NCPTSD: Mission and Vision Mission: To promote the best clinical care and functional status of Veterans through research, education, and training rela

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1 Questions and Answers about PTSD: Posttraumatic Stress Disorder Laurie Slone, PhD Associate Director for Research and Education

2 NCPTSD: Mission and Vision Mission: To promote the best clinical care and functional status of Veterans through research, education, and training related to the etiology, diagnosis, i and treatment t t of PTSD and stress-related related disorders Vision: To be the foremost leader in information on PTSD and trauma

3 Overview What is Trauma? What is, and isn t, PTSD? Relevant issues (stigma, comorbidity) What are effective treatments for PTSD? Other Resources

4 What is Trauma? An event that is life-threatening, or that causes injury or threat of threat of injury May be: - Experienced directly (to oneself) - Witnessed - Or learned about (in the case of trauma to a loved one)

5 Examples of Traumatic Events

6 What Happens When Someone is Exposed to Trauma? During or immediately after, most people have: - Strong emotions such as fear, helplessness, panic, horror, or anger; also may cause numbing (shock) Days and weeks after, most people have symptoms: - Distressing memories and nightmares; avoidance of reminders; feeling numb; feeling keyed up Symptoms usually not severe and diminish within 1-3 months

7 If Most People Have Symptoms, Then What is PTSD? Persistent and severe reaction to a trauma - Reexperiencing - Avoidance/numbing - Hyperarousal Symptoms last at least 30 days Symptoms cause extreme distress or difficulty functioning Onset is usually immediate but may be delayed

8 PTSD Diagnostic Criteria Exposure to a traumatic event in which the person: - experienced, witnessed, or was confronted by death or serious injury to self or others - responded with intense fear, helplessness, or horror Symptoms - re-experiencing, experiencing, avoidance/numbing, hyperarousal - last > 1 month - cause clinically significant distress or impairment in functioning American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed

9 How Often Do Traumatic Events Happen? 60% of men and 50% of women have experienced a trauma at least once TE for Military??? Deployment to war, trauma much more frequent

10 How Common is PTSD in OEF/OIF Veterans? General Population U.S. Lifetime PTSD = 6.8% Current PTSD = 3.6% OEF/OIF Veterans Lifetime PTSD =? Current PTSD = 5-20% Kessler et al., 2006; National Comorbidity Survey-Replication; Seal et al., 2009

11 Stigma and MH DOONESBURY (c) 2005 G. B. Trudeau. Reprinted with permission of UNIVERSAL PRESS SYNDICATE. All rights reserved.

12 Overcoming Barriers Personal stigma, public stigma Information sharing, privacy Leadership support, unit support Treatments are effective, overcome myths Institutional barriers: convenience, military culture, distance

13 What About Co-Occurring Problems? Individuals with PTSD have: Elevated risk of mood, other anxiety, and substance abuse disorders Elevated risk of suicide id attempts t Greater functional impairment Reduced quality of life PTSD had the greatest impact of all anxiety disorders on increasing economic burden to society (Greenberg et al., 1999)

14 Mental Health in Iraq War Military Personnel Hoge et al., 2004

15 Why Do Only Some People Get PTSD? We still do not know Trauma is necessary but not sufficient Risk of PTSD is increased by: - Individual characteristics such as younger age, less education, female gender, prior trauma - Stressor characteristics such as longer or more severe trauma, serious injury or (witnessing) death Risk of PTSD decreased by: - Characteristics of the recovery environment such as strong social support

16 What Are PTSD Treatment Options? Effective Treatment Exists Psychotherapy Exposure therapy Cognitive therapy Anxiety management Desensitization EMDR Pharmacotherapy SSRIs Other antidepressants Mood stabilizers Atypical antipsychotics Anti-adrenergic agents

17 How Well Do Treatments Work? Results from Meta-Analysis Psychotherapy & drugs are effective - Psychotherapy is most effective - Cognitive-behavioral therapy is most effective psycho- therapy - SSRIs are most effective drugs Van Etten & Taylor, 1998

18 What Resources Are Available? Fact Sheets Videos Training materials Links Online modules Publications

19 Online Education Fact sheets, handouts, videos War-zone Guides Understanding PTSD Links to other relevant websites - MyHealtheVet - afterdeployment.org Get Help for PTSD

20 PTSD 101 Curriculum Earn CEs for almost 20 courses on diverse topics focusing on issues related to war zone stress/ptsd Free courses available on-demand at Presented by a faculty of recognized experts in the field of traumatic stress

21 PILOTS : Published International Literature on Traumatic Stress 40,000 citations to articles on traumatic stress Cross disciplinary: Includes reports and foreign-language materials Trauma-specific thesaurus

22 Clinician s Trauma Update Summarizes clinically relevant articles for treating Veterans & military personnel Brief format with links to the full article when available every 2 months Subscribe from PTSD homepage

23 National Rollouts of Effective PTSD Treatments Funded by the VA Office of Mental Health Services Training VA clinicians and others in evidence-based d treatments t t for PTSD - Cognitive Processing Therapy - Prolonged Exposure Therapy Direct provider training as well as development of clinical supervisors and trainers to foster maintenance

24 What Does The Future Hold? Research - on understanding the causes of PTSD, promoting resilience,, and prevention - on ways better treatments t t and ways to improve existing treatments Dissemination of effective treatments Overcoming barriers to care Increased recognition and understanding of the effects of trauma

25 Thank you, and all of our Service Members and their Families

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