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GOOD MORNING

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Title: GOOD MORNING


1
GOOD MORNING!
  • Welcome to
  • COMING HOME
  • COMBAT STRESS TRAUMA
  • IN RETURNING WAR VETERANS
  • AND THEIR FAMILIES
  • Alison Lighthall, RN, MS

2
What to expect today
  • MORNING (0800-1150)
  • Introductions, goals
  • Military Psychology 101
  • 10 Things Everyone Should Know About the
    Returning Vet
  • Biological and Psychological Responses to
    Trauma
  • LUNCH (1150-1300)
  • AFTERNOON (1300-1600)
  • 10 Things You Can Do If You Only Have 10 Min
  • Overview of Medications and Treatments for
    Combat PTSD
  • Dynamic Stress Management
  • ANYTIME
  • Discussion, questions, pontifications, etc.

3
MILITARY PSYCHOLOGY101
  • Helping America Understand
  • and Care for
  • Our Returning Service Members

4
THE LINE-UP
  • Where in the world?
  • Quick review of scope of problem
  • Getting to know this new patient population and
    their special world
  • Becoming acquainted with their medical and
    psychosocial issues

5
But I dont work at a VA
  • The military medical system is completely
    overwhelmed by the huge number of injured and
    compromised service members (SMs)
  • So SMs have three options
  • 1. Skip medical care all together
  • 2. Wait for medical care through VA
  • 3. Seek care from
  • civilian medical system

6
Why is this war different?
  • Volunteer vs. draft
  • Multiple deployments
  • Type of suicide bombings
  • Never any safety, no real recovery time
  • Use of civilians as shields and decoys
  • Deliberately targeting our moral code
  • COMMUNICATION! Internet, cell phones, etc.
  • IEDs, RPGs (TBI, hearing loss, neurochemical
    effects)

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Hard numbers
  • Operation Enduring Freedom (OEF)
  • 2001-present, mostly Afghanistan
  • US FATALITIES
  • (195 of which were from non-hostile events)
    500
  • US WOUNDED 1,992
  • DoD CIVILIANS 1
  • TOTAL 2,493
  • (Multiply x 4 to reach estimate of US Citizens
    affected in tangible ways by OEF, up to today)

DoD, 09 JUN 08
10
Hard numbers
  • Operation Iraqi Freedom (OIF)
  • 2003-present, Iraq only
  • US FATALITIES
    4,075
  • US WOUNDED IN ACTION 29,911
  • US WOUNDEDNONCOMBAT 30,143
  • SUICIDES unclear
  • DoD CIVILIANS 11
  • US MISSING IN ACTION 3
  • TOTAL 64,143
  • (Multiply x 4 to reach estimate of US Citizens
    affected in tangible ways by OIF, up to today)

DoD, 09 JUN 08
11
More statistics OIF/OEF
  • 1.6 million service members have been deployed in
    OEF/OIF
  • 15 wounded for every 1 fatality
  • VA predicts that it will treat 263,000 OIF/OEF
    vets in 2008 and 330,000 in 2009
  • Current backlog of veterans is 400,000
  • Heaviest of that backlog is mental health (Ex
    Virginia VA community mental health services has
    a waiting list of 5,700)
  • 550,000 school age children of active duty SMs
  • 52,000 children of Reserve and National Guard SMs
    affected
  • 84 of SMs children attend public school, not DoD
    base schools

12
MOVING FROM CIVILIAN TO SOLDIER
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MILITARY OATH OF ENLISTMENTrecited by all
Service Members at their swearing in ceremony
  • I, (NAME) DO SOLEMNLY SWEAR THAT I WILL SUPPORT
    AND DEFEND THE CONSITUTION OF THE UNITED STATES
    AGAINST ALL ENEMIES, FOREIGN AND DOMESTIC THAT I
    WILL BEAR TRUE FAITH AND ALLEGIANCE TO THE SAME
    AND THAT I WILL OBEY THE ORDERS OF THE PRESIDENT
    OF THE UNITED STATES AND THE ORDERS OF THE
    OFFICERS APPOINTED OVER ME, ACCORDING TO
    REGULATIONS AND THE UNIFORM CODE OF MILITARY
    JUSTICE, SO HELP ME GOD.

15
and then from Soldier to Warrior
16

I AM AN AMERICA SOLDIER. I LIVE BY THIS
CREED
17
  • What the
  • Warrior
  • ethos
  • really means

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FIGHTING FOR LIFE
  • Preview of a new documentary

28
A CLOSER LOOK AT
  • Psychological Injuries
  • Impossible to know the exact numbers yet,
  • but at least 30...
  • and that number keeps rising

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Stressors include threat to life, exhaustion,
extreme environmental conditions, and layers of
grief
34
Deployment Issues
  • OpTempo
  • Family
  • Worst Day experiences
  • Sights
  • Sounds
  • Smells
  • Losses of all kinds

35
Theres just no time to grieve all the losses
  • Too numerous to count,
  • and too much else to do

36
The losses mount
  • Loss of friends, loss of identity, loss of
    safety
  • Loss of time and of life cycle events
  • Loss of moral compass, loss of idealism and
    innocence
  • So many losses to be felt and grieved,
  • and honored.

