PTSD and Combat Stress - NT · PTSD and Combat Stress Light University 6 Video-based Curriculum •...

PTSDandCombatStressCrisisResponseandTrauma

CareSeries

P.O.Box739•Forest,VA24551•1-800-526-8673•www.AACC.net

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WelcometoLightUniversityandthe“PTSDandCombatStress”programofstudy.Our prayer is that you will be blessed by your studies and increase your effectiveness inreaching out to others. We believe you will find this program to be academically sound,clinicallyexcellentandbiblically-based.Our faculty represents some of the best in their field – including professors, counselors andministers who provide students with current, practical instruction relevant to the needs oftoday’sgenerations.We have alsoworked hard to provide youwith a program that is convenient and flexible –givingyoutheadvantageof“classroominstruction”onlineandallowingyoutocompleteyourtrainingonyourowntimeandscheduleinthecomfortofyourhomeoroffice.Thetestmaterialcanbefoundatwww.lightuniversity.comandmaybetakenopenbook.Onceyouhavesuccessfullycompletedthetest,whichcoverstheunitswithinthiscourse,youwillbeawardedacertificateofcompletionsignifyingyouhavecompletedthisprogramofstudy.Thank you for your interest in this program of study. Our prayer is that you will grow inknowledge,discernment,andpeople-skillsthroughoutthiscourseofstudy.Sincerely,

RonHawkinsDean,LightUniversity

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TheAmericanAssociationofChristianCounselors

• Represents the largestorganizedmembership (nearly50,000)ofChristian counselorsandcaregiversintheworld,havingjustcelebratedits25thanniversaryin2011.• Knownforitstop-tierpublications(ChristianCounselingToday,theChristianCounseling

Connection and Christian Coaching Today), professional credentialing opportunitiesofferedthroughtheInternationalBoardofChristianCare(IBCC),excellenceinChristiancounseling education, an array of broad-based conferences and live training events,radioprograms,regulatoryandadvocacyeffortsonbehalfofChristianprofessionals,apeer-reviewed Ethics Code, and collaborative partnerships such as CompassionInternational,theNationalHispanicChristianLeadershipConferenceandCareNet(tonameafew),theAACChasbecomethefaceofChristiancounselingtoday.

• With the needed vision and practical support necessary, theAACC helped launch the

InternationalChristianCoachingAssociation(ICCA)in2011,whichnowrepresentsthelargestChristianlifecoachingorganizationintheworldwithover2,000membersandgrowing.

OurMission

The AACC is committed to assisting Christian counselors, the entire “community of care,”licensedprofessionals,pastors,and laychurchmemberswith littleorno formal training. It isourintentiontoequipclinical,pastoral,andlaycaregiverswithbiblicaltruthandpsychosocialinsights that minister to hurting persons and helps them move to personal wholeness,interpersonalcompetence,mentalstability,andspiritualmaturity.

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OurVision

TheAACC’svisionhastwocriticaldimensions:First,wedesiretoservetheworldwideChristianChurch by helping foster maturity in Christ. Secondly, we aim to serve, educate, and equip1,000,000 professional clinicians, pastoral counselors, and lay helpers throughout the nextdecade.WearecommittedtohelpingtheChurchequipGod’speopletoloveandcareforoneanother.We recognize Christian counseling as a unique form of Christian discipleship, assisting thechurch in its call to bring believers to maturity in the lifelong process of sanctification—ofgrowingtomaturityinChristandexperiencingabundantlife.Werecognizesomearegiftedtodosointhecontextofaclinical,professionaland/orpastoralmanner.Wealsobelieveselected laypeoplearecalledtocareforothersandthattheyneedtheappropriatetrainingandmentoringtodoso.WebelievetheroleofthehelpingministryintheChurchmustbesupportedbythreestrongcords:thepastor,thelayhelper,andtheclinicalprofessional.ItistothesethreerolesthattheAACCisdedicatedtoserve(Ephesians4:11-13).

