1、Post Traumatic Stress Disorder and The Military Veteran Student,Roger P. Buck,Edgardo Padin-Rivera,Autonomy,The organism possess a certain degree of freedom It acts according to its own inherent nature, which is based on intrinsic forces, and is not under the compulsion of outside influences,Autonom
2、y,Characteristics: Self Governing Self Determination Self Understanding Intrinsic Forces “Self” is known “The World” is understood “Shattered Assumptions”,Autonomy: Assumptions about the “Self” and the World,Self,Personal Empowerment Sense of Personal Efficacy Efficiently Manage Self and Decisions S
3、ense of Personal Power and Self Control Capable of interacting effectively with others,World,The World is a Safe Place Some Personal Control over the Environment Efficiently interacts with the Environment & Others Empowered to Keep Oneself & Loved Ones Safe in the World,Autonomy: Once Assumptions ar
4、e Shattered,Crisis with the SELF,Failure to Maintain Sense of Personal Power Question Ability to Self Manage Question Efficiency and Effectiveness of Choices Fear of Losing Control of Self and Uncertainty about the Future,World VIEW,Question the Safety of the World Question Self and ability to contr
5、ol any Aspect of Life in the World Questions Efficiency of Being and Interacting in the World Questions Personal Ability to keep Loved Ones and Self out of Harms Way,Why the Self and World View are Changed,The Crisis Event Rendered the Person “HELPLESS” Crisis events Cause a Person to Question Their
6、 SELF (Decision Making) The Event is Incongruent with Beliefs about Self (Abilities and Strengths),The Event is Incongruent with Belief about Safety of the World An overpowering sense of failure, personal inadequacy, abandonment and/or Rejection Will Often Set in Due to This Incongruence,DANGER As A
7、 Profession,Military Veterans Police Officers Emergency Medical Technicians Fire Fighters Emergency Room Personnel FBI, ATF, other dangerous professions,Danger,Powerful vs. Powerless,Mild danger vs. extreme,Danger,Impact of Traumatic EventsSelf is Changed Beliefs Self Esteem Personality Shift Biolog
8、ical Fear Spiritual Crisis,Danger,Shatters ones perception about themselves and their place in the world. Shatters ones sense of safety & security Most Devastating effect: Autonomous ability to relax Ego Defenses (isolation, anger, guilt, anxiety, depression),Danger,Other Ego Defenses develop: Inabi
9、lity to Trust Inability to Establish or Re-Establish Intimacy Emotional Numbing Hyper-Sensitivity Toward Injustice Pervasive Sense of Feeling Damaged,Symptoms: Physical, Cognitive, Emotional, Behavioral, Spiritual (P.C.E.B.S.),P.C.E.B.S.,Physical,Agitation FatigueHeadaches Vision Problems Hyper-arou
10、sal Exhaustion Chest Pain Muscle Tremors Grinding of Teeth,Cognitive,Intrusive Thoughts Memory/Concentration Confusion Preoccupation Uncertainty Feeling Overwhelmed Poor Problem Solving Poor Abstract thinking Intrusive Images,P.C.E.B.S. (Contd),Emotional,Anxiety Depression Hopelessness Despair Rapid
11、 Mood Swings Unpredictable Mood Denial Agitation Intense Anger,Behavioral,Hyper-vigilance Sleep Problems Substance Abuse Self Mutilation Cry easily Antisocial Acts Defiance of Authority Inability to Rest Erratic Movements Loss of Appetite,P.C.E.B.S. (Contd),Spiritual,Questioning Good and Evil Attemp
12、ting to Make Sense of Senselessness Searching for the Meaning of the Experience Struggling with Understanding Why Questioning God/Faith,Human Toll: Depth of Change,Military Combat Violent Law Enforcement Action First Responders and Horrific Scenes Natural Disasters Virginia Tech Carnage Columbine 9/
13、11 Oklahoma City Bombing,What the Soldier Brings Home: Combat Stress, Trauma & Readjustment,“No one comes back unchanged” COL (Dr.) Tom Burke, Department of Defense, Director of Mental Health Policy,Life on the Front,To understand what the soldier brings home, one needs to look at how the environmen
14、t of war gets inside the mind.,86% received artillery fire.93% were shot at with small arms.77% fired at the enemy. 95% saw dead bodies or remains.89% were attacked or ambushed.86% know a troop injured or killed.65% saw dead or injured American.69% saw injured women/children and were unable to help.
