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Addressing the Needs of Vet's in Addressing the Needs of Vet's in CrisisCrisis

Juanita Buck, M.S., MFTI

CAADAC I

KCMH – Mobile Evaluation Team

 

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“There is a prejudice that persons scarred by trauma should be able to simply “get over it” and move on with life. When the Bullets stop flying society tries to back away from moral responsibility for our soldiers, and the wounds easiest to ignore are those not easily seen”

(Mahoney, 1998).

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Welcome

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Why are you here?

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Military Culture is Unique

Military culture has its own set of values, standards and mores. This culture impacts every area of a service member’s life including their family.

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Military culture is diverse, comprising of members from every culture, religious affiliation, and race.

Military culture is complex, characterized by

continual change

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It Functions in a hierarchical structure of authority

The language is unique as it centers around the military hierarchy and structure

Discipline, loyalty and honor are at the heart of this very closed society

Trust is a very big factor.

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Military society has its own built in stress

factors.

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Tour of Duty

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World and domestic conflict creates elevated alarm that runs through every pore of the culture.

• Relocation and deployment are natural realities for military personnel and their families, which is stressful for the soldiers

and their families.

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Friendships are difficult to sustain

Support systems are short lived

Extended family is usually not close at hand

Traditions are put on hold

Family milestones are missed

In short, a disconnection from their own reality.

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   Approximately 55% of all service membersare married

Approximately 6% of all military marriages are dual-military

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Stress

And

Mental Health

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Separation from family, impending deployment, combat, and general family stressors may exacerbate existing mental health disorders.

Domestic violence, substance abuse, and other familial dysfunctions are common with the population

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Substance use

Alcohol, Illicit Drugs, and the Current Trend to Abuse Prescription Drugs May Be Used As a Means to Cope With and Reduce Stress.

       

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 In most cases, substance use begins after the exposure to trauma.

Exposure to stress is also one of the most powerful triggers for relapse in substance abuse

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PTSD indicators relevant to Military Personnel

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History of Combat Experience. Multiple tours of duty History of substance use Close Proximity to the Event Extended Exposure to Danger Strong Emotional Reactions Upon

Exposure to the Event Physically Injured by the Event.

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This is what the person with PTSD

experiences

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A Post-reaction to the trauma (past and present) involving feelings of extreme fear and powerlessness.

Causing a re-experiencing of symptoms of the trauma – vivid memories of sights, sounds, smells, feelings, reactions, nightmares, dissociative reactions (paranoia, irrational beliefs, hallucinations). And “flashbacks”.

 

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Due to the depressive components of PTSD, a loss of interest in activities, avoiding people and places, perceptions of isolation, and a sense of shortened lifespan occur.

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The person experiences difficulties with sleep, anger regulation, concentration, hyper vigilance (over reactive), and excessive startle response.

In short, the person experiences a breakdown of everyday functioning

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Depression Anxiety Agitation Aggression Frustration Fear Rage Violence Guilt Shame

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Dissociation and PTSD

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Dissociation is a kind of disconnection of the conscious and unconscious mind.

• People who suffer with PTSD may describe their past traumatic experiences in an emotionless way.

• Combat veterans with PTSD may present with strong dissociative thought process.

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“Feeling emotionally numb”.

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Feeling overwhelmed by what would

normally be considered everyday

situations.

Crying uncontrollably.

Isolating oneself from family and

friends and avoiding social

situations.

Relying increasingly on alcohol or

drugs to get through the day.

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Feeling moody, irritable, angry.

Suspicious or frightened.Having difficulty falling asleep or staying

asleep. Sleeping too much and experiencing nightmares.

Feeling guilty about surviving the event or being unable to solve the problem, change the event or prevent the disaster.

Feelings of fear and a sense of doom

about the future.

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Trauma Symptoms are Adaptations to the

Environment.

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The symptoms represent the person’s attempt to cope with overwhelming feelings.

