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- 1. Veterans and Mental Health Learning About PTSD with Dr. Laura Wiedeman Northern California VA Health Care System June 20, 2017
- 2. Posttraumatic Stress Disorder June 2017 Laura Wiedeman, Psy.D. Clinical Psychologist VA Northern CA Health Care System PTSD Clinical Team
- 3. VETERANS HEALTH ADMINISTRATION Objectives • Learn about PTSD epidemiology, symptoms, and recovery • Review available resources for veterans with PTSD, including websites, educational videos, mobile apps, and VA services • Address common misconceptions about PTSD that may be held by veterans and/or the public • Develop a greater understanding of how to interact with veterans who may have PTSD
- 4. VETERANS HEALTH ADMINISTRATION PTSD EPIDEMIOLOGY, SYMPTOMS, AND RECOVERY Objective #1: 3
- 5. VETERANS HEALTH ADMINISTRATION 4 What is a “traumatic” event?
- 6. VETERANS HEALTH ADMINISTRATION 5 Trauma exposure is common.
- 7. VETERANS HEALTH ADMINISTRATION 6 How common is PTSD?
- 8. VETERANS HEALTH ADMINISTRATION 7 Criterion A: Traumatic Event • Directly experiencing a traumatic event • Witnessing, in person, an event that happened to someone else • Learning about the violent or unexpected death of a friend of family member • Experiencing repeated or extreme exposure to aversive details of traumatic events
- 9. VETERANS HEALTH ADMINISTRATION 8 Symptom Clusters
- 10. VETERANS HEALTH ADMINISTRATION 9 Symptom Clusters: Intrusions (Re-experiencing) (Criterion B) • Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s) • Recurrent, distressing dreams related to the traumatic event(s) • Dissociative reactions (e.g., flashbacks) • Intense or prolonged psychological distress at exposure to trauma reminders • Marked physiological reactions to trauma reminders
- 11. VETERANS HEALTH ADMINISTRATION 10 Symptom Clusters: Persistent Avoidance (Criterion C) • Effortful avoidance of distressing memories, thoughts, or feelings related to the traumatic event(s) • Effortful avoidance of external reminders (e.g., people, places, conversations, situations) related to the traumatic event(s)
- 12. VETERANS HEALTH ADMINISTRATION 11 Symptom Clusters: Negative changes in beliefs and feelings (Criterion D) • Persistent, exaggerated negative beliefs about oneself, others, and/or the world • Distorted blame of self or others • Persistent negative emotions • Difficulty feeling positive emotions • Feeling detached or cut off from others • Diminished interest or participation in significant activities • Difficulty remembering important aspects of the trauma
- 13. VETERANS HEALTH ADMINISTRATION 12 Symptom Clusters: Alterations in arousal and reactivity (Criterion E) • Irritable behavior and angry outbursts • Reckless or self-destructive behavior • Hypervigilance • Exaggerated startle response • Problems with concentration • Sleep disturbance
- 14. VETERANS HEALTH ADMINISTRATION Prevalence rates, by service era 13 11-20% • 11-20 out of every 100 veterans who served in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) have PTSD in a given year 12% • About 12 out of every 100 veterans who served in the Gulf War (Desert Storm) have PTSD in a given year 15% • About 15 out of every 100 veterans who served in Vietnam have PTSD in a given year
- 15. VETERANS HEALTH ADMINISTRATION 14 Why do some people get PTSD while others do not?
- 16. VETERANS HEALTH ADMINISTRATION 15 Personal Factors
- 17. VETERANS HEALTH ADMINISTRATION 16 Traumatic Event
- 18. VETERANS HEALTH ADMINISTRATION 17 Recovery Environment
- 19. VETERANS HEALTH ADMINISTRATION 18 Comorbidity: PTSD often co-occurs with other mental health problems.
