Post Traumatic Stress Disorder and The Military Veteran Student

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Post Traumatic Stress Disorder and The Military
Veteran Student
Roger P. Buck
Edgardo Padin-Rivera
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Autonomy

• The organism possess a certain degree of freedom
  It acts according to its own inherent nature,
  which is based on intrinsic forces, and is not
  under the compulsion of outside influences

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Autonomy

• Characteristics
• Self Governing
• Self Determination
• Self Understanding
• Intrinsic Forces
• Self is known
• The World is understood
• Shattered Assumptions

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Autonomy Assumptions about the Self and the
World

• World

• Self

• Personal Empowerment
• Sense of Personal Efficacy
• Efficiently Manage Self and Decisions
• Sense of Personal Power and Self Control
• Capable of interacting effectively with others

• The World is a Safe Place
• Some Personal Control over the Environment
• Efficiently interacts with the Environment
  Others
• Empowered to Keep Oneself Loved Ones Safe in
  the World

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Autonomy Once Assumptions are Shattered

• Crisis with the SELF

• World VIEW

• Failure to Maintain Sense of Personal Power
• Question Ability to Self Manage
• Question Efficiency and Effectiveness of Choices
• Fear of Losing Control of Self and Uncertainty
  about the Future

• Question the Safety of the World
• Question Self and ability to control any Aspect
  of Life in the World
• Questions Efficiency of Being and Interacting in
  the World
• Questions Personal Ability to keep Loved Ones and
  Self out of Harms Way

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Why the Self and World View are Changed

• The Crisis Event Rendered the Person HELPLESS
• Crisis events Cause a Person to Question Their
  SELF (Decision Making)
• The Event is Incongruent with Beliefs about Self
  (Abilities and Strengths)

• The Event is Incongruent with Belief about Safety
  of the World
• An overpowering sense of failure, personal
  inadequacy, abandonment and/or Rejection Will
  Often Set in Due to This Incongruence

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DANGER As A Profession

• Military Veterans
• Police Officers
• Emergency Medical Technicians
• Fire Fighters
• Emergency Room Personnel
• FBI, ATF, other dangerous professions

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Danger

• Powerful vs. Powerless

• Mild danger vs. extreme

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Danger

• Impact of Traumatic Events
• Self is Changed
• Beliefs
• Self Esteem
• Personality Shift
• Biological
• Fear
• Spiritual Crisis

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Danger

• Shatters ones perception about themselves and
  their place in the world.
• Shatters ones sense of safety security
• Most Devastating effect Autonomous ability to
  relax Ego Defenses (isolation, anger, guilt,
  anxiety, depression)

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Danger

• Other Ego Defenses develop
• Inability to Trust
• Inability to Establish or Re-Establish Intimacy
• Emotional Numbing
• Hyper-Sensitivity Toward Injustice
• Pervasive Sense of Feeling Damaged

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Symptoms Physical, Cognitive, Emotional,
Behavioral, Spiritual (P.C.E.B.S.)
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P.C.E.B.S.

• Physical

• Cognitive

• Agitation
• Fatigue
• Headaches
• Vision Problems
• Hyper-arousal
• Exhaustion
• Chest Pain
• Muscle Tremors
• Grinding of Teeth

• Intrusive Thoughts
• Memory/Concentration
• Confusion
• Preoccupation
• Uncertainty
• Feeling Overwhelmed
• Poor Problem Solving
• Poor Abstract thinking
• Intrusive Images

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P.C.E.B.S. (Contd)

• Emotional

• Behavioral

• Anxiety
• Depression
• Hopelessness
• Despair
• Rapid Mood Swings
• Unpredictable Mood
• Denial
• Agitation
• Intense Anger

• Hyper-vigilance
• Sleep Problems
• Substance Abuse
• Self Mutilation
• Cry easily
• Antisocial Acts
• Defiance of Authority
• Inability to Rest
• Erratic Movements
• Loss of Appetite

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P.C.E.B.S. (Contd)

• Spiritual

• Questioning Good and Evil
• Attempting to Make Sense of Senselessness
• Searching for the Meaning of the Experience
• Struggling with Understanding Why
• Questioning God/Faith

