Special Considerations in the Psychotherapeutic Treatment of Appalachian Combat Veterans with ...

30 Pages·2015·10.21 MB·English

Special Considerations in the
Psychotherapeutic Treatment of
Appalachian Combat Veterans
with PTSD
Myra Qualls Elder, Ph.D.
James H. Quillen Veterans Affairs
Medical Center, Mountain Home, TN
Disclaimer
• 
The views expressed are my own and
do not represent the official views of
the Veteran’s Health Administration
(VHA). (They wouldn’t let me out to
do this presentation unless I put in
this slide.)
Objectives
• 
Recognize the special challenges posed by
Appalachian and military cultural identities
• 
Become familiar with rates of substance
use/abuse among combat veterans, and
how this affects treatment
• 
Learn about VA-endorsed Evidence-Based
Treatments (EBTs) for PTSD

ARC’s Map of Appalachia
You are 19…
PTSD in DSM-V
• 
New Category: Trauma- and
Stressor-Related Disorders
• Inclusive of “trauma by proxy”
• 
More descriptive of negative cognitive
and emotional states as sxs
•  (American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 1 June 2013].
dsm.psychiatryonline.org)
PTSD Symptoms After Exposure
• 
Intrusion Sxs: memories, dreams,
flashbacks, distress from triggers
• 
Avoidance Sxs
• 
Negative cognitive/emotional states (this
is the new sx category in DSM-V): guilt,
shame, pervasively negative thinking,
detachment, estrangement, anhedonia
PTSD Symptoms Continued
• 
Arousal: Anger, reckless/self-destructive
behavior (this is new), insomnia, etc.
(American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access
date: 1 June 2013]. dsm.psychiatryonline.org)
• The 4 A’s of PTSD: Anger, Alcohol
(or
, Avoidance, Alexithymia
opioids, or benzos)
Veteran-Specific Dx Questions
• 
When do you do your grocery shopping?
• 
Do you ever eat at a restaurant? Where
do you sit?
• 
Is there a gun in your bedroom? How
many guns are in your house? Your
vehicle? Do you keep them loaded?
• 
How many times a night do you check
your window/door locks?
• 
What do you do on July 4th?