Post Traumatic Stress Disorder

Transcription

1 PTSD Distributed By: Maine Parent Federation PO Box 2067 Augusta, Maine (Maine Only) Website: Online community: Original: (06/2008) Updated: ()

2 Information Disclaimer The purpose of the information packet is to provide individuals with reader friendly information. We believe that a good overview is a realistic one. For this reason we have included a variety of information that may include the more difficult characteristics of a diagnosis or topic along with medical, educational and best practice information. All information contained in this packet is for general knowledge, personal education and enrichment purposes. It is not intended to be a substitute for professional advice. For specific advice, diagnosis and treatment you should consult with a qualified professional. When this packet was developed, Maine Parent Federation made every effort to ensure that the information contained in this packet was accurate, current and reliable. Packets are reviewed and updated periodically as changes occur. 12/ Distributed by Maine Parent Federation

3 Table of Content Page # What is PTSD?... 3 Common Reactions After Trauma... 6 How is PTSD Measured?... 9 Treatment of PTSD.. 11 What Can I Do if I Think I Have PTSD? Discussing Trauma and PTSD with Your Doctor. 17 Finding and Choosing a Therapist PTSD in Children and Teens Community Violence: Effects on Children and Teens.. 27 Lifestyle Changes Recommended for PTSD Patients Helping a Family Member Who Has PTSD 31 State and National Resources 34 MPF Library Materials Distributed by Maine Parent Federation

4 What is PTSD? Used with permission by: National Center for PTSD Posttraumatic stress disorder (PTSD) is an anxiety disorder that can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others' lives are in danger. You may feel afraid or feel that you have no control over what is happening. Anyone who has gone through a life-threatening event can develop PTSD. These events can include: Combat or military exposure Child sexual or physical abuse Terrorist attacks Sexual or physical assault Serious accidents, such as a car wreck. Natural disasters, such as a fire, tornado, hurricane, flood, or earthquake. After the event, you may feel scared, confused, or angry. If these feelings don't go away or they get worse, you may have PTSD. These symptoms may disrupt your life, making it hard to continue with your daily activities. How does PTSD develop? All people with PTSD have lived through a traumatic event that caused them to fear for their lives, see horrible things, and feel helpless. Strong emotions caused by the event create changes in the brain that may result in PTSD. Most people who go through a traumatic event have some symptoms at the beginning. Yet only some will develop PTSD. It isn't clear why some people develop PTSD and others don't. How likely you are to get PTSD depends on many things: How intense the trauma was or how long it lasted If you lost someone you were close to or were hurt How close you were to the event How strong your reaction was How much you felt in control of events How much help and support you got after the event Many people who develop PTSD get better at some time. But about 1 out of 3 people with PTSD may continue to have some symptoms. Even if you continue to have symptoms, treatment can help you cope. Your symptoms don't have to interfere with your everyday activities, work, and relationships. 3 Distributed by Maine Parent Federation

5 What are the symptoms of PTSD? Symptoms of PTSD can be terrifying. They may disrupt your life and make it hard to continue with your daily activities. It may be hard just to get through the day. PTSD symptoms usually start soon after the traumatic event, but they may not happen until months or years later. They also may come and go over many years. If the symptoms last longer than 4 weeks, cause you great distress, or interfere with your work or home life, you probably have PTSD. There are four types of PTSD symptoms: 1. Reliving the event (also called re-experiencing symptoms): Bad memories of the traumatic event can come back at any time. You may feel the same fear and horror you did when the event took place. You may have nightmares. You even may feel like you're going through the event again. This is called a flashback. Sometimes there is a trigger -- a sound or sight that causes you to relive the event. Triggers might include: o o o Hearing a car backfire, which can bring back memories of gunfire and war for a combat Veteran. Seeing a car accident, which can remind a crash survivor of his or her own accident. Seeing a news report of a sexual assault, which may bring back memories of assault for a woman who was raped. 2. Avoiding situations that remind you of the event: You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event. For example: o o o A person who was in an earthquake may avoid watching television shows or movies in which there are earthquakes. A person who was robbed at gunpoint while ordering at a hamburger drive-in may avoid fastfood restaurants. Some people may keep very busy or avoid seeking help. This keeps them from having to think or talk about the event. 3. Feeling numb: You may find it hard to express your feelings. This is another way to avoid memories. o o o You may not have positive or loving feelings toward other people and may stay away from relationships. You may not be interested in activities you used to enjoy. You may not be able to remember parts of the traumatic event or not be able to talk about them. 4 Distributed by Maine Parent Federation

6 4. Feeling keyed up (also called hyperarousal): Post Traumatic Stress Disorder You may be jittery, or always alert and on the lookout for danger. This is known as hyperarousal. It can cause you to: o Suddenly become angry or irritable o Have a hard time sleeping. o Have trouble concentrating. o Fear for your safety and always feel on guard. o Be very startled when something surprises you. What are other common problems? People with PTSD may also have other problems. These include: Drinking or drug problems. Feelings of hopelessness, shame, or despair. Employment problems. Relationships problems including divorce and violence. Physical symptoms. Can children have PTSD? Children can have PTSD too. They may have the symptoms described above or other symptoms depending on how old they are. As children get older, their symptoms are more like those of adults. Here are some examples of PTSD symptoms in children: Young children may become upset if their parents are not close by, have trouble sleeping, or suddenly have trouble with toilet training or going to the bathroom. Children who are in the first few years of elementary school (ages 6 to 9) may act out the trauma through play, drawings, or stories. They may complain of physical problems or become more irritable or aggressive. They also may develop fears and anxiety that don't seem to be caused by the traumatic event. What treatments are available? When you have PTSD, dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But treatment can help you get better. There are good treatments available for PTSD. Cognitive behavioral therapy (CBT)appears to be the most effective type of counseling for PTSD. There are different types of cognitive behavioral therapies such as cognitive therapy and exposure therapy. A similar kind of therapy called EMDR, or eye movement desensitization and reprocessing, is also used for PTSD. Medications can be effective too. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD. The National Center for PTSD does not provide direct clinical care or individual referrals. FOR MORE INFORMATION on PTSD ncptsd@va.gov or Call: The PTSD Information Line at (802) Reviewed/Updated Date: October 5, Distributed by Maine Parent Federation

7 Common Reactions After Trauma Used with permission by: National Center for PTSD After going through a trauma, survivors often say that their first feeling is relief to be alive. This may be followed by stress, fear, and anger. Trauma survivors may also find they are unable to stop thinking about what happened. Many survivors will show a high level of arousal, which causes them to react strongly to sounds and sights around them. Most people have some kind of stress reaction after a trauma. Having such a reaction has nothing to do with personal weakness. Stress reactions may last for several days or even a few weeks. For most people, if symptoms occur, they will slowly decrease over time. All kinds of trauma survivors commonly experience stress reactions. This is true for veterans, children, and disaster rescue or relief workers. If you understand what is happening when you or someone you know reacts to a traumatic event, you may be less fearful and better able to handle things. Reactions to a trauma may include: Feeling hopeless about the future Feeling detached or unconcerned about others Having trouble concentrating or making decisions Feeling jumpy and getting startled easily at sudden noises Feeling on guard and constantly alert Having disturbing dreams and memories or flashbacks Having work or school problems You may also experience more physical reactions such as: Stomach upset and trouble eating Trouble sleeping and feeling very tired Pounding heart, rapid breathing, feeling edgy Sweating Severe headache if thinking of the event Failure to engage in exercise, diet, safe sex, regular health care Excess smoking, alcohol, drugs, food Having your ongoing medical problems get worse You may have more emotional troubles such as: Feeling nervous, helpless, fearful, sad Feeling shocked, numb, and not able to feel love or joy Avoiding people, places, and things related to the event Being irritable or having outbursts of anger Becoming easily upset or agitated 6 Distributed by Maine Parent Federation

