1 st sergeant’s brief lcdr tenaya n. watson, ph.d. u.s. public health service licensed clinical...
TRANSCRIPT
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11stst Sergeant’s Brief Sergeant’s Brief
LCDR Tenaya N. Watson, Ph.D.U.S. Public Health Service
Licensed Clinical PsychologistMaxwell AFB Mental Health Clinic,
42nd MDG(Slides Adapted from Neysa Etienne, Psy.D. & Chad
Morrow, Psy.D.)
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RATIONALE FOR 1st SERGEANTRATIONALE FOR 1st SERGEANT“…the most important enlisted person, give them the most pay and I almost feel like making all Second Lieutenants salute them. The ones I have worked with in the past and many others, I would gladly give the first salute. The First Sergeant is the Captain’s Chief of Staff. A poor one will ruin a good troop no matter what kind of Captain they have. And many a poor Captain has had his reputation saved and his troop kept, or made good, by a fine First Sergeant”
Colonel Charles A. Romeyn,
The Calvary Journal, July 1925
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SIGNIFICANCE OF A SYMBOLSIGNIFICANCE OF A SYMBOL
DIAMONDS 1st SERGEANTUNBREAKABLE LEADERSHIP STRENGTH
EXCELLENT OPTICAL CHARACTERISTICS IDENTIFY AND HIGHLIGHT
FORMED UNDER PRESSURE/HEAT SACRIFICES IN THE PROCESS
RESISTANT TO IMPURITIES/SCRATCHING
HIGHER CODE OF CONDUCT/ETHICS
HARD TOUGH MATERIAL HANDLE TOUGH SITUATIONS
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GOALS OF THIS BRIEFGOALS OF THIS BRIEFULTIMATE GOAL: HELP YOU DO YOUR JOB BY MAKING AN INFORMED DECISION AS YOU SERVE YOUR AIRMAN
WE WILL COVER TWO PSYCHIATRIC CONDITIONS: -Post-Traumatic Stress Disorder (PTSD)-Suicide-Interaction between the two
CRITICAL MATERIAL TO ADDRESS : -Collateral Information-Cause-Symptoms-Treatment
PROVIDE HIGH-YIELD RECOMMENDATIONS:-Intervene-Save Lives-Empower Your Airman
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WHAT IS WHAT IS PTSD???PTSD???PTSD IS AN ANXIETY DISORDER
-Emotion of Anxiety:Feeling fear, terror,
helplessness-Physiological Manifestation
Changes in breathing, body temp, heart rate
PTSD is an EMOTIONAL REACTION to a Traumatic Event-Definition of Traumatic Event
Actual threat to life or physical injury
Perceived threat to life or physical injury
Diagnostic concerns with PERCEPTION & EXPERIENCE-Any experience is unique to individual perception-Either direct experience or witness to event-Subtlety of perceptions and witnessing can block 1st Sgt action
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T: traumatic eventR: re-experienceA: avoidanceP: persistent arousal
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ExperiencedActualWitnessThreatened
Intense emotionsFearHelplessnessHorror
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Persistently re-experienced (at least 1)Distressing recollectionsDreamsRe-occurringPsychological distress @ exposure
Physiological reactivity @ exposure
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Avoidance of associated stimuli (at least 3)Thoughts/feelingsActivities/people/placesInability to recallDiminished interest in significant activities
Detachment/estranged from othersRestricted range of affect (emotionally numb)
Foreshortened future
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Increased arousal (at least 2)Falling or staying asleepIrritability/outbursts of anger
Difficulty concentratingHyper-vigilanceExaggerated startle response
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Longer than 30 daysClinically significant distress
ImpairmentsSocial OccupationalOther
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Sleep problemsWork “sucks”Family problemsApathy & AnhedoniaAbsencesSick call/medical appointmentsChronic PainANGER
• CONSIDER CONTEXT (pre/post deployment)
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ANGERANGERTHE ULTIMATE EMOTION BLOCKERTHE ACCEPTABLE EMOTIONA BONDING EMOTION: Common Enemy
THE ANGER SOLUTION- WHY BLOCK?ANGER BLOCK (-) Emotions
ANGER BLOCK (+) Emotions
Uncertainty/Confusion
Happiness
Disappointment/Distress
Fondness
Worry/Frustration
Closeness
EQUALS WEAKNESS AVOIDS LOSS
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HOW DOES IT HOW DOES IT DEVELOP???DEVELOP???PTSD IS A LEARNED BEHAVIOR
HOW IS THIS BEHAVIOR LEARNED?UCS----------------------------------------UCR(Food) (Salivation)CS------------------------------------------ CR(Bell) (Salivation)UCS---------------------------------------- UCR(IED Blast) (Anxiety)CS-------------------------------------------CR(Environment) (Anxiety)
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Why does IT Why does IT LASTS???LASTS???
