Christian M. Alexander MS LMHC

Veterans Services Therapist

Valley Cities Counseling and Consultation

IntroductionGoals of presentationBe able to identify various types and signs of deployment stress

Understand the basics of treatment approaches

Know where to refer a veteran or family in need

Deployment Stress What are the various sources of deployment stress?

Not everyone who experiences combat stress develops PTSD

Combat Stress vs. ASD vs. PTSD

Resilience is the rule, not the exception

Most stress reactions dissipate after 1-3 months

In some people PTSD develops

TBI -MST –SU/A -PTSDTraumatic Brain Injury (TBI)

Military Sexual Trauma (MST)

Substance use/abuse

Combat Stress/Post-traumatic Stress Disorder (PTSD)

Resources?

Common Wartime Experiences The most common stressors reported by soldiers and

marines during the war included roadside bombs, length of deployment, handling human remains, killing an enemy, seeing dead or injured Americans, and being unable to stop a violent situation.

More than 90% of soldiers and Marines returning from Iraq reported encountering these stressors, with 12% of them reporting being wounded or injured.

Common Readjustment Issues- normal

reactions after being in a war zone

Feeling emotionally dead or constricted

Feeling detached or like you don’t fit in with others

Feeling as if in a daze

Frustration that others don’t understand

Feelings of guilt

Being irritable and intensely angry

Hyperawareness of surroundings and other people

Can’t get to sleep very easily or stay asleep

Nightmares or disturbing dreams

Poor concentration and memory problems

Battlemind vs. Home mind Buddies (cohesion) vs. Withdrawal Accountability vs. Controlling Targeted Aggression vs. Inappropriate Aggression Tactical Awareness vs. Hyper vigilance Lethally Armed vs.“Locked and Loaded” at Home Emotional Control vs. Anger/Detachment Mission Operational Security (OPSEC) vs.

Secretiveness Individual Responsibility vs. Guilt Non-Defensive (combat) Driving vs. Aggressive

Driving Discipline and Ordering vs. Conflict

Statistics Invisible Wounds of War: Rand Corporation (2008).

Survey of OIF and OEF service members and Veterans

14% PTSD

14% Depression

19% TBI

33% PTSD, depression or TBI

5% symptoms of all 3

Risks Isolation

Higher rates of unhealthy behaviors (smoking, overeating, unprotected sex)

Higher rates of physical health problems and mortality

Unemployment or impaired productivity

Substance Abuse

Homelessness

Domestic Violence

Suicide

Barriers to treatment

Military Trauma is complicated by the culture

Treatment is available, yet stigma is greater

Mission vs. Treatment

Multiple Tours

Constant wartime tempo

Consequences of Combat

Military Mental Health, VA Mental Health, and Civilian Mental Health

Stigma There is a perception among the troops that

seeking mental health care means you're weak or a coward and frankly, we in the military kind of foster that attitude”

“You're never going to have complete confidentiality in the military system, there is a big hole in the wall of confidentiality that will never close."

Col. Thomas Burke (US Army)

Family Impact and Stressors 40 % of those deployed have children

Children Frequently change schools

Isolated from extended family/friends

Frequent deployments

Anxiety for safety of parents

Marital conflict

Financial stressors

Be aware of children with parents in the military

PTSD6 Criteria for PTSD Diagnosis

Stressor- A threatening event accompanied by fear, helplessness or horror

Reexperiencing

Avoidance

Arousal

Duration (>1month)

Distress or Impairment

Some PTSD Facts Not everyone one who is deployed develops PTSD –15% to 32% Although many (41% -90%) have readjustment issues, these

usually resolve with help within a relatively short time 25-40% of those with PTSD recoverwithin the first year after

trauma exposure 30-50% of those with PTSD do not recover, even after many

years Intensity and frequency of traumatic stress exposure predicts

likelihoodof PTSD, as well as severityand duration Duration of symptoms is shorter for survivors who obtain

treatment (36 vs. 64+ months) Those needing treatment most usually have many reasons for

not obtaining help –usually out of fear of being seen as crazy or weak, or that the military will find out

Military Sexual Trauma The U.S. Department of Veterans Affairs (VA) defines

military sexual trauma (MST) as sexual harassment that is threatening or physical assault of a sexual nature. These traumas occur when a person is in the military.

MST can happen during war, peace, or training. It can be man-to-woman, woman-to-man, woman-to-woman, or man-to-man.