- 20. VETERANS HEALTH ADMINISTRATION 19 Other Co-occurring Problems
- 21. VETERANS HEALTH ADMINISTRATION Recovery is possible! 20 Reduce symptoms Improve quality of life Effective management
- 22. VETERANS HEALTH ADMINISTRATION 21 How can PTSD be treated? Both medication and psychotherapy are effective, but psychotherapy is more effective
- 23. VETERANS HEALTH ADMINISTRATION 22 Evidence-based Psychotherapy Treatments • First line psychotherapies: A Trauma-focused psychotherapy that includes components of exposure and/or cognitive restructuring, such as: – Prolonged Exposure (PE) – Cognitive Processing Therapy (CPT) – Eye Movement Desensitization and Reprocessing (EMDR)
- 24. VETERANS HEALTH ADMINISTRATION 23 Cognitive Behavioral Therapy (CBT) Works
- 25. VETERANS HEALTH ADMINISTRATION 24 Evidence-based Pharmacological Treatments • First line medications: – Selective Serotonin Reuptake Inhibitors (SSRIs) • E.g., paroxetine (Paxil), sertraline (Zoloft), fluoxetine (Prozac) – Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) • E.g., venlafaxine (Effexor) • Warning: Benzodiazepines (e.g., Xanax, Valium, Klonopin) – Limited efficacy – Increased safety concerns – potential for harm – Not recommended for PTSD
- 26. VETERANS HEALTH ADMINISTRATION RESOURCES AND SERVICES Objective #2
- 27. VETERANS HEALTH ADMINISTRATION National Center for PTSD http://www.ptsd.va.gov 26 Provide education about PTSD and effective PTSD treatments Make available resources to promote treatment engagement Develop tools to foster self help and symptom management
- 28. VETERANS HEALTH ADMINISTRATION 27 PTSD Basics http://www.ptsd.va.gov/public/understanding_ptsd/booklet.pdf • Understanding PTSD and PTSD Treatment is a booklet that explains basic information about: – What is PTSD? – What can cause PTSD? – What are the symptoms of PTSD? – What do I do if I have symptoms? – How do I know if I have PTSD? – Why get treatment for PTSD? – Common questions about treatment – What happens during PTSD treatment? – How do I choose a mental health provider? – Where can I go to get help?
- 29. VETERANS HEALTH ADMINISTRATION Animated Whiteboard Videos • Short (~3 minute), engaging videos about PTSD and effective treatments 28
- 30. VETERANS HEALTH ADMINISTRATION 29 AboutFace http://www.ptsd.va.gov/apps/AboutFace/
- 31. VETERANS HEALTH ADMINISTRATION PTSD Treatment Decision Aid http://www.ptsd.va.gov/decisionaid 30
- 32. VETERANS HEALTH ADMINISTRATION Mobile Apps http://www.ptsd.va.gov/public/materials/apps/index.asp 31 • The National Center for PTSD has partnered with a number of organizations to develop a variety of mobile apps. • Apps are focused on PTSD, related health problems (e.g., insomnia, alcohol use, etc.), or general well-being. • There are apps for patients, providers, and for use with patient-provider dyads.
- 33. VETERANS HEALTH ADMINISTRATION 32 PTSD Coach http://www.ptsd.va.gov/public/materials/apps/PTSDCoach.asp • PTSD Coach mobile app – more than 275,000 downloads in 98 countries. • App provides: – Education about PTSD and PTSD treatment – A self-assessment tool – Portable skills to address acute symptoms – Direct connection to crisis support • Used as stand-alone education and symptom management tool, or with face-to-face care. • Tools are easily accessible when they are needed most.
- 34. VETERANS HEALTH ADMINISTRATION 33 PTSD Coach Online http://www.ptsd.va.gov/apps/ptsdcoachonline/default.htm • PTSD Coach Online offers an expanded suite of 17 tools to help manage symptoms (e.g., problem solving, challenging cognitions). • Users can choose a tool based upon a current problem or a full list of tools. • Video instructions from “coaches” are available for each tool.
