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Association of Traumatic Stress Specialists

Archive for January 2011

National Survey of College and University Student Veterans

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There’s a new survey being conducted by the University of Utah that we want to tell you about: Researchers are looking to hear from veterans to learn more about their experiences on college and university campuses. They’re seeking greater insight on how veterans transition back to student life, and what “common barriers and issues that veterans encounter in returning to or starting school after serving in the military.”

Click here to take the survey-

Here are some more details:

We would like to ask you to follow the internet link below to a web-based survey. Read the consent information and complete the survey. It is anticipated that your participation in this survey will provide college and university campuses with vital information in helping and serving student veterans, as well as ease their transition into college life and alleviate stress and other issues they may be experiencing. Also, the results will provide important information on how to help those student veterans that may be struggling with the transition. There are no foreseeable risks associated with this study.

The information you provide will be saved in an online database to be analyzed by the Principal and Co-investigators. Demographic information will be asked, (i.e. age, sex, ethnicity, etc.) However, no identifying information will be required therefore; no issues with loss of confidentiality are anticipated.

Questions? Concerns? Complaints?

If you have any questions, concerns, or complaints or if you feel you have been harmed by this research please contact M. David Rudd or Jeff Goulding College of Social and Behavioral Science Dean’s Office University of Utah (801) 581-8620.

Contact the Institutional Review Board (IRB) if you have questions regarding your rights as a research participant. Also, contact the IRB if you have questions, complaints or concerns which you do not feel you can discuss with the investigator. The University of Utah IRB may be reached by phone at (801) 581-3655 or by e-mail at irb@hsc.utah.edu.

How long will this survey take?

It should take APPROXIMATELY 15 minutes to complete the web-based survey. Participation in this study is voluntary. You can choose not to take part and you can also choose not to finish survey or omit any question you prefer not to answer without penalty or loss of benefits.

By following the internet link, reading the consent information and answering in the affirmative that you understand it, you are giving your consent to participate in this study.

Your participation in this study is greatly appreciated and the results will go toward helping student veterans like yourself improve their college experience and enhance opportunities and services for them.

Click here to take the survey-

Written by traumalines

January 31, 2011 at 9:48 pm

More from Queensland’s First Responders

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Earlier this month we shared a video about the first responders of the devastating Queensland floods that tore through the north east portion of Australia. The video was about a 13-year-old boy who sacrificed his own life to save his younger brother’s.

We have another story to share about another one of Queensland’s first responders who helped pick up the pieces after the waters subsided:

HELPING people is in Heidi Wallace’s blood. The mother of one and a lieutenant with the Queensland Fire and Rescue Service on Coochiemudlo for six years, was one of the first to be sent into the flood disaster zone.

For five days, she worked on a fire truck that drove around decimated Brisbane streets stopping at houses gutted after a river of mud bashed its way through their walls.

“I was amazed at what I saw. There was destroyed furniture and piles of stuff stacked up on the footpath everywhere,” Heidi said.

Our first responders have no choice but to face whatever traumatic events confront them, no matter how difficult, no matter how long their experiences stay with them:

Heidi has lived on Coochie for eight years, near her sister, Elly Van Acker, a first responder with the Queensland Ambulance Service, who also worked in flooded areas in Brisbane Elly went to Indooroopilly and Toowong at night, just hours after the flood rushed through Brisbane.

She saw a man walk into the swirling black waters and not return.

“What I saw is personally very confronting and will be with me for the rest of my life,” Ely said.

“Police moved me on so I never found out the man’s fate,” Elly said. “The trauma people experienced will be with them for a long time,” Elly said.

Written by traumalines

January 27, 2011 at 9:28 pm

NIMH: Prevention Research Continues

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It was over a year ago when we first discussed how prevention efforts were becoming the top priority of mental health researchers. Well that hasn’t changed. Since December 2009 (when we first discussed prevention on this blog), the types of traumatic events that triggered PTSD in some people haven’t stopped; unfortunately they’ll never stop.

The conflicts in the Middle East rage on, one of the worst earthquakes in history destroyed parts of Haiti, and viscous violence, like the attack on Congresswoman Gabrielle Giffords, infiltrate our society on a far-too-often basis.

