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In our effort to prepare community providers with the training they need to assist service members, veterans and their families, we are always looking for alternate opportunities to share beyond our quarterly trainings for continued education and assistance.  Following are samples of what we are constantly researching and passing on.

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   Call: 847-986-4622

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Lake County Suicide Prevention Task Force Sponsors Seminar
How to Recognize and React to Signs of Suicidal Behavior

Chen

Sharing the latest in suicide prevention trends and practices with area professionals, the Lake County Suicide Prevention Task Force sponsored a day-long seminar on April 11, 2017 at the College of Lake County’s Grayslake campus.

The event was hosted by the College’s Human Services and Social Work Department. About 175 professional social workers and other clinicians attended.

Jason I. Chen PhD, the Health Services Research and Development Fellow at the VA Portland Health Care System, travelled from Oregon to lead the seminar. Chen is a member of the Center to Improve Veteran Involvement in Care (CIVIC) team.

Dr. Chen identified several warning signs that indicate that someone may be at imminent risk of taking their own lives. These include experiencing recent changes in sleep difficulties, hopelessness, anxiety, anger, or mood swings, engaging in risky behaviors, withdrawing from family, friends and co-workers, increased use of alcohol and drugs and talking about death and dying.

These factors also may be influenced by significant stressors such as financial loss or relationship instability, Dr. Chen said. For veterans, possible additional stressors include length, frequency and type of deployment, especially if it includes combat.

Protective factors such as a social support system, a sense of purpose, and values and beliefs, may also play a role in someone’s thinking and actions, he added.

Dr. Chen told the clinicians that, if they encounter someone who is in a suicidal crisis, they can act with care and compassion by following the VA Office of Suicide Prevention’s acronym SAVE:

Signs of suicidal thinking should be recognized;

Ask the most important question: “Are you thinking of taking your own life?;

Validate the person’s experience; and

Encourage treatment while Expediting the intervention of help.

Asking about the presence of guns also is recommended. Firearms were one of the top five leading causes of injury-related deaths nationwide in 2010. Veterans are more likely to use firearms in acts of suicide than the general population.

Dr. Chen said that calling the National Crisis Line National Suicide Prevention Lifeline at 1-800-273-8255, or 911, can be effective ways to get help for people in crisis.

“We are happy that so many professionals attended today’s seminar,” said Katia Marshall, Chair of the Lake County Suicide Prevention Task Force. Marshall is a therapist with the Lake County Health Department.

The task force is comprised of members that include the Lake County Health Department, Waukegan Police Department, area first responders, College of Lake County, Lake County Veterans and Family Services Foundation, Lovell Federal Health Care Center, hospitals, agencies , counseling centers and other resources that can help people in need and in crisis.

“Getting this information to professionals is critical,” Marshall said. “It’s part of our mission to share prevention best practices and available resources with everyone in Lake County. We thank Dr. Chen and CLC for making this seminar possible.”

Copies of the task force’s Resource Guide – “Get Help, Have Hope”, were distributed to attendees. This handy guide offers the contact information for crisis-related resources across Lake County including: addiction, counseling, dental and medical, disability, domestic violence, financial, hunger, homelessness, general hotlines, military, veteran and families, and seniors.

Copies of “Get Help, Have Cope” ”are available by contacting Katia Marshall of the Lake County Suicide Prevention Task Force at This email address is being protected from spambots. You need JavaScript enabled to view it.

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Meditation-based Approaches in the Treatment of PTSD

PTSD Research Quarterly
VOLUME 28/NO. 2, APRIL 2017
The latest issue of the PTSD Research Quarterly (PDF) is now available:

by Alexander M. Talkovsky, PhD and Ariel J. Lang, PhD, MPH

Moving beyond psychotherapies that focus primarily on behavior and cognitive change, the emergence of the Third Wave of Cognitive Behaviorism during the past decade, has led to the development of psychotherapies that have been influenced by Zen Buddhist teachings and mindfulness approaches that embrace acceptance of self, internal experiences, the environment and others.

This issue of the PTSD Research Quarterly provides a guide to recent clinical trials on meditation-based approaches for the treatment of PTSD.  Click here to read full article.

Tell a friend so they can subscribe to the PTSD Research Quarterly Online (RQ).

Sign up for the PTSD Monthly Update or other publications from the National Center for PTSD.

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VA, DOD Study a Major Breakthrough for Understanding PTSD

March 25, 2017 - WASHINGTON — Researchers from the Department of Veterans Affairs (VA) and Department of Defense (DOD) recently released findings of a new study called Prospective Post-Traumatic Stress disorder Symptom Trajectories in va logoActive Duty and Separated Military Personnel, which examines Post Traumatic Stress Disorder (PTSD) symptoms in Veterans, compared with active-duty populations.

This is the first known study comparing PTSD symptom trajectories of current service members with those of Veterans, and is the product of a collaborative effort from VA and DOD researchers analyzing data from the Millennium Cohort Study (MCS), the largest prospective health study of military service members.

According to VA’s National Center for PTSD, the PTSD rate among Vietnam Veterans was 30.9 percent for men and 26.9 percent for women. For Gulf War Veterans, the PTSD rate was 12.1 percent. Operation Enduring Freedom/Operation Iraqi Freedom Veterans had a PTSD rate of 13.8 percent.

“Knowing there are similarities in how PTSD affects service members and Veterans makes it easier to pinpoint which treatments are the best to control the condition,” said Dr. Edward Boyko, an epidemiologist and internist at the VA Puget Sound Health Care System in Washington state, and VA’s lead researcher on the Millennium Cohort Study.

Officials involved with the project said they are hoping the collaboration will improve the understanding of Veterans’ health needs, relative to their experiences in service.

“The data that MCS researchers have been collecting since 2001 is incredibly valuable for both the DOD and VA,” said Dr. Dennis Faix, director of the Millennium Cohort Study and preventive medicine physician. “Going forward, working with VA will allow both agencies to make sure we are getting the best information to develop a comprehensive understanding of the continuum of health in current and former service members.”

The results of the joint VA DOD study will appear in the Journal of Psychiatric Research’s June 2017 issue. It is the first of many joint future publications expected to result from the collaboration between VA and MCS.

You can learn more about the study here: http://millenniumcohort.org/

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Researchers found that 69 percent of veterans who were evaluated for self-reported PTSD symptoms also were at high risk for sleep apnea.

DARIEN, Ill., (UPI) -- Young veterans with post-traumatic stress disorder, or PTSD, have a high probability of obstructive sleep disorder, according to a small study.

"The implication is that veterans who come to PTSD treatment, even younger veterans, should be screened for obstructive sleep apnea so that they have the opportunity to be diagnosed and treated," said Sonya Norman, PhD, researcher at the San Diego VA, director of the PTSD Consultation Program at the National Center for PTSD, and an associate professor of psychiatry at the University of California San Diego School of Medicine, in a press release. "This is critical information because sleep apnea is a risk factor for a long list of health problems such as hypertension, cardiovascular disease and diabetes, and psychological problems including depression, worsening PTSD and anxiety."

The study was conducted based on veterans also reporting snoring and fatigue, motivating researchers to launch the investigation. Among the 159 veterans included in the study, 69 percent were seen as being at high risk for sleep apnea.

Younger veterans generally aren't screened for sleep apnea, however researchers believe that aspects of PTSD, such as disturbed sleep and sleep deprivation, psychological and physical stressors of combat, hyperarousal due to those stressors, may increase the chances of sleep apnea occurring.

The study is published in Journal of Clinical Sleep Medicine.

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New Deep Relaxation Technology Therapy Arrives in the U.S.

Veterans, Athletes, Business People and Many Others Benefits from Blu Room Sessions

Yelm, Washington (PRWEB) March 15, 2017

The Blu Room, a new treatment combining relaxation, technology, music and Narrowband UVB light therapy (phototherapy), will be expanding to six locations in the U.S. in 2017. Three centers in Washington State will be augmented by Blu Rooms in Florida, Missouri and Utah.

Most scientists and the public agree on the benefits of relaxation. Peer-reviewed medical studies on meditation from Johns Hopkins* and UCLA* (see below) confirm the healing powers such as increased attention span, improved memory, relieving anxiety and depression, pain relief, and spurring creativity.

The Blu Room sessions, consisting of 20 minutes of deep relaxation inside a futuristic octagon bathed in blue UV-B light, uses music, tranquility and technology to produce some of the same results noted in those studies. The Blu Room is a non-invasive, non-surgical practice. It's not a tanning device, users wear regular clothing.

The Blu Room was invented in Yelm outside of Seattle by JZ Knight, the exclusive channel for Ramtha. Since the first Blu Room opened in 2015, there have been more than 30,000 user sessions provided.

The Blu Room experience varies from person to person. Many people have described it as being deeply relaxing, lifting their mood, and bringing about a state of slightly detached calm or peace. A common side benefit of this state is a relief from aches and pains. Some people experience dynamic shifts in perspective and spiritual insights. Since the mind is the greatest healer and the mind is inextricably intertwined with DNA, the Blu Room can augment a person's natural healing abilities. Some simply enjoy a break in their daily routine to refresh themselves.

Those enjoying the Blu Room include athletes, housewives, doctors, students, retired people and many active duty and military veterans.

Two veterans in the Olympia area with Post Traumatic Stress Disorder (PTSD) are regulars users. Cynthia Williams-Patnoe, a pilot who served in Afghanistan, returned home from war and was struck by a pickup truck, suffering a traumatic brain injury. She then started using the Blu Room. "The Blu Room was very peaceful and therapeutic," Williams-Patnoe says. She went 3-4 times per week, for 20 sessions. "My short-term memory was coming back thanks to the sessions."

Dale Vaughn, a Vietnam veteran, suffered from years of nightmares and was diagnosed with PTSD. He began using the Blu Room in late 2016. "It feels like I'm going to a place of peace, Vaughn says. "You feel healthy and happy."

The Department of Veterans Affairs estimated up to 30% of Vietnam Veterans have experienced PTSD in their lifetime.

There are 11 Blu Rooms in operation throughout the world in in Austria (2), Germany (2), Switzerland (3) and one each in Ecuador, Italy, Japan and in Quebec, Canada. Six more locations will open in 2017 in Aso, Japan; Bathurst, Australia; Calgary, Canada; Mexico City, Mexico; New Taipei City, Taiwan and Osaka, Japan.

There are medical studies on the benefits of Narrowband UVB light therapy such as relief from psoriasis such as "Therapy Of Psoriasis With Narrowband Ultraviolet-B Light Influences Plasma Concentrations Of MMP-2 And TIMP-2 In Patients," published in the Journal of Therapeutics and Clinical Risk Management in October, 2016.

Other studies mentioned include "Meditation Programs for Psychological Stress and Well-being A Systematic Review and Meta-analysis" by Johns Hopkins researchers published in March 2014 http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1809754 and "Forever Young(er): potential age-defying effects of long-term meditation on gray matter atrophy" http://journal.frontiersin.org/article/10.3389/fpsyg.2014.01551/full published in January 2015.

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If you are enrolled in the VA Health Care System, getting your flu shot at Walgreens or Duane Reade is easy.

