June 2017 – Multiples Perspectives on PTSD
In observance of Post-Traumatic Stress Disorder (PTSD) Awareness Month in June, we were fortunate enough to have two professionals from Ohio University co-author an essay incorporating two slightly different perspectives. One from that of a university counseling and psychological services director and another from a veterans and military student services director; two professionals who work together closely year in and year out and are, in a lot of way, probably the front line of service for students on campuses coping with PTSD (even before DSS offices). We hope that you enjoy the June 2017 entry.
Something that many of us may be aware of, but don’t give much consideration, is that college students are not immune to experiencing traumatic life events. This may include being exposed to life threatening situations, witnessing traumatic events in person, or learning that those who are close to them have experienced some natural disaster or some other threatening event. Some college students who have these experiences may develop some struggles that result in impairment in their functioning, or result in a significant level of distress. In these cases, it is important to encourage folks to speak to a professional so they can determine, not only if PTSD is present, but also explore ways to treat whatever they may be experiencing so it can become more manageable.
The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM V) has a section that is dedicated to Trauma- and Stressor- Related Disorders, and in this sections it identifies criteria for PTSD. Most folks have probably heard of PTSD and may have some stereotyped notions of what that looks like, but the reality is that PTSD can look very different for each person who is experiencing symptoms. Exposure to a traumatic event, some form of re-experiencing that event, avoidance of something associated with that event, maladaptive thoughts and mood related to the event, and changes in reactivity associated with the event would be a very brief summary of what mental health professionals assess for during treatment. However, these symptoms can manifest in different ways and may not always be observable by others, or even noticed by the person who is experiencing them. This is why it is crucial to seek help, or refer others to seek help.
While it can be challenging to for folks to notice symptoms like this, it is important that we be aware of some of the warning signs that someone may be struggling. Just to clarify, I am not suggesting that we attempt to diagnosis folks who may be struggling. What I am suggesting is that we acknowledge those struggles and refer folks to others who may be able to help. Regarding PTSD, folks may want to notice if someone is no longer interested in activities, if they become irritable, changes in sleeping habits, difficulty concentrating, hyper-vigilance or nervousness around others, or having unwanted reactions to stimuli. These may not exclusively be related to PTSD, but these signs would be suggestive of someone who could be struggling with PTSD or some other mental health concern.
You may be thinking, “but now what?” If you are not the person’s mental health provider, then your task is not to “fix” the person’s issue. As a mental health provider I do not view people as ever being broken, even though they may feel that way. I tend to believe that life events happen that impact us greatly and sometimes we need help learning how to manage that impact in a different, more helpful way. To clarify, this does not mean you are powerless to help that person. What I recommend to people is to take a stance of compassion towards the person and then use that compassion to help guide them to the services that best meet their needs. This is not a one size fits all proposition. Some folks may benefit from being connected to counseling services, others may benefit from seeking a consultation with a psychiatrist. Some students may be eligible for academic accommodations. Someone else may benefit from all the above as well as other resources such as the Veterans and Military Student Services Center, the Survivor Advocacy Program, or other offices on and off campus. Having these discussions and making these suggestions could be the first step for someone getting the help they need.
On a closing note, I also want people to be aware that there is treatment that is helpful for PTSD, and other mental health issues. There is empirically supported treatment that is available, and there are multiple options to consider. That being said, there is not a magic solution that instantly changes everything. Change takes time and it is not always pleasant or fun in the moment. With regards to therapy, I often compare it to hiking. Sometimes while we hike we have to go through mud, or thick brush, or manage challenging situations, but if we are heading towards where we want to go, then it is worth the struggle. I thank you for your time spent reading this, and I genuinely hope that you find ways to care for yourself.
-Barry Brady, PsyD.
Post-traumatic stress disorder, as the name indicates, is a condition of persistent mental and emotional stress occurring as a result of an injury or severe psychological shock, often times involving disturbance of sleep and constant vivid recall of the experience, with dulled responses to others and to the outside world. The following information is centered on veterans with PTSD and what we know about it and how to treat it. Notice that I did not use the word “CURE”. PTSD is manageable. However, for many veterans they may not feel that way!
Approximately 30% of returning personnel from serving in either Iraq or Afghanistan, or both, have some type of mental health diagnosis. Most prevalent are PTSD and depression. If a veteran experiences issues such as described above (sleep disturbance, constant vivid recall, etc.) he/she may not think anything about it but just having some issue that will eventually go away. The problem is that most of the time, these things are persistent and, for many, grow in intensity or become worse.