These are just some of the reasons why the research continues into forming a better understanding of why certain individuals react differently to traumatic events. The NIMH has dedicated years to researching traumatic stress reactions, as well as ways to determine which individuals may be more susceptible to long-term mental health issues stemming from traumatic stress.

I really encourage everyone to watch the “Speaking of Science Series — Discussion on PTSD” video from the NIMH. It’s only about 11 minutes long, but both Dr. Robert Heinssen and Dr. Farris Tuma of the NIMH explain how the emergence of prevention has greatly served to increase their industry’s fight, especially within the U.S. military, against traumatic reactions to stress.

Written by traumalines

January 26, 2011 at 8:50 pm

The True Hero of the Queensland Floods

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A 13-year-old Australian boy is being hailed by his fellow countrymen as “the true hero of the Queensland floods.” This boy’s story is one of incredible bravery and self-sacrifice, but also an example of how first responders are exposed to traumatic events that are often hard to forget.

Here’s the boy’s story:

Written by traumalines

January 13, 2011 at 9:21 pm

Haiti: One Year Later

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The Los Angeles Times summarizes the state of the country of Haiti — one year after the devastating earthquake — perfectly:

“The trauma remains fresh for survivors of the magnitude 7.0 earthquake.”

During a national day of reflection in the poorest country in the Western Hemisphere, it’s apparent just how fresh the mental anguish remains in the minds of Haitians. In a display of mourning and remembrance, thousands of Haitians walked for miles to religious centers — some on crutches, some missing limbs, nearly all were crying.

A lot can change in a few weeks, let alone a year. Here in the Northeast portion of the U.S., multiple feet of snow have fallen just within the last few weeks. While traveling is disrupted for a few days, and people are forced to leave for work earlier than they’re used to, the snow melts and things eventually return to normal.

Unfortunately in Haiti, where granted, the magnitude 7.0 earthquake was a far greater natural disaster than any snowstorm the U.S. has ever seen, little to nothing has returned to normal:

A few yards away, Daphne Delva was washing her 2-year-old son Jefferson on the curb, in front of the tent where she and 10 other people have lived for a year.

“I thought by now they would have moved us,” she said as she lathered the tiny boy. “You can never be at peace. Anything can happen at any time. They fight, they throw rocks.” She pointed to holes ripped in the tent.

Delva’s tent faces the compound that contained the presidential palace, a white-domed structure crumpled in the quake.

I’m sure as the years go by, this date will always be honored, at least partially, in remembrance of those who lost their lives in that quake. But today, one year later, the trauma, the heartache, the mourning is still very fresh, still very real.

Written by traumalines

January 12, 2011 at 9:07 pm

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Comparing Traumatic Incident Reduction & Prolonged Exposure Therapy

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The article below was written by ATSS member Nancy Day. Nancy became a member of ATSS and a Certified Trauma Specialist in 1996. She is also certified with Applied Metapsychology International as a facilitator and trainer for Traumatic Incident Reduction and related techniques developed by Frank A. Gerbode, M.D. and colleagues. 

Nancy provides trauma resolution and life stress reduction professional skills training for mental health professionals and others involved with helping individuals overcome the negative effects of traumatic experiences and excessive life stress. 

Program developer Edna B. Foa, Ph.D. summarizes Prolonged Exposure (PE) therapy as a cognitive-behavioral treatment program for individuals suffering from Post-Traumatic Stress Disorder (PTSD). The program consists of a course of individual therapy designed to help clients process traumatic events and thus reduce trauma-induced psychological disturbance. The standard treatment program consists of nine to twelve 90-minute sessions. (SAMHSA, 2003)

Frank A. Gerbode, M.D., psychiatrist, and one of the principal developers of Traumatic Incident Reduction (TIR) summarizes TIR as a procedure that involves tracing back sequences of traumatic incidents to their roots while completing the incomplete receptive cycles that have accumulated in the sequences. What must be assimilated and accommodated from a traumatic incident are one’s reactions to the incident — including one’s thoughts, sensations, feelings, and perceptions. (Gerbode, 1995)

Although there are some remarkable similarities between PE and TIR, there are also some very distinct differences. I have listed the major differences in a table, which is followed by a brief summary of these differences.