- 35. VETERANS HEALTH ADMINISTRATION 34 PTSD Family Coach http://www.ptsd.va.gov/public/materials/apps/PTSDFamilyCoach.asp • PTSD Coach is for family members of those living with PTSD. • App provides: – Education about PTSD and self-care – Information to help take care of your relationship and children – Resources to help a loved one get treatment for PTSD – Tools to manage stress and build social networks – Tracking for stress level over time
- 36. VETERANS HEALTH ADMINISTRATION Printable Materials to Share http://www.ptsd.va.gov/about/press-room/Materials_for_Printing.asp • A variety of handouts, posters, brochures, and flyers • Intended for veterans, families, and general public knowledge • Emphasis on understanding PTSD, co- occurring conditions, treatment, as well as more general readjustment issues 35
- 37. VETERANS HEALTH ADMINISTRATION Veterans Crisis Line https://www.veteranscrisisline.net/ 36 • 24/7 • Phone support • Text messaging • Online chat
- 38. VETERANS HEALTH ADMINISTRATION Make the Connection http://maketheconnection.net • “MakeTheConnection.net is an online resource designed to connect Veterans, their family members and friends, and other supporters with information, resources, and solutions to issues affecting their lives.” – Information about common life challenges, problems, and conditions – Extensive video gallery with good sorting options – Information and resource locator – Self-assessments and self-help 37
- 39. VETERANS HEALTH ADMINISTRATION Where to Get Help: US Dept. of Veterans Affairs 38 Veterans Health Administration (VHA) Hospitals Community Based Outpatient Clinics (CBOCs) Vet Centers Veterans Benefits Administration (VBA) Compensation Education & Training Home Loans National Cemetery Administration (NCA) Burial and memorial benefits **Please note this is not a complete list of services provided by each administration
- 40. VETERANS HEALTH ADMINISTRATION Where to Get Help: Benefits (VBA) • Connect to your local Regional Benefit Office – Locator: https://www.va.gov/directory/guide/state.asp?STATE=CA&dnum=3 – CA locations: Oakland, Los Angeles, San Diego • Find your local County Veterans Service Officer (CVSO) – Assistance and advocacy in connecting veterans and their families with service sand benefits – County locations: https://www.calvet.ca.gov/VetServices/Pages/CVSO- Locations.aspx 39
- 41. VETERANS HEALTH ADMINISTRATION Where to Get Help: Health Care (VHA) Eligibility & Enrollment • Eligibility Criteria: https://www.va.gov/healthbenefits/apply/veterans.asp – Served in the military – Separated under any condition other than dishonorable – Minimum duty requirement (24 consecutive months) • Enrollment – Complete VA Form 10-10EZ – https://www.vets.gov/ – For assistance: • Call 1-877-222-VETS (8387) for help completing the form • Contact the Enrollment Coordinator at your local VA health care facility • Contact a National or State Veterans Service Organization 40
- 42. VETERANS HEALTH ADMINISTRATION Where to Get Help: Health Care (VHA) Locations • Hospitals and Community Based Outpatient Clinics – Hospital & Clinic Locator: https://www.va.gov/directory/guide/division.asp?dnum=1 • Vet Centers – Readjustment Counseling for veterans and their families – For those who served in a combat theater or area of hostility, experienced MST, provided mortuary services, operated unmanned aerial vehicles in support of combat operations – Bereavement counseling – CA Locations: https://www.va.gov/directory/guide/state.asp?dnum=ALL&STATE=CA 41
- 43. VETERANS HEALTH ADMINISTRATION Where to Get Help: Health Care (VHA) PTSD Treatment • All VA Medical Centers provide PTSD care, as well as many VA clinics • Some clinics have specialized PTSD programs – VA PTSD Program Locator: https://www.va.gov/directory/guide/PTSD.asp – Within CA: https://www.va.gov/directory/guide/state_PTSD.cfm?STATE=CA • PTSD services may also be provided over telehealth • Comprehensive resource list: “Where to get help for PTSD” – https://www.ptsd.va.gov/public/where-to-get-help.asp 42
- 44. VETERANS HEALTH ADMINISTRATION COMMON MISCONCEPTIONS Objective #3
- 45. VETERANS HEALTH ADMINISTRATION Common Misconceptions About trauma exposure and/or having PTSD: • You can only have PTSD from combat • PTSD is a lifelong, chronic disease • Having PTSD means I am weak, crazy, broken, or damaged About recovery: • It is too late for me to recover • Everyone who served in combat has PTSD About services: • I am not eligible for VHA services because I am not service connected • I can only get treatment for PTSD at a VA hospital 44
- 46. VETERANS HEALTH ADMINISTRATION INTERACTING WITH VETERANS WHO MAY HAVE PTSD Objective #4:
- 47. VETERANS HEALTH ADMINISTRATION Interacting with Veterans with PTSD • Many veterans will not know or disclose if they have PTSD • Provide information and assistance connecting them to VBA benefits and VHA services • Focus questions on ways they need help – what do you need to know in order to help them? – Talking about specifics of military service, including deployments, may be personal or triggering – Trauma exposure or details are not needed • Be mindful of personal space (e.g., approaching from behind, physical touch, sudden movements) • Offer validation, normalization, and gratitude • Instill hope 46
- 48. VETERANS HEALTH ADMINISTRATION 47 Thank you! Laura Wiedeman, Psy.D. 925.372.2277 Laura.Wiedeman@va.gov
- 49. Infopeople is dedicated to bringing you the best in practical library training and improving information access for the public by improving the skills of library workers. Infopeople, a grant project of the Califa Group, is supported in part by the Institute of Museum and Library Services under the provisions of the Library Services and Technology Act administered in California by the State Librarian. This material is covered by Creative Commons 4.0 Non-commercial Share Alike license. Any use of this material should credit the funding source.
Editor's Notes
- Slides developed by National Center for PTSD, amended for this presentation
- From PTSD 101: PTSD Overview PTSD is an interesting psychological phenomenon because it has a known etiology - a traumatic event. Let’s take a moment and define what a trauma is. We all experience stressors every day. There are the daily hassles – things like the car breaking down or having to pay bills. Then there are larger, more stressful events; losing a job, getting a divorce or even good things like buying a home or getting married fall into this category. Traumatic stressors are different though. These are events in which someone feels that their life or the lives of others are being threatened. They can be witnessed or experienced directly. Or you can learn about a traumatic stressor happening to someone close to you. These include events such as warzone exposure, physical or sexual assault, serious accidents, child sexual or physical abuse, disasters and torture. For some people, stressful events such as having a spouse who cheats on you might be worse than some traumatic events. But the events don’t result in PTSD.
- From PTSD 101: PTSD Overview Over 60% of men and over half of all women experience at least one traumatic event. That means that most of the people you meet every day have probably experienced a trauma in their lifetime. Common military traumas: Combat Training Accidents MST Among Veterans who use VA health care, about: - 23 out of 100 women (or 23%) reported sexual assault when in the military. - 55 out of 100 women (or 55%) and 38 out of 100 men (or 38%) have experienced sexual harassment when in the military. There are many more male Veterans than there are female Veterans. So, even though military sexual trauma is more common in women Veterans, over half of all Veterans with military sexual trauma are men.
- From PTSD 101: PTSD Overview It’s adaptive to have strong reactions to trauma; we want to remember what’s dangerous and stay away from it. So, thousands of years ago, if you were chased by a saber-toothed tiger, you would want to remember it, and react quickly the next time you saw one. But what we want to see is that these reactions decrease once the threat has been removed. For most people, these reactions will lessen within the first few days or weeks after the traumatic event. But for people with PTSD, these reactions don’t go away. If there’s no reduction in symptoms one year after the traumatic event, it’s extremely unlikely that the symptoms will resolve without treatment. Of those who experience trauma, most do not develop PTSD. Only about 7% of all people develop PTSD in their lifetime.
- From PTSD 101: PTSD Overview According to the DSM-5, for a PTSD diagnosis, you need one of these specific types of trauma exposure: Directly experiencing a traumatic event, such as being in combat or a hurricane Witnessing an event that happened to someone else, such as seeing a serious car accident Learning about a traumatic event that happened to friends or family, such as learning about the homicide or suicide of a family member. (Having a family member die of natural causes does not qualify). Or, experiencing repeated or extreme exposure to aversive details of traumatic events such as collecting human remains after combat or terrorist attacks. In the DSM-5, it is explicit that choosing to view media images on TV such as watching coverage of the 9/11 attacks on television is not a traumatic event.
