PTSD in Service Members and Veterans

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1 PTSD in Service Members and Veterans Presented by: Shannon McCaslin, PhD Clinical Psychologist National Center for PSTD Dissemination and Training Division

2 Overview 1) Defining features of PTSD 2) Prevalence and Assessment 3) Treatments 4) Resources

3 Defining i Features Posttraumatic Stress Disorder (PTSD) was first recognized as a diagnosis by the American Psychiatric Association in 1980 Prior to 1980, PTSD was known by different names Shell shock Combat fatigue Rape trauma syndrome Soldier s heart VETERANS Even HEALTH the ADMINISTRATION Greeks recognized the presence of PTSD!

4 DSM5: Changes to PTSD Diagnosis i Now considered d a Trauma and Stressor Related Disorder with 4 symptom clusters Greater emphasis on nature of trauma versus response at time of trauma 1. Re experiencing symptoms (flashbacks, intrusive memories) 2. Avoidance (now stands alone, defining symptom) 3. Negative Alterations in Cognition and Mood (new category) No change in distance/numbing symptoms (e.g., detached, restricted range of affect) Recognition of pervasive negative emotional states (not just fear) New symptom focused on negative expectations about self, others, future New symptom focused on blame: self or others 4. Alterations in arousal and reactivity: (old Hyperarousal) New symptom: reckless or self destructive behavior Duration No change (but elimination of acute/chronic distinction)

5 Prevalence of Trauma/PTSD

6 Traumas of Military Service Traditional Combat Traumas Firefights Seeing or handling mutilated bodies Death and dying Medical care in the field Captivity/POW Torture Non traditional Combat Traumas Atrocities and abusive violence Guerilla style warfare IEDs, suicide bombs, civiliancombatants combatants Other Military Traumas o o o Sexual assault Accidents (MVAs, falls, burns, explosions, etc.) Physical Assaults

7 After Combat Exposure For most readjustment takes time Cultural adjustment (e.g., structure, camaraderie) Family role adjustment Work and skill adjustment Grief/loss Symptoms as skills/adaptive (awareness, sleep) For some recovery is challenging Visible injuries Physical injuries Invisible injuries Physical injuries such as tinnitus, sequelae of mtbi Psychological injuries such as PTSD and Depression

8 Prevalence of PTSD: OEF/OIF

9 Prevalence of PTSD

10 Prevalence of PTSD

11 Military Sexual Trauma Defined by the Department of Veterans Affairs as experiences of sexual assault or repeated, threatening acts of sexual harassment

12 Prevalence and Assessment Prevalence 20 30% of all female veterans enrolled in VA, 14% of OIF/OEF female enrolled in VA 1 10% of male veterans enrolled in VA, 1% of OIF/OEF veterans Estimates are based on assessments that are conducted in primary care and mental health clinics when veterans first seek care through the VA: MST SCREEN While you were in the military did you ever experience any unwanted sexual attention, like verbal remarks, touching, or pressure for sexual favors? Did anyone ever use force or the threat of force to have sex with you against your will? All veterans who screen positive for MST are provided free health and mental health treatment for MST related issues

13 Military Sexual Trauma and PTSD Veterans with military sexual trauma are more likely to be diagnosed with PTSD than combat veterans Female veterans are 3x more likely to be diagnosed with PTSD than their male counterparts

14 Clinical Assessment of PTSD: Simple to Complex PTSD Screening broad assessment of risk (if positive, refer) Self report Measures Symptom severity and frequency, PSTD Check List, is very commonly used Diagnostic Assessment full scale interview conducted by trained individual Evaluation for service related disability benefits VA trained personnel must conduct Co morbidity assessment SUD, depression, anger issues, impact PTSD presentation; must be evaluated by trained individual

15 Evidence-Based PTSD Treatments VA Department of Defense Clinical Practice Guidelines Support three main approaches to treatment Psychotherapy Medications Adjunctive Problem Focused Services Stronglyrecommend recommend one of the evidence based trauma focused psychotherapeutic interventions that include components of exposure and/or cognitive restructuring; or stress inoculation training. Trauma focused treatments Exposure based therapies (e.g., Prolonged Exposure or PE) Cognitive based therapies (e.g., Cognitive Processing Therapy or CPT) Eye Movement Desensitization Reprocessing (EMDR)

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18 QUESTIONS?

19 VA RESOURCES

20 Community Provider Toolkit

21 Mental Health and Wellness Mini Clinics

22 National Center for PTSD

23 AboutFace

24 Online Education National Center for PTSD Fact sheets, handouts, videos War zone Guides Links to other relevant websites MyHealtheVet afterdeployment.orgorg Nationalresourcedirectory.gov

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26 Vets In Crisis

27 PILOTS: Published International Literature on Traumatic Stress 50,000+ citations for articles on traumatic stress Includes reports andforeign language materials Trauma specific thesaurus CSA platform (like PsycInfo) Links to online sources Articles by NCPTSD authors provided as PDFs

28 Programs on Afterdeployment.org

29 Make the Connection

30 MilitaryOneSource.com Target audience: Service members from all branches, family members, service providers Web resources Provides free help and information, by phone with a professionally trained consultant, or online Wide range of issues from budgeting and investing to relationships and deployment Available 24 hours a day, 365 days a year Free counseling services (up to 12sessions per person, per issue), face to face in the local community, by telephone, and online

31 DCoE Outreach Center Chat Call Or VETERANS e mail HEALTH resources@dcoeoutreach.org ADMINISTRATION Information and resources on psychological health (PH) & traumatic brain injury (TBI) issues Connects with the resources to promote their resilience, recovery, and reintegration Assists service members, veterans, families, leaders, healthcareproviders navigate the system of care Responds to information requests about the DCoE Capability/Availability: 24/7 availability of Health Resource consultants Respond by phone, , instant messaging, chat, fax Respond to specific research requests

32 PTSD Coach Phone App PTSD Coachis a mobile phoneapplication for people with Posttraumatic Stress Disorder (PTSD) and those interested in learning more about PTSD. This application provides: education about PTSD a self assessment tool portable skills to address acute symptoms direct connection to crisis support and information about treatment aimed at guiding those who could benefit into care. It can be used as a stand alone education and symptom management tool, or to augment face to face care with a healthcare professional. Due to the application s portability, these tools are easily accessible when they are needed most.

33 Self-Assessment Screenshots

34 Managing Symptoms Symptom or Favorites SUDS baseline Appropriate tool Thumbs up / thumbs down Shake / skip if desired SUDS SUDS feedback Another tool or done

35 Tool Examples

36 A v a i l a b l e N A v a i l a b l e N A u t u m n 2 A u t u m n 2 W i n t e r W i n t e r S p r i n g S p r i n g Other Mobile Apps N o w N o w Other Mobile Apps

37 Where To Get help At times, veterans who want treatment don t know where to go See the VA program locator: Crisis Line ( and Press 1, chat online, or send a text message to to receive confidential support 24 hours a day, 7 days a week, 365 days a year. More about the Veterans Crisis Line

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39 VA OEF/OIF Page OEF/OIF webpage on VA mental health Overview of benefits available to recent returnees Descriptions of different venues where returnees and families may seek hl help Social Media Blogs

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41 QUESTIONS/IDEAS? Photo by SrA Bradley A. LailIraq, USAF