OurCoreValues

InthenameofChrist,theAmericanAssociationofChristianCounselorsabidesbythefollowingvalues:

VALUE1:OURSOURCEWearecommittedtohonorJesusChristandglorifyGod,remainingflexibleandresponsivetotheHolySpiritinallthatHehascalledustobeanddo.VALUE2:OURSTRENGTHWearecommittedtobiblicaltruths,andtoclinicalexcellenceandunityinthedeliveryofallourresources,services,trainingandbenefits.VALUE3:OURSERVICEWeare committed toeffectivelyandcompetently serve the communityof careworldwide—bothourmembership and the churchat large—withexcellenceand timeliness, andbyover-deliveryonourpromises.VALUE4:OURSTAFFWearecommittedtovalueandinvestinourpeopleaspartnersinourmissiontohelpotherseffectivelyprovideChrist-centeredcounselingandsoulcareforhurtingpeople.VALUE5:OURSTEWARDSHIPWe are committed to profitably steward the resourcesGod gives to us in order to continueservingtheneedsofhurtingpeople.

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LightUniversity• Establishedin1999undertheleadershipofDr.TimClinton—hasnowseennearly200,000

students from around the world (including lay caregivers, pastors and chaplains, crisisresponders,lifecoaches,andlicensedmentalhealthpractitioners)enrollincoursesthataredelivered via multiple formats (live conference and webinar presentations, video-basedcertificationtraining,andastate-of-theartonlinedistanceteachingplatform).

• Thesepresentations,courses,andcertificateanddiplomaprograms,offeroneofthemostcomprehensive orientations to Christian counseling anywhere. The strength of LightUniversity is partially determined by its world-class faculty—over 150 of the leadingChristianeducators,authors,mentalhealthcliniciansandlifecoachingexpertsintheUnitedStates. This core groupof facultymembers represents a literal “Who’sWho” inChristiancounseling. No other university in the world has pulled together such a diverse andcomprehensivegroupofprofessionals.

• Educational and training materials cover over 40 relevant core areas in Christian—

counseling, lifecoaching,mediation,andcrisis response—equippingcompetentcaregiversand ministry leaders who are making a difference in their churches, communities, andorganizations.

OurMissionStatement

TotrainonemillionBiblicalCounselors,ChristianLifeCoaches,andChristianCrisisRespondersbyeducating,equipping,andservingtoday’sChristianleaders.

AcademicallySound•ClinicallyExcellent•DistinctivelyChristian

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Video-basedCurriculum

• UtilizesDVDpresentations that incorporateover 150 of the leading Christian educators,authors,mentalhealthclinicians,andlifecoachingexpertsintheUnitedStates.

• Eachpresentationisapproximately50-60minutesinlengthandmostareaccompaniedbyacorrespondingtext(inoutlineformat)anda10-questionexaminationtomeasurelearningoutcomes.Therearenearly1,000uniquepresentationsthatareavailableandorganizedinvariouscourseofferings.

• Learning is self-directed and pacing is determined according to the individual timeparameters/scheduleofeachparticipant.

• With the successful completion of each program course, participants receive an officialCertificate of Completion. In addition to the normal Certificate of Completion that eachparticipant receives, Regular and Advanced Diplomas in Biblical Counseling are alsoavailable.

Ø TheRegularDiploma isawardedbytakingCaringForPeopleGod’sWay,BreakingFreeandoneadditionalElectiveamongtheavailableCoreCourses.

Ø TheAdvancedDiplomaisawardedbytakingCaringForPeopleGod’sWay,BreakingFree,andanythreeElectivesamongtheavailableCoreCourses.

Credentialing

• LightUniversitycourses,programs,certificatesanddiplomasarerecognizedandendorsedbytheInternationalBoardofChristianCare(IBCC)anditsthreeaffiliateBoards:theBoardofChristianProfessional&PastoralCounselors(BCPPC);theBoardofChristianLifeCoaching(BCLC);andtheBoardofChristianCrisis&TraumaResponse(BCCTR).

• Credentialing is a separateprocess from certificate or diploma completion.However, theIBCC accepts Light University and Light University Online programs as meeting theacademic requirements for credentialing purposes. Graduates are eligible to apply forcredentialinginmostcases.