- From PTSD 101: PTSD Overview In addition to the type of trauma experienced, a diagnosis of PTSD requires a combination of symptoms from specific symptom clusters: intrusion (or re-experiencing), avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity (or hyperarousal). These symptoms must be present for more than one month and must cause significant distress or impairment.
- Requires 1 symptom From PTSD 101: PTSD Overview People with PTSD re-experience the trauma. You need one intrusion symptom for a diagnosis. Re-experiencing includes intrusive thoughts about the trauma, nightmares or flashbacks of the event where it feels like the event is happening again, or becoming emotionally or physically upset by reminders of the trauma. For example, because bridges are dangerous in Iraq, a veteran of the wars in Iraq or Afghanistan might feel nervous and have a racing heart when driving under a bridge. A sexual assault survivor might become distressed when seeing someone who resembles the perpetrator.
- Requires 1 symptom From PTSD 101: PTSD Overview People with PTSD avoid things that remind them of the trauma. For a diagnosis you need 1 avoidance symptom. They may avoid thinking or talking about the trauma or they may avoid people, places and activities that remind them of the trauma. People with PTSD will often avoid crowds because they feel unsafe or they may avoid conversations about the traumatic event. Motor vehicle accident survivors might avoid driving, while hurricane survivors might avoid going outside in bad weather.
- Requires 2 symptoms From PTSD 101: PTSD Overview In DSM-IV, numbing symptoms included the classic numbing symptoms of diminished interest or pleasure in activities (such as not enjoying social events), feeling detached from people, and an inability to feel positive emotions (such as love or happiness). An inability to recall important parts of the trauma was also included in DSM-IV. In DSM-5, the numbing symptoms of PTSD were expanded to include negative cognitions such as having negative beliefs about oneself, others and the world or assigning blame to self or others. For a diagnosis you need two symptoms from this cluster.
- Requires 2 symptoms From PTSD 101: PTSD Overview It makes sense that people with PTSD often feel cranked up or in a state of hyperarousal. They are constantly thinking about the trauma and working hard to push those reminders out of their heads. That takes effort, and as a result, it is hard to relax. You need two alterations in arousal and reactivity symptoms for a diagnosis. People with PTSD often have trouble sleeping. They can be irritable, and have trouble concentrating. They are on guard, and constantly scanning for danger. They may engage in reckless or risky behavior such as driving too fast, and they may startle easily. NOTE symptoms may be present but due to other conditions – concentration, sleep, negative mood, detachment…
- As a reminder, over half of us will experience a traumatic experience in our lifetime that could lead to PTSD. However, only about 7% of Americans develop PTSD at some point in their lifetime. Prevalence of PTSD is higher among women then among men. For more detailed information about the differences in PTSD experiences between men and women, please see our fact sheet: Research on Women, Trauma, and PTSD: http://www.ptsd.va.gov/professional/treatment/women/women-trauma-ptsd.asp Current PTSD refers to the prevalence of PTSD in a given year. For more detailed information about PTSD epidemiology, please see our fact sheet: Epidemiology of PTSD: http://www.ptsd.va.gov/professional/PTSD-overview/epidemiological-facts-ptsd.asp
- From PTSD 101: PTSD Overview So why do some people develop PTSD and others don’t? There are several factors that have an impact on whether someone develops PTSD.
- From PTSD 101: PTSD Overview Personal factors such as prior trauma exposure and demographic characteristics have some effect on who develops PTSD. Several variables that are consistently found to be related to PTSD include: female gender, some genetic factors, adverse childhood experiences, previous psychiatric problems, lower levels of education, lower socioeconomic status, and minority race.