Click to learn

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This section is for Researchers, Providers, and Helpers

PTSD Research Quarterly (RQ)

RQ newsletter

The National Center for PTSD produces the PTSD Research Quarterly (RQ) newsletter.

Each RQ contains a review article written by guest experts on a specific topic related to PTSD.

The article has a selective bibliography with abstracts and a supplementary list of annotated citations.

Recent Issues

Subscribe

*Problems Accessing full text? VA clinicians might have privileges through their university affiliation. However, VA firewalls sometimes block the permissions to access reference materials. If you cannot access the Full Text version of any article, we suggest you contact your local librarian or web/Internet technical person.

If you usually have access to full text from the journal in which an article is published, but are not seeing it from the link provided, try accessing it directly through your university library system. Many online services have password access that only works through a user's library system.

National Center for PTSD
 

The National Center for PTSD does not provide direct clinical care, individual referrals or benefits information.

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Suicide Among Veterans and Other Americans 2001–2014

More than 55 Million Veterans’ Records Reviewed From 1979 to 2014 From Every State in the Nation

WASHINGTON – The Department of Veterans Affairs (VA) today released its findings from the nation’s most comprehensive analysis of Veteran suicide rates in the United States in which VA examined more than 55 million Veterans’ records from 1979 to 2014 from every state in the nation. The effort advances VA’s knowledge from the previous report in 2012, which was primarily limited to information on Veterans who used VHA health services or from mortality records obtained directly from 20 states and approximately 3 million records.. Compared to the data from the 2012 report, which estimated the number of Veteran deaths by suicide to be 22 per day, the current analysis indicates that in 2014, an average of 20 Veterans a day died from suicide.

A link to the report may be found here.

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An Important Perspective

In this July 12, 2010 photo, journalist and documentary film maker Sebastian Junger poses for a photo in Toronto.

Sebastian Junger: Over-Valorizing Vets Does More Harm Than Good

By ADAM LINEHAN

Click here to read entire Interview 

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About Traumatic Brain Injury

Falls are the leading cause of traumatic brain injury for all ages. Those aged 75 and older have the highest rates of traumatic brain injury-related hospitalization and death due to falls.

Doctors classify traumatic brain injury as mild, moderate or severe, depending on whether the injury causes unconsciousness, how long unconsciousness lasts and the severity of symptoms. Although most traumatic brain injuries are classified as mild because they're not life-threatening, even a mild traumatic brain injury can have serious and long-lasting effects.

Traumatic brain injury is a threat to cognitive health in two ways:

1.   A traumatic brain injury's direct effects, which may be long-lasting or even permanent, can include unconsciousness, inability to recall the traumatic event, confusion, difficulty learning and remembering new information, trouble speaking coherently, unsteadiness, lack of coordination and problems with vision or hearing.

2.    Certain types of traumatic brain injury may increase the risk of developing Alzheimer's or another form of dementia years after the injury takes place. 

If Head Injury Occurs

If you or someone you're with experiences an impact to the head and develops any symptoms of traumatic brain injury, seek medical advice even if symptoms seem mild. Call emergency services for anyone who is unconscious for more than a minute or two or who experiences seizures, repeated vomiting or symptoms that seem to worsen as time passes. Also seek emergency care for anyone whose head was injured during ejection from a vehicle, who was struck by a vehicle while on foot, or who fell from a height of more than 3 feet. Even if you don't lose consciousness and your symptoms clear up quickly, a brain injury still may have occurred.

Symptoms

Symptoms of a brain injury include:

·         Unconsciousness

·         Inability to remember the cause of the injury or events that occurred Immediately before or up to 24 hours after

·         Confusion and disorientation

·         Difficulty remembering new information

·         Headache

·         Dizziness

·         Blurry vision

·         Nausea and vomiting

·         Ringing in the ears

·         Trouble speaking coherently

·         Changes in emotions or sleep patterns

The severity of symptoms depends on whether the injury is mild, moderate or severe.

·      Mild traumatic brain injury, also known as a concussion, either doesn't knock you out or knocks you out for 30 minutes or less. Symptoms often appear at the time of the injury or soon after, but sometimes may not develop for days or weeks. Mild traumatic brain injury symptoms are usually temporary and clear up within hours, days or weeks, but they can last months or longer.

·      Moderate traumatic brain injury causes unconsciousness lasting more than 30 minutes. Symptoms of moderate traumatic brain injury are similar to those of mild traumatic brain injury but more serious and longer-lasting.

·      Severe traumatic brain injury knocks you out for more than 24 hours. Symptoms of severe traumatic brain injury are also similar to those of mild traumatic brain injury but more serious and longer-lasting.

 Diagnosis

Evaluations by health care professionals typically include:

·     Questions about the circumstances of the injury

·     Assessment of the person's level of consciousness and confusion

·     Neurological examination to assess memory and thinking, vision, hearing, touch, balance, reflexes and other indicators of brain function

Depending on the nature of the traumatic brain injury and the severity of symptoms, brain imaging with computed tomography (CT) may be needed to determine if there's bleeding or swelling in the brain.

Causes and risks

Falls are the most common cause of traumatic brain injury, and falling poses an especially serious risk for older adults. When a senior sustains a traumatic brain injury in a fall, direct effects of the injury may result in long-term cognitive changes, reduced ability to function and changes in emotional health.

Vehicle crashes are another common cause of traumatic brain injury. You can reduce your risk by keeping your vehicle in good repair, following the rules of the road, and buckling your seat belt.

Sports injuries are also a cause of traumatic brain injury. You can protect your head by wearing a helmet and other protective equipment when biking, inline skating or playing contact sports.

Other causes include:

·         Indirect forces that jolt the brain violently within the skull, such as shock waves from battlefield explosion

·         Bullet wounds or other injuries that penetrate the skull and brain

 Dementia and Traumatic Brain Injury

Over the past 30 years, research has linked moderate and severe traumatic brain injury to a greater risk of developing Alzheimer's disease or another type of dementia years after the original head injury.

·     One of the key studies showing an increased risk found that older adults with a history of moderate traumatic brain injury had a 2.3 times greater risk of developing Alzheimer's than seniors with no history of head injury, and those with a history of severe traumatic brain injury had a 4.5 times greater risk.

·      Other studies — but not all — have found a link between moderate and severe traumatic brain injury and elevated risk.

·     Emerging evidence suggests that individuals who have experienced repeated traumatic brain injuries (concussions) or multiple blows to the head without loss of consciousness, such as professional athletes and combat veterans, are at higher risk of developing a brain condition called chronic traumatic encephalopathy (CTE) than individuals who have not experienced repeated brain injuries.

·      Current research on how traumatic brain injury changes brain chemistry indicates a relationship between traumatic brain injury and hallmark protein abnormalities (beta-amyloid and tau) linked to Alzheimer's.

·     Some research suggests that traumatic brain injury may be more likely to cause dementia in individuals who have a variation of the gene for apolipoprotein E (APOE)called APOE-e4. More research is needed to understand the link between APOE-e4 and dementia risk in those who've had a brain injury.

 

Treatment and outcomes

The most serious traumatic brain injuries require specialized hospital care and can require months of inpatient rehabilitation. Most traumatic brain injuries are mild and can be managed with either a short hospital stay for observation or at-home monitoring followed by outpatient rehab, if needed.

Treatment of dementia in a person with a history of traumatic brain injuries varies depending on the type of dementia diagnosed. Strategies for treating Alzheimer's or another specific type of dementia are the same for individuals with and without a history of traumatic brain injury.

Alzheimer's disease and other dementias that may occur as a long-term result of traumatic brain injury are progressive disorders that worsen over time. As with all dementias, they affect quality of life, shorten lifespan and complicate the effort to manage other health conditions effectively.

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                     “After Services: Veteran Families in Transition”                  

Excerpt “What happens to families after separation from the military? Joy and optimism at the return of a loved one may compete with painful realities and adjustments.”

Sections include

·         Today’s Military Veteran Family

·         Life Reshuffled

·         Physical and Cognitive Wounds of War

·         Assessing Veterans and Families: A Provider’s Key Questions

·         Links to NCTSN Military and Veteran Families Questionnaire (MVFQ)

·         Exploring Solutions and Collaborations

·         Community Provider Toolkit- Serving Veterans Through Partnership

·         Resources and Links

Please share these resources with others in your organizations and networks! Thank you to our Veterans and their Families for your service. We hope these materials will assist our Veteran Families in their transitions.

Gregory Leskin, Ph.D.

Director, NCTSN Military and Veteran Families Program

LCVFSF3-18-16NCTSN Veterans Families Page 1

To Read the Entire Report, Click Here

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 These Are The New Therapies Being Used To Combat PTSD In War Veterans

Traditional psychotherapy may combat the effects of post-traumatic stress for many veterans — but not all of them. Seattle's Veterans Affairs hospital on Beacon Hill has started using several different methods to help our wounded warriors. These new ways to treat and alleviate PTSD didn't come from a government bureaucrat, a clinical study, or an act of Congress. Instead, local agencies and experts around Seattle decided to see if several new programs could work. So far, these innovations seem to be working, and here's why.

Via The National Center for Telehealth And Technology (T2)

SMARTPHONE APPS

Traditional psychotherapy may combat the effects of post-traumatic stress for many veterans — but not all of them. Seattle's Veterans Affairs hospital on Beacon Hill has started using several different methods to help our wounded warriors. These new ways to treat and alleviate PTSD didn't come from a government bureaucrat, a clinical study, or an act of Congress. Instead, local agencies and experts around Seattle decided to see if several new programs could work. So far, these innovations seem to be working, and here's why.

FLY FISHING

One interesting therapy involves fly fishing experts from Project Healing Waters Fly Fishing. These experts teach some veterans how to catch fish using handmade flies, reports Seattle Magazine. Many veterans use this time to concentrate and relax, as fly-tying gives their minds something else to concentrate on through the detailed work involved. Once they finish tying flies, veterans test them out on fishing trips. This low-tech therapy counters some high-tech ways to ease PTSD.

VIRTUAL REALITY

A virtual reality tool developed at the University of Washington also helps bring soldiers back into the memories of their trauma in the hope that they can reduce anxiety symptoms. The virtual reality program, called IraqWorld, has visuals and sounds similar to what soldiers may experience in a real combat zone. Once warriors confront the PTSD symptoms, psychologists believe that symptoms lessen and eventually dissipate completely. Aside from real-world experiences, actual physical activity may also alleviate symptoms.

Via National Center for Telehealth And Technology (T2)

MOVEMENT THERAPIES

Movement therapies help with PTSD symptoms as well. One such therapy combines yoga, philosophy, and traditional psychotherapy into one session. Yoga helps calm the mind and body while the wounded warrior focuses on breathing and the psychological aspects needed to ease PTSD. Yoga therapies are used at many military installations, notes the New York Times.

It's important that complementary therapies are used because different people process stress in different ways, and every wounded warrior needs treatment. Many of these complementary activities don't feel like therapy. Approximately 30 percent of veterans in combat zones have PTSD symptoms, says the City of Seattle. As many as half of veterans diagnosed with psychological issues don't seek treatment for fear of social stigmas or lack of drive to confront their problems. Fly fishing, mobile apps, yoga, and virtual reality all attempt to lessen those concerns while providing a wide range of possibilities for therapy.