8 Blaming yourself or having negative views of oneself or the world Distrust of others, getting into conflicts, being over controlling Being withdrawn, feeling rejected or abandoned Loss of intimacy or feeling detached Turn to your family and friends when you are ready to talk. They are your personal support system. Recovery is an ongoing gradual process. It doesn't happen through suddenly being "cured" and it doesn't mean that you will forget what happened. Most people will recover from trauma naturally. If your stress reactions are getting in the way of your relationships, work, or other important activities, you may want to talk to a counselor or your doctor. Good treatments are available. Common problems that can occur after a trauma Posttraumatic Stress Disorder (PTSD): PTSD is a condition that can develop after you have gone through a lifethreatening event. If you have PTSD, you may have trouble keeping yourself from thinking over and over about what happened to you. You may try to avoid people and places that remind you of the trauma. You may feel numb. Lastly, if you have PTSD, you might find that you have trouble relaxing. You may startle easily and you may feel on guard most of the time. Depression: Depression involves feeling down or sad more days than not. If you are depressed, you may lose interest in activities that used to be enjoyable or fun. You may feel low in energy and be overly tired. You may feel hopeless or in despair, and you may think that things will never get better. Depression is more likely when you have had losses such as the death of close friends. If you are depressed, at times you might think about hurting or killing yourself. For this reason, getting help for depression is very important. Self-blame, guilt and shame: Sometimes in trying to make sense of a traumatic event, you may blame yourself in some way. You may think you are responsible for bad things that happened, or for surviving when others didn't. You may feel guilty for what you did or did not do. Remember, we all tend to be our own worst critics. Most of the time, that guilt, shame or self-blame is not justified. Suicidal thoughts: Trauma and personal loss can lead a depressed person to think about hurting or killing themselves. If you think someone you know may be feeling suicidal, you should directly ask them. You will NOT put the idea in their head. If someone is thinking about killing themselves, call the Suicide Prevention Lifeline TALK (8255) You can also call a counselor, doctor, or 911. Anger or aggressive behavior: Trauma can be connected with anger in many ways. After a trauma, you might think that what happened to you was unfair or unjust. You might not understand why the event happened and why it happened to you. These thoughts can result in intense anger. Although anger is a natural and healthy emotion, intense feelings of anger and aggressive behavior can cause problems with family, friends, or coworkers. If you become violent when angry, you just make the situation worse. Violence can lead to people being injured, and there may be legal consequences. Alcohol/Drug abuse: Drinking or "self-medicating" with drugs is a common, and unhealthy, way of coping with upsetting events. You may drink too much or use drugs to numb yourself and to try to deal with difficult thoughts, feelings, and memories related to the trauma. While using alcohol or drugs may offer a quick 7 Distributed by Maine Parent Federation

9 solution, it can actually lead to more problems. If someone close begins to lose control of drinking or drug use, you should try to get them to see a health care provider about managing their drinking or drug use. Summing it all up Right after a trauma, almost every survivor will find him or herself unable to stop thinking about what happened. Stress reactions such as increased fear, nervousness, jumpiness, upsetting memories, and efforts to avoid reminders, will gradually decrease over time for most people. Use your personal support systems, family and friends, when you are ready to talk. Recovery is an ongoing gradual process. It doesn't happen through suddenly being "cured" and it doesn't mean that you will forget what happened. Most people will recover from trauma naturally over time. If your emotional reactions are getting in the way of your relationships, work, or other important activities, you may want to talk to a counselor or your doctor. Good treatments are available. The National Center for PTSD does not provide direct clinical care or individual referrals. FOR MORE INFORMATION on PTSD ncptsd@va.gov or Call: The PTSD Information Line at (802) Reviewed/Updated Date: April 13, Distributed by Maine Parent Federation

10 How is PTSD Measured? Used with permission by: National Center for PTSD To develop PTSD, a person must have gone through a trauma. Almost all people who go through trauma have some symptoms as a result. Yet most people do not get PTSD. A certain pattern of symptoms is involved in PTSD. There are four major types of symptoms: re-experiencing, avoidance, numbing, and arousal. Deciding if someone has PTSD can involve several steps. The diagnosis of PTSD is most often made by a mental health provider. What is a PTSD screen? A person who went through trauma might be given a screen to see if he or she could have PTSD. A screen is a very short list of questions just to see if a person needs to be assessed further. A positive screen does not mean a person has PTSD. A positive screen means that this person should be assessed further. What can I expect from an assessment for PTSD? Assessments for PTSD can vary widely depending on their purpose as well as the training of the evaluator. The evaluator needs to assess the effect a trauma has had on your life. He or she can then judge whether treatment for PTSD is needed. While an interview may take as little as 15 minutes, the most common evaluation takes about one hour. Some PTSD assessments can take eight or more 1-hour sessions. This is more likely when the information is needed for legal reasons or disability claims. You can expect to be asked questions about events that may have been traumatic for you. You will be asked about symptoms you may have as a result of these events. Assessments that are more complete are likely to involve structured sets of questions. You may be given psychological tests on which you record your thoughts and feelings. Your spouse or partner may be asked to provide extra information. You may also be asked to go through a test that looks at how your body reacts to mild reminders of your trauma. No matter what your case involves, you should always be able to ask questions in advance. The evaluator should be able to tell you what the assessment will include. You can also ask what information the professional expects to get from the assessment. What are some of the common measures used? There are two main types of measures used in PTSD evaluations. Structured Interviews A structured interview is a standard set of questions that an interviewer asks. Some examples of structured interviews are: 9 Distributed by Maine Parent Federation

11 Clinician Administered PTSD Scale (CAPS). Created by the National Center for PTSD staff, the CAPS is one of the most widely used PTSD interviews. The questions ask how often you have PTSD symptoms and how intense they are. The CAPS also asks about other symptoms that commonly occur with PTSD. Structured Clinical Interview for DSM (SCID). The SCID is another widely used interview. The SCID can be used to assess a range of mental health disorders including PTSD. Other interviews include: Anxiety Disorders Interview Schedule-Revised (ADIS) PTSD-Interview Structured Interview for PTSD (SI-PTSD) PTSD Symptom Scale Interview (PSS-I) Each has special features that might make it a good choice for a particular evaluation. Self-report Questionnaires A self-report questionnaire is a set of questions, usually printed out, that you are given to answer. This kind of measure often takes less time and may be less costly than an interview. These measures provide a single score to measure the amount of distress a person has. Examples of self-report measures include: PTSD Checklist (PCL). The PCL is another widely used measure developed by National Center for PTSD staff. This measure comes in several versions including one for civilians and another designed for military personnel and Veterans. Other self-report measures are: Impact of Events Scale-Revised (IES-R) Keane PTSD Scale of the MMPI-2 Mississippi Scale for Combat Related PTSD and the Mississippi Scale for Civilians Posttraumatic Diagnostic Scale (PDS) Penn Inventory for Posttraumatic Stress Los Angeles Symptom Checklist (LASC). The National Center for PTSD does not provide direct clinical care or individual referrals. FOR MORE INFORMATION on PTSD ncptsd@va.gov or Call: The PTSD Information Line at (802) Reviewed/Updated Date: February 17, Distributed by Maine Parent Federation

