Veterans and Mental Health
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1 Veterans and Mental Health Learning About PTSD with Dr. Laura Wiedeman Northern California VA Health Care System June 20, 2017
2 Posttraumatic Stress Disorder Laura Wiedeman, Psy.D. Clinical Psychologist VA Northern CA Health Care System PTSD Clinical Team June 2017
3 Objectives Learn about PTSD epidemiology, symptoms, and recovery Review available resources for veterans with PTSD, including websites, educafonal videos, mobile apps, and VA services Address common misconcepfons about PTSD that may be held by veterans and/or the public Develop a greater understanding of how to interact with veterans who may have PTSD VETERANS HEALTH ADMINISTRATION
4 ObjecFve #1: PTSD EPIDEMIOLOGY, SYMPTOMS, AND RECOVERY VETERANS HEALTH ADMINISTRATION 3
5 What is a traumatic event? VETERANS HEALTH ADMINISTRATION 4
6 Trauma exposure is common. VETERANS HEALTH ADMINISTRATION 5
7 How common is PTSD? VETERANS HEALTH ADMINISTRATION 6
8 Criterion A: Traumatic Event Directly experiencing a traumafc event Witnessing, in person, an event that happened to someone else Learning about the violent or unexpected death of a friend of family member Experiencing repeated or extreme exposure to aversive details of traumafc events VETERANS HEALTH ADMINISTRATION 7
9 Symptom Clusters VETERANS HEALTH ADMINISTRATION 8
10 Symptom Clusters: Intrusions (Re-experiencing) (Criterion B) Recurrent, involuntary, and intrusive distressing memories of the traumafc event(s) Recurrent, distressing dreams related to the traumafc event(s) DissociaFve reacfons (e.g., flashbacks) Intense or prolonged psychological distress at exposure to trauma reminders Marked physiological reacfons to trauma reminders VETERANS HEALTH ADMINISTRATION 9
11 Symptom Clusters: Persistent Avoidance (Criterion C) EfforTul avoidance of distressing memories, thoughts, or feelings related to the traumafc event(s) EfforTul avoidance of external reminders (e.g., people, places, conversafons, situafons) related to the traumafc event(s) VETERANS HEALTH ADMINISTRATION 10
12 Symptom Clusters: Negative changes in beliefs and feelings (Criterion D) Persistent, exaggerated negafve beliefs about oneself, others, and/or the world Distorted blame of self or others Persistent negafve emofons Difficulty feeling posifve emofons Feeling detached or cut off from others Diminished interest or parfcipafon in significant acfvifes Difficulty remembering important aspects of the trauma VETERANS HEALTH ADMINISTRATION 11
13 Symptom Clusters: Alterations in arousal and reactivity (Criterion E) Irritable behavior and angry outbursts Reckless or self-destrucfve behavior Hypervigilance Exaggerated startle response Problems with concentrafon Sleep disturbance VETERANS HEALTH ADMINISTRATION 12
14 Prevalence rates, by service era 11-20% 12% out of every 100 veterans who served in OperaFon Iraqi Freedom (OIF) and OperaFon Enduring Freedom (OEF) have PTSD in a given year About 12 out of every 100 veterans who served in the Gulf War (Desert Storm) have PTSD in a given year 15% About 15 out of every 100 veterans who served in Vietnam have PTSD in a given year VETERANS HEALTH ADMINISTRATION 13
15 Why do some people get PTSD while others do not? VETERANS HEALTH ADMINISTRATION 14
16 Personal Factors VETERANS HEALTH ADMINISTRATION 15
17 Traumatic Event VETERANS HEALTH ADMINISTRATION 16
18 Recovery Environment VETERANS HEALTH ADMINISTRATION 17
19 Comorbidity: PTSD often co-occurs with other mental health problems. VETERANS HEALTH ADMINISTRATION 18
20 Other Co-occurring Problems VETERANS HEALTH ADMINISTRATION 19
21 Recovery is possible! Reduce symptoms EffecFve management Improve quality of life VETERANS HEALTH ADMINISTRATION 20
22 How can PTSD be treated? Both medicafon and psychotherapy are effecfve, but psychotherapy is more effecfve VETERANS HEALTH ADMINISTRATION 21
