PTSD & TBI

Post Traumatic Stress Disorder (PTSD)

What is PTSD?

Post Traumatic Stress Disorder (PTSD) can occur after you have been through a traumatic event. PTSD is an anxiety disorder. A traumatic event is something terrible and scary that you see, hear about, or that happens to you, like:

  • Combat exposure
  • Child sexual or physical abuse
  • Terrorist attack
  • Sexual or physical assault
  • Serious accidents, like a car wreck
  • Natural disasters, like a fire, tornado, hurricane, flood, or earthquake

During a traumatic event, you think that your life or others' lives are in danger. You may feel afraid or feel that you have no control over what is happening around you. Most people have some stress-related reactions after a traumatic event; but, not everyone gets PTSD. If your reactions don't go away over time and they disrupt your life, you may have PTSD.

How does PTSD develop?
Most people who go through a trauma have some symptoms at the beginning. Only some will develop PTSD over time. It isn't clear why some people develop PTSD and others don't.
Whether or not you get PTSD depends on many things:

  • How intense the trauma was or how long it lasted
  • If you were injured or lost someone important to you
  • How close you were to the event
  • How strong your reaction was
  • How much you felt in control of events
  • How much help and support you got after the event

What are the symptoms of PTSD?
PTSD symptoms usually start soon after the traumatic event, but they may not appear until months or years later. They also may come and go over many years. If the symptoms last longer than four weeks, cause you great distress, or interfere with your work or home life, you might have PTSD.

There are four types of symptoms of PTSD:

  • Reliving the event (also called re-experiencing symptoms)

You may have bad memories or nightmares. You even may feel like you're going through the event again. This is called a flashback.

  • Avoiding situations that remind you of the event

You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event.

  • Negative changes in beliefs and feelings

The way you think about yourself and others may change because of the trauma. You may feel fear, guilt, or shame. Or, you may not be interested in activities you used to enjoy. This is another way to avoid memories.

  • Feeling keyed up (also called hyperarousal)

You may be jittery, or always alert and on the lookout for danger. Or, you may have trouble concentrating or sleeping. This is known as hyperarousal.

Can children have PTSD?
Children can have PTSD too. They may have symptoms described above or other symptoms depending on how old they are. As children get older, their symptoms are more like those of adults. Here are some examples of PTSD symptoms in children:

  • Children age birth to 6 may get upset if their parents are not close by, have trouble sleeping, or suddenly have trouble with toilet training or going to the bathroom.
  • Children age 7 to 11 may act out the trauma through play, drawings, or stories. Some have nightmares or become more irritable or aggressive. They may also want to avoid school or have trouble with schoolwork or friends.
  • Children age 12 to 18 have symptoms more similar to adults: depression, anxiety, withdrawal, or reckless behavior like substance abuse or running away.

What other problems do people with PTSD experience?
People with PTSD may also have other problems. These include:

  • Feelings of hopelessness, shame, or despair
  • Depression or anxiety
  • Drinking or drug problems
  • Physical symptoms or chronic pain
  • Employment problems
  • Relationship problems, including divorce

In many cases, treatments for PTSD will also help these other problems, because they are often related. The coping skills you learn in treatment can work for PTSD and these related problems.

Will I get better?
"Getting better" means different things for different people, and not everyone who gets treatment will be "cured." Even if you continue to have symptoms, however, treatment can help you cope. Your symptoms don't have to interfere with your everyday activities, work, and relationships.

What treatments are available?
When you have PTSD, dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But treatment can help you get better. There are two main types of treatment, psychotherapy (sometimes called counseling) and medication. Sometimes people combine psychotherapy and medication.

Psychotherapy for PTSD
Psychotherapy, or counseling, involves meeting with a therapist. There are different types of psychotherapy:

  • Cognitive behavioral therapy (CBT) is the most effective treatment for PTSD. There are different types of CBT, such as cognitive therapy and exposure therapy.
    • One type is Cognitive Processing Therapy (CPT) where you learn skills to understand how trauma changed your thoughts and feelings.
    • Another type is Prolonged Exposure (PE) therapy where you talk about your trauma repeatedly until memories are no longer upsetting. You also go to places that are safe, but that you have been staying away from because they are related to the trauma.
  • A similar kind of therapy is called Eye Movement Desensitization and Reprocessing (EMDR), which involves focusing on sounds or hand movements while you talk about the trauma.

Medications for PTSD
Medications can be effective too. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD. Another medication called Prazosin has been found to be helpful in decreasing nightmares related to the trauma.