Who Gets MST? Among veterans using VA health care, about:

23 out of 100 women (23%) reported sexual assault when in the military

55 out of 100 women (55%) and 38 out of 100 men (38%) have experienced sexual harassment when in the military

Even though military sexual trauma is far more common in women, over half of all veterans with MST are men.

Treatments That Work- PTSD Anxiety management or stress inoculation training

(SIT)

Cognitive therapy (CT, CPT)

Exposure therapy (PE)

As primary intervention

Combined with SIT or CT

EMDR

Antidepressants, Anti-Anxiety Medication, and Prazocin

Anxiety Management A set of techniques that helps patients learn to manage

their anxiety

Relaxation training

Controlled breathing

Positive self-talk and guided imagery

Social skills training

Distraction techniques (e.g., thought stopping)

Cognitive Therapy A set of techniques that help patients change their

negative, unrealistic cognitions by:

Identifying dysfunctional, unrealistic, or unhelpful cognitions (thoughts and beliefs)

Challenging these cognitions

Replacing these cognitions with more functional, realistic, or helpful cognitions

Exposure Therapy A set of techniques designed to help patients confront

their feared objects, situations, memories, and images (e.g., systematic desensitization, prolonged exposure [PE], flooding).

EMDR Access trauma images and memories

Evaluate their aversive qualities

Generate alternative cognitive appraisal

Focus on the alternative

Sets of lateral eye movements while focusing on response

Substance Use and Abuse 7.1 % of veterans report substance use disorder in the

past year

Problems with alcohol and nicotine abuse are most prevalent

At greatest risk are deployed personnel with combat exposures, as they are more apt to engage in new-onset heavy weekly drinking, binge drinking, as well as smoking initiation and relapse.

Traumatic Brain Injury- Definition A traumatic brain injury (TBI) is caused by a blow or

jolt or a penetrating injury that disrupts normal brain function.

Not all blows or jolts to the head result in TBI

Direct blow is not needed to have TBI (whiplash effect)

Severity ranges from mild to severe with different implications for each

Implications of TBI-Physical Decreased Stamina, fatigue

Headaches

Dizziness or balance problems

Sensitivity to light and noise

Weakness of limbs

Implications of TBI: Cognitive Slowed processing of information

Problems with attention/concentration

Less efficient at learning and remembering new information

Executive functioning (reasoning, problem solving, planning, etc)

Implications of TBI: Behavioral/Emotional Irritability

Personality Changes

Impulsivity

Emotional de-regulation

Aggression

Depression, Anxiety

Relationship and family problems

Management of TBI There are no medical treatments to address underlying

cause

Importance of early recognition/education of patient and family

Treatment must be individualized and can include Inpatient programs

Day treatment

Individual and family therapy

Vocational Rehabilitation

Physical and occupational therapy

How You Can Help Honor those Veterans you encounter in and outside

church

Recognize signs of combat stress injury

Educate people about military/veterans issues

Community partnerships- knowing what’s available

Provide support to individual and families

Know where to refer individuals who need assistance

Give the expectation of resiliency and recovery

Resources- Federal PSHCS –American Lake and Seattle VA Medical Centers: 800-329-8387 or 206-764-2636 Spokane VA Medical Center: 509-434-7000 Walla Walla Medical Center: 888-687-8863 Vet Centers: Seattle Vet Center 206-553-2706 Everett Vet Center425-502-0617 Tacoma Vet Center253-565-7038 Portland Vet Center503-273-5370 Spokane Vet Center509-444-8387 Bellingham Vet Center360-733-9226 Yakima Vet Center509-457-2736

County/State Resources King County Veterans may apply for assistance by

contacting the King County Veterans Program at 206-296-7656

WDVA Contractors 1-800-562-2308

33 Private Contractors throughout Washington Statewww.dva.wa.gov

Program can provide services to active, guard, reserves, and their families for readjustment counseling. Can also provide consultations for schools and employers

Readings and Websites After the War Zone, Slone & Friedman

The Sandbox, G.B. Trudeau

www.ncptsd.gov (better for clinicians)

www.BattleMind.org

www.MilitaryOneSource.com

www.ArmyOne Source.gov

www.DVA.WA.gov

www.milspecvets.com

For More Information Christy M. Alexander M.S., LMHC

Therapist, Veterans Services

Valley Cities Counseling and Consultation

Phone –253-632-9746

Email –calexander@valleycities.org