12 Treatment of PTSD Used with permission by: National Center for PTSD Today, there are good treatments available for PTSD. When you have PTSD, dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But talking with a therapist can help you get better. Cognitive behavioral therapy (CBT) is one type of counseling. It appears to be the most effective type of counseling for PTSD. The VA is providing two forms of cognitive behavioral therapy to Veterans with PTSD: Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy. There is also a similar kind of therapy called eye movement desensitization and reprocessing (EMDR) that is used for PTSD. Medications have also been shown to be effective. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD. Types of cognitive behavioral therapy What is cognitive therapy? In cognitive therapy, your therapist helps you understand and change how you think about your trauma and its aftermath. Your goal is to understand how certain thoughts about your trauma cause you stress and make your symptoms worse. You will learn to identify thoughts about the world and yourself that are making you feel afraid or upset. With the help of your therapist, you will learn to replace these thoughts with more accurate and less distressing thoughts. You will also learn ways to cope with feelings such as anger, guilt, and fear. After a traumatic event, you might blame yourself for things you couldn't have changed. For example, a soldier may feel guilty about decisions he or she had to make during war. Cognitive therapy, a type of CBT, helps you understand that the traumatic event you lived through was not your fault. What is exposure therapy? In exposure therapy your goal is to have less fear about your memories. It is based on the idea that people learn to fear thoughts, feelings, and situations that remind them of a past traumatic event. By talking about your trauma repeatedly with a therapist, you'll learn to get control of your thoughts and feelings about the trauma. You'll learn that you do not have to be afraid of your memories. This may be hard at first. It might seem strange to think about stressful things on purpose. But you'll feel less overwhelmed over time. With the help of your therapist, you can change how you react to the stressful memories. Talking in a place where you feel secure makes this easier. 11 Distributed by Maine Parent Federation

13 You may focus on memories that are less upsetting before talking about worse ones. This is called "desensitization," and it allows you to deal with bad memories a little bit at a time. Your therapist also may ask you to remember a lot of bad memories at once. This is called "flooding," and it helps you learn not to feel overwhelmed. You also may practice different ways to relax when you're having a stressful memory. Breathing exercises are sometimes used for this. What is EMDR? Eye movement desensitization and reprocessing (EMDR) is another type of therapy for PTSD. Like other kinds of counseling, it can help change how you react to memories of your trauma. While thinking of or talking about your memories, you'll focus on other stimuli like eye movements, hand taps, and sounds. For example, your therapist will move his or her hand near your face, and you'll follow this movement with your eyes. Experts are still learning how EMDR works. Studies have shown that it may help you have fewer PTSD symptoms. But research also suggests that the eye movements are not a necessary part of the treatment. Medication Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant medicine. These can help you feel less sad and worried. They appear to be helpful, and for some people they are very effective. SSRIs include citalopram (Celexa), fluoxetine (such as Prozac), paroxetine (Paxil), and sertraline (Zoloft). Chemicals in your brain affect the way you feel. For example, when you have depression you may not have enough of a chemical called serotonin. SSRIs raise the level of serotonin in your brain. There are other medications that have been used with some success. Talk to your doctor about which medications are right for you. Other types of treatment Some other kinds of counseling may be helpful in your recovery. However, more evidence is needed to support these types of treatment for PTSD. Group therapy Many people want to talk about their trauma with others who have had similar experiences. In group therapy, you talk with a group of people who also have been through a trauma and who have PTSD. Sharing your story with others may help you feel more comfortable talking about your trauma. This can help you cope with your symptoms, memories, and other parts of your life. 12 Distributed by Maine Parent Federation

14 Group therapy helps you build relationships with others who understand what you've been through. You learn to deal with emotions such as shame, guilt, anger, rage, and fear. Sharing with the group also can help you build self-confidence and trust. You'll learn to focus on your present life, rather than feeling overwhelmed by the past. Brief psychodynamic psychotherapy In this type of therapy, you learn ways of dealing with emotional conflicts caused by your trauma. This therapy helps you understand how your past affects the way you feel now. Your therapist can help you: Identify what triggers your stressful memories and other symptoms. Find ways to cope with intense feelings about the past. Become more aware of your thoughts and feelings, so you can change your reactions to them. Raise your self-esteem. Family therapy PTSD can affect your whole family. Your kids or your partner may not understand why you get angry sometimes, or why you're under so much stress. They may feel scared, guilty, or even angry about your condition. Family therapy is a type of counseling that involves your whole family. A therapist helps you and your family to communicate, maintain good relationships, and cope with tough emotions. Your family can learn more about PTSD and how it is treated. In family therapy, each person can express his or her fears and concerns. It's important to be honest about your feelings and to listen to others. You can talk about your PTSD symptoms and what triggers them. You also can discuss the important parts of your treatment and recovery. By doing this, your family will be better prepared to help you. You may consider having individual therapy for your PTSD symptoms and family therapy to help you with your relationships. How long does treatment last? CBT treatment for PTSD often lasts for 3 to 6 months. Other types of treatment for PTSD can last longer. If you have other mental health problems as well as PTSD, treatment may last for 1 to 2 years or longer. What if someone has PTSD and another disorder? Is the treatment different? It is very common to have PTSD at that same time as another mental health problem. Depression, alcohol or drug abuse problems, panic disorder, and other anxiety disorders often occur along with PTSD. In many cases, the PTSD treatments described above will also help with the other disorders. The best treatment results occur when both PTSD and the other problems are treated together rather than one after the other. 13 Distributed by Maine Parent Federation

15 What will we work on in therapy? When you begin therapy, you and your therapist should decide together what goals you hope to reach in therapy. Not every person with PTSD will have the same treatment goals. For instance, not all people with PTSD are focused on reducing their symptoms. Some people want to learn the best way to live with their symptoms and how to cope with other problems associated with PTSD. Perhaps you want to feel less guilt and sadness. Perhaps you would like to work on improving your relationships at work, or communicating with your friends and family. Your therapist should help you decide which of these goals seems most important to you, and he or she should discuss with you which goals might take a long time to achieve. What can I expect from my therapist? Your therapist should give you a good explanation for the therapy. You should understand why your therapist is choosing a specific treatment for you, how long they expect the therapy to last, and how they will tell if it is working. The two of you should agree at the beginning that this plan makes sense for you. You should also agree on what you will do if it does not seem to be working. If you have any questions about the treatment, your therapist should be able to answer them. You should feel comfortable with your therapist and feel you are working as a team to tackle your problems. It can be difficult to talk about painful situations in your life, or about traumatic experiences that you have had. Feelings that emerge during therapy can be scary and challenging. Talking with your therapist about the process of therapy, and about your hopes and fears in regards to therapy, will help make therapy successful. If you do not like your therapist or feel that the therapist is not helping you, it might be helpful to talk with another professional. In most cases, you should tell your therapist that you are seeking a second opinion. The National Center for PTSD does not provide direct clinical care or individual referrals. FOR MORE INFORMATION on PTSD ncptsd@va.gov or Call: The PTSD Information Line at (802) Reviewed/Updated Date: October 5, Distributed by Maine Parent Federation