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Human Toll Depth of Change

• Military Combat
• Violent Law Enforcement Action
• First Responders and Horrific Scenes
• Natural Disasters
• Virginia Tech Carnage
• Columbine
• 9/11
• Oklahoma City Bombing

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What the Soldier Brings Home Combat Stress,
Trauma Readjustment
No one comes back unchanged COL (Dr.) Tom
Burke,Department of Defense,Director of Mental
Health Policy
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Life on the Front
To understand what the soldier brings home, one
needs to look at how the environment of war gets
inside the mind.
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Life on the FrontHow Combat Shapes Minds,
Emotions, Behaviors

• 86 received artillery fire.
• 93 were shot at with small arms.
• 77 fired at the enemy.
• 95 saw dead bodies or remains.
• 89 were attacked or ambushed.
• 86 know a troop injured or killed.
• 65 saw dead or injured American.
• 69 saw injured women/children and were
  unable to help.
• -- These numbers correspond in part to a study in
  the New England Journal of Medicine and pertain
  to service members in Iraq.

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Life on the FrontHow Combat Shapes Minds,
Emotions, Behaviors
No true safe zone or rear, in Iraq
Afghanistan, there is a sense of danger in all
occupationsand areas all the time. The stresses
and demandson cognitive and emotionalcapacities
are many andalmost constant. Being on constant
alert, orhyper-aroused becomes a way of life.
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Life on the FrontHow Combat Shapes Minds,
Emotions, Behaviors

• Prolonged exposure to combat stress
• Most soldiers exposed to multiple terrorism or
  life threatening events.
• Some may have participated in atrocities.
• Often develop a mindsetof act immediately,
  debate later.

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Life on the FrontHow Combat Shapes Minds,
Emotions, Behaviors
Exhaustion is constant. The soldier does not
have energy or time to process events until after
leaving the battlefield. The violence is
scary, but also exhilarating and immediately
rewarding. Many returning soldiers say combat
wasthe most exciting and importantthing they
have ever done. Many are bored when they come
home.
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Life on the FrontHow Combat Shapes Minds,
Emotions, Behaviors
Many face loss of comrades that can be
emotionallydevastating. Nothing is
moreimportant to a soldier than his
warbrothers. For many service members,a
comrades death is an overwhelmingexperience,
often leadingto prolonged unresolvedmourning
and anger.
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What the Soldier Brings Home

• Post-Combat Battlemind
• Heightened sensory awareness of sights, sounds
  smells.
• Action oriented ways of coping with new
  experiences.
• Identification and closeness with their military
  unit and comrades who have shared similar
  experiences.
• Regimentation into highly structured and
  efficient routines.
• Confused about ideals, values identity shaped
  by war.
• Habituation to intensity and extreme emotions of
  combat life.

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What the Soldier Brings Home

• The PTS Syndrome
• Intrusive thoughts/memories
• Nightmares
• Avoidance/isolation
• Anger/angry outbursts
• Hyper-startle response
• Flashbacks
• Hyper vigilance
• Feelings of grief, guilt, loss

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What the Soldier Brings Home

• Its not just about PTSD
• Disillusionment with civilian life
  activities.
• Challenging of ones previous identity core
  beliefs.
• Irritability anger toward non-military.
• Profound feeling of alienation.
• Social isolation.
• Memories of events that can bedifficult to
  square with civilian reality.
• Self-blame or guilt for acts of war.
• Despair or hopelessness about future.
• Physical health problems
• Alcohol and drug abuse

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Coming Home Life, Work, Learning

• What They Say Are Problems (from Focus Groups)
• Wanting to be left alone - Social
  avoidance/isolation
• Sensitivity to loud noises and jumpiness
  hyper-arousal
• Anger, lack of patience - irritability
• Chronic joint pain, generally ankle, knee and
  back pain
• Memory problems or "lapses - trouble
  concentrating
• Drinking or smoking too much
• Personality changes, emotionally distressed
• Body image issues scars, weight changes, etc.