- From PTSD 101: PTSD Overview Characteristics of the trauma exposure show a larger contribution to the development of PTSD than the personal factors. One of the most consistent findings is that the greater the severity of exposure, the greater the likelihood you’re going to develop PTSD. Greater perceived life threat, feelings of helplessness, and unpredictability or uncontrollability of the trauma are also significant risk factors. Some types of traumatic events are more likely than others to result in PTSD. In general, interpersonal traumas such as combat, or sexual or physical assault are more likely to result in PTSD than events not caused by another human being, such as an accident, a disaster, or illness. It makes sense that PTSD is a common consequence of war given the degree of life threat, unpredictability and its interpersonal nature. About 15% of returning veterans from Iraq and Afghanistan have PTSD, and 9% of Vietnam Veterans have current PTSD.
- From PTSD 101: PTSD Overview The recovery environment risk factors are the ones that are the most interesting and important, because they are the ones we can do something about. Among those is social support following the event. Another factor that’s proving really important is subsequent life stress. Basically, the more life stress, the more likely someone is to develop PTSD. So, if service members come home and they can’t find work, that financial hardship or that stress can contribute to PTSD. Or if a hurricane survivor can’t get an insurance settlement to rebuild their home, that can contribute to PTSD.
- From PTSD 101: PTSD Overview If you have PTSD then it is highly likely you have another mental health problem as well. About 80% of people with PTSD have another problem and many have more than one. People with PTSD have an increased risk of depression, anxiety, and substance use disorders.
- From PTSD 101: PTSD Overview People with PTSD are also more likely to have greater functional impairment and a reduced quality of life. Concentration problems, irritability and avoidance can cause trouble at work and can result in higher unemployment rates. People with PTSD may struggle to maintain relationships, and some may engage in interpersonal violence. PTSD is also a risk factor for suicide. They are more likely to have a wide range of medical problems, as well. A growing body of literature has found a link between PTSD and physical health, but the underlying mechanism is unclear. It may be the case that something associated with PTSD is actually the cause of greater health problems. PTSD may promote poor health through a complex interaction between biological and psychological mechanisms. The National Center for PTSD and other laboratories around the world are studying these mechanisms. Current thinking is that the experience of trauma brings about neurochemical changes in the brain. These changes may have biological, as well as psychological and behavioral, effects on one's health. For example, these neurochemical changes may create a vulnerability to hypertension and atherosclerotic heart disease that could explain in part the association with cardiovascular disorders. Research also shows that these neurochemical changes may relate to abnormalities in thyroid and other hormone functions, and to increased susceptibility to infections and immunologic disorders associated with PTSD. Targeting any of these areas in your interaction with veterans is a way of helping with PTSD
- From PTSD 101: PTSD Overview Both medication and psychotherapy have been shown to be effective for the treatment of PTSD. This slide shows effect sizes for medications and psychotherapy. An effect size tells us how big or noticeable a change is. An effect size of 0.8 is considered large which means that other people would notice there has been a change. NOTE: Psychotherapy trials produce better effect sizes than medication trials. There are many differences between the types of trials, and very few trials compare medications to psychotherapy head-to-head. There is a need for additional research directly comparing the effects of psychotherapy to medications to better address the relative effectiveness between the two.
- From PTSD 101: PTSD Overview Cognitive behavioral therapies or CBT combine building new cognitive skills and engaging in new behaviors or changing existing ones. Numerous randomized, controlled studies on cognitive behavioral therapies for PTSD demonstrate that treatment works. Two of the most consistently proven types of CBT are Prolonged Exposure therapy and Cognitive Processing Therapy. In VA, Prolonged Exposure and Cognitive Processing Therapy are the most commonly offered psychotherapies. Exposure-based therapies (ET) emphasize in-vivo, imaginal, and narrative (oral and/or written) exposure, but also generally include elements of cognitive restructuring (e.g. evaluating the accuracy of beliefs about danger) as well as relaxation techniques and self-monitoring of anxiety. Examples of therapies that include a focus on exposure include Prolonged Exposure Therapy, Brief Eclectic Psychotherapy, Narrative Therapy, written exposure therapies, and many of the cognitive therapy packages that also incorporate in-vivo and imaginal/narrative exposure. Cognitive-based therapies (CT) emphasize cognitive restructuring (challenging automatic or acquired beliefs connected to the traumatic event, such as beliefs about safety or trust) but also include relaxation techniques and discussion/narration of the traumatic event either orally and/or through writing. Examples include Cognitive Processing Therapy and various cognitive therapy packages tested in RCTs Eye Movement Desensitization and Reprocessing (EMDR) (extensively studied in a large number of RCTs) closely resembles other CBT modalities in that there is an exposure component (e.g. talking about the traumatic event and/or holding distressing traumatic memories in mind without verbalizing them) combined with a cognitive component (e.g., identifying a negative cognition, an alternative positive cognition, and assessing the validity of the cognition), and relaxation/self-monitoring techniques (e.g., breathing, “body scan”). Alternating eye-movements are part of the classic EMDR technique (and the name of this type of treatment); however, comparable effect sizes have been achieved with or without eye movements or other forms of distraction or kinesthetic stimulation. Although the mechanisms of effectiveness in EMDR have yet to be determined, it is likely that they are similar to other trauma-focused exposure and cognitive-based therapies.