Via Project Healing Waters Fly Fishing, Inc.

Because PTSD is so widespread among veterans, it is important we make more therapies available to these soldiers. Tell the VA to follow Seattle's example and approve more therapies for PTSD.

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PUBLIC RELEASE: 5-FEB-2016

Pilot study shows meditation can help US veterans manage chronic pain

WASHINGTON, D.C. (Feb. 5, 2016) --They return to the United States with multiple types of trauma, and suffer from one of the highest rates of chronic pain of any population in the United States. They are U.S. veterans. A major challenge for health care providers is how to help them alleviate pain that will last a lifetime. Now, a new study suggests veterans may be empowered to help themselves with the practice of meditation.

A small pilot study conducted at the Washington, D.C. Veterans Affairs Medical Center reveals that veterans who practiced meditation reported a 20 percent reduction in pain intensity (how bad pain hurts or feels), as well as pain interference, how pain interferes with everyday aspects of life, such as sleep, mood, and activity level. The reductions were consistent across several methods by which doctors commonly measure pain in patients.

"Meditation allows a person to accept pain and to respond to pain with less stress and emotional reactivity. Our theory is that this process increases coping skills, which in turn can help veterans to self-manage their chronic pain," said Thomas Nassif, Ph.D., a professorial lecturer in American University's Department of Health Studies, researcher at the D.C. Veterans Affairs Medical Center, and lead author of the new study published in Military Behavioral Health.

Pain is a significant health issue among the approximately 2.6 million service members who have served in Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom in Iraq since these conflicts began in 2001, according to the Veterans Health Administration. Musculoskeletal pain conditions are the most frequently diagnosed medical issue, exceeding any other medical and psychological concern. Chronic pain is also found in most combat veterans who sustained a traumatic brain injury.

The form of mindfulness meditation administered in the study, Integrative Restoration Yoga Nidra, or iRest, is used at Veterans Health Administration medical centers and active-duty military facilities nationwide. The Army surgeon general's Pain Management Task Force has cited iRest as a Tier I intervention for managing pain in military and veteran populations.

The pilot study consisted of four male veterans who received iRest meditation treatment, and five who did not. All study participants served in combat and returned to the U.S. with chronic pain and moderate TBI. The study participants attended meditation sessions twice weekly at the D.C. Veterans Affairs Medical Center and were given iRest recordings to engage in self-practice as well. By the end of eight weeks, the study participants had acquired useful mindfulness skills that empowered them to use meditation as a tool to help manage their pain, Nassif said.

"In many cases, primary care physicians are the ones expected to help individuals overcome their chronic pain," Nassif said. "One of the most commonly used tools we have in our toolbox is opioids. Veterans in this study, and many who come to meditation sessions, find that opioid medication is a short-term solution. Meditation could be a useful tool to help veterans manage their pain over the long term."

The study calls on health care providers to promote self-management in patients by disseminating strategies and techniques to help patients prevent, cope with, and reduce pain, and concludes that iRest represents one promising self-management approach. More research should be conducted, Nassif said, and future studies should include quantitative measures and a greater number of participants.

Author contributors include Julie C. Chapman, Psy.D., director of Neuroscience, Neurology Service, Veterans Affairs Medical Center, Washington, D.C.; Deborah O. Norris, Ph.D., founder and executive director, The Mindfulness Center, Bethesda, Md.; Friedhelm Sandbrink, M.D., neurologist and pain specialist, Neurology Service, Veterans Affairs Medical Center, Washington, D.C.; Karen L. Soltes, LCSW, iRest Instructor; Matthew Reinhard, Psy.D., director, War Related Illness and Injury Study Center, Veterans Affairs Medical Center, Washington, D.C.; and Marc R. Blackman, M.D., Associate Chief of Staff for Research and Development, Veterans Affairs Medical Center, Washington, D.C.

American University is a leader in global education, enrolling a diverse student body from throughout the United States and nearly 140 countries. Located in Washington, D.C., the university provides opportunities for academic excellence, public service, and internships in the nation's capital and around the world.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

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New PTSD Perspective

ON MONDAY, 01 FEBRUARY 2016.

What Does a Parrot Know About PTSD?

An unexpected bond between damaged birds and traumatized
veterans could reveal surprising insights into animal intelligence.

Charles Siebert,  JAN. 28, 2016

Nearly 30 years ago, Lilly Love lost her way. She had just completed her five-year tour of duty as an Alaska-based Coast Guard helicopter rescue swimmer, one of an elite team of specialists who are lowered into rough, frigid seas to save foundering fishermen working in dangerous conditions. The day after she left active service, the helicopter she had flown in for the previous three years crashed in severe weather into the side of a mountain, killing six of her former crewmates. Devastated by the loss and overcome with guilt, Love chose as her penance to become one of the very fishermen she spent much of her time in the Coast Guard rescuing. In less than a year on the job, she nearly drowned twice after being dragged overboard in high seas by the hooks of heavy fishing lines.    Continue Reading

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The War Disorder Beyond the Battlefield

Click here to read

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Clinician Certification and Equine Therapy Scholarships Are Available

Gestalt10-17-14

A fully accredited Gestalt Equine Therapy sessions for clinicians are conducted by Helena Lee, MA, LPC, RN of Urban Balance in Denver, Colorado. The session entails learning basics about horses followed by intense interactions between student and horse. The objective of the training is to enlighten clinicians about how humans and animals build trust through various forms of interpersonal communications. The benefits that are derived from re-living the powerful experience of learning how to trust another can be applied as a basic building block in many forms of recoveries.

The day's seminar prepares each clinical participant to accurately assess and refer consumers for one of 12 ten-week equine therapy scholarships to be conducted at Horsefeathers by Urban Balance that LCVFSF will award over the course of the year.

The scholarships are for active duty military, Veterans and/or their family members who are actively seeking relief from the trauma of deployment: pre, during or post. These include: PTSD, Traumatic Brain Injury, sexual trauma, grief, suicide, re-integration, or substance abuse. Gestalt Equine Therapy is conducted at Horsefeathers Therapeutic Riding Center in Lake Forest, IL. Each scholarship is for 8 weeks of riding. The first 3 weeks will be a one ½ hour session per week. The second 5 weeks will be two ½ hour sessions per week. We are currently recruiting candidates for the awards. To refer a consumer for scholarship application please contact us 847-986-4622

If you are a clinician and are interested being accredited for Gestalt Equine Therapy, we are recruiting for the second class. To apply for the session, contact M.J. Hodgins, Director of Communitry Development for LakeCounty Veterans and Family Services Foundation: This email address is being protected from spambots. You need JavaScript enabled to view it.">MHodgins@lake>vetsfound.org or (847) 986-4622.

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Veterans with PTSD at Higher Risk for Sleep Apnea

 

Researchers found that 69 percent of veterans who were evaluated for self-reported PTSD symptoms also were at high risk for sleep apnea.

DARIEN, Ill., May 20 (UPI) -- Young veterans with post-traumatic stress disorder, or PTSD, have a high probability of obstructive sleep disorder, according to a small study. 

"The implication is that veterans who come to PTSD treatment, even younger veterans, should be screened for obstructive sleep apnea so that they have the opportunity to be diagnosed and treated," said Sonya Norman, PhD, researcher at the San Diego VA, director of the PTSD Consultation Program at the National Center for PTSD, and an associate professor of psychiatry at the University of California San Diego School of Medicine, in a press release. "This is critical information because sleep apnea is a risk factor for a long list of health problems such as hypertension, cardiovascular disease and diabetes, and psychological problems including depression, worsening PTSD and anxiety."

The study was conducted based on veterans also reporting snoring and fatigue, motivating researchers to launch the investigation. Among the 159 veterans included in the study, 69 percent were seen as being at high risk for sleep apnea.

Younger veterans generally aren't screened for sleep apnea, however researchers believe that aspects of PTSD, such as disturbed sleep and sleep deprivation, psychological and physical stressors of combat, hyperarousal due to those stressors, may increase the chances of sleep apnea occurring.

The study is published in Journal of Clinical Sleep Medicine.

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 An instructor with Joined Forces Yoga teaches a class for Soldiers with the 2nd Brigade Combat Team, 101st Airborne Division (Air Assault) offered by Joined Forces Yoga at Fort Campbell, Kentucky, April 23, 2015. (U.S. Army photo/ Sgt. Sierra A. Fown)

An instructor with Joined Forces Yoga teaches a class for Soldiers with the 2nd Brigade Combat Team, 101st Airborne Division (Air Assault) offered by Joined Forces Yoga at Fort Campbell, Kentucky, April 23, 2015. (U.S. Army photo/ Sgt. Sierra A. Fown)

VA Weighs PTSD Care that Avoids Traumatic Memories

NAPLES, Italy — Revisiting a traumatic event in a therapy session can open a door to relief for those suffering from post-traumatic stress disorder. But confronting bad memories may not be the answer for everyone.

After years of emphasizing trauma-focused psychotherapy as a preferred treatment for PTSD, researchers and clinicians with the Department of Veterans Affairs are considering forms of therapy that steer clear of traumatic memories, including those focusing on mindfulness.

Although relatively new and backed by less research than other therapies, the treatments could expand practitioners’ options and could offer patients a greater say in their care, a top VA clinician said. That, in turn, could lead to better outcomes.

“I think the coming years will be a maturation of the field, the realization that there’s more than one door,” said Harold Kudler, chief consultant for VA Mental Health Services.

Since 2008, the VA has largely recommended therapies that focus on trauma. Among the most common is cognitive-processing therapy, or CPT, which pushes patients to readjust their associations with negative memories. Another, prolonged exposure, seeks to reduce the power of a negative memory by having the patient confront it repeatedly.

A study published this month in the Journal of the American Medical Association suggests a number of new possibilities. VA researchers in Minneapolis found that a group of PTSD patients enrolled in a program with yoga and breathing meditation over nine weeks reported greater improvement in symptoms than their counterparts in a control group that taught coping skills.

“It demonstrates that we can have another important arrow in our quiver,” Kudler said of the study. “Because there are many people who aren’t ready to do these kinds of (trauma-focused) therapies.”

Alternative therapies likely will receive more discussion next year as the VA begins work on an updated set of guidelines for PTSD treatment, Kudler said. The publication, a collection of research and clinical studies with recommended treatments, affects thousands of veterans and servicemembers by educating the practitioners who see them.

The VA recommends trauma-focused treatments like cognitive-processing therapy and prolonged exposure because they are considered evidence-based, meaning the substantial weight of research shows they relieve symptoms of PTSD, said Paula Schnurr, executive director of the VA’s National Center for PTSD.

“Right now, a person’s best chance of having a meaningful improvement in PTSD, in remission, in getting relief, is with the trauma-focused therapies,” she said.

But engaging and retaining patients in such therapies has been a challenge. A recent Minneapolis VA review of cases for a large sample of veterans offered cognitive-processing therapy or prolonged exposure found that roughly 50 percent never began or dropped out of their program.