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Beyond exhaustion
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How do they do it?
  • There is a deep bond that comes from shared
    experiences and emotions, and this bond shields
    the human spirit through the harshest of times.

My buddies became my family.
54
At long last, ITS TIME TO GO HOME!
  • A bundle of emotions
  • Relief and excitement
  • Fear and trepidation
  • Overwhelmed
  • Emotionally checked out
  • Exhaustion

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After war trauma, service members often feel
unreachable and very alone
  • I feel like an outsider, even in my own home.

57
Why?
  • They miss the people they served with
  • and worry about their safety
  • Some of them feel embarrassed about coming home
    before the mission was completed
  • Sometimes, coming home means a professional
    demotion
  • The problems at home cant be fixed
    easily theres no clear chain of command
  • They feel like foreigners in their own country
  • They want to go back and make things right

58
Reintegration Issues
  • PTSD
  • TBI
  • Employment
  • Substance abuse
  • Family upheaval
  • Stigma in getting help
  • Processing whats happened
  • Adjusting to civilian life, pace, systems again

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Realizing the bridge is down
  • Homethe place many think is the safe haven to
    find relief from the stress of warmay initially
    be a letdown. When a loved one asks, What was
    it like? and you look into eyes that have not
    seen what yours have, you suddenly realize that
    home is farther away than you ever imagined.
  • Down Range From Iraq and Back, by Cantrell
    Dean, 2005

62
Psychological Injury ContinuumASR to COSR to
PTSD
  • ASR produces biological, psychological, and
    behavioral changes. ASD means it has become
    disruptive and destructive.
  • COSR is expected, common, and occurs throughout
    deployment to some degree. Pretty much everyone
    comes home with some version of combat and
    operational stress.
  • Becomes classified as PTSD if COSR symptoms are
    daily, interfere, and last longer than 1 month

63
SIGNS / SYMPTOMS OF (COMBAT) PTSD
  • HYPERAROUSAL Fight/Flight/Freeze, Angry, poor
    sleep, argumentative, impatient, on alert, tense
    (hypervigilant) speeding tickets (once home),
    intense startle response
  • NUMBING/AVOIDANCE Withdrawn, secretive,
    detached, controlling, removes all reminders,
    avoids similar situations, ends relationships
    with people associated with trauma, etc.
  • RE-EXPERIENCING Nightmares, flashbacks,
    intrusive thoughts

64
And as if that wasnt enough to contend with TBI
  • Traumatic Brain Injury (TBI) occurring in record
    numbers of combat veterans
  • Multiple dynamics at play that contribute to the
    injury (concussive, acoustic, chemical,
    neurological), none of which can be singularly
    determined
  • Lots of overlapping sx with PTSD
  • Sometimes resolves on its own, sometimes never
    resolves
  • Treatment is being researched and changed almost
    constantly
  • ..\IAVA IED explosion video.flv

65
And just as bad
  • Military sexual assault
  • Can happen to either gender
  • If during deployment, it is catastrophic to
    individual
  • Primary thing to remember is that it is just like
    incest

66
OVERVIEW OF POST-DEPLOYMENT INTERVENTIONS
  • 3 HOTS AND A COT
  • CBT / Psychoeducation
  • Group work, CID
  • Medication to help manage symptoms
  • EMDR
  • CES (Alpha-Stim)
  • Exposure Therapy
  • Stress Inoculation
  • Active listening and appropriate support

67
OVERVIEW OF MEDICATIONS
  • SSRIs, maybe
  • Tricyclics
  • MAOIs
  • Sympatholytics (prazosin, propranolol)
  • Hypnotics of various types
  • Anticonvulsants
  • Atypical antipsychotics

68
What you can do
  • WHILE THEYRE DEPLOYED
  • Learn everything you can about their experience
  • Send a free card by going to Xerox Corporations
    www.LetsSayThanks.com
  • Volunteer to help Soldiers Angels, Homes for
    Vets, VFW or AMVETs drives, etc.
  • Hold a drive to collect the Top Ten Necessities
    for Troops (through America Cares / Illinois)
    eCarePackage program for the holidays
  • Check out HAND2HANDCONTACT.ORG for more ideas

69
What you can do
  • AFTER THEYRE HOME
  • Listen quietly and attentively, be relaxed and
    respectful
  • Offer compassion, with strength and without
    judgment
  • Shake their hand and thank them for their service
  • GET INVOLVED (Honor Flight, build a home, etc.)

70
Nice
  • Whats the hardest part about being home?
  • What did you miss the most when you were there?
  • What can I do to thank you for your service?

71
Not so nice
  • All for nothing, what a waste, etc.
  • Did you kill anyone?
  • How hot was it?
  • How bad was it?
  • Are we winning?
  • Should we be over there?
  • What do you think of (President) Bush?

72
Another way in which this war is different
  • Civil Affairs
  • Medical Units
  • Humanitarian Aid
  • The other side of the military that no one talks
    about, because no one believes them
  • (You Got a Friend in Me video)

73
When we help a Veteran to heal, we help his or
her family to heal, and from there, the
community, and from there, our Country.
74
If we have no peace, it is because we have
forgotten that we belong to each
other. Mother Teresa
75
Closing thoughts
  • Keep things in perspective

76
  • QUESTIONS?
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