Ex. Sleeping for days at a time in order not to think, or feel, or remember.

Consider what purpose the behavior serves to the survivor. Ex. People with PTSD will often use drugs to help them

stay in a mental stupor in order not to think about the trauma.

 

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Why is it so difficult for VETS to talk about their

problems?

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What have

we learn so far?

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Basic Components of Post Traumatic Stress Disorder

Symptoms.

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Involved in a traumatic event

Experienced, witnessed, or confronted with an event/events that involve actual or threatened death or serious injury, or a threat to the physical integrity of self or others.

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Crisis Response (fear, helplessness, horror).

Distressed recollections(images, thoughts, perceptions, dreams).

Note: prior history of trauma (child abuses, accidents) exacerbates the current history of trauma.

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Reliving the experience (illusions, hallucinations, dissociative flashbacks.

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Pathological and Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

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Efforts to avoid thoughts, feelings, or conversations associated with the trauma

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Efforts to avoid thoughts, feelings, or conversations associated with the trauma

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Memory loss – inability to recall an important aspect of the trauma

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Diminished interest or participation in significant activities

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Feeling of detachment or estrangement from others

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Restricted range of affect. Unable to have loving feelings toward family.

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Sense of a foreshortened future

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Difficulty falling or staying asleep

Irritability or outbursts of anger

difficulty concentrating

hypervigilance

Exaggerated startle response

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The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

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Helping without hurtingAddress the person openly and honestly. Ask the difficult questions.

Slow things down.

Provide the person with a sense of hopefulness.

Listen

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Error on the side of caution

Remember that you are dealing with multiple traumatic experiences over years. That means layers of emotional pain.

Multiple triggers (memories, mental trauma, dissociations, etc.) means a complicated case. Take it slow..

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Global triggers to Consider

Consider Media attention to military casualties and other war visuals, and their effect on Veterans and their families.

Economics, family stress, life changes, and losses are all triggers.

Remember that PTSD is a series of crisis and traumas in the persons life. This is not just about one incident.

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It is critical at this time to be prepared to address PTSD and related issues that returning troops and their families will be experiencing.

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Mental Health Services

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Psychological Services

Medication may reduce the anxiety,depression,and insomnia, however is limited in other PTSD symptoms.

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Eye Movement Desensitization and Reprocessing (EMDR)

Involves elements of exposure therapy and Cognitive behavioral therapy, combined with techniques (eye movements, hand taps, sounds), which create an alteration of

attention back and for the across the

midbrain.

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Group Therapy

Trauma survivors are able to risk sharing

traumatic memories in safety.

As group members achieve greater

Understanding and resolution of their trauma,they may feel more confident and able to trust.

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Family Therapy

Family support can play an important role

In recovery.

It is also useful to help families

Connect with other families who have

experienced similar event and stressors.  

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Women in the Military

Women associated with the military are particularly vulnerable due to geographic isolation from family and friends, social isolation within the military culture, residential mobility, financial insecurity and fear of adverse career impact (Hansen, 2001).

 

 

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Post-Deployment adjustment and the

Family

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A period of discomfort, role confusion, and renegotiation of relationships may follow the initial homecoming.

 What are the quality and quantity of the Families resources; income, support system, community connections, and interpersonal competencies

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VETERANS HELPING VETS

Camaraderie and a sense of belonging can act as an antidote to the

immediate sense of isolation and guilt.

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Vet’s work best with other Vets for the most part. In crisis situations, a Vet in crisis will respond to another Vet to control the situation for him/her.

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What we have learned in the critical moments?

Cases to review

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Counseling Veterans

The Department of Veterans Affairs provides a network of more than 100 specialized programs for veterans with PTSD and work closely with local Vet Centers operated by VA’s Readjustment Counseling Services.  

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Resources, Referrals, Links

Veterans Services

NAMI

NAMI Frontline

Hotlines:

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Thank You