1. PTSD
soldiers-with-brain-injuries/

2. veterans returning from Iraq or Afghanistan
Prevalence
20 to 40%
veterans returning from Iraq or Afghanistan

3. DSM V Exposure to trauma Intrusion symptoms Avoidance of triggers
Negative alterations in cognition/mood
Hyper-arousal

4. Types of Trauma Sexual Physical Combat Natural Disaster
Working with traumatized people

5. Intrusion Symptoms
Recurrent, involuntary, and intrusive distressing memories
Recurrent distressing dreams
Dissociative reactions (e.g., flashbacks)
Intense psychological distress at exposure to internal or external cues
Marked physiological reactions
Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
Note: In children, there may be frightening dreams without recognizable content.
Note: In children, trauma-specific reenactment may occur in play.

6. Avoidance of Triggers Memories People Places Conversations Activities
Objects
Situations
Car back fire
Fireworks
Smell of diesel
Open market
People in Arab dress
Hospital
Heavy backpack

7. Cognition and Mood Lost memory Negative beliefs Survivor guilt
Detachment, de-realization
Anhedonia

8. hyperarousal Irritability Reckless or Self-destructive behavior
Hypervigilance
Startle Response
Sleep Disturbance

9. Co-occurance PTSD and mild TBI 48%
80% more likely to have another mental disorder
High risk of suicide
Divorce

10. Assessment PCL Military PCL C/S
PCL Military
PCL C/S

11. Treatment: CBT
Source: Learn About PTSD, Department of Defense, Defense Centers of Excellence (afterdeployment.t2.health.mil/providers/briefings)

12. Prolonged Exposure therapy
Imaginal exposure: Repeated and prolonged recounting of the traumatic experience
In vivo exposure: Systematic confrontation of trauma-related situations that are feared and avoided, despite being safe
Increase emotional processing of the traumatic event, so that memories or situations no longer result in:
„X Anxious arousal to trauma
„X Escape and avoidance behaviors

13. Cognitive Processing Therapy
CBT and PET
Identifying and challenging problematic thoughts and beliefs
Particular attention is paid to stuck points: feelings, beliefs, and thoughts that stem from the traumatic events that are hard to accept
Writing and reading aloud a detailed account of the event (all day)

14. Stress inoculation training
Relaxation training
Gradual in vivo exposure
(systematic desensitization for PTSD)

15. EMDR Eye Movement Desensitization and Reprocessing
Focus on the visual image, bodily sensations, negative belief while simultaneously focusing on external stimulus
One of the procedural elements is "dual stimulation" using either bilateral eye movements, tones or taps. During the reprocessing phases the client attends momentarily to past memories, present triggers, or anticipated future experiences while simultaneously focusing on a set of external stimulus.

16. Resources

17. Web sites PTSD: National Center for PTSD Community Provider Toolkit
ptsd.va.gov (professional section)
Community Provider Toolkit
mentalhealth.va.gov/communityproviders
After Deployment (sign in)
Afterdeployment.t2.health.mil

18. Your assignment PTSD and Physical Injury
Workbooks/education materials for Clients with PTSD
CEU for Providers (free)
Evidence-based Practice Resource
Substance-Abuse and PTSD
Military Culture
Assessments for PTSD
OT and PTSD
Resources for Families