Since the Vietnam War, the Department of Defense and the Veterans Administration has conducted exhaustive research to understand PTSD, its’ effects, and ways that veterans can cope. From the Mayo clinic, PTSD is generally grouped into four types: Intrusive Memories, Avoidance, Negative Changes in Thinking and Mood, and Changes in Emotional Reactions. Intrusive Memories has to deal with recurring, unwanted distressing memories of an event, often reliving the traumatic event as if it is actually happening again. Avoidance is trying to avoid thinking or talking about the event and/or avoiding places, activities or people that remind the veteran of the event they experienced. Negative Changes in Thinking and Mood deals with negative feelings about oneself or others; an inability to experience positive emotions; potentially feeling emotionally numb; maybe experience lack of interest in activities once enjoyed; and feelings of hopelessness. Finally, Changes in Emotional Reactions have to deal with irritability, angry outbursts or aggressive behavior; always being on guard for danger; trouble concentrating and trouble sleeping. To some extent, veterans deal with some of these on a continual basis. For example, I constantly evaluate my surroundings for any danger. However, the difference in me as compared to someone who has PTSD is that I evaluate my environment because of 20+ years of training! So, what are ways that our veterans deal with PTSD? (MFMER 2017)
When you meet one veteran, you meet one veteran! Yes, there are stereotypes out there about veterans: they always look sharp; they are always disciplined; they have strong work ethics; they are foul-mouthed and noisy; they are mentally and emotionally unstable; etc. For some veterans that may be true. However, a vast majority of veterans DO NOT fit into these stereotypes. Just like all veterans self-medicate! Now, it is true, that some veterans self-medicate when they have PTSD symptoms and don’t know it, or, realize they have PTSD and don’t do anything about it, or have been clinically diagnosed with PTSD and this is their way of dealing with it. Again, the Department of Defense and the Veterans Affairs have made great strides in understanding PTSD and have developed treatments to help our veterans COPE with the symptoms. Of course, the biggest choice in dealing with PTSD is seeking professional counseling services, through either a Psychologist or Psychiatrist. For many of these professionals they could use Cognitive Behavioral Therapy (CBT), which is simply changing patterns of thinking. Or, they could use Evidence-based treatment, which includes elements of CBT. For many other veterans getting involved in Equine, Art/Music, Writing, and/or Imagery therapy does wonders in helping him/her deal with and cope with PTSD.
As the Director of Ohio University’s Veterans and Military Student Services Center, I encourage any of my veterans who think they may have PTSD to seek counseling services either through our Counseling and Psychological Services office on campus or through the Veterans Affairs. If they have been diagnosed with PTSD I encourage them to continue with the treatment they are on; and, I let them know I am available as a sounding board should they need one. I also ensure they know about our Student Accessibility Services office that can assist them in working with their professors for accommodations. I ensure our veteran students that we have resources on campus to help them should they need it. For some veteran students they struggle with the obstacles in transitioning from the military way of life to a college environment. Things such as finding a place to live, registering for classes, not having a set schedule, thinking they know how to study or take notes but in actuality they don’t, or not knowing how to prepare for a test can all trigger a PTSD episode. Should this occur, I hope our veteran students know enough to contact our Veterans Center to let us know what is going on so we can get them the assistance they need. Veteran students need to feel that there are support services that are genuinely concerning about whatever internal struggle they are dealing with, especially PTSD. And, at Ohio University, we make sure our students know and feel that they do NOT have to face this battle alone—we are their university “battle buddy”! When they struggle, we struggle!
-David Edwards, M.Ed.
The June 2017 OH-AHEAD Blog is courtesy of Dr. Barry Brady, PsyD and David Edwards, SMSgt Retired, USAF; M.Ed.
Barry Brady is the Group Coordinator at Ohio University’s Counseling and Psychological Services. He earned his Psy.D. in clinical psychology from Wright State University’s School of Professional Psychology.
David Edwards is the Director of the Veterans and Military Student Services Center at Ohio University in Athens, Ohio. He earned a Master of Science in Education with a concentration in Postsecondary and Adult Education at Capella University.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC
Mayo Foundation for Medical Education and Research (MFMER), M. C. S. (2017, February 18). Post-traumatic stress disorder (PTSD). Retrieved from http://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/dxc-20308550