Some patients simply may not be ready for intense psychotherapy, Kudler said, a consideration often overlooked by therapists.

“I think in the rush to do good and the belief in what they do, you’ll hear, ‘Well this is good therapy, you should do this,’ ” Kudler said. “The part that is missing is the patient. Therapy is about the patient. Working with veterans is always about the veterans.”

As mental health care for veterans moves toward a patient-centered care model that emphasizes patient preference, clinicians will need more options at their disposal, Kudler said, even if that means getting ahead of the science and using alternative treatments.

The researchers in the mindfulness-based stress reduction study noted the tentative nature of their findings, calling them “promising” but in need of validation by further studies. Schnurr has authored a forthcoming study on a different mindfulness-based treatment, called acceptance and commitment therapy, that shows patients received no more relief from PTSD symptoms than those in a control group.

To date, little research has been done into matching therapies with patients, Schnurr said. For example, the needs of a Vietnam veteran with a history of abuse as a child may differ than those of another patient. “Right now, I think patient preference is incredibly important because we don’t have the science to know if a particular treatment will benefit them,” she said.

For Kudler, trauma-focused therapies are still the best options for patients. But the clinical side of mental health care has a long history of flexibility, he said.

“We won’t, and needn’t, wait for science to say different treatments will work better for certain patients,” he said.

© Copyright 2015 Stars and Stripes. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Efficacy of PTSD treatments questioned

By Patricia Kime, Staff writer

Two treatments for post-traumatic stress that are considered the gold standard for treating the condition in combat veterans are not significantly more effective than some other approaches, including medication, stress management therapy and mindfulness, according to a new study.

Two types of therapy that focus on confronting and dealing with trauma — cognitive processing therapy and prolonged exposure therapy — are largely considered front-line treatments for PTSD.

But a review of PTSD treatment studies dating back to 1989 found that while the two therapies reduce symptoms, they also have high dropout rates and low follow-through, making them less effective and less likely to completely alleviate symptoms.

According to the research, published in the Journal of the American Medical Association on Aug. 4, nearly a quarter of patients who tried CPT or PE dropped out.

Still, nearly 70 percent of those who received one of the two front-line therapies saw a decrease in symptoms, even as two-thirds still met the criteria for having PTSD after treatment.

"When we looked hard at how effective these two treatments were, as well as some other psychotherapies, we found they are reasonably effective — but they are not as definitively helpful as we would like," said Dr. Charles Marmar, a psychiatrist at NYU Langone and one of the article's authors.

According to the review, conducted by Marmar and other researchers at the Cohen Veterans Center for Post-Traumatic Stress and Traumatic Brain Injury and NYU Langone Medical Center, medications, as well as therapies that teach personal skills and coping strategies or focus on relaxation, mindfulness, yoga and exercise, were nearly as effective as the CPT and PE therapy.

Roughly 13 percent of Iraq and Afghanistan veterans have been diagnosed with PTSD, while 10 percent of Persian Gulf War veterans and 11 percent of Vietnam veterans still have symptoms, according to the study.

To treat the disorder — characterized by intrusive thoughts such as anxiety and nightmares, feeling "on edge" or hyper-aroused, or being detached or disconnected, among other symptoms — clinical practice guidelines used by the Veterans Affairs and Defense departments recommend trauma-related exposures like CPT and PE to treat PTSD.

But other therapies, including conventional medications like antidepressants and some complementary and alternative treatments, appear to help many affected veterans nearly as much as those frontline treatments and could help those who have tried either but failed to respond, according to the study authors.

Marmar recalled two World War II veterans whom he treated while working at the San Francisco VA Health System: One had experienced daily nightmares for 40 years with medication, the other sought marriage counseling with his wife for marital problems that began as soon as he returned from the war.

Neither therapy cured the veterans' PTSD. But they helped eliminate symptoms, Marmar said.

A dose of medication let the first veteran sleep peacefully, with the intrusive nightmares retreating to twice a month. The couple embraced coping strategies that improved their marriage, even after nearly 50 years together.

"My experience is one of great optimism," Marmar said. "Don't give up if the first treatment or second treatment doesn't work. ... It's a lot of trial-and-error work, but with persistence, flexibility and compassionate commitment for the veteran, every patient should to be able to get the assistance they need."

For some veterans, treatment may mean group therapy in a structured mindfulness session. Another study published in the same JAMA edition found that in a group of 116 veterans with PTSD, those treated with mindfulness-based stress reduction experienced a greater reduction of symptoms than those treated with "present-centered" therapy, which focuses on managing current problems in a patient's life.

That study was conducted by the Minneapolis Veterans Affairs Health Care System,

Dr. David Kearney and psychologist Tracy Simpson with the VA Puget Sound Health System, said the two articles indicate that proven alternative therapies could be beneficial to veterans.

"Given the large number of individuals with PTSD, not all of whom will opt for or benefit sufficiently from existing approaches, additional treatments suitable for broad implementation are needed," wrote the two in an editorial accompanying the studies

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Chaplain Reflects on Service, Impact of War on Psychological Health

Posted by Carol Roos, DCoE Public Affairs on July 30, 2015

As the Army Chaplain Corps celebrated its 240th anniversary yesterday, retired Army Chaplain David Smith reflected on how his personal experience of war and resiliency – particularly his own recovery from posttraumatic stress disorder (PTSD) brought on during his time in Iraq – affected his work.

As members of the clergy, chaplains possess some advantages that other leaders don't. They are able to listen and counsel service members without prejudice. They can offer spiritual guidance to all faiths no matter the denomination. Service members know that anything they share with a chaplain is confidential.

Smith was deployed nine times during his 30 years in the Army. Nothing brought the war closer than his deployment to Al Anbar Province with the 82nd Airborne Division from August 2003 to April 2004.

"Within a month and a half of being there, I had four near-death experiences with improvised explosive devices and a helicopter hard landing," Smith said. The area was part of the Sunni Triangle, and the insurgency "exploded" in the 82nd's area of operations. He was the task force chaplain supporting 25,000 soldiers. Smith's mission was to be there for others, but Smith found he also needed someone to be there for him.

"The challenges of my mission and the threat were ever-present and presented much stress," he said. "I came back changed." He remained stressed and hypervigilant through three more deployments.

Smith's reactions to the attacks surprised him. Prior to deploying, Smith would prep himself spiritually, emotionally, professionally and physically, and he believed this rendered him somewhat immune to the challenges of the battlefield.

"I thought that this [prep] would have allowed me to be resilient so that no matter what I would go through I would bounce back and continue with the mission," he said. While his preparation helped him get through deployment, Smith learned he was not invincible.

When he returned home from his last deployment in Afghanistan, Smith went to a psychological health professional and submitted to three days of testing.

"The psychotherapist in my outtake session asked me, 'So why are you denying you have [posttraumatic stress disorder (PTSD)]?'"

It was the first time he had been asked that question. Smith was shocked at his diagnosis of something he thought only affected those engaged in fighting. To learn more about PTSD, he volunteered in a pilot program that used cognitive processing therapy. The experience reshaped his ministry, and Smith began applying a different approach to counseling service members with psychological health concerns. Later, he deployed to Afghanistan with two psychologists to assess high-risk soldiers and make sure resources would be available in their communities before they returned home.

"In all, the method was successful," he said. "There was no suicidal ideation, no spouse or family abuse. It [cognitive processing therapy] had a positive effect."

In Smith's final deployment as a senior chaplain in Afghanistan, he served as mentor, coach and trainer for 450 chaplains and chaplain assistants.

Smith's use of psychological health counseling is increasingly shared by chaplains in the military. In a recent pilot, chaplains teamed up with psychological health professionals to prepare service members for mission readiness before and during deployment.

The Army Chaplain Corps, one of the oldest branches of the military, was established July 29, 1775, to serve with the Continental Army. Since then, approximately 25,000 chaplains served in more than 270 major wars and combat engagements.

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Kevlar for the Mind: Helping Professionals for Veterans

Like the decade following the end of World War II, the end of the wars in Iraq and Afghanistan has been marked by a tremendous influx of veterans into the classroom. Traditional "brick and mortar" and virtual universities and schools are frantically trying to keep pace with the opportunities afforded to troops through the Post-9/11 GI Bill.

And these opportunities range from technical and scientific fields as found in the Professional Program for Veterans and Military Personnel at California State University to business as exemplified by the Master of Business for Veterans degree at the University of Southern California.

The allure to veterans of "helping professions" like psychology, counseling and social work has been noted for some time. It's believed that many veterans choose these professional careers because they align with the military culture of service, the desire to help those who are most vulnerable. Fortunately, schools have recognized this draw and are responding accordingly.

The Adler University in Chicago offers a fully online master's degree in military psychology, which is popular among active-duty members and veterans.

Offering courses in the areas of operational psychology, trauma and military ethics, the university prepares entry-level clinicians to effectively work with those who have served. The school also offers a specialization in military psychology within its doctoral program in clinical psychology. Program leaders and many faculty members are former military, which makes for a unique and focused experience.

The Massachusetts School of Professional Psychology specifically recruits veterans and reservists into its doctoral program in psychology, called Train Vets to Treat Vets. Former and current troops are learning about the impact of deployment on military families, effective ways for combating post-traumatic stress, and the impact of addictions on veterans and their loved ones. The school also offers critical field experience working with homeless veterans and teaches traditional psychological skills such as individual and group psychotherapy, psychological testing and research.

Based in "Military City USA," the University of Texas at San Antonio hosts a doctoral program in psychology that focuses on the health of military personnel and veterans. Different from the programs above, this degree prepares psychologists for laboratory and field-based research as opposed to clinical work.

As the need for mental health clinicians and researchers continues to grow, particularly in the area of military psychology, public and private universities and schools will continue to respond.

Caring for our nation's warriors through career training and developing culturally aware mental health providers is a good idea and a necessary response to more than a decade of war.

Bret A. Moore, Psy.D., is a board-certified clinical psychologist who served two tours in Iraq. Email him at This email address is being protected from spambots. You need JavaScript enabled to view it.. This column is for informational purposes only and is not intended to convey specific psychological or medical guidance, 

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Chicago Area Hines Veterans Hospital Sited In Mass VA Scandal

New Generation Of Veterans Has Higher Suicide Risk, Study Finds

By LISA CHEDEKEL Conn. Health I-Team Writer
Mental Health Research Medical Research U.S. Department of Veterans Affairs Richard Blumenthal Joe Courtney Tom Coburn U.S. Department of Defense

Justin Eldridge's family will never fully understand why nothing seemed to ease the anguish of the young Marine and father of five as he wrestled with post-traumatic stress disorder and traumatic brain injury after a deployment to Afghanistan in 2004-05. Despite stints in VA hospitals and an array of medications, he killed himself in his Waterford home on Oct. 28, 2013. He was 31.

"He did his part — he followed the treatment they gave him," said his widow, Joanna Eldridge, who is now raising their children alone. "It just wasn't enough, in terms of following up with him and figuring out why he wasn't getting better. ... We just have to do better at helping these guys after they get home."

