Post-Traumatic Stress
Disorder
CPT David Boyer, Division Psychologist
Plan of Action
• Symptoms
• Prevalence
• Causes
• Prevention
• Treatment
• Leadership Issues
Symptoms of PTSD
• Person experienced, witnessed, or
was confronted with event that
involved threat of death or serious
injury.
• And
• The person’s response involved
intense fear, helplessness, or horror.
Symptoms of PTSD
• -Re-experiencing: flashbacks,
nightmares, re-living, intrusive
thoughts
• -Avoidance: avoiding thoughts and
feelings, avoiding memories, memory
problems, detachment
• -Arousal: sleep probs, anger,
concentration, startle, vigilance
Symptoms of PTSD
• From a biologic perspective, the body’s failure to
return to its pre-traumatic state differentiates
PTSD from a simple fear response. In a normal
fear response, the immediate sympathetic
discharge activates the “fight-or-flight” reaction.
Increases in both catecholamines and cortisol
occur relative to the severity of the stressor.
Cortisol release stimulated by corticotropin-
releasing factor via the hypothalamic-pituitary-
adrenal (HPA) axis acts in a negative feedback
loop to suppress sympathetic activation and cause
further release of cortisol.
Symptoms of PTSD
• PTSD is a hyper-activation of the
sympathetic nervous system
• The symptoms of PTSD are generally
ADAPTIVE in combat zones but are
MALADAPTIVE back home
Symptoms of PTSD
• Associated Features
– Marital Problems
– Alcohol/Drug Abuse
– Violence
– Desperation
Prevalence of PTSD
• North et al. (1999)
• Examined effects of Oklahoma City
bombing
• 45% of those directly affected met
criteria for PTSD 6 months after the
event
Prevalence of PTSD
• Kang et al. (2003)
• 15,000 Gulf War veterans compared
to 15,000 Non-Gulf veterans
• Gulf War veterans 3 times more
likely to develop PTSD symptoms
Prevalence of PTSD
Causes of PTSD
• There is no good predictor of who
might develop symptoms.
• Higher rates of PTSD in:
– Individuals with poor social support
– Depression in first-degree relatives
– Previous trauma
– More combat exposure
– Other psychiatric conditions
– Females
Prevention of PTSD
• Before Traumatic Events
– Hard, realistic training
– Physical training
– Stress Management
– Education about operational stress
– Good leadership
– Informal assessment
– Formal screening
Prevention of PTSD
• Immediately after Traumatic Event
– Critical Incident Stress Debriefing
– Operational Debriefing
– Good leadership
– Stress Management
Treatment of PTSD
• The important thing is to recognize
the symptoms in yourself and your
fellow soldiers
– Alcohol abuse
– Sleep problems
– Marital problems
– Emotional changes
Treatment of PTSD
• Initial treatment should be:
• B – Brief
• I – Immediate
• C – Centrality
• E – Expectancy
• P – Proximity
• S - Simplicity
Treatment of PTSD
• Medical Treatment
– Anti-depressant medications especially
effective at addressing
• Avoidance
• Numbing
• Re-experiencing
• Hyper-arousal
• Alcohol consumption in co-morbid
alcoholics
Treatment of PTSD
• Psychological Treatments
– Cognitive-behavioral therapy: most
effective at addressing guilt, avoidance,
emotional changes
– Best conducted in group format
– Can be done with self-help books: “The
PTSD Workbook”
Treatment of PTSD
• Grinage (1994): Reviewed studies of
effectiveness of therapy
• Positive end-state= 50% reduced sxs
• Approximately 1/3 of patients
achieved end-state in 10 sessions
Treatment of PTSD
• Informal treatment:
– Debriefing/Defusing in workgroups
– Support Groups
Treatment of PTSD
• The difficulty with treatment in
military settings is the barriers
inherent in our line of work
– Stigma: crazy, malingering, weak
– Career: mental health=death
Perceived Stigma of Mental Health Care
Soldiers who screened positive for depression, anxiety, or PTSD reported the
following cultural stigma to seeking mental health care:
My unit leadership might treat me differently
I would be seen as weak
Members of my unit might have less
confidence in me
It would harm my career
It would be too embarrassing
I don’t trust mental health professionals
Treatment of PTSD
• Special aviation-related issues:
– Flight status
• Often mental health is viewed as a death to
a career
• Informal assessment/treatment
– Typical coping style of aviators
• Repression and denial
• Aviators need to be allowed to cope in their
own way
Leadership Issues
• Whether you “believe” in PTSD or
not, there is no argument that a
certain percentage of soldiers will
experience problems and become
casualties of their experience
• May occur either emotionally or
behaviorally
Leadership Issues
• Traumatic stress reactions are common, but often become
less frequent or distressing as time passes, even without
treatment.
• Approximately 5-8% of soldiers who see combat will
develop life long PTS symptoms.
• FEW will seek or get help until they cannot cope.
• Veterans with PTSD often worry that they are going
crazy. This is not true.
• They are experiencing a set of common symptoms and
problems that are connected with trauma.
• Soldiers are concerned that any revealing of their troubles
will result in actions against them or will damage their
reputation/career.
• Leaders must communicate and assure soldiers in their
command that this is NOT the case.
Bottom-Line
• Approx 1/5 of soldiers in the 101st are
likely to be suffering
• Treatment is effective and available
• Aviation represents a “special case”
• We need to work to provide help and
avoid the stigma associated with
mental health
Recommendations
• Prevention
– PTSD education
– Screening
• Barriers to care
– MH teams to each BCT
– Army OneSource
– Aeromed Psychology program?
– Informal treatment methods
Helpful Resources
• Your Unit Chaplain/Physician
• Division Mental Health: 798-8682
• Adult behavior health (BACH): 798-
8802
• Army One Source 1 800 464-8107
• National Center for PTSD:
Http://www.Ncptsd.Org/