Best practices in ptsd handout
- 1. Best Practices: PTSD Student Veterans LT Cliff Overby II, M.M. Jillian Jo Overby, M.Ed.
- 2. Definition of PTSD • An anxiety disorder resulting from exposure to an experience involving direct or indirect threat of serious harm or death; may be experienced alone (rape/assault) or in company of others (military combat) (www.ncptsd.va.gov)
- 3. National Center for PTSD • 7.8% of Americans experience PTSD • Women are at TWICE the risk to experience PTSD • 30% of combat veterans experience PTSD – Approximately 50% of Vietnam veterans experience symptoms – Approximately 8% of Gulf War veterans have demonstrated symptoms (Duke and Vasterling 2005)
- 4. Relevance of Topic • Individuals with traumatic stress reactions may not seek mental health care but do seek out other health and social services • Only 1/3 of Iraq war veterans accessed mental health services first year of post-deployment (Hoge, Auchterloine & Milliken, 2006) • Impact manifests across the lifespan • Each veteran will have a unique set of social, psychological, and psychiatric difficulties
- 5. Signs and Symptoms • Three variations of stress disorders that may be experienced: – Immediate – Acute – Chronic • Depends on a variety of individual, contextual, and cultural factors.
- 6. Immediate: “Combat Fatigue” • Immediate psychological and functional impairment that occurs in war-zone/battle or during other severe stressors during combat • Caused by stress hormones • Features of stress reaction include: – Restlessness – Withdrawal – Stuttering – Confusion – Nausea – Vomiting – Severe suspiciousness and distrust
- 7. Acute Stress Disorder (ASD) • Anxiety occurring within one month after exposure to extreme traumatic stressor • Total duration of disturbance is two days to a maximum of four weeks (i.e. occurs and resolves within one month) • Symptoms include: – One re-experiencing symptom – Marked avoidance – Marked anxiety – Evidence of significant distress or impairment • ASD is considered a predictor of PTSD, though not a necessary precondition (APA 1994)
- 8. Chronic: PTSD • Post Traumatic Stress Disorder is the chronic phase of adjustment to a stressor across lifespan • Symptoms include: – Recurrent thoughts of the event – Flashbacks/bad dreams – Emotional numbness (“It don’t matter”); reduced interest or involvement in outside activities – Intense guilt or worry/anxiety – Angry outbursts and irritability – Feeling “on edge,” hyper-arousal/hyper-alertness – Avoidance of thoughts/situations that remind person of the trauma (APA 1994)
- 9. Duration of PTSD • To meet criteria for PTSD, symptom duration must be at least one month – ACUTE PTSD: duration of symptoms is fewer than three months – CHRONIC PTSD: duration of symptoms is three months or more • Often the disorder is more severe and lasts longer when the stress is of human design (i.e. war-related trauma) (APA 1994)
- 10. Coexisting Problems • Veterans with PTSD are also at risk for: – Depression and anxiety – Substance abuse – Spectrum of severe mental illnesses – Aggressive behavior problems – Sleep problems like nightmares, insomnia, or irregular sleep schedules – Acquired brain injury • Traumatic Brain Injury (TBI) (www.ncptsd.va.gov)
- 11. Where Are They? • Student veterans with PTSD are difficult to identify: – Onset of symptoms may not occur for months to years after trauma – Professionals may misdiagnose or not recognize symptoms – Individual psychosocial factors may interfere with individuals seeking help – Avoidant behaviors may result in an inability for others to recognize the need for treatment
- 12. Identifying At-Risk Students • Symptoms of at-risk individuals: – History of psychiatric problems – Poor coping resources or capabilities – Past history or trauma/mistreatment – Acute Stress Disorder (ASD) – Isolated – Finically burdened – Limited or no respite from work, family, or social demands – Stigma or faulty belief systems around seeking help
- 13. Potential Consequences of PTSD • Physiological Concerns: – Physical complaints are often treated symptomatically rather than as an indication of PTSD • Self-Destructive/Dangerous Behaviors: – Substance abuse – Suicide attempts – Risky sexual behavior – Reckless driving – Self-injury (www.ncptsd.va.gov)
- 14. Potential Consequences of PTSD • Social and Interpersonal Problems: – Relationship issues – Low-self-esteem – Alcohol and substance abuse – School and employment problems – Homelessness – Trouble with the law – Isolation (www.ncptsd.va.gov)
- 15. Implications for Students • Impact on well-being • Employability • Challenges for military reservists • Military versus civilian life issues • Job turnover and maintenance • Failing grades • Steady employment or school attendance is one predictor of better long-term functioning
- 16. Recommended Accommodations for the Instructor: • Give information in writing • Provide detailed, regular feedback and guidance • Provide positive reinforcement • Provide clear expectations and consequences • Allow for flexible start time • Combine small breaks into one larger break during long class sessions • Allow for breaks during short classes • Plan uninterrupted work time
- 17. Recommended Accommodations for the Student: • Divide large assignments • Allow music via headset • Count one occurrence for all PTSD-related absences • Allow for work at home • Extended time on tests and assignments (allow make up work in event of absence) • Provide additional time for new responsibilities • Restructure assignments during times of stress
- 18. Recommended Accommodations for the Classroom: • Reduce distractions • Lighting • Identify and remove environmental triggers • Allow presence of a support animal • Allow student to complete assignments from home • Provide a note-taker • Provide PTSD Awareness training to students, faculty, staff, and administration
- 19. Recommendations for Student Activities: • Coping can be easier when involved in social activities • Encourage students with PTSD to participate in student activities • Keep in mind all recommended accommodations for the classroom and the student • Work with the Student Activities Director • Help student find a “mentor” or “buddy” to participate in activities with • PARTICIPATE in student activities yourself!
