PTSD and Older Veterans By National Center for PTSD

From as long ago as Homer’s ancient story of the battle between the Trojans and the Greeks, and the times of the Bible and Shakespeare, military personnel have been confronted by the trauma of war. Recent books and movies have highlighted the impact of war trauma for veterans of the Vietnam war and the Persian Gulf war, but the traumas faced by veterans of World War II and the Korean conflict have been publicly acknowledged in the media less often and less clearly.

With the release of the movie, “Saving Private Ryan,” the reality of war trauma in World War II came front and center for veterans, their families, and our society at large.

The phrase, “war is hell,” only begins to describe how terrifying and shocking that war was for hundreds of thousands of American military personnel. For most World War II veterans, those memories still can be upsetting, although only occasionally and for brief periods, more than 50 years later. For a smaller number of World War II veterans, the war trauma memories cause severe problems still, in the form of “post-traumatic stress disorder” or PTSD. This Fact Sheet provides information to help veterans of World War II and other wars, their families (some of whom are second and third generation veterans themselves), and concerned members of the public to begin to answer the following important questions about war trauma and PTSD with older veterans:

How does war affect “normal,” “healthy” military personnel?

War is a life-threatening experience that involves witnessing and engaging in terrifying and gruesome acts of violence. It also is, for most military personnel, a patriotic duty to protect and defend their country, their loved ones, and their values and way of life. The trauma of war is the shocking confrontation with death, devastation, and violence. It is normal for human beings to react to war’s psychic trauma with feelings of fear, anger, grief and horror, as well as emotional numbness and disbelief.

We know from numerous research studies that the more prolonged, extensive, and horrifying a soldier’s or sailor’s exposure to war trauma, the more likely that she or he will become emotionally worn down and exhausted — this happens to even the strongest and healthiest of individuals, and often it is precisely these exemplary soldiers who are the most psychologically disturbed by war because they are able to endure so much of it with such courage. Most war heroes don’t feel brave or heroic at the time, but simply carry on and do their duty with a heavy but strong heart so that others will be safer — despite often feeling overwhelmed and horrified.

So it is no surprise that when military personnel have severe difficulty getting over the trauma of war, their psychological difficulties have been described as “soldier’s heart” (in the Civil War), or “shell shock” (in World War I), or “combat fatigue” (in World War II). After World War II, psychiatrists realized that these problems usually were not an inborn “mental illness” like schizophrenia or manic depressive illness, but were a different form of psychological disease that resulted from too much war trauma: “traumatic war neurosis” or “post-traumatic stress disorder” (PTSD).

Most war veterans are troubled by war memories, but were fortunate enough either not to have “too much” trauma to recover from or to have immediate and lasting help from family, friends, and spiritual and psychological counselors so that the memories became “liveable.” A smaller number, probably about one in twenty among World War II veterans now, had so much war trauma and so many readjustment difficulties that they now suffer from PTSD.

How is it possible to have PTSD 50 years after a war?

Because most World War II veterans came home to a hero’s welcome and a booming peacetime economy, many were able to make a successful adjustment to civilian life. They coped, more or less successfully, with their memories of traumatic events. Many had disturbing memories or nightmares, difficulty with work pressure or close relationships, and problems with anger or nervousness, but few sought treatment for their symptoms or discussed the emotional effects of their wartime experiences. They were expected by society to “put it all behind them,” forget the war, and get on with their lives.

But as they grew older, and went through changes in the pattern of their lives — retirement, the death of spouse or friends, deteriorating health and declining physical vigor — many experienced more difficulty with war memories or stress reactions, and some had enough trouble to be considered a “delayed onset” of PTSD symptoms—sometimes with other disorders like depression and alcohol abuse. Such PTSD often occurs in subtle ways: for example, a World War II veteran who had a long, successful career as an attorney and judge, and a loving relationship with his wife and family, might find upon retiring and having a heart attack that he suddenly felt panicky and trapped when going out in public. Upon closer examination, with a sensitive helpful counselor, he might find that the fear is worst when riding in his car, due to some unfinished trauma memories of deaths among his unit when he was a tank commander in the Pacific theater in World War II.

What should I do if I or an older person I know is a military veteran who may have PTSD?

First, don’t assume that feeling emotional about past memories or having some of the normal changes associated with growing older (such as sleep disturbance, concentration problems, or memory impairment) automatically mean PTSD. If a World War II or Korean conflict veteran finds it important, but also emotionally difficult, to remember and talk about war memories, help him or her by being a good listener — or help find a friend or counselor who can be that good listener.

Second, get information about war trauma and PTSD. The Department of Veterans Affairs’ Vet Centers and Medical Center PTSD Teams offer education for veterans and families—and they can provide an in-depth psychological assessment and specialized therapy if a veteran has PTSD. Books such as Aphrodite Matsakis’s I Can’t Get Over It (Oakland: New Harbinger, 1992) and Patience Mason’s Home from the War (High Springs, Florida: Patience Press, 1998) describe PTSD for veterans of all ages and for other trauma survivors, and its effect on the family.

Third, learn about the specialized therapies available at Vet Centers and VA Medical Centers. These include medications to help with sleep, bad memories, anxiety and depression, stress and anger management classes, counseling groups for PTSD and grief (some particularly desgned to bring together older war veterans to support one another in healing from war trauma or prisoner of war experiences), and individual counseling. Involvement of family members in the veteran’s care and in self-care for themselves also is an important part of treatment.

Depression-free holidays: Tidings of comfort and joy…at my pace By Christine Stapleton

The annual holiday home tour is tonight in my neighborhood. I’m not going. Someone from the committee called me earlier this week and asked if I would bake cookies for the dessert table. “No,” just popped out of my mouth. Normally, I volunteer without a second thought, then I smack myself upside the head: D’oh!

I have been working on setting boundaries for several years. I am not very good at it, which is why I shocked the heck out of myself when I heard my “No.” No explanation. Just “no” - as a complete sentence. I think I shocked the woman on the other end of the phone, too.

We’re supposed to be full of goodwill this time of year and I am. But too much goodwill on my part makes me resentful and angry. (Besides, I haven’t made a good batch of Christmas cookie in 30 years - when my sister and I made anatomically correct gingerbread boys and girls.) I have to take the holidays in small bites. Some folks can cannonball right into the holidays. Not me. Not anymore.

The instant I feel stressed about the holidays, I stop. Yesterday I decorated the house. I am a single mother of an almost-18-year-old daughter, who prefers to spend her Saturdays with her boyfriend rather than her mother. No more baking Christmas cookies together, making a gingerbread house, going to see Santa at the mall. She’s all grown up. So, I decorated the house alone.

Didn’t take long before my brain was telling me that I was a pathetic twice divorced, middle-aged, single woman who will go to the midnight Christmas Eve service by herself and wake up Christmas morning to a dog’s cold wet nose. I unpacked my cut of the Christmas ornaments, which my mother divvied up before she and dad died. I miss them so much during the holidays. Whoa. I knew where I was headed. By the end of the day I would be alone, under the covers in a fetal position, feeling sorry for myself.

So I stopped decorating. My friend Paula came over - another twice divorced, middle-aged single mother. We went out for a hamburger and onion rings and then watched a kitschy, non-Christmas movie starring a young Jennifer Anniston. I went to bed feeling much, much better. No fetal position.

I am not going to feel bad when I say “No” to everyone else’s holiday cheer. I can only take so much holiday cheer. If I force myself to feel festive when I don’t, I get frustrated with myself. I ping-pong between feeling sorry for myself and beating myself up for not being “in the mood.”