Ø Credentialinginvolvesanapplication,attestation,andpersonalreferences.

Ø CredentialrenewalsincludeContinuingEducationrequirements,re-attestation,andoccureitherannuallyorbienniallydependingonthespecificBoard.

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OnlineTesting

TheURLfortakingallquizzesforthiscourseis:http://www.lightuniversity.com/my-account/.

• TOLOGINTOYOURACCOUNT

Ø You should have received an email upon checkout that included your username,password,andalinktologintoyouraccountonline.

• MYDASHBOARDPAGE

Ø Once registered, youwill see theMyDVD Course Dashboard link by placing yourmousepointerovertheMyAccountmenuinthetopbarofthewebsite.Thispagewill include studentPROFILE informationand theREGISTEREDCOURSES forwhichyouareregistered.TheLOG-OUTandMYDASHBOARDtabswillbeinthetoprightofeachscreen.Clickingonthe>nexttothecoursewilltakeyoutothecoursepagecontainingthequizzes.

• QUIZZES

Ø Simplyclickonthefirstquiztobegin.

• PRINTCERTIFICATE

Afterallquizzesaresuccessfullycompleted,a“PrintYourCertificate”buttonwillappearnearthetopofthecoursepage.YouwillnowbeabletoprintoutaCertificateofCompletion.Yournameandthecourseinformationarepre-populated.ContinuingEducationThe AACC is approved by the American Psychological Association (APA) to offer continuingeducationforpsychologists.TheAACCisaco-sponsorofthistrainingcurriculumandaNationalBoard of Certified Counselors (NBCC)ApprovedContinuing Education Provider (ACEPTM). TheAACC may award NBCC approved clock hours for events or programs that meet NBCCrequirements.TheAACCmaintainsresponsibilityforthecontentofthistrainingcurriculum.TheAACCalsoofferscontinuingeducationcreditforplaytherapiststhroughtheAssociationforPlayTherapy (APT Approved Provider #14-373), so long as the training element is specificallyapplicabletothepracticeofplaytherapy.It remains the responsibility of each individual to be aware of his/her state licensure andContinuing Education requirements. A letter certifying participation will be mailed to thoseindividuals who submit a Continuing Education request and have successfully completed allcourserequirements.

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PTSDandCombatStressTableofContents:

CRCS101:SignsandSymptomsofPTSD.......................................................................................9MichaelLyles,M.D.CRCS102:RiskFactorsforPTSD..................................................................................................22JenniferCisney,M.A.andChrisAdsit,B.A.CRCS103:TraumaandAddiction................................................................................................28MarkLaaser,Ph.D.CRCS104:SuicideAssessmentandPrevention..........................................................................36KevinEllers,D.Min.CRCS105:TreatmentProtocols...................................................................................................46DavidJenkins,Psy.D.andMichaelLyles,M.D.CRCS106:TheJourneyfromTraumatoTransformation...........................................................58GaryBeikirch,Ph.D.andLoreenBeikirchCRCS107:War,DeadlyForceandtheBible................................................................................68ToddWagner,M.A.CRCS108:TheRealitiesofMilitaryServiceontheServiceMember.........................................75DonSnider,Ph.D.andLTGRobertVanAntwerpCRCS109:TheRealitiesofMilitaryLifeforFamilies..................................................................84LTGRobertVanAntwerp;PaulaVanAntwerp;RosemarieHughes,Ph.D.CRCS110:TheCombatTraumaSpectrum..................................................................................93ChristAdsit,B.A.andRahnellaAdsitCRCS111:TheMilitaryMedicalSystem,VeteransMedicalSystem,andRelatedIssues........103LeighBishop,M.D.,M.A.andMG(Ret.)KenFarmer,M.D.CRCS112:AssessmentandTreatmentProtocols.....................................................................111LeighBishop,M.D.,M.A.andEricScalise,Ph.D.

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CRCS101:

SignsandSymptomsofPTSD

MichaelLyles,M.D.

