Families in the Wake of Trauma

1
Families in the Wake of Trauma
2
PTSD Definition and Description
3
Common Reactions to Trauma

• Fear and anxiety
• Intrusive thoughts about the trauma
• Nightmares of the trauma
• Sleep disturbance
• Feeling jumpy and on guard
• Concentration difficulties

4
Common Reactions to Trauma

• Avoiding trauma reminders
• Feeling numb or detached
• Feeling angry, guilty, or ashamed
• Grief and depression
• Negative image of self and world
• The world is dangerous
• I am incompetent
• People can not be trusted

5
PTSD Diagnostic Criteria

• Reexperiencing (1 of 5)
• Thoughts, nightmares, flashbacks, emotional
  reactions, physiological reactions
• Avoidance (3 of 7)
• Avoid thoughts, avoid reminders,
  amnesia,detachment, numbing, anhedonia,
  forshortened future
• Arousal (2 of 5)
• Sleep disturbance, concentration problems, anger,
  hypervigilance, startle

6
BattleMind Training

• Battlemind skills helped you survive in combat,
  but may cause you problems if not adapted when
  you get home.

Buddies (cohesion) vs. Withdrawal Accountability
vs. Controlling Targeted Aggression vs.
Inappropriate Aggression Tactical Awareness vs.
Hypervigilance Lethally Armed vs. Locked and
Loaded at Home Emotional Control vs.
Anger/Detachment Mission OPSEC vs.
Secretiveness Individual Responsibility vs.
Guilt Non-Defensive Driving vs. Aggressive
Driving Discipline and Ordering vs. Conflict
7
Diagnosis of PTSD Associated Symptoms

• Guilt, shame, despair
• Hostility, aggression
• Social isolation, loss of beliefs
• Feeling constantly threatened
• Poor health

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Trauma and The Social Environment
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Relation Between PTSD and Social Support

• One of the strongest predictors of recovery
  following trauma is social support
• Perceived social support (PSS)
• Received social support (RSS)
• Interaction is complicated
• PSS is often negatively related to trauma
  severity
• RSS is often positively related to trauma
  severity
• Deterioration of perceived social support over
  time may contribute to increased symptoms

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PTSD Symptoms Impact onSocial Support

• PTSD and associated problems can reduce available
  social support
• Emotional numbing
• Detachment
• Hostility and Aggression
• Distrust of others
• Social problem solving deficits
• In addition, as symptoms persist individuals may
  tire of providing support or exhaust resources

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PTSD and Anger

• PTSD has been repeatedly associated with higher
  levels of anger/hostility
• (see Orth Wieland, 2006 for a review)
• Anger/Hostility more associated with PTSD in
  samples of combat veterans than in other trauma
  exposed samples
• (Orth Wieland, 2006)
• Veterans with PTSD respond with more hostility in
  non-provoking interpersonal interactions
• (Beckham et al., 1996)
• Veterans with PTSD experience more anger in
  response to trauma cues
• (Pitman et al., 1987 Taft et al., 2006)

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Anger in Response to Trauma Cues

Taft et al., 2006
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Interpersonal Problems Associated with PTSD in VN
Veterans


Roberts et al., 1982
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PTSD and Social Problem-Solving Deficits
Riggs et al., 2006
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Social Problem-Solving Deficits Associated with
PTSD in VN Veterans



Nezu Carnevale, 1987
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Social Support
Initial Reactions
Trauma
PTSD Symptoms
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The Role of Families

• In general, families provide a primary source of
  social support.
• Spouses and intimate partners are typically
  identified as the chief source of social support.
• Approximately 50 of service members deployed to
  OEF/OIF are married at the time of deployment.