This year, I am doing the holidays at my pace. If someone calls me a humbug, that’s fine. When the spirit moves me I will be the first in line to sit on Santa’s lap. When I am not in the mood, I will not fake it. This year has been a rough one for all of us. Many of us lost our jobs. Those who kept theirs spent their Friday afternoons wondering if the boss would call them into the office and shut the door.

It is okay if I don’t feel “good tidings of cheer” nonstop this holiday season. It’s not okay to wallow in it. Next weekend we will get our tree. We will decorate it when we are good and ready. Then maybe we will make some of the those anatomically correct gingerbread boys and girls.

Christine Stapleton has been a reporter for The Palm Beach Post for 23 years and in 2006, began writing a column entitled, Kicking Depression.

Army suicides to top 2008

By PAULINE JELINEK, Associated Press Writer

WASHINGTON – Soldier suicides this year are almost sure to top last year's grim totals, but a recent decline in the pace of such incidents could mean the Army is starting to make progress in stemming them, officials said Tuesday.

Army Vice Chief of Staff General Peter Chiarelli said that as of Monday, 140 active duty soldiers were believed to have died of self-inflicted wounds so far in 2009. That's the same as were confirmed for all of 2008.

"We are almost certainly going to end the year higher than last year ... this is horrible, and I do not want to downplay the significance of these numbers in any way," he said.

But Chiarelli said there has been a tapering off in recent months from large surges in suspected suicides in January and February.

"Our goal since the beginning has been to reduce the overall incidence of suicide and I do believe we are finally beginning to see progress being made," Chiarelli told a Pentagon press conference.

He attributed those hints of a turning to some unprecedented efforts the Army has made since February to educate soldiers and leaders about the issue.

Officials are still stumped about what is driving the historically high rates across the military force. When asked whether the rates reflect unprecedented high stress from long and repeated deployments to provide manpower for the wars in Iraq and Afghanistan, Chiarelli said he didn't know.

"The reality is there is no simple answer," he said. "Each suicide is as unique as the individuals themselves."

Chiarelli said that on top of the 140 suicides reported from the active duty force, there were another 71 suicides by troops in the National Guard and Reserve.

All of the numbers are preliminary in that investigations into some of the deaths are still ongoing. Of the 140 so far this year among active duty troops, 90 have been confirmed as suicides and 50 are suspected but the probes are not yet finished.

Each year, nearly all suspected suicides are eventually confirmed. For instance in 2008, there were 143 suspected and 140 were eventually confirmed.

Chiarelli said officials will continue to focus on things that are symptoms of high-risk individuals such as undiagnosed brain injuries like concussions; on Post-Traumatic Stress, and on risky behavior such as poor diet and sleep habits as well as more serious behaviors such as drug and alcohol abuse.

The Army widened its suicide prevention in March in an attempt to make rapid improvements. In October, the service introduced its Comprehensive Soldier Fitness program, which Chiarelli called "the biggest step ... taken to enhance wellness in the entire force through prevention rather than treatment."

The program aims to put the same emphasis on mental and emotion strength as the military traditionally has on physical strength. Basic training now includes anti-stress programs as part of a broader effort to help soldiers deal with the aftereffects of combat and prevent suicides.

Also last month, the Army started using a new screening questionnaire to try to determine preexisting or current mental health issues among troops as part of the enlistment process.

Despite those campaigns, another jump in suicide figures for 2009 would make it the fifth straight year that such deaths have set a record within the military. Last year's 140 record erased a high 115 in 2007 and 102 in 2006.

Chiarelli said officials are concerned with increases this year at Fort Campbell, Fort Stewart and Schofield Barracks and are trying to learn why suicides rates are down at Fort Hood, Fort Bragg and Fort Drum.

At Fort Campbell in Kentucky there were 18, while at Fort Bragg, N.C., which has almost double the population, there have been six all year.

Using some bases as examples of the trend downward, Chiarelli said that of the 18 suicides reported this year at Fort Campbell, 11 of those were in the first four months of the year. At Schofield Barracks in Hawaii, there were seven all year so far — five in the first five months of the year and only two since.

The numbers kept by the service branches don't show the whole picture of war-related suicides because they don't include deaths after people have left the military. The Department of Veterans Affairs tracks those numbers and says there were 144 suicides among the nearly 500,000 service members who left the military from 2002-2005 after fighting in at least one of the wars.

The true incidence of suicide among military veterans is not known, according to a report last year by the Congressional Research Service. Based on numbers from the Centers for Disease Control and Prevention, the VA estimates that 18 veterans a day — or 6,500 a year — take their lives, but that number includes vets from all previous wars.

___

On the Net: http://www.army.mil

How To Determine What You Want In Life

How To Determine What You Want In Life





What do you really want in life?



Most people don’t discover what they want in life until it’s time to die – and that’s a shame.



Most people spend the best years of their lives watching television or doing things they dislike. An author described humanity by saying, “Most people die at twenty and are buried at eighty.” Are you one of the living zombies?



What do you really want in life?



Some people struggle in answering such question. When asked what they want or what their goals in life are, many are unsure. They dillydally in their decision, hardly giving any thought about what they want in life. People without definite goals are letting time pass them by. Are you one of these people?



If you are undecided about what you want out of life, do not worry. There are many ways of discovering your purpose in life.



To discover what you want in life, try looking deep into your heart. Oftentimes, people are ruled by logic. People live by what they think they should be or by what others like them to be. The discovery process is the perfect time to listen to your heart. What your heart desires comes from the whispers of your authentic self. Your authentic self is the real you.



Listen to your heart to be able to listen to your authentic self. What your heart says usually feels right. What your heart desires is what you usually love to do and this represents your passion. Anything done with passion is like play where the task is accomplished without hesitation. You pour out your very best and feel no pressure or resistance.



You will totally enjoy doing things that are your passion. Setbacks, difficulties, and obstacles will make it more challenging, but should not deter you from pursuing your goals. Naturally, there may be barriers that may prevent you from reaching your goal, but your heart’s desire will find ways to overcome these barriers so that you may ultimately get what you want in life. Remember this: the universe supports people who are pursuing their passion and those who are pursuing their destiny.



However, this does not mean that you don’t use your head. People are born with both the mind and heart. Your duty is to live your best life and be in harmony with your mind and heart. The poet Rumi wisely said, “Live completely in the head and you cannot feel the breath and rhythm of life. Live completely in the heart and you may find yourself acting like a love-struck fool with poor judgment and discipline. It’s all a fine balance - the head and heart must forge a lifetime partnership if one wants to live a beautiful life.”



Listen to your instinct. Part of human nature is the mysterious and spontaneous reaction on things. Often times, these are called instincts. Your authentic self communicates with you and guides you via instincts. Instincts are those gentle nudges that urge you to act and follow a certain path. Your role then is to listen attentively.



Often times, we listen to what others say and allow them to run our lives. Parents often do this to their children. “We come from a family of doctors, so my son must also be a doctor.” How often do we hear this from parents who have good intentions for their children? Parents unconsciously block the true expression of their child’s real self and calling. Friends and critics will discourage you and point out the impossibility of your dream. Before heeding their advice, evaluate the accomplishments of the critics. Did they achieve theirs dreams? Do they dream big at all?



Remember, it is your destiny that is in line, not theirs. It doesn’t mean, though, that you will not listen to what other people say. Hear them out just the same. But the final decision should be yours.



There is only thing to remember: Every person, to live truly and greatly, must define how he wants to live and what his brightest life will look like. Listen to your instincts and follow your heart’s desire. You will never go wrong.