16 What Can I Do if I Think I Have PTSD? Used with permission by: National Center for PTSD If you think you have PTSD, it's important to get treatment. Treatment can work, and early treatment may help reduce long-term symptoms. If you think you have PTSD: Talk to your family doctor. Talk to a mental health professional, such as a therapist. If you're a veteran, contact your local VA hospital or Vet Center. Talk to a close friend or family member. He or she may be able to support you and find you help. Talk to a religious leader. Fill out a PTSD screen and take it with you to the doctor. While this online PTSD screen asks about stressful military experiences, you can also answer the questions as they would apply to any other kind of trauma. Many people who might need assistance with something like the symptoms of PTSD are afraid to go for help. 1 out of 5 people say they might not get help because of what other people might think. 1 out of 3 people say they would not want anyone else to know they were in therapy. A study that's been done of soldiers coming home from Iraq found that only 4 in 10 service members with mental health problems said they would get help. Some of the most common reasons they gave were: Worried about what others would think Thought it might hurt their military career Might be seen as weak Why seek help? Here are some of the reasons why you should seek help: Early treatment is better Symptoms of PTSD may get worse. Dealing with them now might help stop them from getting worse in the future. Finding out more about what treatments work, where to look for help, and what kind of questions to ask can make it easier to get help and lead to better outcomes. PTSD symptoms can change family life PTSD symptoms can get in the way of your family life. You may find that you pull away from loved ones, are not able to get along with people, or that you are angry or even violent. Getting help for your PTSD can help improve your family life. PTSD can be related to other health problems 15 Distributed by Maine Parent Federation

17 PTSD symptoms can worsen physical health problems. For example, a few studies have shown a relationship between PTSD and heart trouble. By getting help for your PTSD, you could also improve your physical health. It may not be PTSD Having symptoms of PTSD does not always mean you have PTSD. Some of the symptoms of PTSD are also symptoms for other mental health problems. For example, trouble concentrating or feeling less interested in things you used to enjoy can be symptoms of both depression and PTSD. Since different problems have different treatments, it's important to have your symptoms assessed. While it may be tempting to identify PTSD in yourself or someone you know, the diagnosis generally is made by a mental health professional. This will usually involve an evaluation by a psychiatrist, psychologist, or clinical social worker specifically trained to assess psychological problems. What you can do? If you have PTSD or PTSD symptoms, you may feel helpless. Here are ways, though, that you can help yourself: Learn more about PTSD from this website or from other places. Talk to your doctor or a chaplain or other religious leader. Go for a PTSD evaluation by a mental health professional specifically trained to assess psychological problems. If you do not want to be evaluated, but feel you have symptoms of PTSD, you may choose "watchful waiting." Watchful waiting means taking a wait-and-see approach. If you get better on your own, you won't need treatment. If your symptoms do not get better after 3 months, and they are either causing you distress or are getting in the way of your work or home life, talk with a health professional. In a few cases, your symptoms may be so severe that you need immediate help. Call 911 or other emergency services immediately if you think that you cannot keep from hurting yourself or someone else. What treatments are available? Today, there are good treatments available for PTSD. When you have PTSD dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But talking with a therapist can help you get better. Cognitive behavioral therapy (CBT) appears to be the most effective type of counseling for PTSD. There are different types of cognitive behavioral therapies such as cognitive therapy and exposure therapy. There is also a similar kind of therapy called eye movement desensitization and reprocessing (EMDR) that is used for PTSD. Medications have also been shown to be effective. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD. The National Center for PTSD does not provide direct clinical care or individual referrals. FOR MORE INFORMATION on PTSD ncptsd@va.gov or Call: The PTSD Information Line at (802) Reviewed/Updated Date: July 30, Distributed by Maine Parent Federation

18 Discussing Trauma and PTSD with Your Doctor Used with permission by: National Center for PTSD If you have been through a traumatic event, you may find it helpful to tell this to your doctor and report any symptoms you may have. Witnessing or going through a trauma can lead to both emotional and physical problems. You can help your doctor to understand you and plan your treatment better by sharing this crucial information about yourself. Not everyone who goes through trauma will get PTSD, but keep in mind that good treatments are available even if you only have some PTSD symptoms. At first, you may find it hard to discuss your experiences. For this reason, National Center for PTSD staff have put together the checklist below. You can complete this list and show it to your doctor. Brief Checklist of Trauma Symptoms Check the symptoms below that you experience. Include symptoms you have even if you are not sure they are related to a traumatic event. I experienced or witnessed a traumatic event during which I felt extreme fear, helplessness, or horror. The event happened on (day/month/year). What happened?. 1) I have symptoms of re-experiencing or reliving the traumatic event: Have bad dreams or nightmares about the event or something similar to it Behave or feel as if the event were happening all over again (this is known as having flashbacks) Have a lot of intense feelings when I am reminded of the event Have a lot of physical sensations when I am reminded of the event (for example, my heart races or pounds, I sweat, find it hard to breathe, feel faint, feel like I'm going to lose control) 2) I have symptoms of avoiding reminders of the traumatic event: Avoid thoughts, conversations, or feelings that remind me about the event Avoid people, places, or activities that remind me of the event Have trouble remembering some important part of the event 3) I have noticed these symptoms since the event happened: Have lost interest in, or just don't do, things that used to be important to me Feel detached from people; find it hard to trust people Feel emotionally "numb" and find it hard to have loving feelings even toward those who are emotionally close to me Have a hard time falling or staying asleep 17 Distributed by Maine Parent Federation

19 Am irritable and have problems with my anger Have a hard time concentrating Think I may not live very long and feel there's no point in planning for the future Am jumpy and get startled easily Am always "on guard" 4) I experience these medical or emotional problems: Stomach problems Intestinal (bowel) problems Gynecological (female) problems Weight gain or loss Pain, for example, in back, neck, or pelvic area Headaches Skin rashes and other skin problems Lack of energy; feel tired all the time Alcohol, drug, or other substance use problems Depression or feeling down Anxiety or worry Panic attacks Other symptoms such as: Summing it up If you think you have PTSD, or even just some of the symptoms, it is important for you to let your doctor know. Your doctor needs this information to plan your medical treatment. It can also help your doctor connect you with other services you may need, such as a mental health provider, lab tests, and so on. You may find it helpful to print this fact sheet to show your doctor. The National Center for PTSD does not provide direct clinical care or individual referrals. FOR MORE INFORMATION on PTSD ncptsd@va.gov or Call: The PTSD Information Line at (802) Reviewed/Updated Date: June 15, Distributed by Maine Parent Federation

