Combating the Effects of PTSD: Solutions for Rebuilding

Transcription

1 May 13-14, 2014 Walter E. Washington Convention Center Washington, DC Combating the Effects of PTSD: Solutions for Rebuilding Tania Glenn, PsyD Principal Tania Glenn and Associates, PA

2 Traumatic Events Management What is stress - pre and post incident What is the risk of Post-traumatic Stress Disorder (PTSD) What is the importance of peer-driven support and critical incident response teams PTSD

3 Got Stress or Trauma? Got Issues?

4 What is Stress? A state of physical and emotional activation A physical and psychological response to a perceived threat, challenge or change The core element of stress is fight or flight syndrome

5 The Four F s Fight Flight Freeze????

6 What to Watch Nervous system pumps out epinephrine and norepinephrine and leads to a parasympathetic nervous system backlash Sheer exhaustion Cold, flu and other illnesses Chronic state of fight or flight Increased cortisol at a chronic level Fast aging

7 Types of Stress Acute Stress Delayed Stress Cumulative Stress Post-traumatic Stress Disorder

8 Acute Stress Begins on-scene or within 24 hours Very obvious Responders become overwhelmed Physical symptoms kick in Psychological responses

9 Acute Stress The Look The Combatant

10 Delayed Stress Begins 48 or more hours after the incident Symptoms are similar to acute stress Often confusion about this stress response due to the delay in onset

11 Delayed Stress The Event U.S Airways Flight 1549

12 Cumulative Stress Burnout!!! Results from coupling unrealistic expectations with good intentions Too much of something Not enough time off / away Not enough balance in one s life

13 Cumulative Stress The Environment Homeland Defense and Security Missions

14 Stress and The Brain Post-Traumatic Stress Disorder (PTSD)

15 Post-Traumatic Stress Disorder Psychological disorder (PTSD) listed in the DSM-IV Is the end result of exposure to stress trauma which is so extreme, that it is beyond human coping capacity? What is beyond human coping capacity? What is the individual s coping capacity?

16 PTSD (cont d) Individuals are initially traumatized by the five senses Sight Sound Taste Touch Smell

17 PTSD (cont d) Information from the five senses is transmitted up to the frontal lobe of the brain where images are stored like snapshots for later processing The prefrontal cortex is in charge of analyzing, making decisions and empathy During fight or flight, when the heart rate bumps up to bpm, the prefrontal cortex shuts down

18 Post-Traumatic Stress Disorder PTSD The Limbic System The Emotional Brain

19 PTSD (cont d) The Hippocampus Includes structures of the brain associated with the limbic system; it is in charge of managing trauma and loss Manages arousal levels of the amygdale and is damaged by the effects of glucocorticoids associated with the f response Specifically, post-mortem autopsies of combat veterans show shrinking of the hippocampus

20 PTSD (cont d) The Amygdale In charge of sending messages to the hypothalamus to fight or flee Every emotional memory is stored in the amygdale; when current events trigger stored memories, the amygdale acts up and starts firing the alarm bells Is damaged by prolonged exposure to cortisol

21 PTSD (cont d) The Hypothalamus Links the nervous system to the endocrine system to generate the f response The HPA Axis is the hypothalamus pituitary -adrenal axis and forms the fight/flight circuitry that connects the brain and body; this sets the cells in motion to kick butt or get out

22 PTSD (cont d) The result of PTSD is the amygdale being hijacked by the limbic system and constant regeneration of that f response The amygdale is associated with rage, fear and jealousy 2X bigger in men than women

23 PTSD (cont d) Intrusion Recurring thoughts, memories, flashbacks, nightmares, the event feels like it is in your face Arousal Increased anxiety, breathing, heart rate, etc., similar to the fight or flight response experienced onscene Avoidance We spend a great deal of time and energy trying not to think about it

24 Recent PTSD Findings The Severe Trauma

25 PTSD Findings Flashbacks are caused by increased cortisol levels leftover in the brain The limbic system is so deregulated that things like deep breathing to calm down are actually counterproductive Medications help decrease flashbacks but only for the duration taken; the most proven intervention remains cognitive behavioral therapy and progressive desensitization

26 PTSD Findings (cont d) Lessons Learned from History WWII Shellshock compared to Vietnam era PTSD PTSD is highly manageable as intervention usually leads to quicker cessation of symptoms Processing of events results in interpretation and successful downloading of information 30% of first responders develop some form of PTSD symptoms during their careers

27 Misconceptions of PTSD Former Navy SEAL, Sniper among Two Dead at Texas Gun Range Assailant and victim Military PTSD and violence Psychotic behavior and criminals Fact versus fiction

28 Physical Signs of Stress 1. Pupils dilate 2. Saliva thickens 3. Dry mouth 4. Increased gastrointestinal fluids 5. Stomach motility is inhibited 6. Diarrhea 7. Nausea

29 Physical Signs of Stress (cont d) Heart rate increases Blood flow changes Increased cholesterol in blood Reduced coordination Muscle aches Fatigue Chills

30 Cognitive Signs of Stress Confusion Shortened attention span Calculation difficulties Memory problems Decrease in logical thinking Impaired decision making Decreased self-awareness

31 Cognitive Signs of Stress (cont d) Slowed learning speed Cognitive distortions Nightmares Night terrors Law enforcement nightmares Insomnia/Exhaustion/ Microburst Sleep Dissociation

32 Emotional Signs of Stress Depression Anger Anhedonia Bitterness Guilt Numbing Feelings of isolation Helplessness Anxiety Denial Fear

33 Stress The Human Being

34 Behavioral Signs of Stress Increased silence Increased smoking Changes in eating patterns Increased use of alcohol/drugs Loss of interest Hyper vigilance Withdrawal (very dangerous!)

35 Stress Management TALKING Who, what, when, where and how what you saw, heard, tasted, touched and smelled EXERCISE Within 24 hours of a critical incident and on a regular basis RELAXATION Whatever works

36 Stress Management (cont d) EAT WELL Eat foods that are good for you, eat well-balanced meals, avoid excessive sugar and caffeine and take your vitamins CONTROL SUBSTANCE USE Be aware of increased smoking, use of alcohol, use of prescription medications, caffeine, drugs and sleeping aids

37 Stress Management (cont d) Improve your relationships communicate with your loved ones, keep your friends who have normal jobs, spend time with your family Practice breathing Take time off Use humor

38 Stress Management (cont d) Pace yourself appropriately Stick to your schedule as much as possible Delay big decisions until life becomes normal again Set limits on the amount of time you work Have a life outside the job

39 Stress Management (cont d) Remember stress management is something you and your families should do everyday Deal with your baggage; invest in yourself by doing this Plan for your retirement

40 Critical Incidents An Act of Terror

41 Critical Incidents Sudden, powerful and extreme events that overwhelm those who are exposed What might be a critical incident for one person may not be for another Your definition of a critical incident may change over time with experience or as you go through certain phases of your life

42 Critical Incidents (con t) Natural and man-made disasters Biological events/bioterrorism Serious injury to personnel Mass casualty incidents Suicide of a co-worker Line of duty death Acts of terrorism

43 Critical Incidents (con t) Accidental wounding or killing of a citizen Unusual events with a powerful impact Prolonged incidents ending in failure Any event involving children Excessive media coverage Police shootings

44 Questions and Answers Tania Glenn, PsyD, LCSW AUSTIN, TX