1. © Copyright Gary Johnston 2011 Dealing with Trauma in a Traumatised World 'Tis in my head; 'tis in my heart; 'tis everywhere; it rages like madness, and I most wonder how my reason holds.

2. © Copyright Gary Johnston 2011 Trauma - PTSD – The Triggers Instance of exposure to death, violence, rape –War, accident, assault, rape, natural disaster, witnessing such event. –Maybe single or multiple occurrence

3. © Copyright Gary Johnston 2011 Trauma – Most Common Victims War veterans and war survivors ie: refugees from war zones etc. War veterans and war survivors ie: refugees from war zones etc. Natural disasters - civilians Natural disasters - civilians Emergency services – police, fire, ambulance, SES Emergency services – police, fire, ambulance, SES Victims of violent crime, rape etc Victims of violent crime, rape etc Victims of accidents Victims of accidents

4. © Copyright Gary Johnston 2011 PTSD - Symptoms Intrusive thoughts / Flashbacks / nightmares Intrusive thoughts / Flashbacks / nightmares Withdrawal and avoidance Withdrawal and avoidance Hyper-arousal Hyper-arousal Panic attacks /Panic disorder Panic attacks /Panic disorder Depression / hopelessness Depression / hopelessness Phobias Phobias Survivor Guilt Survivor Guilt Anger / violence Anger / violence

5. © Copyright Gary Johnston 2011 PTSD – The Facts (1) 685 out of 1000 people who are exposed to a traumatic event will suffer symptoms of PTSD in the days and weeks following the event, but these recede for 65% over the following 90-120 days. 685 out of 1000 people who are exposed to a traumatic event will suffer symptoms of PTSD in the days and weeks following the event, but these recede for 65% over the following 90-120 days. Estimated 30% of victims of PTSD will have lifetime chronic symptoms unless properly treated. (= about 19% of total trauma victims) Estimated 30% of victims of PTSD will have lifetime chronic symptoms unless properly treated. (= about 19% of total trauma victims)

6. © Copyright Gary Johnston 2011 PTSD – The Facts (2) 61% of men and 51% of women are exposed to at least one traumatic event over the course of their lives. An estimated 7.8% will experience PTSD at some point in their lives (as defined by DSM IV) 61% of men and 51% of women are exposed to at least one traumatic event over the course of their lives. An estimated 7.8% will experience PTSD at some point in their lives (as defined by DSM IV)

7. © Copyright Gary Johnston 2011 PTSD – The Facts (3) 64% of female psychiatric inpatients suffer PTSD. 44% of male psychiatric inpatients were victims of physical abuse and develop PTSD. 64% of female psychiatric inpatients suffer PTSD. 44% of male psychiatric inpatients were victims of physical abuse and develop PTSD. 80% of PTSD patients have at least one co-morbid disorder (anxiety/panic, depression, suicide). 80% of PTSD patients have at least one co-morbid disorder (anxiety/panic, depression, suicide).

8. © Copyright Gary Johnston 2011 PTSD – The Facts (4) Over 250,000 Australians suffer PTSD annually Over 250,000 Australians suffer PTSD annually High instance of alcohol and drug abuse A pproximately 50% of men and 25% of women with chronic PTSD have drug and alcohol issues (Australian Centre for Post Traumatic Mental Health - 1999) High instance of alcohol and drug abuse A pproximately 50% of men and 25% of women with chronic PTSD have drug and alcohol issues (Australian Centre for Post Traumatic Mental Health - 1999) Children of PTSD suffers suicide at 3 times the national average Children of PTSD suffers suicide at 3 times the national average

9. © Copyright Gary Johnston 2011 PTSD – The Facts (5) Women are twice as likely to suffer chronic PTSD than men (wider range of trigger events, rape etc) Women are twice as likely to suffer chronic PTSD than men (wider range of trigger events, rape etc) 80% of women in war zones develop PSTD. Current figure for men is 68.5% 80% of women in war zones develop PSTD. Current figure for men is 68.5%

10. © Copyright Gary Johnston 2011 PTSD – The Facts (6) In USA 58,000 died in Vietnam. 150,000 have died by suicide since the war. (Nam Vet: Dean 1990). Official number is 58,000. In USA 58,000 died in Vietnam. 150,000 have died by suicide since the war. (Nam Vet: Dean 1990). Official number is 58,000. 30 years after Vietnam 10% of veterans suffer chronic PTSD (200,000 in US) (Keonen et al. 2008) 30 years after Vietnam 10% of veterans suffer chronic PTSD (200,000 in US) (Keonen et al. 2008) Current report 18 die per day, 1000/mth try to die (VA) Current report 18 die per day, 1000/mth try to die (VA)

11. © Copyright Gary Johnston 2011 PTSD – The Facts (7) Post major fires 24% of population show PTSD (Marshall et al. 2007 ). Firefighters same statistics as war veterans Post major fires 24% of population show PTSD (Marshall et al. 2007 ). Firefighters same statistics as war veterans The overall prevalences of PTSD, anxiety, and depression symptoms were 7.0 percent, 32.6 percent, and 22.2 percent, respectively in displaced refugees ( JAMA 2011 ). The overall prevalences of PTSD, anxiety, and depression symptoms were 7.0 percent, 32.6 percent, and 22.2 percent, respectively in displaced refugees ( JAMA 2011 ).