20 Finding and Choosing a Therapist Used with permission by: National Center for PTSD These resources can help you locate and choose a therapist who is right for you. A special section for Veterans is included. Finding a therapist There are many ways to find a therapist. You can start by asking friends and family if they can recommend anyone. Make sure the therapist has skills in treating trauma survivors. On the phone One way to locate a therapist is to make some phone calls. When you call, say that you are trying to find a therapist who specializes in effective treatment for PTSD, such as cognitive behavioral therapy (CBT) or Eye Movement Desensitization and Reprocessing (EMDR). Contact your local mental health agency or family doctor. Call your state psychological association. Call the psychology department at a local college or university. Call the Anxiety Disorders Association of America at (240) to access their referral network Call the National Center for Victims of Crime's toll-free information and referral service at FYI- CALL. Call the Sidran Institute s Help Desk at for help finding a therapist who specializes in trauma treatment. You can also Sidran at help@sidran.org. If you work for a large company, call the human resources office or employee assistance plan to see if they make referrals. If you have health insurance, call to find out about mental health providers the insurance company will cover. Some mental health services are listed in the phone book. In the Government pages, look in the "County Government Offices" section. In that section, look for "Health Services (Dept. of)" or "Department of Health Services." Then in that section, look under "Mental Health." In the yellow pages, therapists are listed under "counseling," "psychologists," "social workers," "psychotherapists," "social and human services," or "mental health." Online Information can also be found using the Internet. Some organizations have databases that allow you to search for therapists near you. These databases include profiles of therapists with their areas of expertise and the types of therapy they provide. Search online for find a therapist. Websites you can try are: Anxiety Disorders Association of America* 19 Distributed by Maine Parent Federation

21 The Find a Therapist Service* from the Association of Behavioral and Cognitive Therapies EMDR International Association* The Psychologist Locator* from the American Psychology Association Psychology Today s Therapy Directory* The Mental Health Services Locator from the Substance Abuse and Mental Health Services Administration Help for Veterans All VA Medical Centers provide PTSD care. Or you can use this online VA PTSD Program Locator to find a VA PTSD Treatment program at a VA facility near you. You can also go online to read more about services at Vet Centers. Other resources include: The 24/7 Veteran Combat Call Center: (WAR-VETS) VA Mental Health for Returning Veterans VA Returning Service Members (OEF/OIF/OND) Page My HealtheVet VA Medical Centers and Vet Centers are listed in the phone book. In the Government pages, look under "United States Government Offices." Then look for "Veterans Affairs, Dept of." In that section, look under "Medical Care" and "Vet Centers - Counseling and Guidance." Finding a support group Many VA Medical Centers and Vet Centers have various types of support groups. Use the information in the Help for Veterans section above to find out more. Anxiety Disorders Association of America* offers a self-help group network. National Alliance for Mental Illness* (NAMI) has a website with information for those with mental health problems. You may also find family support groups in a state or local affiliate of NAMI. About.com's PTSD Forum* An online discussion forum. Choosing a therapist There are a many things to consider in choosing a therapist. Some practical issues are location, cost, and what insurance the therapist accepts. Other issues include the therapist's background, training, and the way he or she works with people. Here is a list of questions you may want to ask a possible therapist. What is your education? Are you licensed? How many years have you been practicing? What are your special areas of practice? Have you ever worked with people who have been through trauma? Do you have any special training in PTSD treatment? 20 Distributed by Maine Parent Federation

22 What kinds of PTSD treatments do you use? Have they been proven effective for dealing with my kind of problem or issue? What are your fees? (Fees are usually based on a 45-minute to 50-minute session.) Do you have any discounted fees? How much therapy would you recommend? What types of insurance do you accept? Do you file insurance claims? Do you accept Medicare or Medicaid insurance? These questions are just guidelines. In the end, your choice of a therapist will come down to many factors. Think about your comfort with the person as well as his or her qualifications and experience treating PTSD. And keep in mind the importance of evidence-based, trauma-focused treatments like Cognitive Processing Therapy, Prolonged Exposure, and Eye Movement Desensitization and Reprocessing. Paying for therapy If you have health insurance, check to see what mental health services are covered. Medicare, Medicaid, and most major health plans typically cover a certain number of mental health counseling sessions per year, though you may have a small additional amount you will have to pay called a co-pay. Call your insurance company to see what they cover so you won t be surprised by a big bill. If you don t have health insurance that will cover your therapy, you may still be able to get counseling, even if you can t afford to pay full price. Many community mental health centers have sliding scales that base your fee on what you are able to pay. Who is available to provide therapy? There are many types of professionals who can provide therapy for trauma issues. Clinical Psychologists Clinical psychologists focus on mental health assessment and treatment. Licensed psychologists have doctoral degrees (PhD, PsyD, EdD). Their graduate training is in clinical, counseling, or school psychology. In addition to their graduate study, licensed psychologists must have another 1 to 2 years of supervised clinical experience. Psychologists have the title of "doctor," but in most states they cannot prescribe medicine. Clinical Social Workers The purpose of social work is to enhance human well-being. Social workers help meet the basic human needs of all people. They help people manage the forces around them that contribute to problems in living. Certified social workers have a master's degree or doctoral degree in social work (MSW, DSW, or PhD). Master's Level Clinicians Master's Level Clinicians have a master's degree in counseling, psychology, or marriage and family therapy (MA, MFT). They have at least 2 years of training beyond the 4-year college degree. To be licensed, master's level clinicians must meet requirements that vary by state. 21 Distributed by Maine Parent Federation

23 Psychiatrists Psychiatrists have a Doctor of Medicine degree (MD). After they complete 4 years of medical school, they must have 3 to 4 years of residency training. Board certified psychiatrists have also passed written and oral exams given by the American Board of Psychiatry and Neurology. Since they are medical doctors, psychiatrists can prescribe medicine. Some also provide psychotherapy. The National Center for PTSD does not provide direct clinical care or individual referrals. FOR MORE INFORMATION on PTSD ncptsd@va.gov or Call: The PTSD Information Line at (802) Reviewed/Updated Date: May 13, Distributed by Maine Parent Federation

24 PTSD in Children and Teens Used with permission by: National Center for PTSD This fact sheet provides an overview of how trauma affects school-aged children and teens. You will also find information on treatments for PTSD in children.. What events cause ptsd in children? Children and teens could have PTSD if they have lived through an event that could have caused them or someone else to be killed or badly hurt. Such events include sexual or physical abuse or other violent crimes. Disasters such as floods, school shootings, car crashes, or fires might also cause PTSD. Other events that can cause PTSD are war, a friend's suicide, or seeing violence in the area they live. Child protection services in the U.S. get around 3 million reports each year. This involves 5.5 million children. Of the reported cases, there is proof of abuse in about 30%. From these cases, we have an idea how often different types of abuse occur: 65% neglect 18% physical abuse 10% sexual abuse 7% psychological (mental) abuse Also, 3-10 million children witness family violence each year. Around 40-60% of those cases involve child physical abuse. (Note: It is thought that two-thirds of child abuse cases are not reported.) How many children get PTSD? Studies show that about 15-43% of girls and 14-43% of boys go through at least one trauma. Of those children and teens who have had a trauma, 3-15% of girls and 1-6% of boys develop PTSD. Rates of PTSD are higher for certain types of trauma survivors. Nearly 100% of children get PTSD if they see a parent being killed or if they see a sexual assault. PTSD develops in 90% of sexually abused children, 77% of children who see a school shooting, and 35% who see violence in the area they live get PTSD. What are the risk factors for PTSD? Three factors have been shown to raise the chances that children will get PTSD. These factors are: how severe the trauma is how the parents react to the trauma how close or far away the child is from the trauma 23 Distributed by Maine Parent Federation

