1. PTSD, TBI, & Life After Combat
Replace *soldier(s)* with the term appropriate for your military branch.
Say:
“Today/Tonight we’re going to talk about PTSD, TBI and how they can affect a *soldier* and those who love him or her in life after combat. Hundreds of thousands of members of the military, their families, and friends are struggling to figure out how to cope with the impacts of war. If you are among those people, you are definitely not alone. And, the key to learning how to survive and thrive after combat is to first learn why these changes have happened and then to learn how to cope with them.”
courtesy of

2. Post-Deployment Alphabet Soup
Post-Traumatic Stress Disorder (PTSD)
Secondary Traumatic Stress (STS)
Traumatic Brain Injury (TBI)
Say:
“Following deployment a whole new alphabet soup emerges. To make sure we’re all on the same page going forward, let’s break that down. PTSD stands for Post-Traumatic Stress Disorder, a mental illness caused by various reasons and occurring, at some level, in up to 75% of troops returning from combat. Secondary Traumatic Stress, a mental illness in loved ones of PTSD victims created by living with or being close to someone with PTSD. This can also be called Secondary PTSD. Traumatic Brain Injury or TBI, is physical damage to the brain caused by an explosion (IED, VBIED, RPG, etc) or other injury and sometimes has symptoms that are similar to PTSD.”

3. PTSD Post-Traumatic Stress Disorder
**Ask those attending to turn to the “PTSD (aka post-traumatic stress disorder, aka “beastie boy” ptsd)” handout.**
Replace *soldier(s)* with the term appropriate for your military branch.
Say:
“PTSD is becoming a national topic of conversation. It’s all over the news, internet, and sometimes even the radio. It is being called (along with TBI) one of the “hallmark” injuries of the wars in Iraq and Afghanistan. Unfortunately, though, even with so much discussion, many veterans and members of the military are ignoring the signs that they are suffering from this potentially life-altering disorder. They ignore the signs because of concern about its impact on their career, because they’re somehow afraid it will make them look weak, or simply out of denial that a problem even exists.
We’re going to talk today/tonight about post traumatic stress disorder and how to recognize it in the real world. Then, we’re going to talk about where you can go to get help. It is really important that your *soldier* doesn’t avoid getting help. PTSD will actually get worse and do more damage to his or her life and your family the longer you wait.”
The elephant in every post-deployment room.

4. What is PTSD? PTSD is clinically defined by five clinical factors:
The person has been exposed to a traumatic event (such as combat).
The traumatic event is repeatedly re-experienced in distress, nightmares, or other disturbances.
The person attempts to avoid or numb their responsiveness to the trauma through various methods such as avoiding thoughts, activities, or people that remind them of the trauma.
These symptoms are persistent and last for longer than one month.
These symptoms cause significant distress and/or impairment in social, occupational or other areas of functioning.
Say:
“The clinical definition of PTSD is defined by these five clinical factors.
The person has been exposed to a traumatic event (such as combat).
The traumatic event is repeatedly re-experienced in distress, nightmares, or other disturbances.
The person attempts to avoid or numb their responsiveness to the trauma through various methods such as avoiding thoughts, activities, or people that remind them of the trauma.
These symptoms are persistent and last for longer than one month.
These symptoms cause significant distress and/or impairment in social, occupational or other areas of functioning.”
Diagnostic and Statistical Manual of Mental Disorders, fourth Edition. Copyright 1994; American Psychiatric Association.

5. And what does that REALLY mean?
Essentially you’ve been in combat and have seen a lot of dead people, have been in situations where dying was a real possibility, had to kill combatants and been “on edge” for a long period of time. Your brain is struggling to “come back to normal”. Your brain doesn’t understand that you are back in a safe and secure situation and continues to overreact as if it were still in combat.
**Refer those attending to the sections on the PTSD information sheet titled “The ‘Jeff Foxworthy’ Definition of PTSD” and “A Real World Look at PTSD.” Give them a few minutes to read over the information before continuing.**
Say:
“This is what PTSD is in real-world terms.
Essentially you’ve been in combat and have seen a lot of dead people, have been in situations where dying was a real possibility, had to kill combatants and been “on edge” for a long period of time.
Your brain is struggling to “come back to normal”.
Your brain doesn’t understand that you are back in a safe and secure situation and continues to overreact as if it were still in combat.”