12. © Copyright Gary Johnston 2011 The Effect Net effect is that chronic PTSD causes extremes of anxiety, panic, depression, withdrawal and isolation. Net effect is that chronic PTSD causes extremes of anxiety, panic, depression, withdrawal and isolation. A key factor in isolation is the awareness of the stigma attached to mental disease A key factor in isolation is the awareness of the stigma attached to mental disease

13. © Copyright Gary Johnston 2011 Avoidance Symptoms - 1 Trying to avoid thinking or talking about the trauma, as well as any feelings associated with the trauma. A pproximately 50% of men and 25% of women with chronic PTSD have drug and alcohol issues (Australian Centre for Post Traumatic Mental Health - 1999) Trying to avoid thinking or talking about the trauma, as well as any feelings associated with the trauma. A pproximately 50% of men and 25% of women with chronic PTSD have drug and alcohol issues (Australian Centre for Post Traumatic Mental Health - 1999) Avoiding people, places and activities that trigger memories of the traumatic event. Avoiding people, places and activities that trigger memories of the traumatic event. Not remembering an important part of the traumatic event Not remembering an important part of the traumatic event

14. © Copyright Gary Johnston 2011 Avoidance Symptoms - 2 Losing interest in, and enjoyment of leisure activities, study, work or stop participating in such activities altogether. Losing interest in, and enjoyment of leisure activities, study, work or stop participating in such activities altogether. Feeling detached from other people Feeling detached from other people Being unable to feel joy or have loving feelings Being unable to feel joy or have loving feelings Not be able to see a future for themselves, they don't expect to get married, have a family, live a long time Not be able to see a future for themselves, they don't expect to get married, have a family, live a long time

15. © Copyright Gary Johnston 2011 (Hawthorne 2010)

16. © Copyright Gary Johnston 2011 (Hawthorne 2010)

17. © Copyright Gary Johnston 2011 More Statistics Excess Burden of health in Australia from PTSD early 2000s $348 million for Vietnam Vets alone (Hawthorne 2010) Excess Burden of health in Australia from PTSD early 2000s $348 million for Vietnam Vets alone (Hawthorne 2010) 14.4% of Australians live with severe isolating anxiety illnesses every year – that is 3 million people (ABS). 14.4% of Australians live with severe isolating anxiety illnesses every year – that is 3 million people (ABS).

18. © Copyright Gary Johnston 2011 Social Isolation Isolation stems from avoidance symptoms plus Isolation stems from avoidance symptoms plus Stigma associated with PTSD and mental illness in general Stigma associated with PTSD and mental illness in general (Only 10% of war veterans sought help) (Nam Vet: Dean 1990)

19. © Copyright Gary Johnston 2011 Actions Required Encourage government, military and emergency services organisations to accept responsibility and properly fund research, education and intervention programs. Encourage government, military and emergency services organisations to accept responsibility and properly fund research, education and intervention programs.

20. © Copyright Gary Johnston 2011 Actions Required De-stigmatising effects of trauma through education of public, government, medical, psychologists, schools De-stigmatising effects of trauma through education of public, government, medical, psychologists, schools Educate the educators!! Educate the educators!! Include ethnic education for minority groups from war and natural disaster refugees Include ethnic education for minority groups from war and natural disaster refugees

21. © Copyright Gary Johnston 2011 Actions Required We must normalise anxiety, especially PTSD, so they are viewed as common as the cold – reducing social isolation and encouraging treatment – public awareness. We must normalise anxiety, especially PTSD, so they are viewed as common as the cold – reducing social isolation and encouraging treatment – public awareness. De-isolating improvements in quality of life and reduction in depression, anxiety and anger. De-isolating improvements in quality of life and reduction in depression, anxiety and anger.

22. © Copyright Gary Johnston 2011 Actions Required Encourage adoption of new evidence based methods to deal with both the physical and emotional basis of PTSD Encourage adoption of new evidence based methods to deal with both the physical and emotional basis of PTSD Current research points to biochemical and emotional memory contributors to trauma anxiety and memory /time distortions. Current research points to biochemical and emotional memory contributors to trauma anxiety and memory /time distortions.

23. © Copyright Gary Johnston 2011 Contact details Gary Johnston Grad. Dip. CH, MTLTP Member International Society for Trauma Stress Studies (MISTSS) Australian Association of Clinical Hypnotherapists and Psychotherapists Director of the Australian National Hypnotherapy Register (ANHR) Senior Faculty of Goulding Institute Web: http://www.gmfint.com http://www.ptsdresearch.org Email: garyj@gmfint.com Tel: 03 8682 8772 Mob: 0407 070234