25 Children and teens that go through the most severe traumas tend to have the highest levels of PTSD symptoms. The PTSD symptoms may be less severe if the child has more family support and if the parents are less upset by the trauma. Lastly, children and teens who are farther away from the event report less distress. Other factors can also affect PTSD. Events that involve people hurting other people, such as rape and assault, are more likely to result in PTSD than other types of traumas. Also, the more traumas a child goes through, the higher the risk of getting PTSD. Girls are more likely than boys to get PTSD. It is not clear whether a child's ethnic group may affect PTSD. Some research shows that minorities have higher levels of PTSD symptoms. Other research suggests this may be because minorities may go through more traumas. Another question is whether a child's age at the time of the trauma has an effect on PTSD. Researchers think it may not be that the effects of trauma differ according to the child's age. Rather, it may be that PTSD looks different in children of different ages. What does PTSD look like in children? School-aged children (ages 5-12): These children may not have flashbacks or problems remembering parts of the trauma, the way adults with PTSD often do. Children, though, might put the events of the trauma in the wrong order. They might also think there were signs that the trauma was going to happen. As a result, they think that they will see these signs again before another trauma happens. They think that if they pay attention, they can avoid future traumas. Children of this age might also show signs of PTSD in their play. They might keep repeating a part of the trauma. These games do not make their worry and distress go away. For example, a child might always want to play shooting games after he sees a school shooting. Children may also fit parts of the trauma into their daily lives. For example, a child might carry a gun to school after seeing a school shooting. Teens (ages 12-18): Teens are in between children and adults. Some PTSD symptoms in teens begin to look like those of adults. One difference is that teens are more likely than younger children or adults to show impulsive and aggressive behaviors. What are the other effects of trauma on children? Besides PTSD, children and teens that have gone through trauma often have other types of problems. Much of what we know about the effects of trauma on children comes from the research on child sexual abuse. This research shows that sexually abused children often have problems with fear, worry, sadness, anger, feeling alone and apart from others, feeling as if people are looking down on them, low self-worth, and not being able to trust others behaviors such as aggression, out-of-place sexual behavior, self-harm, and abuse of drugs or alcohol 24 Distributed by Maine Parent Federation

26 How is PTSD treated in children and teens? Post Traumatic Stress Disorder For many children, PTSD symptoms go away on their own after a few months. Yet some children show symptoms for years if they do not get treatment. There are many treatment options, described below: Cognitive-Behavioral Therapy (CBT) CBT is the most effective approach for treating children. One type of CBT is called Trauma-Focused CBT (TF- CBT). In TF-CBT, the child may talk about his or her memory of the trauma. TF-CBT also includes techniques to help lower worry and stress. The child may learn how to assert him or herself. The therapy may involve learning to change thoughts or beliefs about the trauma that are not correct or true. For example, after a trauma, a child may start thinking, "the world is totally unsafe." Some may question whether children should be asked to think about and remember events that scared them. However, this type of treatment approach is useful when children are distressed by memories of the trauma. The child can be taught at his or her own pace to relax while they are thinking about the trauma. That way, they learn that they do not have to be afraid of their memories. Research shows that TF-CBT is safe and effective for children with PTSD. CBT often uses training for parents and caregivers as well. It is important for caregivers to understand the effects of PTSD. Parents need to learn coping skills that will help them help their children. Psychological first aid/crisis management Psychological First Aid (PFA) has been used with school-aged children and teens that have been through violence where they live. PFA can be used in schools and traditional settings. It involves providing comfort and support, and letting children know their reactions are normal. PFA teaches calming and problem solving skills. PFA also helps caregivers deal with changes in the child's feelings and behavior. Children with more severe symptoms may be referred for added treatment. Eye movement desensitization and reprocessing (EMDR) EMDR combines cognitive therapy with directed eye movements. EMDR is effective in treating both children and adults with PTSD, yet studies indicate that the eye movements are not needed to make it work. Play therapy Play therapy can be used to treat young children with PTSD who are not able to deal with the trauma more directly. The therapist uses games, drawings, and other methods to help children process their traumatic memories. Other treatments Special treatments may be needed for children who show out-of-place sexual behaviors, extreme behavior problems, or problems with drugs or alcohol. 25 Distributed by Maine Parent Federation

27 What can you do to help? Reading this fact sheet is a first step toward helping your child. Learn about PTSD and pay attention to how your child is doing. Watch for signs such as sleep problems, anger, and avoidance of certain people or places. Also watch for changes in school performance and problems with friends. You may need to get professional help for your child. Find a mental health provider who has treated PTSD in children. Ask how the therapist treats PTSD, and choose someone who makes you and your child feel at ease. You as a parent might also get help from talking to a therapist on your own. The National Center for PTSD does not provide direct clinical care or individual referrals. FOR MORE INFORMATION on PTSD ncptsd@va.gov or Call: The PTSD Information Line at (802) 296 Reviewed/Updated Date: June 15, Distributed by Maine Parent Federation

28 Community Violence: Effects on Children and Teens Used with permission by: National Center for PTSD Community violence includes many events. It might be a stranger using physical threat or direct violence to take something or hurt someone. It can also be violence between family members, close partners, or peers. These events may include cruel acts such as being shot, raped, stabbed, or beaten. Most of the attention from media and research is on community violence that involves adults. However, many children and teens face violence in their neighborhoods and schools. Such violence can have effects on children. How much community violence do children face? Many people think that community violence only happens in gangs and inner cities. It is true that people who are poor, non-white, and living in crowded inner-city areas deal with a lot of violence. Community violence also occurs, though, in White, middle-class areas, both suburban and rural. All kinds of youth are at risk for community violence. Over one-third of girls and boys across the country ages 10 to 16 years are victims of direct violence. Direct violence includes attempted kidnapping, physical and sexual assault. Even more children have faced indirect community violence. That is, they have seen violence or they know a victim of community violence. In one study, over three-quarters of children in a high-violence urban area reported coming into contact with community violence. Of note, more than half of the parents said that their children had not been exposed to violence in the community. Who is at risk? Sadly, there is no way to make sure your child does not face community violence. However, we do know some of the factors that add to a child's risk for coming into contact with community violence: living in poor, inner-city areas being non-white being in a gang or using alcohol or drugs living in a home with domestic (family) violence males see more community violence than do females and are at more risk for physical attacks females are at more risk for sexual assault What are the effects of community violence? If hurt by violence, a child may have to cope with physical or medical problems. A child may also have mental health problems, including PTSD. Some people think that young children are not harmed by community violence because they are too young to understand or remember. However, studies have found signs of PTSD in babies and young children. 27 Distributed by Maine Parent Federation