BEHAVIOR CONSEQUENCE FUTUREDo Something Lose something
goodDo it less
Do Something Get rid of something bad
Do it more
Do Something Get something good
Do it more
Do Something Get something bad Do it less
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RECOMMENDATIONRECOMMENDATION
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INFLUENCE OF 1INFLUENCE OF 1stst SHIRT???SHIRT???
Acknowledge their courageCommunicate validation of symptoms Share your story if appropriateOffer to facilitate a clinic appointment
Remain non-judgmental of experience
Attempt to collaborate the next step
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Treatment obstaclesTreatment obstacles1.Avoidance of trauma-related material• Triggers• Feelings• Activities• Thoughts• Images• Situations
2.The presence of inaccurate thoughts/beliefs• “The world is unpredictably
dangerous”• “I am unable to cope”
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PROLONGED EXPOSURE > 60 research studies support efficacy
Inadequate evidence supporting medications as effective treatments
Early evidence suggests physical symptoms will not improve if PTSD is not adequately addressed first
Two parts of exposure• Imaginal: in the head• In Vivo: in the environment
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Exposure Prolonged Exposure
Maladaptive Cognitions Cognitive Processing Therapy
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National Prevalence = 8%Trauma Victims = 20-30%Vietnam Veterans = 30%Persian Gulf War I Veterans = 10%Soldiers returning from OIF:
Report one or more PTSD symptoms: 22%
PTSD Diagnosis: 12% Latest Research: All Branches• 15-17% PTSD• 25% psychological difficulties
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Anyone in Theatre
Trauma exposure• High risk Groups• History of trauma exposure
Airmen exposed to trauma will recover• Data indicates 60% / 40% Split
Data is mixed on timing of treatment
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PTSD symptoms & Health
Positive for PTSD symptoms Have twice as many medical visits
Miss twice as many work days
PTSD & depression
PTSD & depression account for physical symptoms more than mTBI
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SECURITY FORCES EOD OSI Intel Medics Transport (helicopters) Unmanned Air Planes Combat Controller JET Multiple deployments Longer deployments
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Amongst all Airmen deployed in support of OEF/OIF:Report one or more PTSD symptoms: 1.9%PTSD Diagnosis: 0.35%
Amongst all Airmen deployed on JET missions in support of OEF/OIF:Report one or more PTSD symptoms: 4.7%PTSD Diagnosis: 1%
AF PTSD discharges increased tenfold since 2001From 10 discharges in 2001 to 110 in 2007
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Direct communication Ambiguity fuels the fire
Normalize Provide Personal examples (disclose appropriately)
Support : Constructive Behaviors Help-seeking behavior
Time off for appointments Healthy living
Eating, sleeping, exercise Group activities versus isolation
Discourage: Destructive Behaviors Drinking Drugs Avoidance of responsibility
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Full-blown PTSD is a low base phenomena
PTSD can be effectively treated PTSD is not a remitting disorder1st Sgt’s play a significant roleConsistency/follow-throughConsult with Clinic Providers
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LCDR Tenaya N. Watson, Ph.D.U.S. Public Health Service
Licensed Clinical PsychologistMaxwell AFB MHC
Commercial: 334-953-5430DSN: 493-5430