Making Your Bad Marriage Good

I was talking to the team at Save My Marriage Today recently, and we were talking about marriages gone bad. It seemed at one time that the only place that marriages went bust was in Hollywood, but anyone you talk to now either knows someone divorced or someone with marital problems. Hey, it may even be you.

The single biggest reason couples break up is due to "falling out of love" or poor communication. It seems as though many couples reach the 5 or 10 year anniversary and it becomes a time of regret and reflection on opportunities lost. Too many people end their marriages because the love is not the same as it used to be, and they don't know how to love their partners anymore. It's so frustrating!

If "falling out of love" sounds familiar to you, help is at hand:

http://www.savemymarriagetoday.com

Online author Andrew Rusbatch showed me the latest course he has created to help troubled couples, and to be honest, I was very impressed! Andrew is the host of Save My Marriage Today Home Study Course. It's a fantastic course that covers all the essential aspects to a healthy marriage.

Are you or your partner falling out of love?
Marriage falling apart and feeling powerless?
Anger and conflict tearing you two apart?
Is your marriage affected by addiction issues?
Partner cheated on you?
Marriage affected by money problems?
Are you in a marriage that is suffering because your partner has depression?
Is the honeymoon over?



Many couples break up over issues that could have been resolved if they had only taken the time for self-examination. Let's face it, you can't always control what your partner does, and the Save My Marriage Today Premium Home Study Course recognizes this and focuses on your actions and beliefs, and how they are shaping your approach to save your marriage.

Andrew's Save My Marriage Today Premium Home Study Course helps all couples, both young and old, consider their relationship problems and how their misconceptions and attitudes can help shape a recovery or add to their ordeal.

Its quite normal for a marriage to go through cycles, and arguments will happen from time to time. In fact, one thing they talk about in the course is how disagreements are normal. It's nothing to be ashamed about! Its how you deal with those arguments and disagreements that determines the health of your relationship.

The Save My Marriage Today Premium Home Study Course is an instant-download 12-part video and written course, AND includes FOUR additional topic-specific courses where Andrew, Richard and Amy delve into relationship issues for couples dealing with depression, addiction, infidelity, and money problems. That's 8 hours of video and 5 study guides to work your way through!

Plus there are bonus interviews with guest relationship coaches Scot and Emily McKay discussing ways to cope with a partner with mental illness, and Mimi Tanner discussing how to keep your spouse interested in you forever.

In addition to this is a free email consultation so that customers can discuss any additional marriage issues with a member of the team. This really can help ANY couple with almost ANY marriage problem!

I really do believe Andrew and the Save My Marriage Today team are onto a good thing here, and they really want to help. The techniques are fresh, thought provoking, come from a range of perspectives, and have been proven over and over to help save marriages. I was very impressed with this course and have recommended it to everyone I know.

I would encourage you to look for yourself and do something today to kick-start your marriage-saving solution. There is never a better time to save your marriage!

Visit: http://www.savemymarriagetoday.com/premium

And take control of your future. I’m sure you will be as impressed as I was.

Stress and The Body

Hot Reactors
Chronic stress can lead to poor health. Some people tend to react to stressors with an all out physiological effort that takes a toll on their health. We call these people hot reactors. If you notice that you get angry easily (you are often anxious or depressed, you urinate frequently, you experience constipation or diarrhea more than usual, or you experience nausea or vomiting), you may be a hot reactor. In that case, you may want to seek regular medical examinations to identify illnesses when they can be easily cured or contained and learn to use stress management techniques and strategies.

Psychosomatic Disease
People have died or have become ill from severe stress, when there seems nothing physically wrong with them. Some illnesses are easily seen as being physical, while others are assuredly recognized as being mental, yet it is impossible to deny the interaction between the mind and the body and the effects of one upon the other. The mind makes the body susceptible. These conditions are called psychosomatic. Psychosomatic disease is not “all in the mind”, contrary to popular belief, but involves both mind and body. Psychosomatic disease is real, can be diagnosed, and is manifested physically. However, it also has a component in the mind, although it is not easily measured. That common cold may be a function of psychological stress, which decreases the effectiveness of the immunological system and results in the body being more vulnerable to cold viruses. That cold may also be caused by psychological stress using up particular vitamins in the body and leading to decreased effectiveness in combating viruses. Psychogenic refers to a physical disease caused by emotional stress. Asthma is an example of this. Somatogenic psychosomatic disease occurs when the mind increases the body's susceptibility to some disease causing microbes or some natural degenerative process. Examples are rheumatoid arthritis and cancer.

Stress-related Conditions and Illnesses
Hypertension
This is the excessive and damaging pressure of the blood against the walls of the arterial blood vessels. There are several causes of hypertension. Excessive sodium (salt) intake may cause hypertension in those genetically susceptible. It can also be caused by a kidney disease, a narrow opening in the aorta (main blood vessel), and the use of contraceptives. However, these conditions cause only an estimated ten percent of all hypertension. Approximately 90 percent of hypertension is termed essential hypertension and has no known cause.

Forty-one percent of the United States population aged twenty to seventy-four are hypertensive, although many of these people do not even know it, since hypertension occurs without signs and symptoms. Since blood pressure increases during stress, the relationship between stress and hypertension has long been suspected. Recognizing this relationship, educational programs for hypertensives have included stress management. Although hypertension can be controlled with medication, the possibility of disturbing side effects from these drugs has led to attempts to control hypertension in other ways. Since obesity, cigarette smoking, and lack of exercise correlates to hypertension, programs involving weight control, smoking withdrawal, and exercise, as well as decreased ingestion of salt, have all been used to respond to high blood pressure.

Stroke
Apoplexy (also called stroke) is a lack of oxygen in the brain resulting from a blockage or rupture of one of the arteries that supply it. Stroke is related to hypertension, which may also result in a cerebral hemorrhage. Stroke has been linked with high blood pressure, diet and stress.

Coronary Heart Disease
Heart attack kills more Americans than any other single cause of death. That stress is related to coronary heart disease is not surprising when we consider the physiological mechanisms that stress brings into play: accelerated heart rate, increased blood pressure, increased serum cholesterol, and fluid retention resulting in increased blood volume. Further, the stereotypical heart attack victim has been the highly stressed, overworked, overweight businessperson with a cigarette dangling from his lips and a martini in his hand.

Ulcers
Ulcers are fissures or cuts in the wall of the stomach and other parts of the intestines. For many years, it was thought that stress led to the excessive amounts of hydrochloric acid being produced in the stomach and the intestines. One theory explaining the effects of stress on the development of ulcers pertains to the mucous coating that lines the stomach. The theory states that, during chronic stress, secretions cause the stomach lining to constrict. This, in turn, results in a shutting down of mucosal production. Without the protective barrier, hydrochloric acid breaks down the tissue and can even reach blood vessels, resulting in bleeding ulcer.
Many cases of ulcers are caused by a bacterium called H. pylori. It is believed that H. pylori inflames the gastrointestinal lining, stimulates acid production, or both. Another major cause of ulcers is the ingestion of aspirin and other non-steroidal anti-inflammatory drugs, like ibuprofen and naproxenan piroxicam. These drugs promote bleeding in the stomach and can wear away its protective lining. Still, stress can exacerbate the conditions in the digestive tract to make ulcers more likely to occur. Stress results in an increase in hydrochloric acid in the intestines and stomach, and a decreased effectiveness of the immune system that is marshaled to combat the invasion by H. pylori.