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Coming Home Life, Work, Learning

• Obstacles to Restoring Previous Ties
• Homecoming feelings of joy and euphoria are short
  lived (Eventually not reinforcing).
• Attempts to restart old ways of interacting, old
  roles fail.
• Difficulties arise in trying to generate a new
  normal (rigidity, fears, isolative struggles
  get in the way).
• Civilian life at home may not have the edge and
  adrenaline and life or death purpose associated
  with wartime duty.
• Problems of internal chaos impinge on
  relationships.

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Coming Home Life, Work, Learning

• Greatest need after traumaticexperiences is for
  activeengagement, affiliation, andcomfort
  available throughsupportive relationships.
• Biggest (unrealized) fear
• of most returning soldiers
• is engagement, affiliation,
• and intimacy.

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Coming Home Life, Work, Learning

• Problems Reconnecting with Friends Community
• Difficult for soldier to feel at ease with
  civilians who do not understand military or
  combat life (will gravitate toward veterans).
• Soldier may find self unable to share
  experiences with non-combat friends they
  wouldnt understand, they would react with
  horror or shock).

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Coming Home Life, Work, Learning

• Difficulties with Public Interactions
• Tension about the politics of war public has
  mixed views of the war.
• Awkwardness on both sides Public may not always
  know what to do or say.
• Veteran too often becomes a community media
  event.
• Veteran unsure who he/she can talk to.
  Questions can arise about What will they want
  me to talk about? What can I talk
  about? How will they react to a story or event?

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Coming Home Life, Work, Learning

• Workplace Problems
• Veteran ability and employer expectations may
  conflict.
• Veteran may be unable to do same work
• Same exact job may not be available.
• Post-war images and memories may intrude on
  ability to concentrate.
• Co-workers may behave differently toward him/her.
• Veteran may feel others expect things he/she may
  not be able to do or meet.

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Coming Home Life, Work, Learning

• Learning Environment Problems
• Veteran learning capacity vs instructor
  expectations.
• May not be able to focus on single subject for
  long periods of time.
• Has difficulty with vague subject matter or
  mixed conclusions. Need for concrete outcomes.
• mTBI issues may create short term memory
  deficits (difficulty with details, memorization,
  etc)

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Coming Home Life, Work, Learning

• Learning Environment Problems
• Internal chaos (intrusive images and memories)
  may intrude on ability to concentrate, pay
  attention.
• Hyper-arousal (on guard), in crowds, among new
  persons, changing environments (new classroom
  each course), may create tension, irritability,
  anxiety.
• Tendency toward social isolation leads to
  difficulty seeking help for studies, working with
  other students.
• May feel others expect things he/she may not be
  able to do.
• Other students may behave differently toward
  him/her.
• Subject Matter or presentation may arouse anger,
  irritation, isolating response (politics,
  history, social sciences are especially red
  flags).

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Coming Home Life, Work, Learning

• The perception of positive community
  supportwhether or not it is used is one of the
  best known antidotes to chronic mental health
  problems after a traumatic event. So

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Fifteen Environmental Cues That May Trigger
Increased Symptoms

• Cues that May Cause Agitation, Anxiety, Panic,
  Intense Anger, Apprehension, Sadness
• Inefficient Support Services
• Non-Compassionate Attitude of Staff Members
• Waiting in Long Lines for Services
• Getting the run-around about Administrative
  Paperwork
• Immoral and Unethical Practices by Staff, Faculty
  or Students
• Lack of Clear Chain of Command to resolve
  problems or concerns

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Environmental Cues (Contd)

• Lack of Respect for Acknowledgment of Veteran
  and Their Service
• Lack of Respect by Faculty or Staff for
  Sacrifice of Veterans Friends Killed and Injured
  in War
• Childish Behavior by Traditional Teenage
  Students (Loud Music after lights out Dorm
  life)
• Roll Call
• Overall Lack of effective and efficient
  leadership at the college
• Timeliness of GI Bill Processing and Other
  Financial Supports
• Large, Loud and Crowded Classrooms
• Classrooms Where Veteran Cannot Sit With Back to
  the Wall
• Chaotic Classroom Instructor Not in Charge

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Sensory Triggers to Consider

• Visual
• Use of Laser Pointer
• Emergency Light Flashing
• Middle Eastern Student/Clothing
• Human Suffering
• Dry/Arid Environment

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Sensory Triggers to Consider

