CLASS 4. The Invisible Wounds of War: Introduction to War Related Illnesses, Injuries and Conditions. Warriors at Ease 2015TYMMC Part 1 Class 4 1

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1 CLASS 4 The Invisible Wounds of War: Introduction to War Related Illnesses, Injuries and Conditions Warriors at Ease 2015TYMMC Part 1 Class 4 1

2 Class 4 Introduction This class is crucial for beginning to understand the special emotional and psychological needs of the military and veteran communities. Though of course not everyone in military communities has been effected by these warrelated conditions, understanding these psychological challenges will enable you to better support the safety and well-being of your students. With peace and joy, The Warriors at Ease Team Warriors at Ease 2015 TYMMC Part 1 Class 4 2

3 Class 4 Agenda Preparing to work with combat-related conditions The nervous system and the impact of trauma Autonomic nervous system and how it responds to trauma Signature Wounds of War-PTS(D) and TBI Other combat related symptoms Why Yoga is good for PTSD How to understand and utilize research Warriors at Ease 2015 TYMMC Part 1 Class 4 3

4 Preparing to Work with Combat-Related Conditions Do I have to be a psychotherapist? Do I have to be a neuroscientist? NO! Warriors at Ease 2015 TYMMC Part 1 Class 4 4

5 You do need: Preparing to Work with Combat-Related Conditions a basic understanding of combat-related conditions and their effects on the brain and the body. a basic knowledge of the symptoms these conditions cause. TO BE A SKILLED, EFFECTIVE YOGA & MEDITATION TEACHER in MILITARY COMMUNITIES Warriors at Ease 2015 TYMMC Part 1 Class 4 5

6 The Autonomic Nervous System (ANS) The autonomic nervous system controls the insides of the body: the viscera or gut. It carries information about the inside of the body to the CNS (Central Nervous System) and controls the action of internal organs, including the gut, the heart, the secretion of epinephrine (adrenalin) and norepinephrine (noradrenalin) from the adrenal gland, etc. Warriors at Ease 2015 TYMMC Part 1 Class 4 6

7 Warriors at Ease 2015 TYMMC Part 1 Class 4 7

8 The ANS continued The autonomic nervous system plays an essential role in keeping the body's internal environment (temperature, salt concentration, blood sugar, oxygen and carbon dioxide level in blood, etc.) in proper balance, a condition called homeostasis. Warriors at Ease 2015 TYMMC Part 1 Class 4 8

9 The ANS continued The autonomic nervous system also plays a major part in emotional experience and expression. When you are emotionally excited, the body shows many changes: blood pressure and heart beat increase, mouth is often dry, stomach has "butterflies" in it. These and other body actions are controlled by the autonomic nervous system. Warriors at Ease 2015 TYMMC Part 1 Class 4 9

10 The ANS continued The autonomic nervous system also had been traditionally described as having two divisions: the sympathetic division the parasympathetic division These systems were thought to have antagonistic relationship, i.e. one would be dominant Warriors at Ease 2014 TYMMC Part 1 Class 4 10

11 The Sympathetic Nervous System (SNS) The sympathetic division is the emergency system. It prepares the body to put out energy and to protect it from effects of injury. FIGHT, FLIGHT or FREEZE The SNS: shuts the gut down, speeds up the heart, increases blood pressure, dilates (makes bigger) the pupils of the eyes, makes more glucose (blood sugar) available in the blood for energy Warriors at Ease 2015 TYMMC Part 1 Class 4 11

12 The ParaSympathetic Nervous System (PNS) The parasympathetic division is the "housekeeping" division. It acts to replace and recover from the activities of living. Its action is (almost always) the opposite of the sympathetic division. The PNS activates: the gut for digestion slows heart rate decreases blood pressure lowers blood sugar Warriors at Ease 2015 TYMMC Part 1 Class 4 12

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14 Polyvagal Theory and Trauma Traditionally the interaction between the PNS and SNS was described as working antagonistically with each other Stephen Porges has further explained the complex working of the body in response to stress with Polyvagal Theory He has identified a second defense system in response to trauma that explains the freeze response to trauma Warriors at Ease 2015 TYMMC Part 1 Class 4 14

15 Polyvagal Theory and Trauma Challenges the previous description of the freeze response as a function of the PNS Polyvagal Theory explains some of the possible symptoms that develop in the face of trauma and life threatening circumstance This model helps us to understand how to support individuals in healing from trauma and how yoga can help Warriors at Ease 2015 TYMMC Part 1 Class 4 15