Migraines
Migraine headaches are the result of a constriction and dilation of the carotid arteries of one side of the head. The constriction phase, called the pre13 attack or prodome, is often associated with light or noise sensitivity, irritability, and a flushing or pallor of the skin. When the dilation of the arteries occurs, certain chemicals stimulate adjacent nerve endings, causing pain. The migraine is not just a severe headache. It is a unique type of headache with special characteristics, and it usually involves just one side of head. The prodome consists of warning signs, such as flashing lights, differing
patterns, or some dark spaces. Migraines are a sign and symptom of a lifestyle gone awry. Signs and symptoms should be treated with either medication or meditation without eliminating the underlying cause. Rather than care for the migraine after it strikes, why not prevent it in the first place by changing your lifestyle?

Cancer
Although many people do not realize it, both the prevention and the treatment of cancer are suspected of being related to stress. Some researchers believe that chronic stress results in a chronic inability of the immune response to prevent the multiplication of mutant cells, which some believe are present but normally controlled in most people. The role of stress in the development of cancer is still being debated. Since cancer is the second leading cause of death in the US, research in this area has been and is presently being conducted. Further, some support has been provided for the cancer-prone personality type. The cancer-prone person has been described as holding resentment, with the inability to forgive, using self-pity, lacking the ability to develop and maintain meaningful interpersonal relationships, and having poor self-image.

Tension Headaches
Headaches may be caused by muscle tension accompanying stress. This muscle tension may include the forehead, jaw, or neck. Once the headache occurs, it tends to fuel itself. It is difficult to relax when you're in pain. Treatment for tension headaches may include medication, heat on tense muscles, or massage. Others have also reported on the effectiveness of relaxation training for control and prevention of tension headache.

Allergies And Asthma
Some medical scientists, unable to identify any antigen in many asthmatics, have argued that allergies are emotional diseases. This was shown in an experiment in which a woman who was allergic to horses began to wheeze when shown only a picture of a horse, another woman who was allergic to fish had an allergic reaction to a toy fish and empty fishbowl' and others reacted to uncontaminated air when suspecting it contained pollen. Crying-induced asthma, brought on during stressful events is another example. Some have concluded, therefore, that the effects of stress on the immune system either decrease our ability to withstand an antigen or, even in the absence of an antigen, can lead to allergic-like response. Some allergy sufferers
-- in particular, asthmatics -- are being taught relaxation techniques and breathing control exercises to enable them to control their physiology during allergic reactions.

Post Traumatic Stress Disorder
PTSD is a condition that develops in people who have experienced an extreme psychological and/or physical event that is interpreted as particularly distressing. PTSD is defined as:
· A threat to one's life or serious injury or being subject to horror with intense fear and helplessness
· Recurrent flashbacks, repeated memories and emotions, dreams, nightmares, illusions or hallucinations related to traumatic events from which one is often amnesic
· Trying to avoid feelings, thoughts, or places that may trigger associations
with trauma
· Poor sleep, poor appetite
· Self-recrimination
· Feeling jumpy, irritable, or emotionally explosive or "spaced out"
· Having difficulty concentrating, socializing, or working
Among the characteristics of those who have successfully managed PTSD are that they had supportive relationships with family and friends, they did not dwell on the trauma, they had personal faith/religion/hope, and they had a sense of humor.

Other Conditions
Stress has been shown to affect other health conditions, as well. Stress can lead pregnant women to miscarry. In a study, 70 percent of women who had miscarriage had at least one stressful experience four to five months before the miscarriage, as compared with 52 percent who did not have one. Even sports injuries occur more frequently in athletes who have experienced stressors and who do not have the resources and skills to cope well with stress. With high stress and poor coping resources, the result is increased muscle tension and attention redirected toward the stress and away from the event.

Taking Medication: 16 Ways to Become a Smart Self-Advocate By Margarita Tartakovsky, M.S.

When we walk into the doctor’s office, for many of us, the scenario looks like this: We list off our symptoms, the doctor asks a few questions, writes out a prescription and we go on our way.

From her work in primary care settings, Risa Weisberg, Ph.D, assistant professor (research) and co-director of the Brown University Program for Anxiety Research at Alpert Medical School, has seen “firsthand how a great many patients accept a prescription from their provider without asking many questions about it, or often, without even knowing for what symptoms/disorder it is being prescribed.”

Such a scenario can stall or sabotage your treatment. Confused, you’re likely left with tons of questions, unaware of what you’re taking and how it’s supposed to help. You may be feeling helpless — a spectator in your own recovery — and hopeless, if the medication doesn’t seem to work or has bad side effects. Your doctor likely is clueless about your real concerns, not having all the information to guide his or her decision-making process.

But you don’t have to feel like a powerless bystander, on the outskirts of your own treatment. In order to become a sharp self-advocate, you just need some information. Here’s some hints for for taking medication safely and effectively. At the end, you’ll also find a basic glossary of common medication-related terms.

1. Haven’t picked a physician yet? Do your homework and conduct an interview. Before you decide on a doctor, whether it’s a primary care physician or a psychiatrist, ask some questions about qualifications and see if he or she is a good fit for you. Questions to get you started: Where did you go to school and do your training? Do you specialize in a specific mental illness? Do you have hospital privileges? Here’s a list of excellent questions to ask a psychiatrist during and after your first appointment. They focus on bipolar disorder, but you can easily adapt them to any disorder.

2. Ask the doctor about your diagnosis. You have the right to know precisely what you’re diagnosed with and how the doctor came to that conclusion. Making a diagnosis doesn’t happen in a 5-minute interview. You want to make sure that the doctor conducted a thorough evaluation. Did the doctor get your medical and mental health history? Did you complete a standardized test? Did the doctor ask about your symptoms and recent experiences?

3. Seek out psychotherapy. Medication isn’t your only option. Depending on the disorder, you may only need psychotherapy or you may take medication and see a therapist. Psychotherapy provides lasting benefits, whereas a medication’s effects stop as soon as you stop taking it. Cognitive-behavioral therapy effectively treats depression, anxiety disorders and bipolar disorder. To find a therapist, you can ask your doctor for a recommendation, browse the Web or check with universities and medical schools. Be sure the therapist specializes in your mental illness. For advice on finding a good therapist, check out this eBook.

Some Web sources for finding a therapist:

• Psych Central’s therapist finder
• The Association for Behavioral and Cognitive Therapy for CBT-trained therapists
• Children and Adults with Attention Deficit/Hyperactivity Disorder
• Anxiety Disorders Association of America
• National Eating Disorder Association

4. Before taking the medication, ask specifics. Peter Roy-Byrne, M.D., professor and chief of psychiatry at the University of Washington at Harborview Medical Center, and Michael R. Liebowitz, M.D., professor of clinical psychiatry at Columbia University and managing director of The Medical Research Network, suggest asking:

• How will I know if this medication is working?
• What are the side effects, and what do I do if I experience them?
• When will the medication start to work?
• How long will I have to take it?
• If I take it for X amount of time, what’s the likelihood of reducing symptoms?
• What are the dose requirements?
• Will you be monitoring me throughout the course of this medication?
• When will you talk to me next?

The Agency for Healthcare Research and Quality has a basic handout with more questions. Here’s a thorough list if your child is taking medication, which you can easily revise for your situation.

5. Unsure about medication? Explore why. Are you on the fence because of potential side effects, the stigma of having a disorder or taking medication, a bad past experience, fears of addiction or uncertainty about the validity of your diagnosis? Talk to the doctor about your concerns before making the decision to take or refuse the medication.