15、 - These numbers correspond in part to a study in the New England Journal of Medicine and pertain to service members in Iraq.,Life on the Front: How Combat Shapes Minds, Emotions, & Behaviors,No true safe zone or rear, in Iraq & Afghanistan, there is a sense of danger in all occupations and areas al
16、l the time.The stresses and demands on cognitive and emotional capacities are many and almost constant.Being on constant alert, or “hyper-aroused” becomes a way of life.,Life on the Front: How Combat Shapes Minds, Emotions, & Behaviors,Prolonged exposure to combat stress Most soldiers exposed to mul
17、tiple terrorism or life threatening events. Some may have participated in atrocities. Often develop a mindset of “act immediately, debate later”.,Life on the Front: How Combat Shapes Minds, Emotions, & Behaviors,Exhaustion is constant. The soldier does not have energy or time to process events until
18、 after leaving the battlefield. The violence is scary, but also exhilarating and immediately rewarding. Many returning soldiers say combat was the most exciting and important thing they have ever done. Many are bored when they come home.,Life on the Front: How Combat Shapes Minds, Emotions, & Behavi
19、ors,Many face loss of comrades that can be emotionally devastating. Nothing is more important to a soldier than his war brothers. For many service members, a comrades death is an overwhelming experience, often leading to prolonged unresolved mourning and anger.,Life on the Front: How Combat Shapes M
20、inds, Emotions, & Behaviors,What the Soldier Brings Home,Post-Combat Battlemind Heightened sensory awareness of sights, sounds & smells. Action oriented ways of coping with new experiences. Identification and closeness with their military unit and comrades who have shared similar experiences. Regime
21、ntation into highly structured and efficient routines. Confused about ideals, values & identity shaped by war. Habituation to intensity and extreme emotions of combat life.,The PTS Syndrome Intrusive thoughts/memories Nightmares Avoidance/isolation Anger/angry outbursts Hyper-startle response Flashb
22、acks Hyper vigilance Feelings of grief, guilt, & loss,What the Soldier Brings Home,Its not just about PTSD Disillusionment with “civilian life” & activities. Challenging of ones previous identity & core beliefs. Irritability & anger toward non-military. Profound feeling of alienation. Social isolati
23、on. Memories of events that can be difficult to “square” with civilian reality. Self-blame or guilt for acts of war. Despair or hopelessness about future. Physical health problems Alcohol and drug abuse,What the Soldier Brings Home,What They Say Are Problems (from Focus Groups) Wanting to be left al
24、one - Social avoidance/isolation Sensitivity to loud noises and jumpiness hyper-arousal Anger, lack of patience - irritability Chronic joint pain, generally ankle, knee and back pain Memory problems or “lapses“ - trouble concentrating Drinking or smoking too much Personality changes, emotionally dis
25、tressed Body image issues: scars, weight changes, etc.,Coming Home: Life, Work, Learning,Coming Home: Life, Work, Learning,Obstacles to Restoring Previous Ties Homecoming feelings of joy and euphoria are short lived (Eventually not reinforcing). Attempts to restart old ways of interacting, old roles
26、 fail. Difficulties arise in trying to generate a “new normal” (rigidity, fears, isolative struggles get in the way). Civilian life at home may not have the edge and adrenaline and “life or death” purpose associated with wartime duty. Problems of internal chaos impinge on relationships.,Greatest nee
27、d after traumatic experiences is for active engagement, affiliation, and comfort available through supportive relationships. Biggest (unrealized) fearof most returning soldiersis engagement, affiliation,and intimacy.,Coming Home: Life, Work, Learning,Coming Home: Life, Work, Learning,Problems Reconn
28、ecting with Friends & Community Difficult for soldier to feel “at ease” with “civilians” who do not understand military or combat life (will gravitate toward veterans). Soldier may find self unable to share experiences with non-combat friends: “they wouldnt understand”, “they would react with horror
29、 or shock”).,Coming Home: Life, Work, Learning,Difficulties with Public Interactions Tension about the “politics” of war; public has mixed views of the war. Awkwardness on both sides: Public may not always know what to do or say. Veteran too often becomes a community media event. Veteran unsure who
30、he/she can talk to. Questions can arise about: What will they want me to talk about? What can I talk about? How will they react to a story or event?,Coming Home: Life, Work, Learning,Workplace Problems Veteran ability and employer expectations may conflict. Veteran may be unable to do same work Same
31、 exact job may not be available. Post-war images and memories may intrude on ability to concentrate. Co-workers may behave differently toward him/her. Veteran may feel others expect things he/she may not be able to do or meet.,Learning Environment Problems Veteran learning capacity vs instructor exp
32、ectations. May not be able to focus on single subject for long periods of time. Has difficulty with “vague” subject matter or mixed conclusions. Need for concrete outcomes. mTBI issues may create short term memory deficits (difficulty with details, memorization, etc),Coming Home: Life, Work, Learnin