29 A child's exposure to community violence affects the whole family. Parents are often very worried about their child's health and well-being. If resources and help are limited, parents can become angry. As a parent, you might blame yourself for not being able to keep your child safe. You may even become too protective. Parents sometimes use harsh discipline when the child acts out, even though the child's behavior is related to a trauma. Relations among family members can become strained. Parents are trying to comfort their child while at the same time trying to handle their own fears. This is hard, even more so if they live in an area where violence is common. What can we do? Children can be helped. The best thing for a child is a caring adult. If a child is touched by violence, spend time with the child. Be sure the child understands that you are there to listen. Help the child talk about the trauma, but do not make him or her talk. Answer questions honestly using words that your child understands. Try to understand that children may have new problem behaviors as a result of the trauma. These behaviors need your patience and understanding. Ask for help from friends, family, and medical and mental health experts for you and your child. Prevention programs are also important to keep community violence from happening. This involves gang prevention. Also, programs can help children and teens at risk for violence learn how to peacefully solve problems. These programs work better if they happen before age 6 years. They are also better if they are taught in the children's homes and schools. Programs should also try to prevent high-risk behaviors such as alcohol and drug use and carrying weapons. The National Center for PTSD does not provide direct clinical care or individual referrals. FOR MORE INFORMATION on PTSD ncptsd@va.gov or Call: The PTSD Information Line at (802) Reviewed/Updated Date: March 2, Distributed by Maine Parent Federation

30 Lifestyle Changes Recommended for PTSD Patients Used with permission by: National Center for PTSD People with PTSD need to take active steps to deal with their PTSD symptoms. Often these steps involve making thoughtful changes in your lifestyle. By making these changes, you can reduce your symptoms and improve your quality of life. Here are some positive changes you could make: Have more contact with other trauma survivors Other trauma survivors are a good source of understanding and support. You could join a survivors' organization. For example, Veterans may want to join a Veterans' organization. By having contact with others who have had similar experiences, you will no longer be isolated. You will also begin to break down any distrust of others. It may be hard to take the first step and join a PTSD treatment group or other peer support group. You may have said to yourself, "What will happen there? Nobody can help me anyway." Many people with PTSD find it hard to meet new people. They have trouble trusting enough to open up to someone new. Yet it can also be a great relief to feel that you have taken positive action. You will learn that you are not the only one dealing with the types of feelings you have. In time you may also end up being friends with another survivor. Start exercising Walking, jogging, swimming, weight lifting, and other forms of exercise often reduce physical tension. It is important to see a doctor before starting to exercise. If your doctor gives the OK, exercise in moderation can help those with PTSD. Exercise may give you a break from difficult emotions. It may distract you from painful memories or worries. Perhaps most important, exercise can improve self-esteem. It may create feelings of personal control. Change neighborhoods Survivors with PTSD often think that the world is a very dangerous place. You may think it is likely that you will be harmed again. If you have PTSD, living in a high-crime area may confirm these beliefs and make you more fearful. If it is possible, move to a safer area. It may then be easier for you to rethink your beliefs about danger. You may be better able to trust that you will be safe. Volunteer in the community Most people need to feel as though they can contribute to their community. You may not feel you have anything to offer others, especially if you are not working. One way survivors can reconnect with their communities is to volunteer. You can help with youth programs, health services, reading programs, sports activities, building housing, and in many other ways. Stay away from drinking and drugs 29 Distributed by Maine Parent Federation

31 Sometimes trauma survivors turn to alcohol and drugs to help them cope with PTSD. While these substances may distract you from your painful feelings for a short time, relying on alcohol and drugs always makes things worse in the end. These substances get in the way of PTSD treatment and recovery. Rather than trying to beat an addiction by yourself, you may want to join a treatment program. It is often easier to deal with addictions if you can be around others who are working on the same kinds of issues. Invest more in personal relationships Most trauma survivors have a son or daughter, a wife or partner, or an old friend or work buddy. Make an effort to renew or increase contact with that person. This can help you reconnect with others, which in turn helps you cope with PTSD. It will increase the chances you have to feel good and have fun. Others can offer you emotional support as you change your habits and behaviors. The National Center for PTSD does not provide direct clinical care or individual referrals. FOR MORE INFORMATION on PTSD ncptsd@va.gov or Call: The PTSD Information Line at (802) Reviewed/Updated Date: June 15, Distributed by Maine Parent Federation

32 Helping a Family Member Who Has PTSD Used with permission by: National Center for PTSD When someone has PTSD, it can change family life. The person with PTSD may act differently and get angry easily. He or she may not want to do things you used to enjoy together. You may feel scared and frustrated about the changes you see in your loved one. You also may feel angry about what's happening to your family, or wonder if things will ever go back to the way they were. These feelings and worries are common in people who have a family member with PTSD. It is important to learn about PTSD so you can understand why it happened, how it is treated, and what you can do to help. But you also need to take care of yourself. Changes in family life are stressful, and taking care of yourself will make it easier to cope. How can I help? You may feel helpless, but there are many things you can do. Nobody expects you to have all the answers. Here are ways you can help: Learn as much as you can about PTSD. Knowing how PTSD affects people may help you understand what your family member is going through. The more you know, the better you and your family can handle PTSD. Offer to go to doctor visits with your family member. You can help keep track of medicine and therapy, and you can be there for support. Tell your loved one you want to listen and that you also understand if he or she doesn't feel like talking. Plan family activities together, like having dinner or going to a movie. Take a walk, go for a bike ride, or do some other physical activity together. Exercise is important for health and helps clear your mind. Encourage contact with family and close friends. A support system will help your family member get through difficult changes and stressful times. Your family member may not want your help. If this happens, keep in mind that withdrawal can be a symptom of PTSD. A person who withdraws may not feel like talking, taking part in group activities, or being around other people. Give your loved one space, but tell him or her that you will always be ready to help. How can I deal with anger or violent behavior? Your family member may feel angry about many things. Anger is a normal reaction to trauma, but it can hurt relationships and make it hard to think clearly. Anger also can be frightening. If anger leads to violent behavior or abuse, it's dangerous. Go to a safe place and call for help right away. Make sure children are in a safe place as well. 31 Distributed by Maine Parent Federation

33 It's hard to talk to someone who is angry. One thing you can do is set up a time-out system. This helps you find a way to talk even while angry. Here's one way to do this. Agree that either of you can call a time-out at any time. Agree that when someone calls a time-out, the discussion must stop right then. Decide on a signal you will use to call a time-out. The signal can be a word that you say or a hand signal. Agree to tell each other where you will be and what you will be doing during the time-out. Tell each other what time you will come back. While you are taking a time-out, don't focus on how angry you feel. Instead, think calmly about how you will talk things over and solve the problem. After you come back: Take turns talking about solutions to the problem. Listen without interrupting. Use statements starting with "I," such as "I think" or "I feel." Using "you" statements can sound accusing. Be open to each other's ideas. Don't criticize each other. Focus on things you both think will work. It's likely you will both have good ideas. Together, agree which solutions you will use. How can I communicate better? You and your family may have trouble talking about feelings, worries, and everyday problems. Here are some ways to communicate better: Be clear and to the point. Be positive. Blame and negative talk won't help the situation. Be a good listener. Don't argue or interrupt. Repeat what you hear to make sure you understand, and ask questions if you need to know more. Put your feelings into words. Your loved one may not know you are sad or frustrated unless you are clear about your feelings. Help your family member put feelings into words. Ask, "Are you feeling angry? Sad? Worried?" Ask how you can help. Don't give advice unless you are asked. If your family is having a lot of trouble talking things over, consider trying family therapy. Family therapy is a type of counseling that involves your whole family. A therapist helps you and your family communicate, maintain good relationships, and cope with tough emotions. During therapy, each person can talk about how a problem is affecting the family. Family therapy can help family members understand and cope with PTSD. Your health professional or a religious or social services organization can help you find a family therapist who specializes in PTSD. 32 Distributed by Maine Parent Federation