A new study suggests that the suicide risk for Eldridge and other veterans who served in the recent wars in Iraq and Afghanistan is significantly higher — 41 percent to 61 percent higher — than for the general population. The study, led by federal Department of Veterans Affairs and Army researchers, is the most comprehensive look to date at the suicide risk for veterans who were on active duty during the recent wars.

The analysis — to be published next month in the journal Annals of Epidemiology — found that the suicide rate was the highest among veterans during the first three years after leaving military service, and that the risk was elevated for both deployed and non-deployed service members. Suicide rates were not significantly different for those who deployed once, like Eldridge, and those who deployed multiple times.

The study notes that before the Iraq and Afghanistan wars, the suicide rates among active duty and former military personnel had been 20 percent to 30 percent lower than the U.S. general population. But the recent wars are "substantially different" from Vietnam or the first Gulf War, with veterans serving longer tours, deploying multiple times and suffering different kinds of injuries, many from blasts.

In addition, absent a military draft, the recent conflicts might have attracted more volunteers "who may have a higher level of risk-taking behaviors" and who face economic stress and employment problems when they transition home.

The study comes as U.S. Sen. Richard Blumenthal, D-Conn., pushes efforts to revive a suicide prevention bill that died last year. The bill, which passed the House earlier this month, would require an outside review of existing suicide-prevention programs at the Department of Defense and the VA to gauge their effectiveness, and make recommendations for improvement. It also calls for more online and community outreach mental health services and includes incentives to attract psychiatrists to work with veterans.

Dubbed the Clay Hunt Suicide Prevention for American Veterans Act — named for a Texas Marine who killed himself in 2011 — the bill was blocked last year by Republican Sen. Tom Coburn, who has since retired from the Senate.

The new study does not propose reforms to stem veterans' suicides, but instead examines patterns within the 1,868 suicide deaths of veterans who had served between 2001 and 2007 and who left the military during that time. It identified suicides through Dec. 31, 2009.

In contrast to previous studies, the review found that deployment to the war zone did not contribute to an elevated suicide risk. In fact, after controlling for age, sex, race and other factors, veterans who had deployed were at a slightly lower risk of suicide than those who had never deployed.

The authors speculated that troops with psychological and behavioral problems might have been held back from deploying, and that troops who did deploy might have received more screening, counseling and treatment than those who did not.

Male veterans were three times more likely than female veterans to kill themselves, the study found. But the suicide risk for female veterans, when compared to women in the U.S. population, was greater than the difference in risk between male veterans and civilians.

In terms of overall deaths, veterans had a 25 percent lower "all-causes" mortality risk, compared with the general population. The authors attributed that lower risk to the so-called "healthy soldier effect": Military members are believed to be healthier than the general population because of the initial screening for service, requirements to maintain certain standards of physical fitness and access to medical care.

Blumenthal, who has called the suicide prevention bill his "first priority," has cited Eldridge's death in discussing the need for legislation. The two men had met when Eldridge helped form a chapter of the Marine Corps League in southeastern Connecticut, Blumenthal said.

"I cannot express in words how deeply sorry I am that [Eldridge's] treatment evidently proved unsuccessful — perhaps not the result of the VA or its doctors or its hospital, [but] because we are only beginning to learn as a country and society how to confront post-traumatic stress and traumatic brain injury with the specialized diagnosis and care that these diseases demand," Blumenthal said in a speech on the Senate floor last fall.

Joanna Eldridge, who was in Washington on Tuesday to attend the State of the Union address as Blumenthal's guest, said she supports the proposed bill and wants to help bring attention to the need for more resources for veterans with PTSD.

In the five years before Justin's death, she said, he struggled with depression and alcohol and drug addiction. After his first suicide attempt, in 2008, the VA told the couple that Justin would have to wait three weeks for specialized treatment, she recalled. She contacted her congressman, U.S. Rep. Joseph Courtney, and Blumenthal, then the state's attorney general, to intervene. The VA admitted Justin three days later.

Although she is grateful for the help that her husband did receive, Joanna said, "I just don't feel like he got the correct treatment. There was a lot of changing his medications — sometimes he'd be in a zombie state." She became his full-time caregiver, supporting him as he kicked alcohol and drugs — but watching helplessly as he spiraled into despair.

"I think he just had enough of the pain," she said. "He didn't want to see it and feel it anymore."

This story was reported under a partnership with the Connecticut Health I-Team (www.c-hit.org).

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Working Effectively with Military Families: 10 Key Concepts All Providers Should Know

New Military Families Product!  

The NCTSN is pleased to announce a new product for providers working with military families. Working Effectively with Military Families: 10 Key Concepts All Providers Should Know is now available. This brief tip sheet outlines the top ten things to keep in mind when working with military families and, for each key concept, includes links to additional information.

   Also, the NCTSN childhood Traumatic Grief Committee has developed three new factsheets:


Collateral damage: The mental health issues facing children of veterans

Not all our casualties of war served overseas in combat. Some are children who never left our shores. Collateral damage, some might call it. Our Cover Story from Martha Teichner:

How many of these homecomings have you seen on television since we went to war in Iraq and Afghanistan more than a decade ago? How many children, looking into a returning soldier's eyes for the parent who went away?

These are supposed to be happy endings, happily-ever-after moments. But often they are anything but.

"Before his deployment, he was always kind of the fun parent," said 15-year-old Abigail Barton, who lives in Newburgh, Ind., Her father, Aaron Barton, is a veteran of the Iraq war.

"I just figured he'd come home and he'd start, just like he used to, start taking us to the park, playing basketball, getting ice cream, all that stuff," said Abigail. "And it just immediately changed, it was completely gone."

"Yeah, I was scared to go out of the house at the time," said Aaron. "Crowds make me nervous. I'm always still looking for snipers."

Barton was a specialist in the Army National Guard. His two deployments in Iraq, in 2005 and again in 2007, left him with injuries to his brain and spine, and post-traumatic stress disorder. He's able to work as a butcher for a local supermarket, as long as he works alone.

"I just get to a point where the rage takes over," Barton said. "I can't control that. It's like a Dr. Hyde-Jekyl thing, you know? It scares me almost as bad as them."

Asked what he tells his children when something happens, Aaron replied, "I usually say, 'Leave me alone.' I would never intentionally harm them." Facing his daughter Abigail, Barton said, "You're my life."

The stories of veterans' lives upended by PTSD are all too familiar to us -- the struggles of their children practically unknown.

"I would get so angry," said Abigail. "I would just think, 'This is what Iraq did to my father.' I'd start blaming it on America's military, you know? I would be like, 'You guys stole my father.'

"So yeah, I developed depression over the time and a lot of anxiety."

"Did your school understand?" asked Teichner.

"No, no. I haven't gotten any help through school. All of my, I guess, depression and anxiety help, it's come from other places -- through our family doctor."

Abigail Barton's brother Alex is 18, and uncomfortable speaking on camera. A year ago, he attempted suicide and spent four days on life support.

What's it been like for Alex, Teichner asked. "Devastating, devastating," said his mother, Wendy Barton, "to see the changes in his dad, and to feel helpless."

"I don't think that America is intentionally neglecting these kids by any means, but I think that they need to wake up," said Wendy Barton, "because this is a real problem, and it is certainly not just my children that are suffering."

It's estimated that as many as five million kids have had a parent or sibling serve in Iraq or Afghanistan since 9/11.

Ron Avi Astor, professor of social work at the University of Southern California, said, "The vast majority of the kids and families, even with a lot of deployments and a lot of moves, about 70 percent or more depending on the issue you're looking at, are doing fine."

But Astor says the other thirty percent -- up to a million and a half kids -- are not doing fine. He studied 30,000 high school students in eight California school districts. Particularly troubling: Astor found one out of four military kids is likely to consider suicide -- significantly more than non-military kids.

And what does the Veterans Administration do for the children and siblings of people who've come back from the war? Not much, said Astor.

The VA spent almost $500 million last year for PTSD treatments for veterans of Iraq and Afghanistan. But their family members (a VA spokeswoman informed us by email) may receive counseling "if determined to be essential to the effective treatment and readjustment of the veteran."

In other words, veterans' kids who have psychological issues are largely on their own, if they get help at all.

Abigail Aaron said that every day when she walks out her door she puts on her "normal" act: "It's like putting on a shirt now. It's incredibly easy. You just walk outside, put on a smile."

Her experience is typical. Her salvation has been soccer.

"Every time I step on the field or anything, all stresses go away," Abigail said. "I don't think about anything but the game, you know?

Christal Presley told Teichner, "My mom had asked me not to talk about the things that were happening with my father. In fact, if my mom mentioned the word Vietnam, it was with a whisper."

Soldiers' kids can be collateral damage in our nation's wars -- all their lives. Presley said, "I was feeling very suicidal, very depressed, very angry, anxiety-ridden."

Until, at the age of 30, Christal did what terrified her most: she asked her father, a Vietnam veteran with PTSD, to talk to her about the war.

"Why do you think at that point he said yes?" Teichner asked.

"Well, I know now it was also because he felt like there was also a hole in his soul and that he never really knew his daughter."

Delmer Presley returned to rural Virginia shattered by the killing he witnessed and participated n in Vietnam, and by the hatred he encountered when he got home.

When he couldn't control himself, he would lock himself in his room and play his guitar, or just face the wall.

"I felt ashamed of myself," he said. "I figured rage would get out, I'd maybe harm somebody or something like that, you know?"

"So while my dad was hiding away in his room, I would lock myself away in my room," Christal said. "I would vacillate between depression and rage just like my father."

It was as if she, too, had PTSD, and by her own admission it was eating her alive, when she first picked up the phone for that first of 30 phone calls.

"He said, 'I don't want to talk about the war, I don't know anything about a war,'" Christal said.

And what was her response?

"We hung up the phone, and slowly but surely, over the next few weeks, he started really opening up to me."

Teichner asked Delmer, "Do you think those conversations helped you?"

"Oh yeah, yeah," he replied. "I mean, sometimes when you have an episode, I just feel like calling her and talking to her, and that helps, you know?"

After a lifetime of telling no one, Christal Presley dared to go public, in a blog that -- to her astonishment -- went viral, and eventually became a book,

She's received emails from thousands of veterans and the children of veterans as far back as WWII. She's begun a website and Facebook group called United Children of Veterans.

"I think part of me still feels the relief of, 'Christal, you're not alone,'" she told Teichner. "And the other part of me feels so sad, because I wasn't alone."

Counting small victories, Christal Presley no longer considers herself a victim of her father's war, but a survivor.

"I understand now that talking can be a matter of life and death," Christal said. "Sharing your story can be a matter of life and death."

When asked what was the best thing that came out of his telephone conversations with Christal, Delmer replied, "For me, just knowing that, I hope she knows I love her, and always have."


 

 On "Transitioning" An Email from an Iraq Veteran

Hi, Im a 17 year old girl Making a Documentary based on PTSD in soldiers as part of my college work. If there is any way you could be of help, (answering questions honesty) id be grateful

Thank you

Kind Regards

Veteran: I'd be happy to help you however I can.

