Recommended Approaches to Working with Veterans with PTSD

1
Recommended Approaches to Working with Veterans
with PTSD

• Dr. Paul Decancq Psychologist, PTSD Clinic
  Canandaigua VA Medical Center
• Dr. Jim Bridges Clinical Chief, Psychology,
  Canandaigua VA and Rochester Outpatient Clinic

2
Goals for Todays Session

• Describe what the VA provides for the treatment
  of PTSD (slide 5)
• Describe current recommended approaches if
  providers in the audience would like to broaden
  their skills in treating PTSD (slide 17)
• Treatment for PTSDcomplicating conditions.
• Briefly cover changes in reformulation of PTSD
  diagnostic criteria in the new DSM-5

3
Dispelling a Myth

• Myth Every Veteran returning from OEF/OIF/OND
  has PTSD.
• Fact Like every other war we have tracked, only
  about one third are developing symptoms.
• Vietnam theater veterans Lifetime PTSD 31
  men 27 women.
• OEF/OIF estimates post-deployment through four
  months later range from 11 to 17, but these are
  early days.

4
Another Myth

• Myth Once you have PTSD, theres no cure.
• Fact Many people with PTSD experience
  significant reductions in symptoms after
  effective treatment.

5
What does the VA have to offer Veterans with PTSD?

• Two fully staffed PTSD Clinics
• Rochester Outpatient Clinic (ROPC) -Westfall Road
• Canandaigua VAMC Fort Hill Ave

6
What Services are offered by the two PTSD
Clinics?

• Diagnostic Assessment
• Individual and group therapy for PTSD / MST
• A variety of Evidenced Based intervention
  techniques
• We will get to these in a few minutes

7
What Services are offered by the two PTSD
Clinics?

• Dual diagnosis (PTSD/SUD) treatment
• Training in Coping Skills (Seeking Safety
  Groups)
• Combat Processing Groups (CPT based)
• MST Group
• Family Therapy
• Couples Therapy
• Suicide Risk Assessment

8
A Basic Principle

• PTSD symptoms are most often NOT THE ONLY
  THING!!!!!

9
Coordinated Care through

• PTSD-SUD Specialists
• MST Specialist
• Wide variety of Coping Skills and CBT Groups or
  Individual Therapy for depression, anxiety,
  mindfulness, memory skills, problem-solving
  training, pain, sleep, suicide prevention
• Full SUD services (Motivational Interviewing, CBT
  for Relapse Prevention, 12-Step Facilitation,
  Contingency Management)
• Integrated treatment for serious mental illness

10
Whats New?

• VITAL outreach and assistance on college
  campuses.
• Family Services NAMI Family-to-Family
  psychoeducation family therapy coordination
  with Rochester Vet Center
• Psychology Services through Home-Based Primary
  Care
• Integrated Primary Care Mental Health Staff,
  located in Primary Care areas
• Caregiver Support Program
• OEF/OIF/OND Outreach Program
• OASIS Adaptive Sports
• Equine Therapy
• Mobile RV that will be providing serves in some
  rural areas surrounding Rochester (i.e. Sodus,
  Seneca Falls)
• Secure Messaging through MyHealtheVet
• Technology

11
Cadence Square

• Run by Community Partners, on
• the Canandaigua VAMC campus
• Low income apartments
• HUDVASH residences
• Safe Haven (15 beds)

12
Established Collaboration in the Community

• Vet Center
• Veterans Service Agencies in the surrounding
  counties
• Vet Court (Judge John Schwartz)
• Warrior Salute

13
Technology

• Veterans Crisis Line 1-800-8255
• 24/7/365 crisis line available to veterans (or
  active duty personnel across the globe)
• Referrals to local VA Suicide Prevention
  Coordinators for linkage to mental health
  services
• Rescues if needed
• Texting Chat

14
(No Transcript)
15
PTSD Coach
16
Some Apps (some in development)
17
Best Practices What do we typically see so what
symptoms are you trying to get at?

• What is the typical presentation of a veteran
  with PTSD?
• Anxiety, often conditioned inappropriately to
  neutral cues
• Cognitive Distortions and misinterpretations
  around themes of Safety/Danger, Trust,
  Power/Control, Intimacy, and Esteem
• Avoidance of a wide range of activities, places,
  topics, and people

18
Based on these symptoms you want to focus on
grounding, exposure based interventions, and
interventions that help clients analyze and
correct their thinking

• There are a variety of Evidenced Based
  intervention techniques
• Prolonged Exposure Therapy (Foa)
• Cognitive Processing Therapy (Resick)
• Cognitive Behavioral Therapy (Beck)
• Acceptance and Commitment Therapy (Steven Hayes)
• Seeking Safety (Najavits)

19
Changes in PTSD in DSM-5

• Moved to Trauma- and Stressor-Related Disorders
• Criterion A (stressor) includes sexual violence
  learning about restricted to family or friend
  and must have been violent or accidential Added
  repeated exposure to aversive details first
  responders graves registration, etc. TV and
  movies dont count. A2 deleted (terror, horror,
  helplessness).
• Avoidance split into C. Avoidance and D.
  Negative Alterations in Cognitions and Mood
  (persistent and exaggerated negative beliefs
  about oneself, others, or the world distorted
  cognitions about the cause or consequences
  persistent negative emotional state inability to
  experience positive emotions.
• E. Arousal includes reckless or
  self-destructive behavior
• Subtype With Dissociative Symptoms
  (depersonalization or derealization).