and educated about PTSD • Ask for help and support (National Center for PTSD)

24. Resources for Families • Family Assistance Centers http.www.jointservicesupport.org/ResourcesFinderSearchFilter.aspx • Army Community Services(ACS) http.www.armymwr.com • Strong Bonds, Building Ready Families http.wwwstrongbonds.org • Sesame Street “Workshop” archive.sesameworkshop.org/tlc • Military Families at Real Warriors http.www.realwarriors.net/family • Navy Fleet & Family Support Services http.www.cnic.navy.mil • Air Force Reserve Family Readiness http.afrc.af.mil/library/family/asp • Older Adult Service (585) 279-7849 Individual, couples, and family therapy

25. Resources • VA Crisis Hotline http://www.veteranscrisisline.net/ • Army Strong http://www.arfp.org/index.php/programs/army-strong-community-center-ascc • Department of Veterans Affairs http://www.va.gov/ • Help Base Greater Rochester http://www.hbrochester.org/ • Military One Source http://www.militaryonesource.mil/ • NAMI Family to Family http://www.nami.org/Content/NavigationMenu/Find_Support/Veterans_Resources/Veterans_Resource_Center.htm • National Center for PTSD http://www.hbrochester.org/ • VA Caregiver Support http://www.caregiver.va.gov/ • VA Homeless Hotline http://www1.va.gov/HOMELESS/NationalCallCenter.asp • Vet Center http://www.vetcenter.va.gov/

26. References • Brewin, C.R., Andrews, B., & Valentine, J.D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68, 748-766. • Freyd, J.J. (1996). Betrayal trauma: The logic of forgetting childhood abuse. Cambridge, MA: Harvard University Press. • Gottman, J. (1999). The marriage clinic. New York, NY: Norton. • Johnson, S. (1996). The practice of emotionally focused couple therapy: Creating connection. London: Bruner/Mazel. • Monson, C.M. & Fredman, S.J. (2012). Cognitive-behavioral conjoint therapy for PTSD. New York, NY: The Guilford Press. • VA National Center for PTSD. (2010). A Guide for families of military members. Retrieved from www.ptsd.va.gov

27. Thank You