IMPORTANT: Benzodiazepines and atypical antipsychotics should generally be avoided for PTSD treatment because they do not treat the core PTSD symptoms.

How can I help my Veteran with PTSD? What are some tips I can use?
If the Veteran is experiencing difficulty managing his or her anger, you may feel like you live in an atmosphere of constant chaos. If the Veteran you are caring for is your spouse or partner, you may experience additional changes in your relationship. This might include feeling worried that your Veteran is no longer emotionally or physically attracted to you due to emotional unavailability, or a decreased interest in physical intimacy and sexual activity. In addition, due to sleep disturbance (for example, insomnia, waking-up frequently, nightmares), many couples choose to sleep in separate beds (and rooms), which may cause further feelings of emotional separation.
At times, you may experience your own feelings of sadness, anger, frustration, discouragement and loss when the Veteran you care for experiences symptoms of PTSD. These reactions are normal, but can be challenging to deal with on your own.
Consider seeking help either by confiding in a friend, participating in a support group or consulting a professional mental health practitioner.

Caregiving Tips

  •  Learn as much as you can about PTSD by reading, going to lectures, talking with others in similar situations, and talking with the Veteran’s treatment team.
  •  Consider encouraging the Veteran you care for to seek mental health treatment. VA has proven treatments for PTSD that help Veterans manage their symptoms in all types of environments. Just remember that not everyone is ready to admit they need help, so if there is no threat of harming themselves or others, respect a Veteran’s decision about seeking treatment.
  • If the Veteran you care for decides to seek treatment, encourage and fully support that decision. It’s important for both of you.
  •  Request to be part of the Veteran’s treatment.
  •  If the Veteran you care for agrees, talk with the mental health providers regularly. Ask questions and take notes.
  •  Recognize the Veteran’s social and/or emotional withdrawal is due to his or her own issues and not your relationship. A Veteran with PTSD will have good days and bad days. Foster relationships with family, friends, and others to stay connected and get support.
  • Learn coping skills to manage stigma sometimes associated with mental health disorders.
  • Pay attention to warning signs of a potential relapse, including an increase in symptoms or other changes in behavior. Keep the psychiatrist and/or therapist, local crisis team, Veterans Crisis Line, and other emergency phone numbers handy.
  •  If any Veteran talks about suicide, take it seriously and seek help immediately. The Veterans Crisis Line is 1-800-273-8255 (Press 1 for Veterans).
  •  Don’t forget to pay attention to your own needs. Visit your doctor regularly, and get plenty of rest so you can stay strong. Your health is essential to your ability to keep providing for the Veteran you care for.

6 Tips to Deal with Post-deployment Stress

1. You can experience secondary trauma. While service members with PTSD may feel hypervigilant and edgy, their stress can rub off on family members. Townsend points out that spouses will often walk on egg shells wondering what will set their spouses off that they themselves become hypervigilant. "They anticipate what might be a trigger and how they will react," Townsend said. "How their spouse reacts one day may differ from how they act another day."

2. Education is power. "We have to educate ourselves about what he or she (returning military member) has been through," Townsend said. She tells the story of one woman who was upset that her husband had been driving so erratically after he got home from Iraq. Townsend showed the woman a video of what it was like to drive in Iraq, and the woman immediately had a better understanding of why her husband had been so aggressive behind the wheel.

Sometimes, you assume you know what your spouse is dealing with because you have heard stories about what happens in Iraq or Afghanistan, but what he or she experienced may be completely different. "I have seen a lot of spouses have ‘a-ha' moments when I explain something about the other spouse's deployment experience."

Townsend added that a lot of service members don't want to share traumatic memories with their spouses, since they may return to the front lines.

3. Make time as a couple. Sure, therapists tell couples this all the time, but it's especially important that any couple who has been through a trauma make a special effort to make time for each other. Remember why you fell in love in the first place! "That means being with each other without any electronic devices," Townsend said. "Remember the good things about your relationship. It's a great time to focus on what is good in your life."

4. Have your own support group. It's important to have support outside of your family. "Support groups let you know that you are not alone in [your experience] and what you are seeing is normal adjustment," Townsend said. If you are on a military base, reach out to whichever community feels most comfortable for you. Perhaps you'd prefer a group of other spouses rather than a military chaplain, or maybe the opposite is true. There are likely a lot of resources on your installation. If you are not in contact with other military families, look in your community for nonprofit organizations or some other source of support. Townsend recommends a website called www.notalone.com, http://couragebeyond.org/ which have online and face-to-face support groups.

