Understanding and Managing Post-Traumatic Stress Disorder

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1 Understanding and Managing Post-Traumatic Stress Disorder Dr Steph HODSON CSC National Manager, Veteran and Veteran Families Counselling Service Men's Health EXPO

2 Impact of military service

3 Only the dead have seen the end of war" George Santayana Nearly all returning from combat or deployment have been changed or affected by the experience Most will integrate the experience, some will mature and experience post traumatic growth, some will experience an injury Exposures associated with risk of PTSD unable to respond to a threatening situation; being involved in body handling; or being exposed to human degradation Trauma can be experienced in Australia or on deployment - PTSD is not the only mental health injury

4 Trajectory of Disorder Deployed US Personnel 3,393 with single deployment 4,394 with multiple deployments Pre-deployment and 3 year follow up Latent growth mixture modeling (Bonanno et al Brit J Psychiatry 2012)

5 Impact Impact of Repeated of Exopsure Exposure Do we become hardened and resilient? Does the risk of disorder increase with repeated exposure?

6 Five to 10 per cent of people will suffer from posttraumatic stress disorder (PTSD) at some point in their lives. The Australian Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder provide information about the most effective treatments for PTSD. They are the first national Guidelines that provide guidance on the treatment of children and teenagers who experience PTSD. The Expert Guidelines: Diagnosis and Treatment of Post- Traumatic Stress Disorder in Emergency Service Workers can be downloaded from the Black Dog Institute website

7 PTSD Diagnosis A diagnosis of PTSD requires a number of criteria to be met: Presence of one or more intrusive symptoms intrusive memories of the event; recurrent distressing dreams related to the event; dissociative reactions (e.g., flashbacks); psychological distress or physiological reactions to reminders of the event. Persistent avoidance of either internal (memories, thoughts, or feelings) or external (people, places, conversations, activities) reminders of the event. Presence of two or more symptoms of negative alterations in mood and cognitions inability to remember an important part of the event; negative beliefs about oneself, others, or the world; distorted beliefs about the cause or consequences of the event; persistent negative emotional state; diminished interest in activities; feelings of detachment from others; inability to experience positive emotions. Presence of two or more arousal symptoms irritable, angry, or aggressive behaviour; reckless or self-destructive behaviour; hypervigilance; exaggerated startle response; concentration problems; sleep disturbance. These symptoms must be present for at least one month following trauma exposure.

8 Prevalence It is estimated that between 5 and 10 percent of the general population will develop PTSD at some point in their lives. The rate of PTSD differs according to the type of trauma experienced. Higher rates of PTSD (up to 50%) are seen in survivors of intentional acts of violence or prolonged/repeated events than in survivors of non-intentional trauma such as natural disasters or accidents (around 10%). Military similar to community rates but a different profile.

9 Psychological interventions Trauma-focused psychological interventions: trauma-focused cognitive behavioural therapy (TF-CBT) eye movement desensitisation and reprocessing (EMDR) TF-CBT Exposure therapy confronting the memory of traumatic experiences or imaginal exposure and confronting trauma-related avoided situations and activities through in vivo exposure Cognitive therapy which helps the individual to identify, challenge and modify any biased or distorted thoughts and memories of their traumatic experience, as well as any subsequent maladaptive or unhelpful beliefs they may have developed (eg., Cognitive Processing Therapy) EMDR EMDR is based on the assumption that, during a traumatic event, overwhelming emotions or dissociative processes may interfere with information processing. The experience being stored in an unprocessed way, disconnected from existing memory networks.

10 Service System Veteran Mental Health Service System

11 5. Client Resources

12 Practitioners Resources

13 PTSD Coach Australia

14 PTSD Coach - Australia Sam 55 year old Warrant Officer 6 deployments overseas Presenting panic attacks, mild dissociation, flashbacks, chronic dysthymia Predisposing Neglect filled childhood, maternal mental illness, lack of mirroring experiences, unstable family environment Precipitating bullying on deployment Perpetuating - interpersonal awkwardness difficulty asking for help and identifying psychological state (alexithymia, concrete thinking), prominent somatisation (unexplained physical reactions) Prognostic help seeking, strong therapeutic alliance, supportive partner

15 Case formulation and treatment planning John 26 year old Afghan veteran Presenting - anger and alcohol abuse, relationship stress Predisposing early disrupted attachment, fragile family environment, lack of early mirroring experiences due to maternal depression. Witnessing violence/frightening parental interactions Helplessness/shame Precipitating witnessing abuse of young children in Afghanistan, loss of mate in green on blue extreme anger and feelings of helplessness Perpetuating underlying guilt and shame blocked by use of alcohol and anger. Avoidance of triggers that stimulate helplessness altruistic acts Prognostic stable relationship, high intelligence, capacity to reflect on behaviour psychologically minded. Not suicidal, help seeking.

16 Resources