1. Jessica Duffel, Psy.D. Clinical Psychologist Family Mental Health Program Oklahoma City VA Medical Center

2. Review the signs and symptoms of PTSD Identification of risk factors and protective factors associated with posttraumatic stress Examine the principles of recovery and resilience Describe the impact of posttraumatic stress in the family and school settings

4. Exposure to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence Direct exposure or witnessing Indirect exposure Repeated or extreme indirect exposure to gruesome details of the event(s), usually in the course of professional duties

5. Sexual abuse, physical abuse, domestic violence Violent crimes: assault, mugging, kidnapping War Natural or man-made disasters Community violence Transportation accidents

6. R e-experiencing A voidance I ncreased arousal N egative thoughts and feelings

7. Recurrent, involuntary, and intrusive memories Children age 6+ may show repetitive play Traumatic nightmares Children may have frightening dreams without content related to the trauma(s) Dissociative reactions- flashbacks Children may reenact the event in play Intense distress after exposure to traumatic reminders

8. Efforts to avoid distressing trauma-related stimuli associated with the event: Trauma-related thoughts or feelings Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations)

9. Irritable or aggressive behavior Self-destructive or reckless behavior Hypervigilance Exaggerated startle response Problems in concentration Sleep disturbance

10. Negative beliefs and expectations about oneself, others, or the world Blaming self or others for causing the traumatic event Negative trauma-related emotions (e.g., fear, horror, anger, guilt, or shame) Decreased interest in previously enjoyed activities Feeling alienated from others (e.g., detachment or estrangement) Inability to experience positive emotions

11. Symptoms persist for at least one month Negatively impact important areas of life There may be delay in appearance of symptoms

12. Fear Worry Sadness Anger Feeling alone Low self-esteem Difficulty trusting Aggression Self-harm Alcohol or drug use/misuse

13. Not everyone who experiences trauma develops PTSD Posttraumatic reactions vary by the individual and depend on many variables What variables?

14. Risk Factor = behavioral, hereditary, and environmental effects that increase the likelihood of developing a disorder Protective Factor = factors that prevent or reduce vulnerability for developing a disorder

15. Severity of the trauma Physical proximity to the trauma Trauma involved interpersonal violence Repeated traumas For Children: Parents’ reaction to the trauma Child has a preexisting mental health condition Parent(s) with mental health concerns

16. Use of healthy coping skills Holding the belief that there is something you can do to manage your feelings and cope Being resourceful and having good problem-solving skills Helping others Finding positive meaning in the trauma

17. Self-disclosure of the trauma to loved ones Having an identity as a survivor as opposed to a victim Distance from the trauma For children, parents demonstrating resilience after trauma Being more likely to seek help

18. Availability of social support Being connected with others – family, friends, community * Consistently cited in research as an extremely important protective factor

20. The process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress Research has shown that resilience is ordinary, not extraordinary American Psychological Association, 2015

21. Self-direction: determine own path to recovery Individualized and person-centered: multiple pathways to recovery based on individuals’ unique strengths, needs, preferences, experiences, and cultural backgrounds Empowerment: individuals choose among options and participate in all decisions that affect them APA, 2015

22. Holistic: recovery focuses on people’s entire lives, including mind, body, spirit, and community Nonlinear: recovery isn’t a step-by-step process but one based on continual growth, occasional setbacks, and learning from experience Strengths-based: recovery builds on people’s strengths APA, 2015

23. Respect: acceptance and appreciation of the individual Responsibility: responsibility for self-care in recovery Hope: recovery’s central, motivating message is a better future — that people can and do overcome obstacles APA, 2015

25. Help child learn what it means for a parent to have PTSD Help the child understand it is not his/her fault Individual therapy for parent Individual therapy/supportive counseling for child Family therapy is a good option Caution against parents or others oversharing the details of the parent’s trauma (depends on age and maturity of child) Be aware of possible violence in the home

26. May feel that their parent does not care about or love them May worry their parent cannot take care of them May worry about their parent’s well-being May show similar symptoms as parent May take on the adult role May not learn how to manage their feelings

27. Adults: Prolonged Exposure Cognitive Processing Therapy Acceptance and Commitment Therapy Couples and Family Therapy Family Education Programs Children: Trauma-Focused Cognitive Behavioral Therapy Play Therapy Specialized treatments for behavior problems or substance use * Parent involvement in treatments

29. Difficulty paying attention Slowed processing of information Learning and memory difficulties Difficulty with problem-solving, planning, organization Negative attitudes toward school

30. Extra time on in-class exams or out-of-class assignments Additional reminders for due dates Allow for audio recording of class lessons/lectures Give seating options Alternative seating arrangements Breaks during class

31. Allow to stand in back of class for brief periods When possible, use of break out groups Tutoring Excused absence procedures for medical and/or mental health appointments Communicate directly to educators about student being a trauma-survivor (if known) and suggestions for accommodations to help the student succeed

32. Speak calmly and gently, yet firm Respectful language Even tone of voice, not shouting Approach from the front Minimize sudden movements Avoid touching the individual unless asked or given permission Minimize loud, sudden noises Firmly ask the individual to leave the setting if being disruptive

33. “Life doesn’t get easier or more forgiving, we get stronger and more resilient.” -Steve Maraboli, Life, the Truth, and Being Free

34. OKC VA Med Center Family Mental Health Program: 405-456-5183405-456-2392 National Center for PTSD: http://www.ptsd.va.gov/ National Child Traumatic Stress Network, Psychological First Aid, Appendix E: http://www.nctsn.org/sites/default/files/pfa/english/a ppendix_e.pdf Vet Parenting Toolkit http://www.ouhsc.edu/VetParenting

35. American Psychiatric Association, DSM 5 American Psychological Association Agaibi, C.E., & Wilson, J.P. (2005). Trauma, PTSD, and resilience: A review of the literature. Trauma, Violence, and Abuse, 6, 195-216.