23 Evidence-based Psychotherapy Treatments First line psychotherapies: A Trauma-focused psychotherapy that includes components of exposure and/or cognifve restructuring, such as: Prolonged Exposure (PE) CogniAve Processing Therapy (CPT) Eye Movement DesensiAzaAon and Reprocessing (EMDR) VETERANS HEALTH ADMINISTRATION 22
24 Cognitive Behavioral Therapy (CBT) Works VETERANS HEALTH ADMINISTRATION 23
25 Evidence-based Pharmacological Treatments First line medicafons: SelecFve Serotonin Reuptake Inhibitors (SSRIs) E.g., paroxefne (Paxil), sertraline (Zolob), fluoxefne (Prozac) Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) E.g., venlafaxine (Effexor) Warning: Benzodiazepines (e.g., Xanax, Valium, Klonopin) Limited efficacy Increased safety concerns potenfal for harm Not recommended for PTSD VETERANS HEALTH ADMINISTRATION 24
26 ObjecFve #2 RESOURCES AND SERVICES VETERANS HEALTH ADMINISTRATION
27 National Center for PTSD Provide educaaon about PTSD and effecfve PTSD treatments Make available resources to promote treatment engagement Develop tools to foster self help and symptom management VETERANS HEALTH ADMINISTRATION 26
28 PTSD Basics Understanding PTSD and PTSD Treatment is a booklet that explains basic informafon about: What is PTSD? What can cause PTSD? What are the symptoms of PTSD? What do I do if I have symptoms? How do I know if I have PTSD? Why get treatment for PTSD? Common quesfons about treatment What happens during PTSD treatment? How do I choose a mental health provider? Where can I go to get help? VETERANS HEALTH ADMINISTRATION 27
29 Animated Whiteboard Videos Short (~3 minute), engaging videos about PTSD and effective treatments VETERANS HEALTH ADMINISTRATION 28
30 AboutFace VETERANS HEALTH ADMINISTRATION 29
31 PTSD Treatment Decision Aid VETERANS HEALTH ADMINISTRATION 30
32 Mobile Apps The NaFonal Center for PTSD has partnered with a number of organizafons to develop a variety of mobile apps. Apps are focused on PTSD, related health problems (e.g., insomnia, alcohol use, etc.), or general well-being. There are apps for pafents, providers, and for use with pafent-provider dyads. VETERANS HEALTH ADMINISTRATION 31
33 PTSD Coach PTSD Coach mobile app more than 275,000 downloads in 98 countries. App provides: EducaFon about PTSD and PTSD treatment A self-assessment tool Portable skills to address acute symptoms Direct connecfon to crisis support Used as stand-alone educafon and symptom management tool, or with face-to-face care. Tools are easily accessible when they are needed most. VETERANS HEALTH ADMINISTRATION 32
34 PTSD Coach Online PTSD Coach Online offers an expanded suite of 17 tools to help manage symptoms (e.g., problem solving, challenging cognitions). Users can choose a tool based upon a current problem or a full list of tools. Video instructions from coaches are available for each tool. VETERANS HEALTH ADMINISTRATION 33
35 PTSD Family Coach PTSD Coach is for family members of those living with PTSD. App provides: EducaFon about PTSD and self-care InformaFon to help take care of your relafonship and children Resources to help a loved one get treatment for PTSD Tools to manage stress and build social networks Tracking for stress level over Fme VETERANS HEALTH ADMINISTRATION 34
36 Printable Materials to Share A variety of handouts, posters, brochures, and flyers Intended for veterans, families, and general public knowledge Emphasis on understanding PTSD, cooccurring condifons, treatment, as well as more general readjustment issues VETERANS HEALTH ADMINISTRATION 35
37 Veterans Crisis Line 24/7 Phone support Text messaging Online chat VETERANS HEALTH ADMINISTRATION 36
38 Make the Connection MakeTheConnec7on.net is an online resource designed to connect Veterans, their family members and friends, and other supporters with informafon, resources, and solufons to issues affecfng their lives. InformaFon about common life challenges, problems, and condifons Extensive video gallery with good sorfng opfons InformaFon and resource locator Self-assessments and self-help VETERANS HEALTH ADMINISTRATION 37
