Slide 1

Overview of the common symptoms of PTSD. Overview of the common problems in children of veterans with PTSD including some common mechanisms of vicarious experiences of PTSD in children. Identify interventions for children who may be experiencing indirect effects of their parents traumatization while deployed. Overview of the effects of PTSD on the couples relationship. Describe a recoverybased psycho-education model that provides families with resources that will help them manage and cope more effectively with their loved ones PTSD. Slide 2 Veterans suffering from PTSD or other forms of post-traumatic stress have symptoms that can become catastrophic for families. Catastrophic stress is sudden, unexpected and produces frightening experiences that are often accompanied by a sense of helplessness, destruction, disruption and loss. Slide 3 What distinguishes this loss from normal loss is there is little time to prepare for it, no previous experience, no guidance, feeling isolated, remaining in crises for long period of time, lack of control, disruption and destruction and high emotional impact. Slide 4 A. 1. The person experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. 2. The persons response involved intense fear, helplessness or horror. Slide 5 B. The traumatic event is persistently re- experienced in one or more of the following ways: Recurrent and intrusive images Recurrent distressing dreams of event. Acting or feeling as if the traumatic event were recurring Intense psychological distress at exposure to internal or external cues Physiological reactivity Slide 6 C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness. Efforts to avoid thoughts, feelings or conversations associated with the trauma. Efforts to avoid activities places, or people that arouse recollection of the trauma. D. Marked avoidance of stimuli that arouse recollections of the trauma Slide 7 Re-experiencing Traumatic Events Avoidance and Numbing Symptoms Hyperarousal Easily Startled Irritability and Anger Avoidance of Activities Difficulty Concentrating Difficulty with Trust Slide 8 Extensive research with family members of Vietnam Veterans in the last 20 years has revealed there can be serious consequences on the family of veterans with PTSD. Slide 9 Slide 10 Children may be frightened by watching a parent re-experiencing their symptoms. Children likely do not understand what is happening, and they may start to worry about their parents well-being. Children also may be fearful that their parents cannot properly care for them. Slide 11 A common response to PTSD, Emotional numbing may prevent the Veteran from experiencing positive emotions toward family members. As a result, children may feel unloved or assume that their parent is angry toward them. Slide 12 Parents with PTSD often avoid activities outside the home, including activities with their children. As a result of this lack of involvement, children may feel that their parents do not care for them. Social avoidance and emotional numbing influence the satisfaction that parents with PTSD experience from parenting. Slide 13 Living with someone who is expressing high levels of anxiety and arousal, as well as being constantly on guard for danger, often results in the child developing the belief that the world is a dangerous place one in which he/she needs to be fearful. Slide 14 Children living with individuals who exhibit constant irritability often results in children feeling unloved by their parents. Research has found that this creates barriers to and prevents close family relationships. Increased potential for violence in the home. Slide 15 Substance abuse is often a co-occurring condition in veterans with PTSD (i.e., 50% of veterans). Substance abuse alone results in an array of psychological trauma for children that has been well documented in research and clinical literature. Slide 16 Social and Behavioral Problems Depression, Anxiety Hyperactivity & Difficulty with Concentration Difficulty forming and maintaining friendships. Nightmares about parents trauma. Secondary PTSD related to violence in the home. Slide 17 Over-identified child- experiences secondary traumatization and comes to experience many of the symptoms the parents is having. Rescuer-child takes on parental roles and responsibilities to compensate for the parents difficulties Emotionally uninvolved child-this child receives little emotional support and does not learn how to appropriately cope with emotions, which results in problems at school, depression, anxiety, and relationship problems later in life. Slide 18 Poor Attitude and lack of motivation at school. Negative attitude toward fathers and other authority figures. Higher levels of depression and anxiety. Lower creativity and described as not working up to their ability. Problematic behavior at home and at school. Slide 19 Children are taught to avoid discussion of events, situations, thoughts, or emotions related to their parents experience. They perceive this is a taboo subject and resist asking questions. This tends to increase their anxiety as they often worry about provoking the parents symptoms. Because a child does not understand the parents symptoms, or have details about the traumatic event, the child may develop ideas that are even more horrifying than what actually occurred. Slide 20 When children are exposed to graphic details about their parents traumatic experience, they may start to experience their own set of PTSD symptoms in response to horrific images generated. This has often been referred to as vicarious traumatization. Slide 21 Children may start to identify with the parent to such a degree that they begin to share in his or her symptoms as a way to connect with the parent. Slide 22 Children also may be pulled to re-enact some aspect of the traumatic experience because the traumatized parent has difficulty separating past experiences from present. Slide 23 Redefining Roles, Expectations, and Division of Labor. Managing Strong Emotions. Abandoning Emotional Constriction Creating Intimacy in relationship Creating a Sense of Shared Meaning Surrounding Deployment Experience. Slide 24 .a traumatized soldier often returns to a traumatized family and neither is recognizing the other (Hutchinson & Banks- Williams, 2006, p. 67) Slide 25 Some adjustment issues resolve on their own. Often, however, returning soldiers can exacerbate the familys trauma, (resulting from the deployment experience), because they have difficulty connecting to others, have sleep problems, and miss the structure and camaraderie of military service. Divorce rates among active duty Army officers tripled between 2001 and 2004. Rates among enlisted men increased by 50%. Domestic violence rates among military personnel increased also (Perry & Flournoy, 2006). Slide 26 Short and long-term disruptions to intimacy. Increased difficulties with trust. Avoidance of partner. Preoccupation with guilt, shame and self- blame. Difficulty accessing and managing emotions. Isolating and withdrawing from partner. Increased use of drugs/alcohol. Slide 27 Can identify their problems and express their commitment to resolve them without imposing strict rules about how and when to address them. Utilize skills that address the issues without blaming or judging each other. Have identified others they turn to for support Slide 28 In reaction to the research that has identified the impact of PTSD on family members of Vietnam Veterans, the military, VA, other organizations (SAMSHA, NAMI, etc.) are addressing issues related to children and families of the current returning veterans through education and treatment. Slide 29 Interventions: 1. Development and/or incorporation of evidence- based practices for the treatment of PTSD. 2. Early screening for returning veterans with free treatment for a period of five years. 3. Preparing families for mobilization, deployment, and return. 4. Availability of treatments for veterans that incorporates family interventions. 5. Efforts to reduce stigma associated with treatment. Slide 30 Psycho-education: PTSD and its effects A Strength-based approach Creating a support network Instilling hope Tools to help families manage crises. Slide 31 Do not confuse the secondary symptoms with primary symptoms and provide treatment only to the child. Assess for domestic violence, child abuse, overdisclosure, or other forms of exposure of the child to violence. Examine assessment tools for exploring trauma issues i.e., International Society for Traumatic Stress Studies (ISTSS) Resources for Clinicians list (ISTSS, 2007). Educate the parent(s) about the potential influence of PTSD symptoms on children. Slide 32 Encourage the parent to explain the reason for the parents difficulties without providing graphic details. (children should see that symptoms are in no way related to them). Provide information on resources to help the parent know how to prevent transferring their symptoms or the consequences of their symptoms to their children. Veteran Centers (www.va.gov/rcs/)www.va.gov/rcs/ Veterans Affairs (www.va.gov) National Center for PTSD (www.ncptsd.va.gov)www.ncptsd.va.gov Slide 33 Encourage the veteran to seek treatment first so that other family members involvement should be viewed as an adjunct therapy that provides support and education. Depending on the degree of symptoms and age, individual therapy with the child may be indicated. Regardless of treatment suggestions, it is important that each person in the family have a voice in expressing his or her concerns. Slide 34 Slide 35 Slide 36