Girl: Thank you sooo much! If possible could you answer this question? Was the transition between soldier and civilian hard? If yes, why? Can you describe (if not too painful) what it was like? Thank you again

Veteran: The transition from being a soldier in combat to being a civilian is hard. It is worth mentioning that making the transition from civilian life to combat is easy. I know you didn't ask this question, but I'm telling you anyway. Pretty much 100% of the people I've ever spoken to about my combat service have been shocked to hear me say this. I've told them that if it were them, they would see how easy it is too. They all disagree with me because they want to think that I am different from them, but they are wrong. We're all the same. Humans are built to fight and survive. Put a human in a situation where she needs to fight and survive, she'll do just fine. She'll find a way and she'll make that transition almost instantly. But once that switch has been flipped, it is not easily unflipped.

Coming home is a motherfucker. "Transitioning" back to civilian life? There is no transition. You never really transition. You either learn to cope or you kill yourself.

When veterans, and civilians who care about veterans, discuss this topic, they usually refer to it as the "civilian-military divide". You can think of it as a wide gap between the experiences of the veteran and the experiences of the civilian. They want to connect—mostly it's the civilian who is making an effort to find an empathetic connection with the veteran. A lot of work is being done to bridge this gap, but I'll let you in on a secret: it will never be bridged. The gap cannot be closed. There will always be a gap. But that's okay. Veterans will usually easily understand other veterans, and civilians will try their very best to understand veterans, and many will do (and are doing) a pretty decent job, but there is not a way you can directly bridge this gap. It's a frustrating predicament. Anyone who thinks otherwise is dangerously naive and will ultimately do more harm than good.

I want to tell you what it feels like to transition back to civilian life, but after trying over and over and over again at social gathers and in casual conversation I have come to the conclusion that there is no way to explain what it's like. Not directly at least. The best way I can think to explain what it is like is like this:

Imagine you worked really hard in high school and after you graduated you got accepted into a fantastic Ivy League school. While at this school you met so many people who were so smart and motivated and brilliant and with them you learned more than you ever thought you could learn. You had incredible experiences, created imaginative work, and made bonds with so many different types of people in so many different ways. You had no idea there was so much that could be experienced in life, you never knew you could feel so much, and so deeply. You grew up, you matured, you were sharp, and mostly you learned how to really care. Now let's say you graduate, and you move back home for a while before going out into the world and deciding what to do next, like get a job. But when you get home, the entire world is a kindergarten class. There are all these ridiculously little chairs and little desks. There's a teacher who is older than dirt and sucks at her job and you can't get her attention to ask her what the hell is going on. Everyone is 4 or 5 years old. They can barely speak English, yet alone talk to you about all your new passions and experiences. When you do try to talk to someone, they just cry, or walk away, or babble stupidly. One kid just peed his pants, another actually shit himself and won't stop laughing. The best part of the day is art time, but everyone just finger-paints badly and makes a mess, all the activities are meant entirely for small children and you are bored out of your mind because the entire world has suddenly become one huge kindergarten class and there isn't one single person you can talk to in an adult voice or about one single thing you care about. Now do this for days. And weeks. And years. It never ends. So you try to act normal, you try to fit in. You try to act like you enjoy finger-painting and you try to act like you enjoy sing-along time and you try your best to not be rude or impatient with Susie when she talks to you about her American Girl doll. But it's all an act. You still know you're trapped in this fucking kindergarten class and you have to either learn to assimilate or go mad. I doesn't matter what anyone says—an adult will never have a meaningful connection with a pants-shitting kindergartener.

This transition is probably something akin to overcoming addiction. The way Alcoholics Anonymous approach it is by first admitting that you are an addict, then working your way from there. I think that once you've been in combat and you've gotten The Addiction (and trust me, it is a powerful addiction), you have to first realize that coping with The Addiction is a life-long process. It's this dark companion you will always have. And if you're smart and healthy about it, you'll look for real ways to live with it. It's different for everyone, but it almost always involves years of therapy. In my humble opinion, I think the best thing for veterans to do is to find an occupation or a hobby where they get to make something. I'm a writer (sometimes), but these days I'm a software engineer.

Being a soldier is about service. True service is something that is done for its own sake and once you've done it there is no record of it; nothing persists. That's the nature of service and that's what makes it great. You do it for the fuck-all of it; you do it for glory; you do it for duty; you do it for love; you do it because someone's gotta do it and you feel like it might as well be you. Service is one of the greatest things you will ever be able to experience as a human: helping other humans. And when your service is complete, it is my opinion that the person who has served should turn to something creative. Something that persists. Something that exists not just for it's own sake but the sake of something else. You've served. Now build.

Jason is the author of the memoir, Just Another Soldier: A Year on the Ground in Iraq, published in 2005 by HarperCollins.

FURTHER READING

One Deployment Didn't Win Afghanistan...And That's OK — Reflections of a Veteran via Lynch, Frank Lynch

Why Society Needs Reintegration — The performance and discipline of the civilian workforce is an unpleasant sight. I fail to find a reason to "reintegrate" into a culture ...


The Remarkable Impact of Yoga Breathing for Trauma

Emma Seppala on January 31st, 2014
"Military guys doing yoga and meditation?" I've been asked in disbelief. It's true that when they first arrived to participate in my study (a yoga-based breathing program offered by a small non-profit organization), the young, tattoo-covered, hard-drinking, motorcycle-driving all-American Midwestern men didn't look like your typical yoga devotees. But their words after the study said it all: "Thank you for giving me my life back" and "I feel like I've been dead since I returned from Iraq and I feel like I'm alive again." Our surprisingly positive findings revealed the power that lies in breath for providing relief from even the most deep-seated forms of anxiety.

As many of us know, there is an unspoken epidemic that is taking 22 lives a day in the U.S.

Who is impacted? Those who are willing to make the ultimate sacrifice in protection of others: Veterans.

How? Suicide.

Why? War trauma.

Average age? 25.

After a long deployment of holding their breath in combat, these men and women often return to civilian life no longer knowing how to breathe. Though the military trains service members for war, it doesn't train them for peace. Ready to give up their life for others, service members embody the values of courage, integrity, selflessness, and a deep commitment to serving. They've trained under extreme conditions to do things most civilians don't encounter: lose parts of their body, kill or injure another human being under orders or by mistake, get right back to work and keep fighting hours after seeing a friend killed, be separated from families and loved ones for months and even years, and live with the horrendous physical and emotional consequences thereof upon their return home.

The National Institutes of Health estimates that 20-30 percent of the over 2 million returning Iraq and Afghanistan war veterans have symptoms of post-traumatic stress disorder (PTSD). This anxiety disorder involves hyper-alertness that prevents sleep and severely interferes with daily life, triggers painful flashbacks during the day and nightmares at night, and causes emotional numbness that leads to social withdrawal and an inability to relate to others. Side effects of PTSD include rage, violence, insomnia, alienation, depression, anxiety, and substance abuse. PTSD symptoms are associated with higher risk of suicide, a fact that may explain the alarming rise in suicidal behavior amongst returning veterans.

While traditional treatments work for some, a large number of veterans are falling through the cracks. Dropout rates for therapy and drug treatments remain as high as 62 percent for veterans with PTSD. Symptoms can persist even for veterans who actually undergo an entire course of psychotherapeutic treatment and drug treatment results are mixed.

Our research at the University of Wisconsin-Madison and Stanford showed that the week-long Project Welcome Home Troops intervention was successful, with our analyses showing significant decreases in PTSD and anxiety. Improvements remained one month and one year later, suggesting long-term benefit. More telling even than the data are the veterans' words; with a veteran of the war in Afghanistan writing:

A few weeks ago shooting, cars exploding, screaming, death, that was your world. Now back home, no one knows what it is like over there so no one knows how to help you get back your normalcy. They label you a victim of the war. I AM NOT A VICTIM... but how do I get back my normalcy? For most of us it is booze and Ambien. It works for a brief period then it takes over your life. Until this study, I could not find the right help for me, BREATH'ing like a champ!

The Project Welcome Home Troops program teaches a specific breathing practice – Sudarshan Kriya Yoga – taught by certified instructors. (To learn more about the science why breathing can help us overcome anxiety and trauma, see this post on the science of breath.) Research in non-veteran populations shows that it's helpful for anxiety, depression, stress, and even gene expression for immunity. An award-winning documentary filmmaker, Phie Ambo, shadowed our entire study and filmed the veterans' transformation. It is called Free the Mind, and you can see trailers on my website.

Although many of the participants in my study were a little reluctant when they first walked in, expecting this to be "hippy dippy sh_ _" or even a "cry fest," they took to the breathing practices immediately. Why? Because the practices are fundamentally empowering – which is what being a service member is all about. Veterans don't easily embrace victim-hood. "I am not a victim." A man or woman with the courage to go to war isn't the type to feel sorry for him or herself. Instead, he or she seeks to take responsibility. Yoga-based practices allow veterans to take responsibility because they don't require dependence on a therapist or drug. The veterans learn how to take care of their own mind and well-being using their own breath.

Besides, the military and yoga have another important element in common: an emphasis on service to society. Empowered and relieved of their anxiety, the veterans I've worked with often reconnect with the spirit of service that led them to volunteer for the military in the first place. Now, their spirit of service is directed in new ways: toward helping other veterans. Travis Leanna, the one who said, "Thank you for giving me my life back," is a veteran of the U.S. Marine Corps and a veteran of the Iraq war who participated in our study and then decided to become an instructor with Project Welcome Home Troops so he could help other vets.

Project Welcome Home Troops would like to help more veterans. But because the organization offers programs free of charge, it needs funds. It recently launched an online fundraising campaign, and a sign of the success of the program is that many of those who have pledged to raise funds and many of those who are donating are none other than veterans themselves!

Inspired by the results that I've seen in our research, I've also created a fundraising page for their campaign, which you can find here. If you feel moved to do so, please start your own fundraising page or donate what you can to mine. Even if you're not able to help financially but wish to contribute, you can do so by sharing this article or the cause on your social networking sites.

For more information on Project Welcome Home Troops and how veterans can attend classes free of charge, please visit this website.
 For more on the science of breathing, see here. 
To see the trailers of the Free the Mind film made about the research we conducted, see here.
 And non-veterans who wish to learn Sudarshan Kriya Yoga can attend classes through the Art of Living Foundation.

Emma Seppala, PhD, is associate director of Stanford's Center for Compassion and Altruism Research and Education and a research psychologist at the School of Medicine. She is also a certified yoga, pilates, breath work and meditation instructor. A version of this piece originally appeared on Psychology Today.

See more at: http://scopeblog.stanford.edu/2014/01/31/the-remarkable-impact-of-yoga-breathing-for-trauma/#sthash.EVlxfVYN.dpuf


Suicides of Young Vets Top Those of Active Duty Troops

Greg Zoroya, USA Today

Whatever torment has driven troops to commit suicide in historically high numbers is following them as they leave the service, according to data released by the Department of Veterans Affairs.

Young veterans just out of the service and receiving health care from the government committed suicide at nearly three times the rate of active-duty troops in recent years, according to data released Thursday by the Department of Veterans Affairs.

VA officials say the data show that severe personal issues driving self-destructive tendencies for those in uniform follow them when they leave the military. The figures were released through a USA TODAY public records request.