6. PTSD Symptoms Psychological Behavioral Physical
There are three kinds of PTSD Symptoms:
Psychological
Stuff going on in your head.
Behavioral
Stuff you are doing because of stuff going on in your head.
Physical
Physical symptoms a doctor can look at and analyze.
**Refer those attending to the sections on the PTSD information sheet titled “Indications that you might have PTSD are…” at the top of the second page. Give them a few minutes to read over the information before continuing.**
Replace *soldier(s)* with the term appropriate for your military branch.
Say:
“Symptoms of PTSD fall into three categories: #1 – Psychological, which is the stuff going on inside of a *soldiers* head; #2 – Behavioral, which are actions caused by the things going on inside of a *soldier’s* head, and #3 – Physical. We’re going to talk more about these reactions but this is by NO MEANS an exhaustive list of PTSD signs and symptoms. Symptoms vary drastically from person to person and it is highly likely that a complete list of all signs and symptoms doesn’t even exist due to the vast variety.

7. Psychological Symptoms
Depression
Anxiety
Guilt
Avoidance/Lack of Emotion
Intrusive Thoughts
Hallucinations
Say:
“Psychological symptoms of PTSD include:
Depression – not enjoying, looking forward to, or being excited about anything.
Anxiety – you worry about everything or things you never considered previously.
Guilt – Sometimes called “Survivor’s Guilt”. You feel guilty because you survived, weren’t injured as bad as your fellow soldiers, etc.
Avoidance/Lack of Emotion – Avoiding any situation that would cause an emotional reaction or not responding to emotional situations at all.
Intrusive Thoughts – Thinking about or having “flashbacks” of combat that you can’t stop and did not purposefully start.
Hallucinations – Seeing or hearing things that aren’t really there.”

8. Behavioral Symptoms Extreme rage Short fuse Isolating yourself
Alcohol or drug abuse
Always being “on guard” (Hypervigilant)
Feeling numb
Memory problems
Lack of concentration
Nightmares
Unable to fall asleep or stay asleep
Being easily startled
Low self-esteem
Feeling hopeless about the future
Not wanting to see/hear anything that reminds you of combat
Lack of appetite and/or overeating
Say:
“Behavioral Symptoms of PTSD include:
Extreme rage – anger over things that would not have bothered you in the past.
Short fuse – going from relaxed to extremely angry in a matter of seconds.
Isolating yourself – not wanting to share thoughts, feelings, or emotions with anyone. You also may not want to be physically close to anyone.
Alcohol or drug abuse – also referred to as “self-medicating”. Many veterans who previously had absolutely no problem with alcohol or drugs will begin abusing them.
Always being “on guard” or Hypervigilant – Constantly scanning crowds, traffic, etc. for possible threats. May also repeatedly check house, car, etc. for security. This can also mean your veteran feel that everyone (including you!) is out to “get” him or her.
Feeling numb – not feeling or feeling very little about the people and things going on around you.
Memory problems – losing car keys, not being able to remember conversations or phone numbers.
Lack of concentration – unable to concentrate on work, hobbies, or conversations.
Nightmares – One of the most common symptoms.
Unable to fall asleep/stay asleep – taking only “cat naps”, lying awake for hours despite exhaustion, getting up to frequently recheck home, family, and security.
Being easily startled – most often as a response to a loud noise such as fireworks, gun fire, a car backfiring, or a balloon popping.
Low self-esteem
Feeling hopeless about the future – both long and short sighted. Sometimes even planning something in a few days is just “not worth it”.
Not wanting to see/hear anything that reminds you of combat – including friends, television news, war movies, etc.
Lack of appetite and/or overeating”