39 Where to Get Help: US Dept. of Veterans Affairs Veterans Health AdministraFon (VHA) Veterans Benefits AdministraFon (VBA) NaFonal Cemetery AdministraFon (NCA) Hospitals CompensaFon Burial and memorial benefits Community Based OutpaFent Clinics (CBOCs) Vet Centers EducaFon & Training Home Loans **Please note this is not a complete list of services provided by each administration VETERANS HEALTH ADMINISTRATION 38
40 Where to Get Help: Benefits (VBA) Connect to your local Regional Benefit Office Locator: hqps:// CA locafons: Oakland, Los Angeles, San Diego Find your local County Veterans Service Officer (CVSO) Assistance and advocacy in connecfng veterans and their families with service sand benefits County locafons: hqps:// VETERANS HEALTH ADMINISTRATION 39
41 Where to Get Help: Health Care (VHA) Eligibility & Enrollment Eligibility Criteria: hqps:// Served in the military Separated under any condifon other than dishonorable Minimum duty requirement (24 consecufve months) Enrollment Complete VA Form 10-10EZ hqps:// For assistance: Call VETS (8387) for help complefng the form Contact the Enrollment Coordinator at your local VA health care facility Contact a NaFonal or State Veterans Service OrganizaFon VETERANS HEALTH ADMINISTRATION 40
42 Where to Get Help: Health Care (VHA) Locations Hospitals and Community Based OutpaFent Clinics Hospital & Clinic Locator: hqps:// Vet Centers Readjustment Counseling for veterans and their families For those who served in a combat theater or area of hosflity, experienced MST, provided mortuary services, operated unmanned aerial vehicles in support of combat operafons Bereavement counseling CA LocaFons: hqps:// VETERANS HEALTH ADMINISTRATION 41
43 Where to Get Help: Health Care (VHA) PTSD Treatment All VA Medical Centers provide PTSD care, as well as many VA clinics Some clinics have specialized PTSD programs VA PTSD Program Locator: hqps:// Within CA: hqps:// PTSD services may also be provided over telehealth Comprehensive resource list: Where to get help for PTSD hqps:// VETERANS HEALTH ADMINISTRATION 42
44 ObjecFve #3 COMMON MISCONCEPTIONS VETERANS HEALTH ADMINISTRATION
45 Common Misconceptions About trauma exposure and/or having PTSD: You can only have PTSD from combat PTSD is a lifelong, chronic disease Having PTSD means I am weak, crazy, broken, or damaged About recovery: It is too late for me to recover Everyone who served in combat has PTSD About services: I am not eligible for VHA services because I am not service connected I can only get treatment for PTSD at a VA hospital VETERANS HEALTH ADMINISTRATION 44
46 ObjecFve #4: INTERACTING WITH VETERANS WHO MAY HAVE PTSD VETERANS HEALTH ADMINISTRATION
47 Interacting with Veterans with PTSD Many veterans will not know or disclose if they have PTSD Provide informafon and assistance connecfng them to VBA benefits and VHA services Focus quesfons on ways they need help what do you need to know in order to help them? Talking about specifics of military service, including deployments, may be personal or triggering Trauma exposure or details are not needed Be mindful of personal space (e.g., approaching from behind, physical touch, sudden movements) Offer validafon, normalizafon, and graftude InsFll hope VETERANS HEALTH ADMINISTRATION 46
48 Thank you! Laura Wiedeman, Psy.D VETERANS HEALTH ADMINISTRATION 47
49 Infopeople is dedicated to bringing you the best in pracfcal library training and improving informafon access for the public by improving the skills of library workers. Infopeople, a grant project of the Califa Group, is supported in part by the InsFtute of Museum and Library Services under the provisions of the Library Services and Technology Act administered in California by the State Librarian. This material is covered by CreaFve Commons 4.0 Non-commercial Share Alike license. Any use of this material should credit the funding source.
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