"The rates ... are honestly alarming. This group of young veterans appears to be in some trouble," says Janet Kemp, head of the department's suicide prevention program.

The Army has struggled with suicide among active-duty troops more than other service branches during the wars in Iraq and Afghanistan, and the risk persists after soldiers return to civilian life.

Veterans ages 18-24 enrolled in the VA's health program killed themselves at a rate of 46 per 100,000 in 2009 and nearly 80 per 100,000 in 2011, the latest year of data available, according to the figures.

Non-veterans of the same age had a suicide rate during 2009 and 2010, the most recent data available, of about 20 per 100,000, according to data from the Centers for Disease Control and Prevention.

Thirty-six young veterans receiving some form of VA health care committed suicide in 2009 and 65 died by their own hand two years later. Among those in the broader age group 18-29, the suicide numbers rose from 88 in 2009 to 152 in 2011.

The overall suicide rate for active-duty personnel in the Army hovered at 22 per 100,000 during 2009-11, according to military figures.

The number of soldier suicides peaked at 185 in 2012 and a record rate for the Army that year of 30 per 100,000. Numbers for 2013 are not yet available.

Kemp says a preliminary analysis shows that most of them were not receiving mental health therapy but had been treated for other health issues by the VA.

"They're young. They've just gotten out of the service," she says. "They're more concentrated on going home, getting jobs, for the most part. They're not coming in for mental health care."

VA epidemiologist Robert Bossarte says a similar pattern was found among veterans in the past.

"There were were several studies after Vietnam that showed increases in suicide and other forms of injury/mortality for about the first five years following return from service," Bossarte says. "Those rates (eventually) came down to be about the same as the rest of the population."

A positive sign in the new data, Kemp says, is that suicide rates for male veterans of all ages who are diagnosed and treated for mental health problems by the VA have fallen steadily from 2001-2011, in contrast to suicide patterns among non-veteran males.

The same is not true for female veterans, whose suicide rates have not improved and remain higher than women who are not veterans, according to the VA data.

Kemp says recent success in reaching veterans through social media offers hope that more young people can be brought into therapy.

Online chat connections with veterans through the VA's suicide prevention office (hotline number is 1-800-273-8255) have increased from several hundred in 2009 to nearly 55,000 last year, VA data show.

"If we can get them engaged in (mental health) services, we can make a huge difference, and that's encouraging," she says.

_______________________

 

Why Veterans of Combat Need SoulRepair

The Silent Suffering Caused by Moral Injury and Unprocessed Grief

Click to Watch Soul Repair


New opportunities and information available on the Army One Source Resource Center

Treating the Invisible Wounds of War

Over 1.6 million men and women have served in Operation Iraqi Freedom and Operation Enduring Freedom (OEF/OIF) to date. Almost half of those Service Members are married, and almost half have dependent children--the majority 5 years old and younger. In today's unique combat situation--where there is no front line and constant vigilance must be maintained on the ground, where individuals are serving as many as four deployments that are longer in duration than in the past, and where Service Members and Families are asked to give more because of our all-volunteer military--we're learning that, "The wounds of war are not limited to the battlefield."

Army OneSource has launched a formal campaign, supported by the U.S. Army, to encourage civilian health and Behavioral Health providers to complete a FREE online course in the series titled, "Treating the Invisible Wounds of War." This series of courses was designed to help primary care physicians, case workers, mental health providers, and other professionals - who may see a veteran or family member on an unrelated issue - develop a better understanding of the culture in which Service Members and Veterans, as well as their Families, live and work. The course also provides best practices for identifying, assessing, and treating Behavioral Health problems that result from the trauma of war.

1.Treating the Invisible Wounds of War (TTIWW): PTSD/TBI Length: 4 Hours Credit Type(s): 4.0 NBCC Hours - Provider #5470; 4.0 CNE Contact Hours (AP004-1211); 4.0 DC Contact hours; Contact Hours; 0.4 CEU; 4 Contact Hours (category B) CE for NC Psychologists

2. TTIWW: A Primary Care Approach Length: 1 Hour Credit Type(s): 1.0 AMA PRA Category 1 Credit, 1.0 AAFP Prescribed

3. TTIWW: Issues of Women Returning from Combat Length: 3 Hours Credit Type(s): 3.0 Contact Hours NBCC (Provider #5470), 3.0 CNE Contact Hours (AP004-1212), 3.0 Contact Hours, 0.3 CEU; 3.0 DC Contact hours; 3 Contact Hours (category B) CE for NC Psychologists

4. TTIWW: Recognizing the Signs of mTBI during Routine Eye Examinations Length: 2 Hours Credit Type(s): 2.0 COPE Hours (Course ID: 32660-NO), 2.0 Contact Hours, 0.2 CEU

5. TTIWW: Understanding Military Family Issues Length: 3 Hours Credit Type(s): 3.0 NBCC Credit Hours (Provider #5470); 3.0 Contact Hours; 0.3 CEU

In addition to better supporting Service Members, those who complete the course will:\ receive a poster to display in their offices inviting Service Members and their Families to talk to a health professional about any troubling symptoms, receive a Certificate of Completion suitable for framing, be eligible for FREE Continuing Education Unit (CEU)

INSTRUCTIONS:

From your browser, go to http://www.aheconnect.com/citizensoldier/

Step 1: Click on New Users tab at the top of the screen

Step 2: Create a personal user account following the instructions on the screen *NOTE: Be sure to enter your Army OneSource referral code: LMVFS in the space provided. If you don't have a referral code, contact your local Army OneSource Community Support Coordinator.

Step 3: Login to the system using your new ID and password Step 4: Click on Courses tab at the top of the screen

Step 5: Select a course you wish to complete.

Step 6: Click on Register Once you complete the course, your CEU will be recorded, and you will have access to download and print a Certificate of Completion.

Thank you for your support!

NEW STATE DATA

Don't forget to check out the NEW "Returning Service members" maps on your state information page. Click here for direct access to the state search page.

  1. here and login to the AOS Resource to Learn, Exchange or Engage.

Questions, comments or suggestions can be emailed to This email address is being protected from spambots. You need JavaScript enabled to view it..">This email address is being protected from spambots. You need JavaScript enabled to view it.">This email address is being protected from spambots. You need JavaScript enabled to view it.This email address is being protected from spambots. You need JavaScript enabled to view it..">.


Department of Veteran Affairs Community Provider Toolkit

The Department of Veteran Affairs website is a comprehensive source of information for providers regarding the mental health needs of veterans.  We found this particular page focused on community providers including a "toolkit" including military culture information and mini-clinics.  We hope you find it helpful. Click Here.


Suicide Prevention Strategies and Resources to Improve Services for Service Members, Veterans, and their Families

The archive of the webinar entitled, "Suicide Prevention Strategies and Resources to Improve Services for Service Members, Veterans, and their Families," is now available for viewing. Sponsored by SAMHSA's Service Members, Veterans, and their Families (SMVF) Technical Assistance Center, the webinar provided an overview of the risk and protective factors associated with SMVF suicide. Resources and strategies that can be used to help SMVF who are in crisis were discussed. The webinar also included a review of a comprehensive suicide prevention plan and examples of what states, communities, and organizations are doing to reduce SMVF suicides.

Presenters: Janet Kemp, R.N., Ph.D., National Mental Health Program Director, Suicide Prevention and Community Engagement, U.S. Department of Veterans Affairs, Julie Ebin, Ed.M., Senior Prevention Specialist, Suicide Prevention Resource Center, Casey Olson, Prevention, Response, and Outreach Strategic Initiatives Program Manager, National Guard Bureau, Luana J. Ritch, Ph.D., Nevada Policy Academy State Team Leader, Quality Assurance Specialist III, Veterans & Military Families, Nevada Mental Health Services

Please click here to view the webinar replay and access materials: http://www.sprc.org/training-institute/samhsa-webinars

DHCC Daily News

Deployment Health News 14 September 2015

Welcome to the Deployment Health News, now distributed by Gov Delivery! Please be sure to add the new addressThis email address is being protected from spambots. You need JavaScript enabled to view it. to your contact list so that your computer will recognize the address and not place the newsletter in your spam box.

Summit: ‘As Good As It Gets’ Not Good Enough, Speakers Say

DCoE News, 10 September 2015

“A top Pentagon official this morning hammered home the message of the 2015 Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury Summit: providers need to continue improving treatment for psychological health and traumatic brain injury (TBI). ‘We need to continue to push the boundaries of what we know now,’ said Dr. Karen S. Guice, principal deputy assistant secretary of defense for health affairs, to 1,750 live and virtual conference registrants. ‘Look into that next approach, that next better treatment, that next better protocol that gives us a better outcome.’”

Panel: Stigma is obstacle to mental health care

Military Times, 11 September 2015

“The Pentagon and VA have ‘nudged the needle’ forward in promoting mental health treatment to troops and veterans but many still refuse to get care, concerned about stigma, their jobs and psychiatric medications, a panel of experts said Wednesday at a military and family symposium in Washington, D.C. Negative perceptions of mental health conditions and treatment continue to keep troops and veterans from seeking care, but the issue is larger than just the stigma of a diagnosis; it is complicated by concerns over keeping their careers and not wanting to be medicated, panelists said.”

Military medicine tackles suicide with prevention tools for patients, families and providers

Health.mil, 8 September 2015

“When it comes to preventing suicide, the military provides resources for individuals, friends, families and providers who can make a difference and help save lives. The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) and other Department of Defense experts collaborated with the Department of Veterans Affairs (VA) to develop a new set of tools, released last year in support of the 2013 clinical practice guideline for the assessment and management of suicide risk.”

Anxiety Contributes to Suicide Risk

U.S. News and World Report, 1 September 2015

“The majority of Americans view mental health as important for overall health, but only half understand that anxiety is a risk factor for suicide and many perceive that getting help is difficult, according to a new survey, which suggests that reforms under President Barack Obama's health care law are still far from effective. The survey, released Tuesday, ahead of the Sept. 3-7 National Suicide Prevention Week, was conducted by the Harris Poll from Aug. 10-12 and included 2,020 adults ages 18 and over. It was commissioned by the Anxiety and Depression Association of America, the American Foundation for Suicide Prevention and the National Action Alliance for Suicide Prevention.”

Possible new weapon against PTSD

MIT News, 31 August 2015

“About 8 million Americans suffer from nightmares and flashbacks to a traumatic event. This condition, known as post-traumatic stress disorder (PTSD), is particularly common among soldiers who have been in combat, though it can also be triggered by physical attack or natural disaster. Studies have shown that trauma victims are more likely to develop PTSD if they have previously experienced chronic stress, and a new study from MIT may explain why. The researchers found that animals who underwent chronic stress prior to a traumatic experience engaged a distinctive brain pathway that encodes traumatic memories more strongly than in unstressed animals.”