9. Physical Symptoms Headaches Rapid Heart Rate Sweating
Constant or intermittent
Varying degrees from mild to migraine
Rapid Heart Rate
Especially when reminded of traumatic events or “for no particular reason”.
Sweating
Replace *soldier(s)* with the term appropriate for your military branch.
Say:
“Physical symptoms of PTSD include:
Headaches – which can be constant or only happen every once in a while, and can vary from mild pain to extreme, migraine-like pain
Rapid Heart Rate and Sweating – these can happen when a *soldier* is reminded of something that happened in combat or for no reason at all.”

10. Crunch the Numbers
According to various studies approximately 20% (between 12-25%) or more veterans returning from combat operations have PTSD symptoms.
Based on the approximately 2 million soldiers who have deployed into Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn that means at least 400,000 PTSD veterans.
Less than half (200,000) of these will seek treatment.
Say:
“The numbers according to the most recent RAND study show that we have at least 400,000 PTSD veterans out there, less than half of which will actively seek treatment. Of those who begin a program, even fewer will see it through to completion.”

11. STS Secondary Traumatic Stress
**Ask those attending to turn to the “STS (aka secondary traumatic stress, aka secondary ptsd)” handout.**
Say:
“When troops first started returning from deployments in Iraq and Afghanistan, very few people had ever heard of Secondary Traumatic Stress, which is also known as Secondary PTSD. For the first time in several decades, family members who lived with veterans who had PTSD were beginning to develop PTSD-like symptoms of their own. “
Because living with someone with PTSD can actually cause PTSD.

12. Secondary Traumatic Stress
STS (also called Secondary PTSD) is essentially PTSD caused by PTSD. It can affect:
Spouses
Children
Parents
Loved ones
Say:
“STS is basically PTSD that is caused by living with someone who has PTSD. It can affect spouses, children, parents, and loved ones – anyone who is living or having almost constant contact with a veteran who has post traumatic stress disorder.”

13. STS Symptoms Depression Anxiety Frustration Anger Unable to Sleep
Unable to Concentrate
Irrational Behavior
Crying
An inability to cope with daily tasks
**Refer those attending to the section on the STS information sheet titled “Signs and Symptoms of Secondary PTSD”. Read the script below and then give them a few minutes to read over the information before continuing. This may be a good time to ask if anyone knows of someone experiencing STS or, if they’re comfortable saying so, if they feel like they are.**
Say:
“Many STS symptoms are a lot like PTSD symptoms. Some of those symptoms are:
Depression
Anxiety
Frustration – often at being “the only one”.
Anger – explosive or slow burning
Unable to Sleep – often despite being utterly exhausted
Unable to Concentrate – on seemingly anything.
Irrational Behavior – Often in terms of just wanting to walk away from it all.
Crying – uncontrollably and without being able to stop.
An inability to cope with daily tasks – often due to feeling completely overwhelmed.”

14. Crunch the Numbers
Approximately 40% of those who care for someone with PTSD will develop STS.
Using our earlier PTSD number, if we consider only spouses, approximately 160,000 spouses will develop STS from their veteran’s PTSD.
Remember, this number just includes spouses, not other loved ones such as parents, children, and siblings.
Less than 10% of those who have Secondary PTSD will seek help. That means approximately 145,000 spouses are going untreated for STS.
**Refer those attending to the section on the STS information sheet titled “Am I Alone?”.**
Say:
“Many people who have Secondary PTSD feel like they are alone. It is important to know that you are definitely not. Let’s look at these statistics:
Approximately 40% of those who care for someone with PTSD will develop STS.
Using our earlier PTSD number, if we consider only spouses, approximately 160,000 spouses will develop STS from their veteran’s PTSD.
Remember, this number just includes spouses, not other loved ones such as parents, children, and siblings.
Less than 10% of those who have Secondary PTSD will seek help. That means approximately 145,000 spouses are going untreated for STS.”