- Cognitive behavioral therapies or CBT combine building new cognitive skills and engaging in new behaviors or changing existing ones. Numerous randomized, controlled studies on cognitive behavioral therapies for PTSD demonstrate that treatment works. Two of the most consistently proven types of CBT are Prolonged Exposure therapy and Cognitive Processing Therapy. From PTSD 101: PTSD Overview CAPS stands for the Clinician-Administered PTSD Scale. It’s our gold standard for measuring PTSD. A CAPS in the 70s would be considered severe PTSD. Both Prolonged Exposure and Cognitive Processing Therapy result in very large changes that are maintained at post-treatment and 9 month follow up. But even more exciting, is that when the researchers went back 5-10 years later to check on these people (and a few new people who had enrolled since the study started), they looked even better. These CAPS scores are in the mild or sub-threshold range - about 80% of the study participants no longer met criteria for PTSD.
- From PTSD 101: PTSD Overview The gold standard as of now for medication are the SSRI’s or selective serotonin reuptake inhibitors. Sometimes, doctors will prescribe medicines called “benzodiazepines” for people with PTSD. These medications are often given to people who have problems with anxiety, and while they may be of some help at first, they do not treat the core PTSD symptoms. They also may lead to addiction, especially for people who have had problems with alcohol or drugs. So, benzodiazepines are not recommended for long-term PTSD treatment.
- This section offers an overview of products and tools most useful for those who may have PTSD or care for someone who does. Resources for the general Public are also intended for general education for all users as well.
- Now I’d like to offer an overview of the educational products we have on the NCPTSD website (www.ptsd.va.gov) that may be helpful for you. Keep in mind that NCPTSD has two target audiences. The first are Veterans, other trauma survivors, and family members. The Center’s educational goals are to provide the Public with information about PTSD and PTSD treatment, encourage them to engage in treatment and help them manage their PTSD. The second target audience includes providers and researchers. Information on clinical practice, trainings, resources to make clinical work as effective as possible. We will focus on resources for Veterans, Trauma Survivors, Families & Caregivers, and the General Public **Note this website has information in both English and Spanish
- Goal: education & normalization
- Goal: education & normalization, treatment engagement Series of five whiteboard videos available to help explain PTSD and treatment options in plain language for the Public. These short animated videos combine narration with animated hand-drawn images. Each one is about 3 minutes in length. Can be viewed on NCPTSD website or YouTube The titles are: What is PTSD? PTSD Treatment: Know Your Options “Evidence-based” Treatment: What Does It Mean? Cognitive Processing Therapy for PTSD Prolonged Exposure for PTSD
- Goal: education & normalization AboutFace is an Educational Awareness campaign with the goal to help Veterans recognize PTSD, reduce barriers to care, and motivate them to seek treatment. AboutFace includes videos of Veterans and family members speaking about their experiences with PTSD and treatment. Veteran and clinician videos further explain how PTSD treatment can turn your life around. Knowing about PTSD does not necessarily mean that someone recognizes PTSD in themselves. Goal: Present real stories to help users identify if they have PTSD and break down barriers to seeking care. Present testimonials of how bad it can get with PTSD (e.g., family, functioning, co-occurring conditions, etc.). Highlight that treatment helps. Offer advice from Veterans and family members who have been there and turned their lives around with treatment. Offer videos of VA clinicians talking in plain language about their experiencing treating Veterans with PTSD. Link to fact sheets on the NCPTSD website.