Study Reports High Prevalence of Military Sexual Trauma Among Recent Veterans

MedicalResearch.com, 31 August 2015

“MedicalResearch.com Interview with: Shannon K. Barth MPH, Department of Veterans Affairs, Office of Public Health, Post Deployment Health, Epidemiology Program. Medical Research: What is the background for this study? Response: This study used data from the “National Health Study for a New Generation of U.S. Veterans,” a population-based health study of a sample of 20,563 Operation Iraqi Freedom and Operation Enduring Freedom Veterans and their non-deployed counterparts, conducted in 2009-2011…”

The number of child abuse cases in the military hits a decade high

The Washington Post, 2 September 2015

“Confirmed cases of abuse and neglect of military children increased markedly in 2014, Defense Department data showed on Wednesday, prompting concerns among Pentagon about efforts to safeguard the nation’s over 1 million military children. In fiscal year 2014, officials tracking family violence within the military confirmed 7,676 cases of child abuse or neglect, an increase of 10 percent from the previous year, according to annual statistics on child abuse and domestic violence. Confirmed cases of neglect – which excludes physical and sexual abuse – rose by 14 percent, military officials said.”

Army works to prevent suicide through education, intervention

Army.mil, 3 September 2015

“The International Association for Suicide Prevention and the World Health Organization will observe World Suicide Prevention Day, Sept. 10, with the theme ‘Preventing Suicide: Reaching Out and Saving Lives.’ This observance acts as a call to action to both individuals and organizations that suicide can be prevented through education and intervention.”

Mission Family: Help your family deal with your PTSD

Army Times, 6 September 2015

“It’s the elephant in the room for too many military families — post-traumatic stress. It doesn’t affect just the individual. It affects entire families. In heartbreaking ways, it can change relationships with family members who may not understand the changed behaviors that are manifesting, particularly children, who often have minimal insight into or understanding of the combat experience.”

Injured Heroes, Broken Promises (Part 4) – From marching orders to doctors’ orders

The Dallas Morning News, 3 September 2015

“James Moffatt was as gung-ho as they come. His goal: to become the top enlisted soldier in the Army. But combat changed that. During deployments to Afghanistan and Iraq, he was exposed to multiple explosions, suffering head, neck and spinal injuries. He had achieved the rank of a staff sergeant when he began to suffer symptoms of post-traumatic stress disorder.”

How the Army is Unlocking Soldier Suicide

Government Executive, 8 September 2015

“The phrase ‘war is hell,’ perhaps first uttered by Union Gen. William Tecumseh Sherman during the Civil War, is both a concise description and partial justification for what happens when opposing blades, bullets and bombs meet human flesh. But for some soldiers, those three brief words signify something darker and far more personal. One of the most troubling statistics to emerge from the wars in Iraq and Afghanistan that followed the Sept. 11, 2001, terrorist attacks has been the suicide rate among military personnel.”

Womack clinical trial: Old treatment offers new hope for post-traumatic stress

Fayetteville Observer, 8 September 2015

“It's not a cure-all or a magic bullet, but a century-old medical treatment finding new use among those fighting post-traumatic stress has given new hope to providers and patients on Fort Bragg. Officials at Womack Army Medical Center are on the front lines of treating combat-related post-traumatic stress with a procedure known as a stellate ganglion block.”

3 Ways Modern Technology Increases Veterans' Likelihood of PTSD

Huffington Post, 9 September 2015

“Over the last decade or so, the American public's appreciation for soldiers has generally increased. I've witnessed dozens, possibly hundreds, of people thanking uniformed soldiers for their service, in stores, cafes, and airports. This commercial beautifully reflects that sentiment. We'll celebrate through local parades and discounted prices by major retailers who may or may not do anything special for veterans.”

Across much of US, a serious shortage of psychiatrists

Associated Press, 7 September 2015

“It is an irony that troubles health care providers and policymakers nationwide: Even as public awareness of mental illness increases, a shortage of psychiatrists worsens. In vast swaths of America, patients face lengthy drives to reach the nearest psychiatrist, if they can even find one willing to see them. Some states are promoting wider use of long-distance telepsychiatry to fill the gaps in care. In Texas, which faces a severe shortage, lawmakers recently voted to pay the student loans of psychiatrists willing to work in underserved areas. A bill in Congress would forgive student loans for child psychiatrists.”

Psychology Is Not in Crisis

The New York Times, 1 September 2015

“Boston — IS psychology in the midst of a research crisis? An initiative called the Reproducibility Project at the University of Virginia recently reran 100 psychology experiments and found that over 60 percent of them failed to replicate — that is, their findings did not hold up the second time around. The results, published last week in Science, have generated alarm (and in some cases, confirmed suspicions) that the field of psychology is in poor shape. But the failure to replicate is not a cause for alarm; in fact, it is a normal part of how science works.”

Disclaimer: These published news articles are offered as a service to DoD health care beneficiaries and their health care providers. Articles are selected for dissemination solely based on the military health relevance of the topic. Provision of these articles is intended to rapidly inform clinicians of information that is publicly available to patients, because that information sometimes causes patients to seek medical advice and care. A wide-range of views, positions, and publications are represented in these articles. These views, positions, and publications are not endorsed by nor do they necessarily represent the views of the Deployment Health Clinical Center or any other US government agency or department.

 

About Traumatic Brain Injury

Falls are the leading cause of traumatic brain injury for all ages. Those aged 75 and older have the highest rates of traumatic brain injury-related hospitalization and death due to falls.

Doctors classify traumatic brain injury as mild, moderate or severe, depending on whether the injury causes unconsciousness, how long unconsciousness lasts and the severity of symptoms. Although most traumatic brain injuries are classified as mild because they're not life-threatening, even a mild traumatic brain injury can have serious and long-lasting effects.

Traumatic brain injury is a threat to cognitive health in two ways:

  1. A traumatic brain injury's direct effects, which may be long-lasting or even permanent, can include unconsciousness, inability to recall the traumatic event, confusion, difficulty learning and remembering new information, trouble speaking coherently, unsteadiness, lack of coordination and problems with vision or hearing.
  2. Certain types of traumatic brain injury may increase the risk of developing Alzheimer's or another form of dementia years after the injury takes place. 
    Learn more.

If a Head Injury Occurs

If you or someone you're with experiences an impact to the head and develops any symptoms of traumatic brain injury, seek medical advice even if symptoms seem mild. Call emergency services for anyone who is unconscious for more than a minute or two or who experiences seizures, repeated vomiting or symptoms that seem to worsen as time passes. Also seek emergency care for anyone whose head was injured during ejection from a vehicle, who was struck by a vehicle while on foot, or who fell from a height of more than 3 feet. Even if you don't lose consciousness and your symptoms clear up quickly, a brain injury still may have occurred.

 

Symptomsback to top

Symptoms of a brain injury include:

  • Unconsciousness
  • Inability to remember the cause of the injury or events that occurred Immediately before or up to 24 hours after
  • Confusion and disorientation
  • Difficulty remembering new information
  • Headache
  • Dizziness
  • Blurry vision
  • Nausea and vomiting
  • Ringing in the ears
  • Trouble speaking coherently
  • Changes in emotions or sleep patterns

The severity of symptoms depends on whether the injury is mild, moderate or severe.

  • Mild traumatic brain injury, also known as a concussion, either doesn't knock you out or knocks you out for 30 minutes or less. Symptoms often appear at the time of the injury or soon after, but sometimes may not develop for days or weeks. Mild traumatic brain injury symptoms are usually temporary and clear up within hours, days or weeks, but they can last months or longer.
  • Moderate traumatic brain injury causes unconsciousness lasting more than 30 minutes. Symptoms of moderate traumatic brain injury are similar to those of mild traumatic brain injury but more serious and longer-lasting.
  • Severe traumatic brain injury knocks you out for more than 24 hours. Symptoms of severe traumatic brain injury are also similar to those of mild traumatic brain injury but more serious and longer-lasting.

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Diagnosisback to top

Evaluations by health care professionals typically include:

  • Questions about the circumstances of the injury
  • Assessment of the person's level of consciousness and confusion
  • Neurological examination to assess memory and thinking, vision, hearing, touch, balance, reflexes and other indicators of brain function

Depending on the nature of the traumatic brain injury and the severity of symptoms, brain imaging with computed tomography (CT) may be needed to determine if there's bleeding or swelling in the brain.

Causes and risksback to top

Home Safety and Dementia

Use our online tool, Alzheimer's Navigator, and get a personalized action list on how to prevent falls and make your home safe for someone with dementia. Learn more

Falls are the most common cause of traumatic brain injury, and falling poses an especially serious risk for older adults. When a senior sustains a traumatic brain injury in a fall, direct effects of the injury may result in long-term cognitive changes, reduced ability to function and changes in emotional health.

Vehicle crashes are another common cause of traumatic brain injury. You can reduce your risk by keeping your vehicle in good repair, following the rules of the road, and buckling your seat belt.

Sports injuries are also a cause of traumatic brain injury. You can protect your head by wearing a helmet and other protective equipment when biking, inline skating or playing contact sports.

Other causes include

  • Indirect forces that jolt the brain violently within the skull, such as shock waves from battlefield explosion
  • Bullet wounds or other injuries that penetrate the skull and brain

Dementia and traumatic brain injury

Over the past 30 years, research has linked moderate and severe traumatic brain injury to a greater risk of developing Alzheimer's disease or another type of dementia years after the original head injury.

    • One of the key studies showing an increased risk found that older adults with a history of moderate traumatic brain injury had a 2.3 times greater risk of developing Alzheimer's than seniors with no history of head injury, and those with a history of severe traumatic brain injury had a 4.5 times greater risk.

Does every hit to the head lead to dementia?

Not everyone who experiences a head injury develops dementia. There’s no evidence that a single mild traumatic brain injury increases dementia risk. More research is needed to confirm the possible link between brain injury and dementia and to understand why moderate, severe and repeated mild traumatic brain injuries may increase risk.

  • Other studies — but not all — have found a link between moderate and severe traumatic brain injury and elevated risk.
  • Emerging evidence suggests that individuals who have experienced repeated traumatic brain injuries (concussions) or multiple blows to the head without loss of consciousness, such as professional athletes and combat veterans, are at higher risk of developing a brain condition called chronic traumatic encephalopathy (CTE) than individuals who have not experienced repeated brain injuries.
  • Current research on how traumatic brain injury changes brain chemistry indicates a relationship between traumatic brain injury and hallmark protein abnormalities (beta-amyloid and tau) linked to Alzheimer's.
  • Some research suggests that traumatic brain injury may be more likely to cause dementia in individuals who have a variation of the gene for apolipoprotein E (APOE)called APOE-e4. More research is needed to understand the link between APOE-e4 and dementia risk in those who've had a brain injury.

Treatment and outcomesback to top

The most serious traumatic brain injuries require specialized hospital care and can require months of inpatient rehabilitation. Most traumatic brain injuries are mild and can be managed with either a short hospital stay for observation or at-home monitoring followed by outpatient rehab, if needed.

Treatment of dementia in a person with a history of traumatic brain injuries varies depending on the type of dementia diagnosed. Strategies for treating Alzheimer's or another specific type of dementia are the same for individuals with and without a history of traumatic brain injury.

Alzheimer's disease and other dementias that may occur as a long-term result of traumatic brain injury are progressive disorders that worsen over time. As with all dementias, they affect quality of life, shorten lifespan and complicate the effort to manage other health conditions effectively.