1.  Overview for this evening Seminar!  Anxiety Disorders (PTSD) and Acute Stress  Treatment planning for PTSD  Therapy methods for PTSD and Acute Stress

2.  PTSD (Posttraumatic Stress Disorder and Acute Stress Disorder)  PTSD is one of several anxiety disorders.  For general purposes, the others are as follows:  Phobias (including Agoraphobia, Specific Phobia, and Social Phobia)  Panic Disorder  Obsessive-Compulsive Disorder  Generalized Anxiety Disorder

3.  PTSD and Acute Stress disorder  Both PTSD and Acute Stress disorder involve a reaction to an extreme stressor that has caused or threatened death or severe injury.  Extreme stressors include rape, combat, automobile accidents, and natural disasters, among others.

4.  A person’s contact with the stressor may involve direct experience, observation (as with a firefighter or the witness to an accident) or vicarious experience (as when a friend, family member, or close associated experiences the stressor).

5.  DSM-IV includes the following criteria as relevant to the diagnosis of these disorders:  Great fear and helplessness in response to the traumatic event.  Persistent reexperiencing of the event (for example, through dreams, distressing recollections, or intense distress on exposure to reminders of the event)  Loss of general responsiveness,

6.  And, at least three indications of avoiding reminders of the trauma (for example detached from others, believing that one’s life is foreshortened, and dissociating from or being unable to recall major aspects of the traumatic experience).

7.  At least two persistent symptoms of arousal and anxiety (such as sleep disturbances, anger or startle responses, and difficulty concentrating) that are apparently due to the stressor and are severe enough to cause significant distress or impairment.

8.  The primary differences between PTSD and Acute Stress Disorder?

9.  There are two primary differences  First, is the time of onset and second would be the duration.  Acute Stress Disorder begins within four weeks of exposure to a traumatic stressor and lasts at least two days but no longer than four week; it sometimes develops into PTSD.

10.  PTSD is describe Acute if it lasts for less than three months and is Chronic if the symptoms last longer.  The disorder is termed PTSD with delayed onset if the symptoms begin more than six months after exposure to the stressor.

11.  What are some possible Intervention Strategies when treating PTSD?

12.  Treatment and Acute Disorder and PTSD should begin as soon as after the trauma, and preventive treatment is recommended even before symptoms.  However this does not always happen?  With military, law enforcement and or any other similar field why would treatment be delayed or what would be some reasons for people not seeking treatment immediately.

13.  Group and individual counseling are treatment methods.  One group intervention (CISD) or Critical Incident Stress Debriefing is use to provide early help for people who have undergone traumas.  CISD should be provided within 24-72 hours after the event, and is also used for people have experienced airplane crash, act of terrorism, natural disaster, as well as officers of the law, firefighters, military and EMS, etc.

14.  With Groups ideally 8-12 people, ongoing sessions and the emphasis is on caring, peer support, hope and empowerment of the participants.

15.  Stages of the Group process:  1. Introductions, information about the process, guidelines for the group.  2. Exploration of facts and information related to the trauma.  3. Discussion of thoughts about the event. Continue on next Slide!

16.  4. Exploration of emotions and reactions.  5. Exploration of symptoms of distress.  6. Teaching about reactions to trauma and risk factors.  7. Reinforcement of coping skills, management of life and encouragement of reentry and closure.  Additional treatment skills, will continue on the next slide.

17.  Other treatment skills are:  CBT or Cognitive-behavioral interventions in accordance to research seems best for the treatment of PTSD and Acute Stress Disorder and exposure to the memory of the trauma is an important element of treatment.  CPT or Cognitive processing therapy which is twelve-session structured model in which exposure is combined with cognitive restructuring to change people’s disrupted cognitions.

19.  AMT or Anxiety Management Training, typically pairs prolonged activation of traumatic memories with techniques (such as relaxation, cognitive restructuring and biofeedback) designed to modify these memories and the associated fears.

20.  SIT-Stress inoculation training includes education and training in six coping skills (muscle relaxation, thought stopping, breath control, guided self-dialogue, cover modeling and role playing)  And there are others treatment methods, at this point I will stop there.  Questions for the class

21.  What are some possible long-term effects of PTSD?

22. See you next week for Seminar #4! Remember No seminar in Unit#5 and Unit#10!