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CourseDescriptionInthis lesson,studentswillbecomefamiliarwithageneraloverviewofPost-TraumaticStressDisorder.Dr.MichaelLyleswilldiscussthesignsandsymptomsofPTSD,thenatureoftrauma,and the diagnostic criteria regarding PTSD. Students will also gain an understanding of thechallenges thathelpersandcounselorscan face in traumasufferers. Becausepeopledealingwith symptoms of PTSD are literally reliving their traumatic experiences, it is important forstudents to understand important factors such as avoidance behavior, numbing effects,hyperarousal,andneurobiologicalissues.

LearningObjectives:Bytheendofthislesson:

1. ParticipantswillbeabletounderstandthediagnosticcriteriaofPTSD.

2. Participantswill be able to understand diagnostic difficulties, and learn questions for

initiatingdialogueregardingtraumaticevents.3. Participantswillbeabletolearnanoverviewoftheneurobiologicalfactorstakingplace

inaperson’sbrainwhileexperiencingPTSDsymptoms.

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I.Post-TraumaticStressDisorderGeneralOverview

A. Definition – An anxiety disorder that occurs after exposure to a traumatic eventwhichtriggersmemoriesofthetraumaticeventandischaracterizedbyintensefear,helplessness,andhorror.

B. Approximately25-30%ofvictimsofsignificanttraumadevelopPTSD.

C. Trauma• Traumacanoccurfromwitnessingorexperiencingatraumaticevent• Traumacanoccurfromtryingtohelpsomeonedealwithatraumaticevent• The risk for PTSD varies with severity, duration, and subjective experience of the

trauma• TraumaticEvents

1. Naturaldisasters2. Automobileaccidents3. Rapeorsexualmolestation4. Airplanecrash5. Torture6. Physicalassault7. Terroristattack8. Witnessingthedeathofanotherperson

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D. Symptoms• Usuallybeginwithinthreemonthsofthetrauma(canbeginyearslater)• Occursforlongerthanamonth

• Keepsapersonfromlivinganormallife

II.DiagnosingPTSD

A. DiagnosticCriteria

• Exposuretoatraumaticeventwithbothofthefollowing:

1. The person experienced, witnessed, or was confronted with an event(s) that

involvedactualorthreateneddeathorseriousinjury,orathreattothephysicalintegrityofselforothers

2. Theperson’sresponseinvolvedintensefear,helplessness,orhorror

• Repeatedlythinkingaboutthetrauma.Traumaispersistentlyrelivedinatleastoneof:

1. Recurrent,upsetting,intrusivememories2. Recurrent,upsettingdreams3. Acting/feelingasiftheeventwasoccurringnow4. Intense psychological or physiological distress with exposure to internal or

externaltriggersoftheevent

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• Avoidingremindersofthetrauma(canbeavoidingtriggersofthetraumaornumbingone’sfeelingssoonedoesnotexperiencereminders).Mustbeindicatedbythree(ormore)ofthefollowingcategories:

1. Effortstoavoidthoughts,feelings,orconversations2. Numbingofgeneralresponsivenessthatwasnotpresentbeforethetrauma3. Avoidanceofactivities,places,orpeople4. Inabilitytorecallanimportantaspectofthetrauma5. Markeddecreaseofinterestorparticipationinpleasurableactivities6. Feelingdetachedorestrangedfromothers7. Feelingrestrictedrangeofemotions8. Senseofdoomthatsomethingbadisjustgoingtohappen;it’sjustamatterof

time9. Assumingtheworst

• Being constantly alert or on guard. Must have two or more of the followingpersistentsymptomsofincreasedarousal(notpresentbeforethetrauma):

• Difficultyfallingorstayingasleep• Irritabilityorangeroutbursts• Difficultyconcentrating• Hypervigilance• Exaggeratedstartleresponse

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B. MakingtheDiagnosis

• Symptomslastformorethanamonth,andnotpresentpriortothetrauma• Symptomscauseclinicallysignificantdistressorimpairmentinsocial,occupational,or

otherimportantareasoffunctioning• AcuteStressDisorder(resolveswithinamonth)• AcutePTSD(lastslessthanthreemonths)• ChronicPTSD(lasts3monthsormore)• DelayedOnset(begins6ormoremonthsafterthetraumaticevent)

B. DiagnosticDifficulties

• Patientdoesnotlinksymptomswithtrauma• Doesnotwanttotalkaboutthetraumaticevent• Othersymptoms/problemsdemandmoreattention• Focusonphysicalsymptoms

C. QuestionsforInitiatingDialogue

• “Were there missions on which you came into contact with life threateningsituations?”