- Goal: Promote treatment engagement The PTSD Treatment Decision Aid is an online tool designed to help people with PTSD learn about effective treatment options and start to think about which one might be right for them. The decision aid was developed by the National Center for PTSD, but it is not just for Veterans. It is designed for anyone who has (or thinks they might have) PTSD and is considering treatment. People with PTSD can use the Decision Aid to LEARN about PTSD, COMPARE treatment options and ACT in partnership with their provider to select a treatment. Patients can move through PTSD Treatment Decision Aid step-by-step, or jump to the sections that most interest them. They can: • Read about effective treatments • Watch videos explaining how different treatments work • Compare features of the treatments they like best • Get answers to common questions about PTSD treatment
- Goal: Self-help & management As you can see, there are a growing number of mobile apps on the market, some of which are specific to PTSD, and others focused on co-occurring problems. We provide an overview of relevant apps and their features on our website, as well as links to the Google Play and iTunes markets for access to download. Most relevant ones for your use: PTSD Coach PTSD Family Coach AIMS Vet Change Moving Forward
- Taking a quick look at some of the available apps – we can start with PTSD Coach. This app has now been downloaded over 100,000 times in 74 countries around the world. PTSD Coach is also available in 2 international versions: PTSD Coach Australia and PTSD Coach Canada. It can help patients learn about and manage symptoms that often occur after trauma. We are still awaiting the release of PTSD Coach in Spanish, and PTSD Family Coach. Features include: Reliable information on PTSD and treatments that work Tools for screening and tracking your symptoms Convenient, easy-to-use tools to help you handle stress symptoms Direct links to support and help Always with you when you need it.
- You can see that apps were intended to give patients “on the go” access to information and tools to help in the moment. This is PTSD Coach Online. We took the PTSD Coach app and expanded it so that it moved from being an immediate tool to help manage symptoms into more of a self-help symptom management intervention. We had a number of calls and emails requesting the app content for those who did not have smartphones, so we worked with Julia Hoffman’s team to expand upon the success of her product. With PTSD Coach Online we have more time to teach other symptom management techniques like problem solving and challenging cognitions. You can start by choosing a feeling or problem you are having, such as “anger” or “trauma reminders.” Doing so presents you with a list of tools that are targeted for that feeling or problem. Or, you can choose to view a list of all 17 tools and choose the one that most interests you. The tools are interactive, allowing you to work on your specific feelings or concerns. You can also print these pages to keep for reference. Video coaches guide users through each tool.
- PTSD Family Coach is for family members of those living with Posttraumatic Stress Disorder (PTSD). The app provides extensive information about PTSD, how to take care of yourself, how to take care of your relationship with your loved one or with children, and how to help your loved one get the treatment they deserve. The app also provides a great deal of information that is specific to Veterans and active duty members of the military. Living with a family member who has PTSD can be incredibly stressful, and PTSD Family Coach includes 24 unique tools to help you manage this stress, including mindfulness exercises, tools to help you re-build your social networks, and tools to help with difficult thoughts and emotions you may be experiencing. The app also provides a way for you to track your stress level over time, using scientifically valid measures, and can provide specific feedback about your progress. Finally, PTSD Family Coach offers a number of ways for you, and your loved one, to connect with support.
- We offer a variety of handouts, posters and flyers that you can use to raise PTSD awareness or educate clients and patients about PTSD and effective treatments. Any NCPTSD web page can be printed on a computer, but the brochures and materials included on this page are intended for distribution. Materials are available for Professionals and for the Public, and many materials are available in Spanish as well.
- Another good resource Useful for looking up specific symptoms or concerns (e.g., hopelessness, trouble sleeping)