Traumatic Incident Reduction (TIR) Prolonged Exposure (PE) Therapy
A.    100% Person-Centered  Therapist evaluates client’s progress
B.     Client is not interrupted when viewing trauma  Therapist takes a SUDs[1] rating every 5 minutes
C.    Sessions have no fixed length  Sessions are terminated in 45-60 minutes
D.    TIR sessions are complete Homework is required
E.     TIR produces rapid resolution of trauma, often in a single session or in a few sessions. In 10-15 sessions, chronic PTSD symptoms reduced 58%

 

 A. TIR: The Rules of Facilitation ensure that there are no interpretations, evaluations or other judgments made during the TIR session. (French and Harris, 1998; AMI/TIRA, 2007)

A. PE: During the session when the client is reviewing the trauma with eyes closed, the therapist lets the client know that he is there by offering brief but encouraging comments once in awhile, for example: “You’re doing very well. Hang in there,” “Great job, stay with your feelings,” “Remember, memories are not dangerous like the trauma was.”(Foa, et al, Prolonged Exposure Therapy for PTSD, 2007)

B. TIR: In basic TIR training, the facilitator enhances her skill in managing communication during session through a series of eight Communication Exercises. The facilitator’s job is to help the viewer move from his existing scene to as close as he can get to his ideal scene. She does this by following the specific steps of the TIR technique; no unnecessary extraneous verbiage is allowed, as it would be unproductive in helping the client reach his goals. (AMI/TIRA, 2007)

B. PE: The therapist probes for thoughts, feelings, and physical reactions by asking brief, specific questions while the client is recounting the trauma. She also asks the client for a SUDs rating every 5 minutes and makes notes about things the client says or does that seem important to discuss later. (Foa, et al, Prolonged Exposure Therapy for PTSD, 2007)

C. TIR: Taking a TIR session to a point of resolution is a key factor in the success a client has in viewing a past traumatic incident. Therefore, TIR sessions must be open ended. When the TIR technique has taken the requisite amount of emotional charge out of a traumatic incident, a certain set of phenomena will typically appear, indicating that the client has reached a valid end point. These end point indicators are: Positive indicators (examples: expression of relief, a smile, the elimination of negative affect earlier present in the session); Extroversion of attention; Realization, insight, or expressed decision or intention made at the time of the incident or because of the incident. (French and Harris, 1998)

C. PE: After about 45-60 minutes of imaginal exposure, the therapist terminates the exercise by asking the client to open his eyes and end the imaginal experience by saying “OK, let’s stop here. Great job⎯now let’s talk about how this was for you.” (Foa, et al, Prolonged Exposure Therapy for PTSD, 2007)

D. TIR: When the client reaches an end point of a TIR session and his attention is more in the here and now and he feels a sense of relief or resolution, his work is done until the next session. His success with TIR is acknowledged by ending the session when the end point has been reached. (AMI/TIRA, 2007)

D. PE: Session 2 begins with a homework assignment. The client is instructed to have an “in vivo” experience, that is, he is instructed to confront certain activities or situations that he has been avoiding, and to use a breathing technique when he feels anxious. The client’s imaginal exposures sessions are also recorded and the client is instructed to listen to the audiotape of his 45-60 minute sessions. The therapist and the client review the client’s homework assignments. (Foa, et al, Reclaiming Your Life From a Traumatic Experience Workbook, 2007)

E. TIR: It is not unusual for a single traumatic experience to resolve in one session of TIR. With long-term trauma or if there is an unknown source for negative feelings, emotions, sensations, attitudes or pains, an extensive intake interview is conducted with a customized case plan drawn up to address the client’s issues as efficiently as possible. A complete Life Stress Reduction program typically takes between 20 and 40 hours (10-20 sessions). The Life Stress Reduction program is judged to be complete when the client is no longer bothered by, or interested in, the issues he presented during the intake interview and any other issues that may have come up during the Life Stress Reduction sessions. (Volkman, 2005; Powell, 2006)