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PTSD and Difficulties in Families
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Impact of PTSD on Families

• PTSD can impact directly on intimate
  relationships
• Direct effects impact on relationship
• Indirect effects impact on relationship skills
• Impact of PTSD on perception of relationship
• PTSD can impact the spouse/partner
• Direct effects impact of PTSD symptoms
• Indirect effects impact of added stress
• PTSD can impact on children
• Direct effects impact on child
  development/adjustment
• Indirect effects impact on parenting skills

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PTSD and Intimate Relationships
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PTSD and Relationship Quality



Carroll et al., 1982
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PTSD and Relationship Quality




Riggs et al., 1998
Jordan et al., 1992
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PTSD and Relationship SkillsVietnam Veterans




Riggs et al., 1998
24
PTSD and Relationship SkillsWW II and Korean
War POWs



Cook et al., 2004
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PTSD and Relationship SkillsVietnam Veterans



Carroll et al., 1982
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Partners of People with PTSD
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Distress Among Partners of Veterans With PTSD





Calhoun et al., 2002
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Distress Among Partners of Veterans With PTSD







Dekel Solomon, 2006
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Distress Among Partners of Veterans With PTSD






Westerink Giarratano, 1999
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Distress Among Partners of People with PTSD

• Secondary Trauma
• Contagious PTSD
• Cycle of Trauma
• Lessons Learned
• Compassion Fatigue
• Emotionally Drained
• Exhaustion
• Caregiver Burden
• Crisis Symptom Management
• Isolation
• Family Stress

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Children of People with PTSD
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Parental PTSD and Childrens Distress

• Children of Vietnam veterans with PTSD, compared
  to children of veterans without PTSD, are more
  likely to experience symptoms
• 36 vs. 14 indicated symptoms severe enough to
  cause distress on GHQ (Westerink Giarratano,
  1999)
• more and more severe behavior problems reported
  (Kulka et al., 1988)
• 23 vs. 0 had received psychiatric treatment
  (Davidson et al., 1989)

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Parental PTSD and Childrens Distress
Davidson Mellor, 2001
Caselli Motta, 1999
34
PTSD and Parenting Skills

• Clinical descriptions have characterized
  parenting by veterans with PTSD as
• Overprotective (or potentially avoidant) (Haley,
  1984)
• Controlling, overprotective, demanding (Harkness,
  1993)
• Enmeshed (Jurich, 1983 Rosenheck, 1986)
• Highly emotional (Rosenheck, 1986)
• Children of PTSD veterans describe families as
• More conflicted (Westerink Giarratano, 1999)
• Less Cohesive (Westerink Giarratano, 1999)
• Veterans with PTSD are more likely than those
  without PTSD to endorse severe parenting problems
• 54.7 vs. 17.3 (Jordan et al., 1992)

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PTSD and Parenting Skills






AI Affective Involvement AR Affective
Responding BC Behavior Control C
Communication PS Problem Solving R - Roles
Davidson Mellor, 2001
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PTSD and Parenting Relationships
PTSD Scores Total Reexp Avoid Aro
usal Parenting -.27 -.17 -.30
-.17 Satisfactiona Child .27 -.01
.35 .33 Misbehaviorb Positive -.31
-.10 -.46 -.25 Sharingb Child Critical
.28 .22 .30 .25 Of
Fatherb Relationship -.55 -.39 -.63
-.48 Qualityb
a Samper et a., 2004 b Ruscio et al., 2002
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A Model for Understanding the Impact of PTSD on
Families
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Social Information Processing
39
BattleMind Training

• Battlemind skills helped you survive in combat,
  but may cause you problems if not adapted when
  you get home.

Buddies (cohesion) vs. Withdrawal Accountability
vs. Controlling Targeted Aggression vs.
Inappropriate Aggression Tactical Awareness vs.
Hypervigilance Lethally Armed vs. Locked and
Loaded at Home Emotional Control vs.
Anger/Detachment Mission OPSEC vs.
Secretiveness Individual Responsibility vs.
Guilt Non-Defensive Driving vs. Aggressive
Driving Discipline and Ordering vs. Conflict
40
Cued Traumatic Responses
External Trauma Cues Sights Sounds Smells Situati
ons
Internal Trauma Cues Emotional State Physical
State Thoughts
Traumatic Reactions Emotions Thoughts Arousal
41
Impact of Trauma Memory on Social Information
Processing