6. Research your medication. Before having your prescription filled, look for information about your medication and its side effects.

7. Pose questions to your pharmacist. Along with your physician, the pharmacist is a great resource for information, so ask away!

8. Remember that you and your doctor are a “health care team,” Weisberg said. Together, you collaborate on your treatment. And as such, you should feel comfortable asking questions and raising concerns, all the while respecting your physician’s expertise. If you feel like your doctor isn’t listening or brushes you off, find a professional who will be part of your team. It’s what doctors are there for.

9. Keep a list of your medication. Include the name of your medication and the dose and always bring your list to appointments, said Holly Swartz, M.D., associate professor of psychiatry at the University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic in Pittsburgh. Your list is especially essential if you’re seeing both an internist and a psychiatrist, she added.

10. Keep another list of medication you stopped taking. Include the reasons you stopped taking the medication, Dr. Swartz said. This gives your doctor the whole picture and helps guide decisions about what medications will be safe and effective for you.

11. Purchase a pill box. A pill box can be helpful if you’re taking many medications or multiple doses, said Dr. Swartz, who suggests counting out your pills in the beginning of each week.

12. Take your medication as prescribed. This may seem like a no-brainer, but many individuals skip a dose or stop taking medication altogether, because they left their medication at home, forgot to get a refill, couldn’t stand the side effects or felt better. Not taking your medication can make symptoms return.

“If you stop an anxiety drug, the anxiety may come back, and with the passage of time, it could be worse than before,” Dr. Roy-Byrne said. Or you may experience “discontinuation syndrome,” what many people think of as withdrawal. Symptoms vary for each individual, but may include insomnia, dizziness, anxiety, blurred vision and hallucinations.

Relapse is another concern. Individuals with bipolar disorder are at higher risk for relapse if they stop taking medication, Dr. Swartz said.

13. Monitor your progress. Some doctors will give you tools, such as a standardized scale to measure your progress. If they don’t, start documenting it on your own and bring the materials to every appointment. For instance, for bipolar disorder, Melvin McInnis, M.D., psychiatrist and professor of mood disorders with the department of psychiatry and the Depression Center at the University of Michigan, suggests keeping a journal with your mood, quality of sleep and energy levels and finding a self-report scale to track your symptoms. If you can’t find a good scale, create a daily log of symptoms your medication is supposed to reduce and evaluate them from 1-10. And keep a record of side effects. Dr. Roy-Byrne also has his patients closely monitor their symptoms before they start taking medication. This way, it’s easier to pinpoint the changes the medication has caused, not your natural symptoms.

14. Give your doctor feedback. Let your doctor know how you’re feeling, particularly if you’re experiencing bothersome side effects. Your doctor can help minimize side effects by adjusting the dose, changing how you take the medication or prescribing a different drug altogether. Have trouble sleeping? Your doctor may suggest taking medication in the morning. Not communicating with your doctor can compromise treatment. “If you have secretly stopped one medication, your doctor may start telling you to increase another medication without understanding that your new symptoms are actually unrecognized withdrawal symptoms from stopping the other medication,” Dr. Swartz said. When tapering off medication, if something doesn’t feel right, talk to your doctor, who can then make the proper adjustments.

15. Understand that it’s a process. Finding the right medication may “require a process of trial and error and refinement,” Dr. Swartz said. “Try not to feel discouraged if the medications do not work right away or cause side effects that require serial medication adjustments.” This is why giving feedback to your doctor and tracking your progress is key.

16. Disclose any supplements, vitamins or medication you’re taking. Any of these substances can interact with your medication — some with dangerous results.

Medication Lingo

Here’s a quick look at common terms you may run across:

Half-life: The time it takes for half of the medication to leave the body. For instance, Paxil has a short half-life, leaving the body in about a day, whereas Prozac, which has a longer half-life, takes a week.

Black-box warning: The most serious type of label applied to prescription drugs by the Food and Drug Administration (FDA). For instance, the FDA requires that all antidepressants carry a black-box warning about the potential increased risk of suicidal symptoms in 18- to 24-year-olds.

Side effects: Adverse effects caused by medication.

Discontinuation syndrome: One or more side effects that occurs when individuals stop taking medication abruptly, including dizziness, headache, insomnia and numbness. For more on discontinuation syndrome, see here and here.

Antidepressants: A group of medications used to treat mood disorders, including depression, by acting on neurotransmitters in the brain – namely dopamine, serotonin and norepinephrine. The following are types of antidepressants: selective serotonin reuptake inhibitors (SSRIs); serotonin and norepinephrine reuptake inhibitors (SNRIs); tricyclic antidepressants (TCAs); and monoamine oxidase inhibitors (MAOIs).

Antipsychotics (or neuroleptics): Developed in the mid-1950s, these medications are known as traditional or typical antipsychotics. They treat severe mental disorders such as schizophrenia by reducing symptoms such as hallucinations and delusions. Antipsychotics have a risk of extrapyramidal side effects, including tremors, slurred speech, akathisia (shakiness and fidgeting) and tardive dyskinesia (involuntary movements). Other medications, including Prozac, Zoloft and Lithium, also may cause tardive dyskinesia.

Atypical (or “second generation”) antipsychotics: Developed in the 1990s, this group of medications also treats psychotic symptoms. It’s the first line of treatment for schizophrenia and may be prescribed to treat the manic phase of bipolar disorder. Overall, tardive dyskinesia and extrapyramidal symptoms occur less often with atypical antipsychotics. However, recent studies suggest that Abilify may cause akathisia.

Atypical antipsychotics also may raise the risk of obesity, diabetes and high cholesterol. Clozapine is an effective atypical antipsychotic, but is usually prescribed when other medications don’t work, because of its ability to reduce white blood cells (which fight infection) in some people.

Monoamine oxidase inhibitors (MAOIs): Used in the 1950s, MAOIs were the first antidepressants on the market. They work by metabolizing dopamine, norepinephrine and serotonin to help boost mood. These medications typically are prescribed when other antidepressants haven’t worked, because they require stringent dietary restrictions.

Selective Serotonin Reuptake Inhibitors (SSRIs): This group of newer antidepressants acts on the neurotransmitter serotonin by blocking its reuptake (reabsorption). It’s believed that higher levels of serotonin in the brain will help mood. The most famous SSRI is Prozac, which was introduced in 1987. Common side effects include sexual problems, trouble sleeping, nausea, dizziness and weight gain. Mayo Clinic offers advice on reducing SSRI side effects.

Serotonin norepinephrine reuptake inhibitors (SNRIs): A class of medications that inhibits the reuptake of both serotonin and norepinephrine. Common side effects resemble those for SNRIs but typically cause fewer sexual problems. Effexor (venlafaxine) can cause high blood pressure at high doses, so it’s important to have your blood pressure checked regularly.

Tricyclic antidepressants (TCAs): An older group of medications, TCAs are prescribed when newer antidepressants are ineffective to treat depression. They’re also prescribed for bipolar disorder. TCAs either work on serotonin, norepinephrine or both (called “dual action”). They may not be safe for individuals with heart disease and may be fatal in overdose.

Mood stabilizers: These medications help to regulate mood and are prescribed for bipolar disorder and borderline personality disorder. Examples include lithium and anti-seizure medications, such as Depakote, Tegretol and Lamictal. Side effects include weight gain and nausea.

Benzodiazepines: A group of fast-acting medications, including Xanax, Ativan and Valium, that treats anxiety, panic disorder, insomnia and sometimes bipolar disorder. Benzodiazepines act on the gamma-aminobutyric (GABA) receptors, inducing relaxation. When used for a long time or in high doses, benzodiazepines may cause physical dependence. Stopping abruptly can trigger severe symptoms, including anxiety, irritability, difficulty sleeping, muscle cramps and confusion.

