PTSD: Beyond the Basics D. Ryan Hooper, Ph.D. Jesse Brown VA Medical Center

Transcription

1 PTSD: Beyond the Basics D. Ryan Hooper, Ph.D. Jesse Brown VA Medical Center.

2 PTSD: Beyond the Basics Overview What is it? How does it develop? How many people have PTSD? What treatment options do we have? Co-occurring issues Services available at the VAMC

3 What is PTSD?

4 What is PTSD? Post Traumatic Stress Disorder

5 What is PTSD? Post After an event One of the few DSM-5 mental health disorders that is directly related to an event

6 What is PTSD? Traumatic Exposure to actual or threatened death, serious injury, or sexual violence through: Directly experiencing the event Witnessing as events occurred to others Repeated or extreme exposure to aversive details of event Examples include: Combat Robbery or physical assault Sexual assault Child sexual or physical abuse Serious accident (e.g., car accident)

7 What is PTSD? Traumatic

8 What is PTSD? Stress Fight, Flight, or Freeze response. Also known as the acute stress response Built into us as a natural, adaptive response A physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival

9 What is PTSD? Disorder (or Disruption) Reactions to traumatic events are expected Feeling tense or afraid Feeling agitated and jumpy Feeling on alert Wanting to be alone Experiencing anger spells Feelings of guilt Less patience with loved ones Avoid certain people or situations Increase drinking and/or drug use However, this typically reduces with time 1 month criteria for PTSD Disruption of natural recovery

10 What is PTSD? Symptoms Reliving the event (Reexperiencing) Feeling keyed up (Hyperarousal) Negative changes in beliefs and feelings Avoidance

11 How does PTSD Develop?

12 How does PTSD develop? How likely someone is to develop PTSD after a traumatic event can depend on many things including: How intense the trauma was or how long it lasted If a close loved one was lost in the trauma Physical proximity to the trauma Strength of the initial reaction Sense of control during the event Level of support received after the trauma Previous traumatic experiences

13 How does PTSD develop? While we don t have the definitive reason that PTSD develops for some individuals and not for others, research suggests that PTSD sticks around when the natural recovery process is disrupted

14 How does PTSD develop? Another theory of PTSD is based on the Cognitive Therapy conceptualization of mental health disorders We try to make meaning of what happens to us, including trauma: This leads us to either force a traumatic event into our beliefs Or we throw out beliefs and form new ones based on the traumatic experience

15 How many people have PTSD?

16 How many people have PTSD? About 7-8% of the US population will have PTSD at some point in their life 5.2 million adults have PTSD in a given year 4% of men will develop PTSD at some point in their life vs 10% of women who will develop PTSD in their life

17 How many people have PTSD? Vietnam War: About 15% of Vietnam veterans met criteria during last large scale study (1980s). Estimated that 30% met criteria in their lifetime Gulf War (Desert Storm): About 12% have PTSD in a given year OEF/OIF: 11%-20% have PTSD in a given year

18 Co-Occurring Issues

19 Co-Occurring Issues Substance Use Traumatic Brain Injury Chronic Pain Relationship problems Employment problems

20 Co-occurring Substance Use Disorders More than 20% of veterans with PTSD have a substance use disorder. Almost 30% of all veterans seeking SUD treatment have PTSD. 1 in 10 of all OEF/OIF veterans meet criteria for a SUD.

21 Co-occurring Traumatic Brain Injury

22 Co-occurring Chronic Pain Chronic pain is defined as pain in a particular area of the body for 3 months or more. Approximately 15% - 35% of individuals with chronic pain also have PTSD. Some veterans may have chronic pain in relation to traumatic events, which could serve as a reminder of their PTSD

23 Relationship Problems Symptoms of PTSD may lead survivors feel distant and numb, have less interest in social and sexual activities, as well as feeling increasingly jumpy and on edge May also feel an increased need to protect their family members, which may come across as tense or demanding Partners, friends, or family may feel hurt, cut off, or sad because a survivor has not been able to get over the trauma

24 Employment Problems Veterans with PTSD are less likely to be employed and if employed are likely to receive a lower wage. Increased severity of PTSD was related to a decreased likelihood of full-time employment.

25 Treatment Options

26 What does Recovery look like? Passive Coping Problem Avoidance VS. Active Coping Problem Solving Self-Criticism or Wishful Thinking Bottle Up Emotions Re-Thinking Discuss Emotions Social Withdrawal Seek Social Support

27 What treatment options do we have? Treatment approaches are active, practice-oriented, and requires work between sessions Skills-based vs. Trauma-based therapy Group vs Individual options

28 Skills-Based Treatments Many treatment options for improving life stability and coping Seeking Safety (PTSD & Substance Use Disorders) Coping Skills ACT (Mindfulness) Anger Management

29 Other Life Changes to Consider Exercise Volunteering School/Employment More contact with other trauma survivors Invest more in personal relationships

30 Trauma-Based Treatments Prolonged Exposure (PE) is an evidence-based treatment for PTSD including: Education Trauma processing In-vivo practice

31 Trauma-based Treatments Cognitive Processing Therapy (CPT) is an evidence-based treatment for PTSD including: Becoming aware of thoughts and feelings Understanding changes in beliefs Learning skills to manage and change thoughts (and emotions)

32 Long-term Follow-up of a Clinical Trial Comparing CPT and PE. Patricia A. Resick, Lauren Williams Robert Orazem and Cassidy Gutner ISTSS & ABCT, Nov., 2005

33 Research Supporting Efficacy Follow-up conducted at five + years post-treatment (M= 6 yrs, range 5-10). 171 women were in the intent-to-treat sample. Of the 143 we located: 17 refused to participate (12%) 2 were located but were not appropriate Complete assessments on % participation rate 33

34 ITT CPT and PE cross-sectional CPT PE Pre Post 3 mo 9 mo 5+ yr CPT, N= PE, N=

35 CPT and PE on CAPS across 5 years (all assessments) CPT PE CPT, N= 35 PE, N= 32 Pre Post 3 mo 9 mo 5+ yr 35

36 Referral Options

37 Jesse Brown VA Medical Center Psychiatric Assessment Clinic: (312) OEF/OIF/OND Program Manager: Valerie Creedon, LCSW (312) PTSD Clinic Program Manager: Joseph Yount, Ph.D. (312) Women s Clinic: Jenny Garretson (312)

38 Edward Hines Jr. VA Hospital Mental Health Intake: (708) , Ext OEF/OIF Program Manager: Ivy Lloyd (MSW) (708) PTSD Clinic: Kelly Maieritsch (708) , Ext Polytrauma Director: Monica Steiner (MD) (708) , Ext

39 Online Resources

40 Thank you for listening Give your hands to serve and your hearts to love. Mother Teresa Find me on