- 20. Recommendations when Dealing with High Emotions: • Allow telephone calls during class time to contact doctors or counselors • Use stress management techniques • Allow frequent breaks • Develop strategies with the student for dealing with conflict
- 21. Dealing with Angry Students • Anger is often the most troublesome problem • Attempt to understand anger from the student’s perspective • Intervene – Recognition – Establish boundaries/rules – Follow emergency procedures if necessary • Preemptively discuss the advantages and disadvantages of anger expression in the classroom • Seek consultation • Refer to counselors/student services for further assistance
- 22. Procedures to Follow: • Specific procedures to follow if a student demonstrates PTSD symptoms during your class: – Display calmness – Provide reassurance – Orient to place – Take a break – Guide – Recommend an appropriate referral
- 23. Take Home Points • Essential Features of PTSD: – Re-experiencing symptoms (nightmares, intrusive thoughts) – Avoidance of trauma cues – Numbing/detachment from others – Hyper-arousal • A variety of factors including personal, cultural, and social characteristics, coping abilities, experiences in war, and the post-deployment/civilian environment all contribute to the level, severity, and duration of stress factors • Work with students individually to find accommodations that fit both the needs of the student and the classroom
- 24. References • American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. American Psychiatric Association: Washington, D.C. • American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revised. American Psychiatric Association: Washington, D.C. • Cozza, S.J., Benedek, D.M., Bradley, J.C., Grieger, T.A. (2004). Topics specific to the psychiatric treatment of military personnel. In Iraq War Clinician’s Guide (2nd Ed.). http://www.ncptsd.va.gov/war/guide/index.html • Duke, L.M. & Vasterling, J.J. Epidemiological and methodological issues in neuropsychological research on PTSD. In Neuropsychology of PTSD: Biological, Cognitive and Clinical Perspectives. Vasterling & Brewin, Eds. The Guilford Press: 2005. • Harvey, A.G., & Bryant, R.A. (1998). Predictors of acute stress following mild traumatic brain injury. Brain Injury, 12, (2): 147-154. • Harvey, A.G. & Bryant, R.A. (2000). Two-year prospective evaluation of the relationship between acute stress disorder and posttraumatic stress disorder following traumatic brain injury. The American Journal of Psychiatry, 157, (4): 626-628. • Hoge, C.W., Castro, C.A., Messer, S.C., McGurk, D. (2004). Combat duty in Iraq and Afghanistan, mental health problems and barriers to care. The New England Journal of Medicine, 35, (1): 13-22. • Hoge, C.W., Auchterloine, J.L., Milliken, C.S. (2006). Mental health problems, use of mental health services, and attrition from military service after returning from deplloyment to Iraq or Afghanistan. Journal of the American Medical Association, 295, 1023-1032. • Insurance Information Institute. http://www.iii.org. • National Center for PTSD. http://www.ncptsd.va.gov • Prins, A., Ouimette, P., Kimerling, R., Camerond, R.P., Hugelshofer, D.S., Shaw- Hegwar, J., Thraikill, A., Gusman, F.D., Sheikh, J.I. (2004). The primary care PTSD screen (PC-PTSD): development and operating characteristics. Primary Care Psychiatry, 9 (1), January 2004, 9-14.