15. Keeping PTSD from affecting our next generation.
PTSD & Children
**Ask those attending to turn to the “Children & PTSD (helping them understand, watching for signs of stress)” handout.**
Say:
“PTSD can have a huge impact on children of all ages. And, while we don’t have time today/tonight to cover the recommendations for every age group, you should take time to read over the information in this handout. If you have any questions or concerns about your child, consider talking to your child’s pediatrician. It is very important that we help our children cope with their parent’s PTSD and that we watch out for signs that they are developing STS. While Secondary PTSD in adults can be extremely difficult, if it’s left unchecked in children it can literally have a negative impact on the rest of their life.”
Keeping PTSD from affecting our next generation.

16. STS in Children
Here are a few of the symptoms children can exhibit when they have Secondary PTSD:
Extreme mood changes, irritability;
Losing creativity and interest in activities they would typically enjoy;
Loneliness, withdrawal and pulling away;
Acting out more than a child should at their age;
Fighting and trying to harm siblings;
Attempting to take on more than they should at their age;
Suddenly getting into an unusual amount of trouble and taking place in violent acts.
**Refer those attending to the section on the Children & PTSD information sheet titled “Signs & Symptoms Of Secondary Ptsd In Children”.**
Say:
“There is a longer list of symptoms available on your handout. Here are just a few of the signs of trouble you should watch for if your child is living in a household with someone who has PTSD:
Extreme mood changes, irritability;
Losing creativity and interest in activities they would typically enjoy;
Loneliness, withdrawal and pulling away;
Acting out more than a child should at their age;
Fighting and trying to harm siblings;
Attempting to take on more than they should at their age;
Suddenly getting into an unusual amount of trouble and taking place in violent acts.”

17. TBI Traumatic Brain Injury
**Ask those attending to turn to the “TBI (aka traumatic brain injury, the hidden result of too many explosions)” handout.**
*If you’d like an extra visual aid, an egg carton with a slightly cracked egg inside can help you illustrate TBI.*
Replace *soldier(s)* with the term appropriate for your military branch.
Say:
“How many of your *soldiers* have had a close call with at least one IED, VBIED, RPG, or mortar? Raise your hands. Okay. How many of them have experienced more than five close calls? (PAUSE) How about ten?
Each time your *soldier* was nearby when some type of ordinance exploded, his or her brain was literally rocked around inside of their skull. This rocking was actually caused by the power of the explosion and the wave of energy it pushed into the area nearby… almost like watching that occur after a single rock is dropped in a lake. Even though a *soldier* may seem fine right after the blast, he or she may actually have had a traumatic brain injury.
Another way to look at TBI is this. Why do you check inside of a carton of eggs before you buy it? (IF you brought the egg carton, hold it up) You check to make sure there aren’t any broken eggs, right? Because even though the carton seems perfectly fine an egg inside (IF you brought the egg carton, open it to show the broken egg) may actually be broken. Well, with TBI, there’s the same problem. Even though your *soldier’s* head looks fine, his or her brain inside may actually be damaged.”
When blasts damage more than it may first appear.

18. Traumatic Brain Injury (TBI) If you were ever exposed to a blast, TBI is a very possible problem. Symptoms include:
Headaches and/or neck pain that will not go away.
Difficulty concentrating, remembering, or making decisions.
Slowness in thinking, acting, speaking, or reading.
Getting lost or easily confused.
Feeling tired all the time – having no energy or motivation.
Mood changes (feeling sad and/or angry for no reason).
Changes in sleep patterns (Sleeping more or difficulty sleeping).
Lightheadedness, dizziness, and/or loss of balance.
Increased sensitivity to light, sound, and/or distractions.
Nausea.
Blurred vision or eyes that tire easily.
Loss of smell or taste.
Ringing in the ears.
Depression and/or anxiety.
**Refer those attending to the section on the TBI information sheet titled “TBI Symptoms”.**
Read a few of the symptoms from this slide and ask those attending to take a few minutes to review the rest on their handout.