34 How can I take care of myself? Helping a person with PTSD can be hard on you. You may have your own feelings of fear and anger about the trauma. You may feel guilty because you wish your family member would just forget his or her problems and get on with life. You may feel confused or frustrated because your loved one has changed, and you may worry that your family life will never get back to normal. All of this can drain you. It can affect your health and make it hard for you to help your loved one. If you're not careful, you may get sick yourself, become depressed, or burn out and stop helping your loved one. To help yourself, you need to take care of yourself and have other people help you. Care for yourself Don't feel guilty or feel that you have to know it all. Remind yourself that nobody has all the answers. It's normal to feel helpless at times. Don't feel bad if things change slowly. You cannot change anyone. People have to change themselves. Take care of your physical and mental health. If you feel yourself getting sick or often feel sad and hopeless, see your doctor. Don't give up your outside life. Make time for activities and hobbies you enjoy. Continue to see your friends. Take time to be by yourself. Find a quiet place to gather your thoughts and "recharge." Get regular exercise, even just a few minutes a day. Exercise is a healthy way to deal with stress. Eat healthy foods. When you are busy, it may seem easier to eat fast food than to prepare healthy meals. But healthy foods will give you more energy to carry you through the day. Remember the good things. It's easy to get weighed down by worry and stress. But don't forget to see and celebrate the good things that happen to you and your family. Get help During difficult times, it is important to have people in your life who you can depend on. These people are your support network. They can help you with everyday jobs, like taking a child to school, or by giving you love and understanding. You may get support from: Family members. Friends, coworkers, and neighbors. Members of your religious or spiritual group. Support groups. Doctors and other health professionals The National Center for PTSD does not provide direct clinical care or individual referrals. FOR MORE INFORMATION on PTSD ncptsd@va.gov or Call: The PTSD Information Line at (802) Reviewed/Updated Date: March 8, Distributed by Maine Parent Federation

35 State Resources National Alliance of Mental Illness of Maine (NAMI Maine) NAMI-Maine is a grassroots, non-profit organization dedicated to improving the quality of life of everyone affected by mental illness. Services are provided both directly, and through a statewide structure of local affiliates and support groups. NAMI Maine s purpose is to: Offer compassion and provide social/emotional support Advocate for improved quality of services Educate, inform, and provides resources Raise public awareness and promote understanding Promote the importance of peer support Train volunteers and professionals Fosters a statewide network of affiliates and support groups No family or person living with mental illness in Maine needs to be alone. NAMI Maine families are there to help. They understand and want to help others meet the challenges and face the struggles that are so apparent when dealing with mental illness. Address: 1 Bangor Street, Augusta ME Contact: Phone: or Fax: Web: info@namimaine.org Department of Health and Human Services, Office of Children and Family Services (OCFS) Children s Behavioral Health Services (CBHS) Provides information and referrals for children to their 21 st birthday with developmental disabilities/delays, mental retardation, Pervasive Developmental Disorder (PDD)/autism and mental health disorders. Address: 2 Anthony Avenue SHS #11 Augusta, ME Contact: Phone: Crisis Number: Fax: Web: A Family Information Specialist is a parent of a child with special needs that works with families to meet the needs of the children. To contact the Family Information Specialist in your area, call: District 1(York County) or ( TTY) District 2 (Cumberland County) or ( TTY) Districts 3, 4 & 5(Kennebec, Somerset, Androscoggin, Franklin, Oxford, Sagadahoc, Knox, Lincoln & Waldo) , or ( TTY) Districts 6, 7 & 8 (Aroostook, Hancock, Penobscot, Piscataquis and Washington Counties) or ( TTY 34 Distributed by Maine Parent Federation

36 National Resources The National Center for PTSD The National Center for PTSD does not provide direct clinical care or individual referrals. FOR MORE INFORMATION on PTSD Phone: (802) The PTSD Information Line Website: National Institute of Mental Health (NIMH) Science Writing, Press, and Dissemination Branch 6001 Executive Boulevard, Room 8184, MSC 9663 Bethesda, MD Phone Numbers (local) (toll-free) (TTY) (TTY toll-free) (Fax) Address: Website: 35 Distributed by Maine Parent Federation

37 Maine Parent Federation Lending Library Procedures The MPF Library is a valuable resource to families and professionals in Maine. The success of the library is greatly determined by the quality and availability of the materials we offer. To help us maintain our library, we ask that you follow these guidelines. How to Request Materials Call: (Maine Only) dnewcombe@mpf.org Fax: Write: MPF Library Visit: 484 Maine Ave. #1 PO Box 2067 Farmingdale, Maine Augusta, Maine Hours: 8:30-4:30 Mon. Fri. Library Policy The complete library list is available in print or online at. You may borrow two materials at a time. You are responsible for the cost of return postage. Materials will be mailed out on the day you request them if they are available. Materials are loaned for a two-week period. If you need to renew them, call to check with us, we may be able to extend the due date as long as there is not a waiting list for the material. If materials are more than one week late we will ask you for a $5 late fee donation, payable to the MPF Library for every week the material is overdue. A reminder card will be mailed during the first week that materials are overdue. We keep a waiting list for materials that are already on loan when you request them. You can ask that your name be added to the waiting list and materials will be mailed to you as soon as they become available. About the Library List The library list is arranged by topic then listed alphabetically by title. Materials are not cross-referenced, so each title appears only once and you may have to check other sections. Please remember - we are always adding new materials and updating the library list. 36 Distributed by Maine Parent Federation

38 We have over 1,200 titles available in the library covering a broad range of topics. Please call the library if you need assistance locating a particular item,. Materials are grouped under the following topics: Abuse/Neglect Adoption/Foster Care Adults Advocacy/Self Advocacy Anxiety/Stress/Fears Assistive Technology Attention Deficit Disorder Autism/Aspergerís Syndrome/PDD Behavior/Discipline Bipolar Disorder Birth to Three Brain Injury Bullying Cerebral Palsy Child Development Communication Depression Developmental Disabilities Diabetes Divorce/Step-Parenting Early Childhood Eating Disorders Employment Epilepsy Gender Issues Grief Health/Medical Hearing Loss Inclusion/Integration Learning Disabilities Mental Illness Miscellaneous Neurobiological Non-Verbal Learning Disabilities Obsessive Compulsive Disorder Other Disabilities Parent Involvement Parent/Family Issues Personal Stories Physical Disabilities Play Potty Learning Recreation School/Education Self-Esteem/Social Skills Sensory Integration Special Education Spina Bifida Support Tourette Syndrome Visual Impairments REV. 07/ Distributed by Maine Parent Federation