33、g,Learning Environment Problems Internal chaos (intrusive images and memories) may intrude on ability to concentrate, pay attention. Hyper-arousal (on guard), in crowds, among new persons, changing environments (new classroom each course), may create tension, irritability, anxiety. Tendency toward s
34、ocial isolation leads to difficulty seeking help for studies, working with other students. May feel others expect things he/she may not be able to do. Other students may behave differently toward him/her. Subject Matter or presentation may arouse anger, irritation, isolating response (politics, hist
35、ory, social sciences are especially red flags).,Coming Home: Life, Work, Learning,Coming Home: Life, Work, Learning,The perception of positive community support whether or not it is used is one of the best known antidotes to chronic mental health problems after a traumatic event. So,Fifteen Environm
36、ental Cues That May Trigger Increased Symptoms,Cues that May Cause Agitation, Anxiety, Panic, Intense Anger, Apprehension, Sadness:Inefficient Support Services Non-Compassionate Attitude of Staff Members Waiting in Long Lines for Services Getting the “run-around” about Administrative Paperwork Immor
37、al and Unethical Practices by Staff, Faculty or Students Lack of Clear “Chain of Command” to resolve problems or concerns,Environmental Cues (Contd),Lack of Respect for & Acknowledgment of Veteran and Their Service Lack of Respect by Faculty or Staff for Sacrifice of Veterans Friends Killed and Inju
38、red in War Childish Behavior by “Traditional Teenage Students” (Loud Music after lights out Dorm life) Roll Call Overall Lack of effective and efficient leadership at the college Timeliness of GI Bill Processing and Other Financial Supports Large, Loud and Crowded Classrooms Classrooms Where Veteran
39、 Cannot Sit With Back to the Wall Chaotic Classroom Instructor Not in Charge,Sensory Triggers to Consider,Visual: Use of Laser Pointer Emergency Light Flashing Middle Eastern Student/Clothing Human Suffering Dry/Arid Environment,Sensory Triggers to Consider,Other Senses Loud Noises Helicopter Blades
40、 Smells (Raw Sewage) Smells (Sweat) Oppressive Heat Taste/Smell of Middle Eastern Foods Sitting in uncomfortable chairs with back pain, knee injuries other chronic medical concerns,Twelve Administrative Action Items,1. Ask the Vets2. Special Supports During Registration for Rapid Enrollment3. Vetera
41、n Task Force4. Encourage and Develop Peer Support Organization (Student Veterans of America) www.studentveterans.org5. Host Veteran Recognition and Welcoming Activities6. Specific College Policy and Procedures addressing action if student deployed7. Institution Admin consistency: GI Bill, Course Cre
42、dit for Military Schooling, Financial Aid etc.,Administrative Action (Contd),8. Present “Veteran Awareness and Sensitivity” training for all Staff & Faculty9. Create a Veteran Resource Center & Devote Office Space10.Register as Service Member Opportunity College (SOC)11.Develop a Veteran Foundation
43、Account to Assist Student Veterans with Tuition, Books, Fees and Household Emergencies12.Presidential and Senior Leadership Support,Fifteen Faculty and Staff Actions To Consider,1. Recognize you “Will” Have Higher Numbers of Both Male and Female Veterans With Traumatic Stress History2. Recognize the
44、 Cultural Diversity That Exists Between Traditional Students and Military Veterans3. Military Veterans are Permanently Changed Due to Experiences and are Often in a Period of Intense Adjustment and Transition4. Military Veterans with Combat Experience will Have Normal and Predictable PCEBS,Faculty a
45、nd Staff Action,5. Recognize there are Potential Cues in the College Environment That Will Trigger PCEBS Symptoms6. Recognize Some Veterans will meet ADA Criteria for Support Due to Injury (TBI)7. Understand there are Major Financial Stresses Due to GI Bill Delays, Federal Red Tape, VA Medical Appoi
46、ntments etc.8. Readjustment after Extreme Experiences Cause Family Strain As Well as College Stressors,Faculty and Staff Action,9. Recognize the Veteran is Reintegrating Into More Than One Environment.10.Some Veterans will Admit Their Veteran Status While Others May Keep it Quiet (Women Veterans)11.
47、Honor and Respect Differing Viewpoints and Strong Emotional Commitment to a Position or Belief12.Be Flexible with Attendance and Classroom Assignments,Faculty and Staff Action,13. Recognize and Support Military Dependents14.Learn the Various Trauma Symptoms That Occur with all Trauma Victims15. Know
48、 all Veteran Support Services on Your Campus and in the Community,Institutional Services to Provide,Local College Military Veteran Task Force Determines Specific Services - To Include the Following as a Minimum Orientation Program specific to veterans One stop Center of Excellence Veterans Advisory
49、Council Prevention Program Veteran Volunteer Program Develop “on-line” and Print Educational Information,Resource Listing,National Center for Post Traumatic Stress Disorder (NCPTSD) (www.ncptsd.va.gov) National Child Traumatic Stress Network (NCTSN) (www.nctsn.org) National Center for Trauma Informe
50、d Care (NCTIC) (www.mentalhealth.samhsa.gov/nctic/ ) Student Veterans of America (www.studentveterans.org),If you see a returning service member this month, just say thank you.,Contact Information,Roger P. Buck, Ph.D. Director, Counseling Services 3301 Hocking Parkway Hocking College Nelsonville, OH 45764 Phone: 740 753-6133 Buck_rhocking.edu,