19. Crunch the Numbers
Approximately 22.8% of soldiers returning from combat are likely to have TBI. This number is relative. Sources have indicated numbers both above and below this ranging from 15%-30%+.
Based on our number of approximately 2 million deployed soldiers, that would mean over 450,000 veterans with TBI.
The vast majority of these cases are mild and likely to go untreated, especially if the blast was unreported to medical personnel.
Say:
“One of the reasons TBI is so common among those who have served in Iraq or Afghanistan is because the likelihood of developing traumatic brain injury and issues from that injury is increased with each additional explosion.
Statistics about how many troops have sustained a TBI vary a lot. If we take an average of some of those studies which is approximately 22.8% and apply that to the 2 million heroes who have served in overseas combat since September 2001, that would mean more than 450,000 veterans have TBI.”

20. Should my vet be screened for TBI?
The Veteran’s Administration uses these four question to decide if a veteran needs to be screened for TBI. If your veteran answers “Yes” to all four questions, he or she should be seen as soon as possible at your nearest military or veteran medical facility.
Were you exposed to a trauma or blast while in Iraq or Afghanistan?
As a result of the trauma or blast did you have a loss or alteration in consciousness (see stars, have bell rung, feel disoriented or confused)?
Did you develop problems with headache, insomnia, dizziness, thinking, or behavior immediately to soon after the trauma or blast?
Do you still have the problems with headache, insomnia, dizziness, thinking difficulties or behavior that you developed immediately to soon after the trauma or blast?
**Refer those attending to the section on the TBI information sheet titled “Should My Veteran Be Screened?”.**
*If possible, have the phone number on hand for the TBI department at your military medical facility or for the nearest VA medical facility.*
Replace *soldier(s)* with the term appropriate for your military branch.
Say:
“If your *soldier* answers yes to all of these questions and he or she has not already been screened for TBI, it is important the that screening be done as soon as possible. The number for our medical facility / the nearest VA medical facility is ______________ (or, if *soldiers* are required to go through sick call, etc, explain that process).”

21. How do I talk to my child about TBI?
Be honest.
Give age-appropriate information.
Watch for signs of stress.
Let everyone talk about their feelings.
Keep life as normal as possible.
**Refer those attending to the “Explaining TBI to Kids” information sheet.**
Say:
“Talking to kids about TBI may be hard, but start off with a policy of always telling them the truth, even if its difficult. Your handout will give you information about how to talk with children in each age group. It also gives you ideas about what signs or symptoms of stress to be on the lookout for.
Encourage your children to talk to you about how they are feeling. Set aside time for low-key family activities that will encourage talking.
It’s also important to keep life as “normal” as you can. Children of all ages thrive on routine. Dealing with the changes caused by TBI will be much easier if there are some other parts of their life they can count on being the same.”

22. 400,000 with PTSD 450,000+ with TBI 160,000+ with STS (just spouses)
Recap
400,000 with PTSD 450,000+ with TBI 160,000+ with STS (just spouses)
You are
ABSOLUTELY
not alone!

23. Where Do We Go From Here?
Realize there is a problem.
Educate yourself about the symptoms and signs.
Actively encourage the veteran to seek help,
Courage is the key to seeking treatment.
Help each other by creating your own support network.
Say:
“Where do we go from here? We R.E.A.C.H.
We *R*ealize there is a problem in our community and that we are not alone.
We *E*ducate ourselves about the symptoms and signs of PTSD, TBI, and STS and watch for them in our spouses, ourselves, our children, our loved ones, and each other.
We *A*ctively encourage our veteran and others, including family members, to seek help.
We have *C*ourage because that’s what it takes to step up and point out to someone we love that there’s a problem and also to seek treatment ourselves.
We *H*elp each other by leaning on each other, supporting each other, and reminding each other that we are in this together.”

24. Resources Mental Health Family Advocacy Military Family Support Group
Chaplain
*Please give local phone numbers, locations, and information for on base or nearby resources.*