Stimulant medication: Medications used to treat attention deficit hyperactivity disorder (ADHD), including methylphenidates (Ritalin) and amphetamines (Adderall). Stimulant medications increase dopamine levels, affecting the core symptoms of ADHD: inattention, impulsivity and hyperactivity. Side effects include reduced appetite and sleeping problems, but these tend to go away after several weeks or after adjusting the dose.

Serotonin: Chemical in the brain that regulates mood, sleep, sex drive, appetite, memory and learning, body temperature and behavior.

Dopamine: Neurotransmitter that controls pleasure-seeking, emotion, attention and movement.

Norepinephrine: Neurotransmitter that regulates blood pressure, heart rate and respiration.

Additional Resources

Psych Central’s comprehensive medication guide
Guidelines for Anxiety Medication Use (can be applied to other illnesses)
Medication guide from the National Institute of Mental Health
Podcast from ADDA on medication for anxiety disorders with Dr. Roy-Byrne

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Virtual Therapy for PTSD

By Rick Nauert PhD Senior News Editor

Reviewed by John M. Grohol, Psy.D.

New research suggests post-traumatic stress disorder can affect 10 to 30 percent of combat zone soldiers, depending on the conflict in which they served. Given the instability of the global environment the ranks of active duty and retired soldiers will continue to grow.

As such, PTSD is on the rise and is a target for military health care personnel. A number of PTSD-focused studies presented at a military health research forum evaluated the effectiveness of both pharmacologic and alternative treatment options.

A novel intervention included use of virtual environments and new medicines to help military personnel diagnosed with PTSD or other comorbidities. If effective, the therapy technique could be used for the general public.

“PTSD is a condition that has affected decades of war veterans, and treatments continue to evolve,” stated Captain E. Melissa Kaime, M.D., Director of the CDMRP.

According to experts, about 20 percent of combat veterans returning from Iraq suffer from mild traumatic brain injury (mTBI) or PTSD.

Traditional treatment for these conditions consists of medication and psychotherapy, demanding frequent travel to a clinic, a potential hardship for many veterans.

Researchers led by Charles Levy, M.D., are attempting to leverage combat veterans’ comfort and familiarity with communications technology and immersive environments (through cell phones, the Internet, and video games) and build a prototype of a virtual world environment (VWE) in which to conduct therapy.

The VWE will simulate everyday life encounters that are challenging to those with mTBI/PTSD, and allow the veteran and therapist to confront and overcome barriers that block successful social reintegration.

The clinical team chose a supermarket as the virtual scenario where veterans could receive cognitive and emotional challenges, including following a shopping list, purchasing items, making change, colliding with other shopping carts, and engaging with clerks and other patrons at checkout.

Currently, a virtual supermarket is under construction that allows a therapist and patient, each at their own computer, to enter the virtual supermarket and experience these challenges together.

This research explores an innovative new concept. Previous use of virtual reality exposure among combat veterans has been limited to portraying battle as a part of exposure therapy.

“Oftentimes, the nuances of everyday life can unexpectedly trigger angry responses from warfighters hindered by mTBI and PTSD,” Levy said.

“This project shows great potential to expedite and expand care to veterans and wounded warriors in a short timeframe, in a way that minimizes travel for treatment, and in a cost-effective manner.”

Source: US Department of Defense Congressionally Directed Medical Research Programs

Law keeps veterans with post-traumatic stress disorder out of jail

By Chris Roberts
El Paso Times



EL PASO -- Combat veterans with post-traumatic stress disorder who are accused of certain crimes may soon have a choice between a trial or mental-health treatment.

El Paso judges last week took the first step in creating a Veterans Mental Health Treatment Court. They authorized the program for Judge Ricardo Herrera's county criminal court.

"I just think we need to get ahead of the curve a little bit and get this in place," said Herrera, who proposed the idea to the Council of Judges.



He said the court would make sense for El Paso because of Fort Bliss and its explosive growth. The post has about 20,000 active-duty soldiers and is expected to grow to 34,000 by 2013.

The court would be geared to active-duty soldiers or veterans who served in combat zones or other hazardous assignments and suffer from post-traumatic stress disorder, said Cesar Prieto, who works in Herrera's court.

He said the court for veterans would include felonies and misdemeanors, but not the most serious crimes, such as murder and rape. Prosecutors would have to approve a defendant's participation in the program.

The plan is still subject to approval by the El Paso County Commissioners Court. One member, Dan Haggerty, says he supports the idea.

"They used to put a rubber band around your head and tell you to snap out of it," said Haggerty, a Vietnam War veteran. "But some of these people can't. ... Absolutely, we need to move forward with it."

Counties can create such programs under a bill approved by the Texas Legislature. It provides only general guidelines, so details of the El Paso program would be worked out among Fort Bliss attorneys, Beaumont Army Medical Center officials, the El Paso County district attorney's staff, Veterans Affairs officials and others.

Participants in the veterans court would have to have a primary diagnosis of post-traumatic stress disorder, Prieto said. Other service-related disabilities that could be considered are traumatic brain injury and severe depression.

Crimes that could be handled by the court include assault, possession of marijuana, drunken driving and family violence, Prieto said.

The court would have the authority to require attendance in rehabilitation, educational, vocational, medical, psychiatric or substance-abuse programs, he said. It also could require that a participant take medication.

Treatment would last at least six months, but no longer than the period of community supervision normally required for the charged offense. Participants who did not complete the program would be prosecuted.

The court for veterans would be available only to those facing charges in the civilian system. A soldier arrested on post would still be subject to the military justice system, including the possibility of court-martial.

Herrera's staff is preparing to apply for a state grant that would provide $500,000 for one year to create a mental-health court for veterans. If the program is successful, it could qualify for $500,000 each year for five more years. Prieto said the court could be running by the end of the year.

"As more counties follow El Paso's lead, we will be able to keep more veterans out of jail and quickly get them the treatment they need," said state Sen. Rodney Ellis, D-Houston, who sponsored the enabling legislation. "After successfully completing their treatment program, veterans can have their cases dismissed and avoid a criminal conviction, which will ensure they can get a job and provide for their families."

State Rep. Joe Moody, D-El Paso, said the program did not give veterans a "get-out-of-jail-free card." The requirements would be rigorous, he said, and the goal would be to transform an offender into a productive citizen.

"Our success in El Paso is tied to the troops at Fort Bliss and we have to take care of them," Moody said. "If we don't help them, we'll have to take care of it at the back end."

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Agony and Ecstasy and PTSD

By Charles H. Elliott, Ph.D.

The anxiety disorder called Post Traumatic Stress Disorder (PTSD) can occur when a person witnesses or is involved in a traumatic experience. In most cases, the person is present at the trauma, but other times the trauma happens to someone very close. The event generally involves a serious threat of death or injury. The person feels intense horror, fear, and helplessness. Here are three examples of PTSD.Although most people don’t have all of these, symptoms of PTSD which occur after a traumatic event include:

• Intrusive and distressing images, thoughts, perceptions of the event
• Recurrent Dreams
• Flashbacks of the event
• Intense distress when reminded of the event
• Over reactive psychological symptoms
• Avoiding talking about the trauma
• Avoiding activities that bring back memories
• Attempts to repress or forget the trauma
• Less interest in life activities
• Feelings of detachment
• Belief that the future is limited
• Increased arousal
• Problems with sleep
• Angry outbursts
• Irritability
• Problems with concentration
• Hypervigilance
• Easily startled

For those with PTSD, cognitive behavioral therapy is a very good therapeutic choice. Like those with OCD, exposure to the feared event is part of the treatment. The problem in the past has been that many people with PTSD avoid getting help because of a strong desire to avoid anything that reminds them of the trauma–and exposure certainly does that.