5. Avoid one-upping each other. Townsend said that sometimes couples fall into the trap of "one-upping" each other. Sure, the person deployed faced challenges, but so did the person at home who was taking care of things by him or herself. "There were sacrifices made at both ends, and it's important to remember not to compare."

6. You can't fight fire with fire. If your partner does have PTSD and experiences a flashback, it's important that you try not to fight it. "Just make sure you are in a safe [environment]. Some people will zone out. Other people may run."
Fortunately, PTSD is a treatable condition, and post-deployment stress gets better with time. Don't lose hope if times are difficult, and always remember to reach out to family and friends. Let them know your need for support has not disappeared just because your family member has returned.

 

Traumatic Brain Injury (TBI)     What Do I need To Know????

What is Traumatic brain Injury (TBI)?
Traumatic brain Injury (TBI) happens when something hits the head heard or makes it move quickly. Injuries may be due to blasts in combat, or as a result of motor vehicle accidents, falls, falling or flying objects, or assaults. TBI is called “mild,” and may also be referred to as a concussion, when there is a brief change in awareness or consciousness at the time the injury occurs. It is called ‘moderate” or “severe” when there is longer period of unconsciousness or amnesia, which means memory loss. The initial injury does not necessarily predict what long-term symptoms and individual may have.

What are the physical and mental changes to expect?
There are some common physical and thinking changes that can occur with TBI depending on the type and severity of the injury. Some symptoms may be present immediately, while others may appear later. The Veteran’s symptoms and course of recovery may differ from others with a similar type of injury. One individual may recover with little remaining problems, while others experience symptoms that can last for days, weeks, or sometimes longer. In general, recovery from TBI is slower for older individuals, and for those who have had a previous brain injury. For individuals with a more severe TBI, there may be lifelong changes to or problems with physical, emotional or cognitive (thinking) functioning.

Physical changes may include:

  • Problems with vision, weakness and coordination, as well as headaches, dizziness, fatigue, pain, and sleep disturbances.
  • Thinking changes may include: memory and learning problems, decreased concentration, problems with judgment, and slower thinking.
  • Emotional issues may include: irritability, problems managing anger or frustration, depression, anxiety, adjustment difficulties, and problems with social functioning.

What Does This Mean for Me?
Family Caregivers play an important role in recovery. In fact, many people who work with TBI patients believe that having a Family Caregiver is one of the most important aids to recovery. You can offer support, encouragement and guidance to your injured family member, and help ensure the treatment plan established by the medical professionals caring for the Veteran is followed.
At times, you may feel overwhelmed, angry or scared. You may also feel alone, or feel worn out by caregiving responsibilities. These reactions are normal and typically come and go. If you feel like there is just too much to deal with, seek help either by confiding in a friend, participating in a support group or consulting a professional mental health practitioner.

As a caregiver what are some tips that will help me?

  • It is often difficult for an individual with TBI to multitask, so give one instruction at a time. Try using lists and memory notebooks. A calendar is also a helpful tool to organize daily tasks.
  •  Be sensitive to the issue of fatigue. If your family member seems tired or overwhelmed, suggest they take a break.
  • Establish a routine in which your family member pre-plans activities for the day. Scheduling the most important activities for the morning is a good idea, because energy levels tend to decline over the course of the day. Remember that your loved one will have good days and bad days, both emotionally and physically. This is a normal part of recovery.
  •  Know what resources are available and reach out to friends, family, and professionals. VA can help you learn about available resources at www.caregiver.va.gov.
  • Attend visits to the medical provider with your family member and provide detailed information about the Veteran’s progress and challenges.
  • Ask questions and take notes.
  •  Be supportive and patient, but also remember to take care of yourself. If you find yourself completely overwhelmed or you feel yourself “losing it,” take a moment and call someone — a friend, a family member, or VA’s Caregiver Support Line (1-855-260-3274) are all good places to start. Support groups may also be available in your community or at your local VA.
  •  Visit your doctor regularly, and get plenty of rest so you can stay strong. Remember, you are doing the best you can and you are making a difference in your loved one's life.
  • More information on TBI and caregiving can be found at www.polytrauma.va.gov. An additional resource, Traumatic Brain Injury: A Guide for Caregivers of Service Members and Veterans can be found at www.traumaticbraininjuryatoz.org. If you are the Family Caregiver of a Veteran who has sustained a moderate or severe TBI, contact fcp@dvbic.org for information on obtaining a copy of the guide.

Acknowledgments:
US Department of Veterans Affairs:  www.caregiver.va.gov 

National Center of PTSD   www.ptsd.va.gov/ 

Department of Veterans Affairs  www.caregiver.va.gov Adapted

www.Military.com MilitaryPathways blog