• Other Senses
• Loud Noises
• Helicopter Blades
• Smells (Raw Sewage)
• Smells (Sweat)
• Oppressive Heat
• Taste/Smell of Middle Eastern Foods
• Sitting in uncomfortable chairs with back pain,
  knee injuries other chronic medical concerns

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Twelve Administrative Action Items

• 1. Ask the Vets
• 2. Special Supports During Registration for
  Rapid Enrollment
• 3. Veteran Task Force
• 4. Encourage and Develop Peer Support
  Organization (Student Veterans of America)
• www.studentveterans.org
• 5. Host Veteran Recognition and Welcoming
  Activities
• 6. Specific College Policy and Procedures
  addressing action if student deployed
• 7. Institution Admin consistency GI Bill,
  Course Credit for Military Schooling, Financial
  Aid etc.

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Administrative Action (Contd)

• 8. Present Veteran Awareness and Sensitivity
  training for all Staff Faculty
• 9. Create a Veteran Resource Center Devote
  Office Space
• 10.Register as Service Member Opportunity College
  (SOC)
• 11.Develop a Veteran Foundation Account to
  Assist Student Veterans with Tuition, Books, Fees
  and Household Emergencies
• 12.Presidential and Senior Leadership Support

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Fifteen Faculty and Staff Actions To Consider

• 1. Recognize you Will Have Higher Numbers of
  Both Male and Female Veterans With Traumatic
  Stress History
• 2. Recognize the Cultural Diversity That Exists
  Between Traditional Students and Military
  Veterans
• 3. Military Veterans are Permanently Changed Due
  to Experiences and are Often in a Period of
  Intense Adjustment and Transition
• 4. Military Veterans with Combat Experience will
  Have Normal and Predictable PCEBS

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Faculty and Staff Action

• 5. Recognize there are Potential Cues in the
  College Environment That Will Trigger PCEBS
  Symptoms
• 6. Recognize Some Veterans will meet ADA Criteria
  for Support Due to Injury (TBI)
• 7. Understand there are Major Financial Stresses
  Due to GI Bill Delays, Federal Red Tape, VA
  Medical Appointments etc.
• 8. Readjustment after Extreme Experiences Cause
  Family Strain As Well as College Stressors

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Faculty and Staff Action

• 9. Recognize the Veteran is Reintegrating Into
  More Than One Environment.
• 10.Some Veterans will Admit Their Veteran Status
  While Others May Keep it Quiet (Women Veterans)
• 11.Honor and Respect Differing Viewpoints and
  Strong Emotional Commitment to a Position or
  Belief
• 12.Be Flexible with Attendance and Classroom
  Assignments

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Faculty and Staff Action

• 13. Recognize and Support Military Dependents
• 14.Learn the Various Trauma Symptoms That Occur
  with all Trauma Victims
• 15. Know all Veteran Support Services on Your
  Campus and in the Community

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Institutional Services to Provide

• Local College Military Veteran Task Force
  Determines Specific Services - To Include the
  Following as a Minimum
• Orientation Program specific to veterans
• One stop Center of Excellence
• Veterans Advisory Council
• Prevention Program
• Veteran Volunteer Program
• Develop on-line and Print Educational
  Information

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Resource Listing

• National Center for Post Traumatic Stress
  Disorder (NCPTSD) (www.ncptsd.va.gov)
• National Child Traumatic Stress Network (NCTSN)
  (www.nctsn.org)
• National Center for Trauma Informed Care (NCTIC)
  (www.mentalhealth.samhsa.gov/nctic/ )
• Student Veterans of America (www.studentveterans.o
  rg)

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If you see a returning service member this month,
just say thank you.
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Contact Information

• Roger P. Buck, Ph.D.
• Director, Counseling Services
• 3301 Hocking Parkway
• Hocking College
• Nelsonville, OH 45764
• Phone [phone]
• Buck_r_at_hocking.edu

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Contact Information

• Edgardo Padin-Rivera, Ph.D.
• Louis Stokes Cleveland DVA Medical Center
• 10,000 Brecksville Road, Brecksville, OH 44141
• Phone (440)- 526-3030 xt. 6900
• Email edgardo.padin_at_va.gov