trauma informed care for posttraumatic stress …...trauma informed care for posttraumatic stress...
TRANSCRIPT
Trauma Informed Care for
Posttraumatic Stress Disorder and
Military Sexual Trauma in the
Veteran Population
Paul Decancq, Psy.D..
Chelsey Wilkes, PhD
Canandaigua VA Medical Center
Paul.Decancq@ va.gov
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Military Culture
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Military Culture
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Above the waterline:
behaviors, customs,
traditions (uniform, salute,
rank)
Military Culture
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Below the waterline: hidden
culture – more enduring and
powerful.
Beliefs, values, assumptions,
judgments.
Guiding ideals that are kept
for life. Known as the
warrior ethos.
Understanding the “Military Culture”
• Warrior Ethos
• I will always place the mission first.
• I will never accept defeat.
• I will never quit.
• I will never leave a fallen comrade.
Moral Injury
Two definitions:
• Betrayal of what is morally correct by someone in a
position of authority in a high-stakes situation
(Jonathan Shay)
• “Perpetrating, failing to prevent, bearing witness to,
or learning about acts that transgress deeply held
moral beliefs and expectations.” • *Litz et al., 2009. “Moral injury and moral repair in war veterans: A preliminary model and
intervention strategy.” Clinical Psychology Review, 29,695-706.
Relationship between PTSD and Moral Injury
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PTSD Moral Injury
Cause Real or perceived threat
to life
Leadership betrayal/
Violation of moral values & expectations
PTSD VS. MORAL INJURY
PTSD Moral Injury
Cause Real or perceived threat
to life
Leadership betrayal/
Violation of moral values & expectations
Individual’s role at the time of the event Witness/Victim Perpetrator/
Witness/Victim
PTSD VS. MORAL INJURY
PTSD Moral Injury
Cause Real or perceived threat
to life
Leadership betrayal/
Violation of moral values & expectations
Individual’s role at the time of the event Witness/Victim Perpetrator/
Witness/Victim
A reaction to… An event that happens to a
person
Acts of commission or omission
behavior of others/bearing witness
PTSD VS. MORAL INJURY
PTSD Moral Injury
Cause Real or perceived threat
to life
Leadership betrayal/
Violation of moral values & expectations
Individual’s role at the time of the event Witness/Victim Perpetrator/
Witness/Victim
A reaction to… An event that happens to a
person
Acts of commission or omission
behavior of others/bearing witness
Predominant emotions Fear/
horror/hopelessness
Betrayal/
shame/guilt
PTSD VS. MORAL INJURY
PTSD Moral Injury
Cause Real or perceived threat
to life
Leadership betrayal/
Violation of moral values & expectations
Individual’s role at the time of the event Witness/Victim Perpetrator/
Witness/Victim
A reaction to… An event that happens to a
person
Acts of commission or omission
behavior of others/bearing witness
Predominant emotions Fear/
horror/hopelessness
Betrayal/
shame/guilt
What was lost? Safety Trust/Connection/Self Concept
PTSD VS. MORAL INJURY
PTSD Moral Injury
Cause Real or perceived threat
to life
Leadership betrayal/
Violation of moral values & expectations
Individual’s role at the time of the event Witness/Victim Perpetrator/
Witness/Victim
A reaction to… An event that happens to a
person
Acts of commission or omission
behavior of others/bearing witness
Predominant emotions Fear/
horror/hopelessness
Betrayal/
shame/guilt
What was lost? Safety Trust/Connection/Self Concept
What is needed to heal? Restore sense of safety Forgiveness/Reconciliation/Moral Repair
PTSD VS. MORAL INJURY
PTSD Moral Injury
Cause Real or perceived threat
to life
Leadership betrayal/
Violation of moral values & expectations
Individual’s role at the time of the event Witness/Victim Perpetrator/
Witness/Victim
A reaction to… An event that happens to a
person
Acts of commission or omission
behavior of others/bearing witness
Predominant emotions Fear/
horror/hopelessness
Betrayal/
shame/guilt
What was lost? Safety Trust/Connection/Self Concept
What is needed to heal? Restore sense of safety Forgiveness/Reconciliation/Moral Repair
Treatment Cognitive Processing Therapy
/Prolonged Exposure
Adaptive Disclosure
Impact of Killing
PTSD VS. MORAL INJURY
Treatment for Moral Injury
“Moral-injury informed care:”
• Be careful to avoid re-injury through
inadvertent judging, shaming or being
dismissive
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Treatment for Moral Injury (cont.)
• “What’s done is done” – Macbeth
– Better to listen, be a witness and gently offer reframing:
• The event itself is NOT ongoing
• Individuals in the event might have moved on, changed,
or passed
• Circumstances of the event might have ended
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