16 The Signature Wounds of War Post-Traumatic Stress PTS Traumatic Brain Injury mtbi Warriors at Ease 2015 TYMMC Part 1 Class 4 16

17 PTS or PTSD Post-traumatic Stress Disorder, PTSD, is an anxiety disorder than can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat. Note: Many officials and treatment providers are now dropping the D in PTSD, to acknowledge that it is not a disorder, and thus lessen stigma. Warriors at Ease 2015 TYMMC Part 1 Class 4 17

Fatigue Second-hand exposure via those with

18 PTS or PTSD Primary Trauma First hand exposure to traumatic event(s) Secondary Trauma Or Compassion Fatigue Second-hand exposure via those with Primary Trauma Warriors at Ease 2015 TYMMC Part 1 Class 4 18

19 PTSD & the Brain Warriors at Ease 2015 TYMMC Part 1 Class 4 19

20 Three Clusters of PTSD Symptoms Intrusion Symptoms flashbacks, nightmares, obsessive thoughts Avoidance Symptoms Shutting down, avoiding situations that one might illicit strong reactions Overstimulation/Hyper-vigilance Symptoms Chronic state of hyperarousal, insomnia Warriors at Ease 2015 TYMMC Part 1 Class 4 20

21 Key Symptoms of PTSD Persistent re-experiencing of a traumatic event Persistent avoidance of trauma associated stimuli Numbing of general responsiveness Increased physical arousal Higher levels of SNS activation Lower heart rate variability Warriors at Ease 2015 TYMMC Part 1 Class 4 21

22 Key Symptoms of PTSD Sleep problems including nightmares & waking early Flashbacks & replays which you are unable to switch off Impaired memory, forgetfulness, inability to recall names, facts and dates Impaired concentration Hyper-vigilance (feels like but is not paranoia) Exaggerated startle response Irritability, sudden intense anger, occasional violent outbursts Panic attacks Impaired learning ability (e.g., through poor memory and inability to concentrate) Hypersensitivity, whereby every remark is perceived as critical Warriors at Ease 2015 TYMMC Part 1 Class 4 22

23 Traumatic Brain Injury (mtbi) Traumatic brain injury (TBI) occurs from a sudden blow or jolt to the head. Brain injury often occurs during some type of trauma, such as an accident, blast, or a fall. Often when people refer to TBI, they are mistakenly talking about the symptoms that occur following a TBI. Actually, a TBI is the injury, not the symptoms. Warriors at Ease 2015 TYMMC Part 1 Class 4 23

24 Common Symptoms Immediately After a Brain Injury Being dazed, confused, or seeing stars Not remembering the injury Losing consciousness (knocked out) Warriors at Ease 2015 TYMMC Part 1 Class 4 24

25 Mild Traumatic Brain Injury (mtbi) Commonly known as concussion, is one of the most common neurological disorders. Early mild TBI symptoms may appear subtle, but they can lead to significant, life-long impairment in an individual s ability to function physically, cognitively, and emotionally. All brain injuries are different and so is recovery. Most people with mild injuries recover fully, but it can take time. Some symptoms can last for days, weeks, or longer. Warriors at Ease 2015 TYMMC Part 1 Class 4 25

26 TBI continued The most common causes of traumatic brain injury (TBI) are falls, motor vehicle accidents, assaults/blows and explosive blasts (military). Severity ranges from: mild - in which there is a brief change in mental state or consciousness, to severe - in which there is an extended period of unconsciousness or amnesia after the injury. Although not life threatening, the long term effects of even a mild TBI can be serious. Warriors at Ease 2015 TYMMC Part 1 Class 4 26

27 Longer Term Symptoms of Brain Injury Motor & Sensory Headaches Dizziness Sensory deficits - Visual, Vestibular, Strength & Coordination Seizures Spasticity Dis-inhibition Sleep disturbances Hydrocephalus Pain Fatigue Cognitive & Emotional Impaired judgment Slower thinking Physical aggression Irritability Labile Emotions Depression Substance abuse Decreased concentration & focus Poor control over basic physical urges Impulsive/disruptive behavior Warriors at Ease 2015 TYMMC Part 1 Class 4 27