A few recent studies have introduced a new way to perform exposure. The patient is given 3,4-methylenedioxymethamphetamine (MDMA) during the exposure. Although the studies are preliminary, it appears that MDMA may facilitate exposure.

MDMA, aka, Ecstasy, is known for its positive effects on mood and empathy. The behavioral treatments with exposure and MDMA take no longer (usually 10-12 sessions) than standard behavior therapy. The drug is given under medical supervision only during the session and is discontinued after exposure is complete. Considerably more research is required before we can wholly endorse this approach. However, we thought you might find it interesting to know what’s in the pipeline of possibilities for treating PTSD.

Finally, this should not be tried at home! Nor are we recommending MDMA for other purposes. And we recommend that you avoid Raves as well.

Charles H. Elliott, Ph.D. is a clinical psychologist and a Founding Fellow in the Academy of Cognitive Therapy. He is also a member of the faculty at Fielding Graduate University. He specializes in the treatment of adolescents and adults with obsessive compulsive disorder, anxiety, anger, depression, and personality disorders. Dr. Elliott is coauthor of: Obsessive Compulsive Disorder For Dummies, Seasonal Affective Disorder For Dummies, Anxiety and Depression Workbook For Dummies, Depression For Dummies, Overcoming Anxiety For Dummies, Why Can't I Get What I Want?, Why Can’t I Be the Parent I Want to Be?, and Hollow Kids: Recapturing the Soul of a Generation Lost to the Self-Esteem Myth.

Service Dogs Help With PTSD

New PTSD Program Answers Need

by Capt. Bryan Lewis

LANDSTUHL REGIONAL MEDICAL CENTER, Germany - Symptoms of combat stress and post-traumatic stress disorder include continual nightmares, avoidance behaviors, denial, grief, anger and fear.

Some Soldiers, battling these and other symptoms, can be treated successfully as an outpatient while assuming their normal duties. For others, however, returning to work and becoming their old selves again were challenges recognized by several mental health professionals across the European theater.

"We were looking at how we can best meet the needs of our clientele, and we were identifying that a lot of the Soldiers needed more than once-a-week outpatient, individual therapy and probably needed more than once- or twice-a-week group therapy," said Joseph Pehm, chief of Medical Social Work at Landstuhl Regional Medical Center.

The solution came in the creation of an intensive eight-week therapeutic Post-Traumatic Stress Disorder Day Treatment Program called "evolution" that began in March 2009 at LRMC. During the eight-hour days, patients enrolled in the program participate in multiple disciplines and interests, including art therapy, yoga and meditation classes, substance abuse groups, anger and grief management, tobacco cessation, pain management and multiple PTSD evidence-based practice protocols.

"I am a great believer in the kitchen sink, meaning I throw everything, including the kitchen sink, and something will stick," said Dr. Daphne Brown, chief of the Division of Behavioral Health at LRMC. "And so we've come with all the evidence-based treatment for PTSD that we know about ... We've taken everything that we can think of that will be of use in redirecting symptoms for these folks and put it into an eight-week program."

Brown, Pehm and Sharon Stewart, a Red Cross volunteer who recently received a doctorate in psychology, said the program is designed from research into the effects of traumatic experience and mirrors successful PTSD programs at Walter Reed Army Medical Center and the Department of Veterans Affairs, as well as programs run by psychologists in the U.S.

"We are building on the groundbreaking work that some of our peers and colleagues have done and just expanding it out," said Brown.

During treatment, patients begin the day with a community meeting where they discuss how well they feel and any additional issues or concerns since their last meeting. The remainder of the day depends on the curriculum scheduled for that week.

The first few weeks focus on learning basic coping skills such as how to reduce anxiety and fight fear, as well as yoga and meditation for relaxation. Eye Movement Desensitization and Reprocessing, or EMDR, an evidence-based practice for treating PTSD, is also conducted during the early phases of the treatment program.

"The concept behind EMDR is that, essentially, memories become fixed in one part of our brain and they maintain their power and control over our emotions as long as they are fixed there," said Brown. "And if we can activate a different part of the brain while we're experiencing that memory, we can help to remove some of that emotional valence from it. So we use physiological maneuvers to activate both sides of the brain."

The goal at the beginning of the PTSD program is to provide patients with a number of tools they can use to help them calm down when feeling overwhelmed, especially before more intense therapy begins in the latter weeks. Cognitive processing therapy is used throughout the program. EMDR and prolonged exposure therapy are also available on an individual basis at the Soldier's request. All three techniques are research-based treatments.

When life-changing events occur, Brown said perceptions about the world may change. For example, before Soldiers experience combat trauma they may think the world is safe. Following combat, a Soldier's perceptions may change - a majority of the world may now seem unsafe. Cognitive processing therapy attempts to re-address experiences and reshift a Soldier's perceptions.

Prolonged exposure therapy is behaviorally based and addresses a Soldier's fears, which are seen as reflex reactions to a stimulus. To decondition the reactions, a patient is continually exposed to the stimulus by retelling the story repeatedly, minus the negative outcome. Brown compared it to riding a roller coaster over and over again to overcome a fear of roller coasters.

"So they're getting EMDR, they're getting cognitive processing therapy, they're getting individual therapy, they're getting group therapy, they're getting education, anger management, self-esteem, relationship issues, grief and loss, yoga, meditation exercise, skill building -- a little bit of everything across the board," said Brown. "Not everything's going to resonate with everyone who comes through, but something's going to resonate for everyone who comes through."

In addition to the overall core curriculum, Brown and her staff have programs such as pain management, relationship enrichment and tobacco cessation to help individualize treatment.

"The core of the group and individual education is consistent for everyone," said Brown. "But we recognize that every patient is different, and we have to tailor-make it to give an individualized treatment plan. We don't keep people in pain management if they're not in pain. We don't give them tobacco cessation if they're not smoking. So we do try and tailor as much of it as we can."

Spirituality, relationship enrichment and gender-specific issues are also areas of focus.
"The program is holistic," said Pehm. "It looks at people from different spheres, not just the medical model, because everything is impacted when someone has combat stress or PTSD - not just the individual Soldier, but everybody who comes in contact with them."

The intensity, length and "kitchen sink" qualities are not the only aspects that make this program unique, said Brown. It is a joint military and civilian effort accomplished entirely by volunteers. The staff is as diverse as the therapy options, and includes chaplains, social workers, Red Cross volunteers, psychiatrists, a nurse practitioner, enlisted psychiatric technicians, and graduate students. Brown said having a sundry of personnel keeps the program fresh and the staff excited.

"The patients get perspectives from people from a number of different backgrounds," said Brown.

Thus far, the staff outnumbers the program's participants.

"By design we started out small, and we were able to establish a really good working relationship with the local Warrior Transition Unit people ... It's been a wonderful working relationship with them," said Pehm.

Evolution is currently on it second eight-week course, with five patients enrolled. The first class had four. The goal is to keep the class size small in order to benefit from the program's intensity. Thinking small also helps keep the impact large by successfully returning Soldiers to their units, while also expanding access outside the WTUs. However, Pehm said they would like to expand the program to include patients from throughout the European Command.