E. PE: It is reported that there is a large body of research supporting the effectiveness of PE. The PE treatment program gained a 2001 Exemplary Substance Abuse Prevention Program Award by the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), and was designated as a Model Program for national dissemination. In Tel Hashomer Hospital, clients who had chronic PTSD related to combat reduced their symptoms by 58% with 10-15 sessions of PE. (Foa, et al, Prolonged Exposure Therapy for PTSD, 2007)

Conclusion

This paper outlines the main differences between TIR and PE. However, there are many similarities as well. Interested readers are encouraged to read the books listed in References below and engage in professional skills training in these methods for resolving trauma. Both TIR and PE have proven to be very effective tools in helping clients resolve traumatic stress and Post-Traumatic Stress Disorder.

(Footnote): 1 Subjective Units of Distress (SUDs): Wolpe’s scale measures intensity of subjective distress in response to a particular stimulus, such as a memory. It is widely used, and has been shown to correlate with several physiological measures of stress. Non-reactivity to a traumatic memory is considered an indicator of recovery (Horowitz, 1986). This 11 point scale uses 10 as the highest level of distress and 0 as the lowest level, or absence of distress.

References

AMI/TIRA (2007) Traumatic Incident Reduction Workshop Training Manual, Fifth Edition, AMI Press, Ann Arbor, MI

Foa, Edna B. (2003) Prolonged Exposure Therapy for Posttraumatic Stress, Substance Abuse and Mental Health Services Administration (SAMHSA) U.S. Dept. of Health and Human Services, http://www.samhsa.gov

Foa, Edna B., Hembree, Elizabeth A., Rothbaum, Barbara Olasov (2007) Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences, Therapist Guide, Oxford University Press

Foa, Edna B., Hembree, Elizabeth A., Rothbaum, Barbara Olasov (2007) Reclaiming Your Life From a Traumatic Experience, Workbook, Oxford University Press

French, G.D. and Harris, C.J. (1998), Traumatic Incident Reduction (TIR), CRC Press, Boca Raton, FL

Gerbode, Frank A. (1995) Beyond Psychology: An Introduction to Metapsychology, IRM Press, Menlo Park, CA

Horowitz, M. J. (1986). Stress Response Syndromes (2nd ed.). Northvale, NJ: Jason

Powell, David W. (2006) My Tour In Hell: A Marine’s Battle with Combat Trauma LovingHealing Press, Ann Arbor, MI

Volkman, Victor, Ed. (2005), Beyond Trauma: Conversations On Traumatic Incident Reduction, 2nd Ed. Loving Healing Press, Ann Arbor, MI

Combat Trauma Innovation 2011

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“Combat Trauma Innovation 2011” is a massive military medical conference taking place in London for two days in late January.

“Why should I care about a medical conference taking place in the UK,” you may be asking.

Hopefully this answers that question: Innovation 2011 is a gathering of medical and military professionals from around the world, including the U.S. and Canada. According to Medical News Today, “The [conference’s] world class agenda challenges existing procedure and promotes the very latest techniques and technology being employed on the battlefields of Afghanistan.”

I think this excerpt from Innovation’s “about the event” page sums up just how import a global gathering like this is for the trauma care and trauma responds fields:

After a decade of fighting in some of the most inhospitable terrains known to man, are trauma care capabilities able to keep up?

The last 10 years of overseas operations have seen an enormous increase in injuries from traditional and non-traditional means.  Whether it be a penetration injury or Traumatic Blast injury caused from an IED strike, it is essential that all healthcare professionals keep up to date with the latest techniques, procedures and equipment available to treat our wounded warriors.

Just last week we wrote about research being done in the area of PTSD prevention. Scientists at Northwestern University conducted studies with mice in which they exposed the animals to intensely stressful situations, and then treated them with two chemicals. While trauma experts all agreed that the results were encouraging, developing a pill that could prevent PTSD is still a long way off.

While we’re not expecting something like a PTSD pill to be introduced at Innovation 2011, the discussions that will ensue between professionals, the new products and treatment methods that will be introduced, the world-wide show of support for active military personnel that will all result from this medical conference will bring nothing but renewed growth and vigor to fight against traumatic incidence.

Written by traumalines

January 10, 2011 at 9:51 pm