28 Overlapping Symptoms Symptoms of PTSD and mtbi Warriors at Ease 2015 TYMMC Part 1 Class 4 28

29 Other Combat-Related Conditions Anxiety Depression Sleep Disorders ED-Erectile Dysfunction Substance Abuse Warriors at Ease 2015 TYMMC Part 1 Class 4 29

30 Yoga and the Traumatized Nervous System Breathing Can Balance the Nervous System and Reduce Hyper-arousal Breathing Impacts the Vagal Response and Heart Rate Variability Asana Can Further Soothe Body and Brain and helps in connecting to the present moment Warriors at Ease 2015 TYMMC Part 1 Class 4 30

31 Why Yoga is Helpful with PTSD Yoga gets the individual out of the mind and into the body. Yoga can allow for the safe release of traumatic body memories which creates space for a new schema to take hold. Warriors at Ease 2015 TYMMC Part 1 Class 4 31

32 Using Yoga to Address PTSD Pioneered by Bessel van der Kolk, M.D. Trauma - original event not that important Problems are due to the residue of imprints left behind in the sensory and hormonal system People lose touch with physical sensations in the body They remain lost in time Proposes that most need some form of body oriented psychotherapy or body work to recover fully Warriors at Ease 2015 TYMMC Part 1 Class 4 32

33 What about Research? Do your homework Prepare yourself with relevant research Never make claims you cannot back up with evidence-based published research Find research or data that is salient Warriors at Ease 2015 TYMMC Part 1 Class 4 33

34 What about Research? Make students the expert on their own experience Connect to researchers in a setting Always check the regulations in a particular setting about the permissions needed for research Warriors at Ease 2015 TYMMC Part 1 Class 4 34

35 Resources for Yoga Research Number of Studies is growing exponentially Good websites to keep up with: Warriors at Ease Life Force Yoga Integrative Restoration Institute MBSR Mind and Life Institute International Association of Yoga Therapy Mind Fitness Training Institute Warriors at Ease 2015 TYMMC Part 1 Class 4 35

36 Write the ACW for this class here: What were your gems from this class? Warriors at Ease 2015 TYMMC Part 1 Class 4 36

37 Class 4 Homework Check out these excellent websites for more information 1. NIH website on PTSD National Institute of Mental Health 2. Regarding TBI Traumatic Brain Injury National Institute of Neurological Disorders and Stroke PBS Documentary on PTSD A Soldier s Heart Warriors at Ease 2015 TYMMC Part 1 Class 4 37

38 Class 4 Homework 4. Defense Centers of Excellence (DCOE) This is a great website to spend some time with because it not only has a lot of good information, DCOE is tasked with addressing the psychological needs of service members returning from deployments and their families. It will give you an idea of some of the ways the military is working to support its people This video on youtube from DCOE shows yoga at work with PTSD patients at Deployment Health Clinical Center. You can also search on youtube, (DCOE yoga nidra) 6. Stephen Porges video on Polyvagal Theory: Warriors at Ease 2015 TYMMC Part 1 Class 4 38

39 Class 4 Homework Part Two: Reflections for Journaling What has been my own experience with depression, anxiety, PTSD, or other psychological challenges? How have I responded in the face of traumatic events, both during the event and in the aftermath? How do I anticipate my own experience will impact my teaching? Warriors at Ease 2015 TYMMC Part 1 Class 4 39

40 Class 4 Homework cont. Part Two: Reflections for Journaling What kinds of feelings do I anticipate may get stirred up (or have been stirred up if you are already teaching) as I step into the role of the teacher, when I meet men and women with psychological challenges? How do I view my own role in helping the students I work with to navigate their personal challenges? What supports do I have available that will support my personal reactions and my ability to be an effective teacher as I confront students with challenging emotional/psychological challenges? Warriors at Ease 2015 TYMMC Part 1 Class 4 40

41 Class 4 Homework Part Three: Reading Assignment Please read Chapters 3-7 in: Finding Balance, Understanding and Optimizing Your Stress System After Deployment (Guide for service members and veterans) by Pam Woll. The link to download this document is in every . We hope that it deepens your understanding of how combat-stress affects human beings. Warriors at Ease 2015 TYMMC Part 1 Class 4 41

PTSD and Brain Injury- The Perfect Storm Part I

PTSD and Brain Injury- The Perfect Storm Part I Lori Wardlow, LMSW VA Nebraska Western Iowa Health Care System Peggy Reisher, MSW Brain Injury Alliance of Nebraska 2016 Invisible Wounds of War 19% of personnel