"Ideally, we'd like to max it at about 10 because it is so intensive," said Brown. "These are folks we hope to remediate and return to the Army to be functional members again. Also, if they go back to their communities and their providers or spouses see the changes that have come about, that will increase the willingness or desire of more people to be here."

Though few have completed this young program, signs of success have already started to surface.

"With the last group, the shift from 'I have to be here' to 'I'm so glad I came' was really phenomenal," said Pehm.

"One of them said that he didn't think he was getting anything out of the program," Brown said. "It was about week six until he saw himself react differently to a situation that came up, and watched himself do it differently using skills that he didn't know he learned. He went 'Wow,' maybe I am getting something out of this."

It is too early, and the numbers are too small, to generalize the early trends, but self-completed PTSD checklists showed a significant decrease in reported symptoms for three of the four patients in the first cohort. Additionally, anxiety and depression symptom measures decreased.

"The whole idea is that we know all the changes aren't going to take place here," said Brown. "But we hope we give them enough learning to send them in a different direction. My hope is that we can build a program to provide valid, effective treatment to folks who have put themselves in harm's way at the request of their country, and help them live happier and better lives."

Invisible Injuries

Not all wounds are visible.

Invisible injuries can remain long after the battle is over: depression, post-traumatic stress disorder, and traumatic brain injuries among them. The symptoms aren’t always clear, and may not be what you think. Like any wound, they can fester and worsen if ignored. They can get in the way of being a parent, sibling, soldier, friend and co-worker.

If untreated, invisible injuries can lead to an onslaught of problems including domestic violence, alcoholism and even suicide. Rates of each run high among vets compared to the civilian population.

It doesn’t have to be this way. Seeking help sooner rather than later can spare you and those around you a lot of pain.

Many vets learn to cope with these wounds, and come away stronger. One Iraq vet who fought to get his life back on track describes a renewed sense of purpose. “You know, I almost died, so I figured there’s a lot of stuff I need to do.” He went on to start a nonprofit outdoor adventure group for disabled people.

Get help.

• Contact your health care professional
• Find your nearest VA hospital by calling 877-222-VETS
• Check out the Vet Center Readjustment Services
• Call the VFW or American Legion for soldier support services

Soldiers in Colorado slayings tell of Iraq horrors

COLORADO SPRINGS, Colo. – Soldiers from an Army unit that had 10 infantrymen accused of murder, attempted murder or manslaughter after returning to civilian life described a breakdown in discipline during their Iraq deployment in which troops murdered civilians, a newspaper reported Sunday.

Some Fort Carson, Colo.-based soldiers have had trouble adjusting to life back in the United States, saying they refused to seek help, or were belittled or punished for seeking help. Others say they were ignored by their commanders, or coped through drug and alcohol abuse before they allegedly committed crimes, The Gazette of Colorado Springs said.

The Gazette based its report on months of interviews with soldiers and their families, medical and military records, court documents and photographs.

Several soldiers said unit discipline deteriorated while in Iraq.

"Toward the end, we were so mad and tired and frustrated," said Daniel Freeman. "You came too close, we lit you up. You didn't stop, we ran your car over with the Bradley," an armored fighting vehicle.

With each roadside bombing, soldiers would fire in all directions "and just light the whole area up," said Anthony Marquez, a friend of Freeman in the 1st Battalion, 9th Infantry Regiment. "If anyone was around, that was their fault. We smoked 'em."

Taxi drivers got shot for no reason, and others were dropped off bridges after interrogations, said Marcus Mifflin, who was eventually discharged with post traumatic stress syndrome.

"You didn't get blamed unless someone could be absolutely sure you did something wrong," he said

Soldiers interviewed by The Gazette cited lengthy deployments, being sent back into battle after surviving war injuries that would have been fatal in previous conflicts, and engaging in some of the bloodiest combat in Iraq. The soldiers describing those experiences were part of the 3,500-soldier unit now called the 4th Infantry Division's 4th Brigade Combat Team.

Since 2005, some brigade soldiers also have been involved in brawls, beatings, rapes, DUIs, drug deals, domestic violence, shootings, stabbings, kidnapping and suicides.

The unit was deployed for a year to Iraq's Sunni Triangle in September 2004. Sixty-four unit soldiers were killed and more than 400 wounded — about double the average for Army brigades in Iraq, according to Fort Carson. In 2007, the unit served a bloody 15-month mission in Baghdad. It's currently deployed to the Khyber Pass region in Afghanistan.

Marquez was the first in his brigade to kill someone after an Iraq tour. In 2006, he used a stun gun to shock a drug dealer in Widefield, Colo., in a dispute over a marijuana sale, then shot and killed him.

Marquez's mother, Teresa Hernandez, warned Marquez's sergeant at Fort Carson her son was showing signs of violent behavior, abusing alcohol and pain pills and carrying a gun. "I told them he was a walking time bomb," she said.

Hernandez said the sergeant later taunted Marquez about her phone call.

"If I was just a guy off the street, I might have hesitated to shoot," Marquez told The Gazette in the Bent County Correctional Facility, where he is serving a 30-year prison term. "But after Iraq, it was just natural."

The Army trains soldiers to be that way, said Kenneth Eastridge, an infantry specialist serving 10 years for accessory to murder.

"The Army pounds it into your head until it is instinct: Kill everybody, kill everybody," he said. "And you do. Then they just think you can just come home and turn it off."

Both soldiers were wounded, sent back into action and saw friends and officers killed in their first deployment. On numerous occasions, explosions shredded the bodies of civilians, others were slain in sectarian violence — and the unit had to bag the bodies.

"Guys with drill bits in their eyes," Eastridge said. "Guys with nails in their heads."

Last week, the Army released a study of soldiers at Fort Carson that found that the trauma of fierce combat and soldier refusals or obstacles to seeking mental health care may have helped drive some to violence at home. It said more study is needed.

While most unit soldiers coped post-deployment, a handful went on to kill back home in Colorado.

Many returning soldiers did seek counseling.

"We're used to seeing people who are depressed and want to hurt themselves. We're trained to deal with that," said Davida Hoffman, director of the privately operated First Choice Counseling Center in Colorado Springs. "But these soldiers were depressed and saying, 'I've got this anger, I want to hurt somebody.' We weren't accustomed to that."

At Fort Carson, Eastridge and other soldiers said they lied during an army screening about their deployment that was designed to detect potential behavioral problems.

Sergeants sometimes refused to let soldiers get PTSD help or taunted them, said Andrew Pogany, a former Fort Carson special forces sergeant who investigates complaints for the advocacy group Veterans for America.

Soldier John Needham described a number of alleged crimes in a December 2007 letter to the Inspector General's Office of Fort Carson. In the letter, obtained by The Gazette, Needham said that a sergeant shot a boy riding a bicycle down the street for no reason.

Another sergeant shot a man in the head while questioning him, lashed the man's body to his Humvee and drove around the neighborhood. Needham also claimed sergeants removed victims' brains.

The Army's criminal investigation division interviewed unit soldiers and said it couldn't substantiate the allegations.

The Army has declared soldiers' mental health a top priority.

"When we see a problem, we try to identify it and really learn what we can do about it. That is what we are trying to do here," said Maj. Gen. Mark Graham, Fort Carson's commander. "There is a culture and a stigma that needs to change."

Fort Carson officers are trained to help troops showing stress signs, and the base has doubled its number of behavioral-health counselors. Soldiers seeing an Army doctor for any reason undergo a mental health evaluation.

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On the Net:

Colorado Springs Gazette: http://www.gazette.com