• “Wereyoueverinasituationwhereyoufearedforyourlife?”

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• “Wereyouinsituationswhereteammemberswerewounded?”• “Did youeverparticipate in any situations that involved the lossof life, friendlyor

enemy?”• “Didyouunexpectedlywitnessadeadbodyordeadbodyparts?”

III.PTSDChallenges

A. CommonChallenges• Guilt,shame• Self-destructive,impulsivebehaviors• Feelingpermanentlydamaged• Feelingconstantlythreatened• Feelingineffective• Despair,hopelessness• Hostility,personalitychange• Lossofpreviouslysustainedbeliefs• Socialwithdrawal,impairedrelationships

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• Dissociativesymptoms• Somaticsymptoms

B. EspeciallyDifficultChallenges• Self-medicatingbehaviors• Depressionandsuicidalthoughts• Panicattacks,feelingsofmistrust

C. Co-ExistingConditions• ANational Co-morbidity Survey found that 88.3%ofmenand79%ofwomenwith

PTSDhaveatleastoneotherpsychiatricproblem(usuallydepression)• 59%ofmenand44%ofwomenmeetcriteriaforthreeormorepsychiatricdisorders• Co-ExistingDisorders

1. Depression2. Alcohol/SubstanceAbuseDisorders3. Phobias4. SocialAnxietyDisorder5. PanicDisorder6. EatingDisorder7. ObsessiveCompulsiveDisorder

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IV.CourseofPTSD

A. Duration of symptoms is affected by the intensity, duration, subjectiveinterpretation,andproximityofthetrauma.

B. Symptomsmaycomeandgo.

C. AverageDurationofTreatedPatients:36Months

D. AverageDurationofUntreatedPatients:64Months

E. Morethanonethirdneverrecover.

F. About50%recoverwithinthefirstthreemonths.

G. PTSDsymptomsonlyoccurinaminorityofpatientsexposedtotrauma,sosomethingmustbedifferentwiththosewhodevelopPTSD.

V.BiologyoftheBraininPeopleWhoDevelopPTSD

A. TheEmotionalBrain(LimbicSystem)

B. Amygdala – activated by the sympathetic nervous systemwhen danger is present.The“HOT”system.

C. Hippocampus– filters the threat throughemotionalmemory filters toevaluate thenatureofthethreat.The“COOL”system.

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D. Cingulate–thedecisionmakerregardingimpulsecontrolandcourseofaction.

E. BrainImagingStudies• Smallhippocampus(COOLSystem)

• Hyperactiveamygdala(HOTSystem)• Inactivecingulatedcortex(Nomediator)• TheResult:Allacceleratorandnobrakesorsteering.

F. TheHPASystemChainofCommand• The cortisol engages the stressful threat and “handles” it with the appropriate

intervention• The high cortisol levels feedback to the HPA system to turn the speed of cortisol

productiondown–likecruisecontrolonacar–tokeepcortisollevelsfrompeakingtoohighfortoolong(nothealthyforheart,pancreas,lipids,etc.)

G. TheSystemisDifferentinPTSD

Normally WithPTSDCortisolincreaseswithstress CortisoldecreaseswithstressFew cortisol receptors (radar) in pituitary &hypothalamus because the cortisol signal issostrong

More radar (cortisol receptors) because thecortisolsignalissolow

Feedback inhibition works properly (cruisecontrol)

Feedback inhibition is “trigger happy” andover-responds to cortisol changes (cruisecontrol overreacts to manual pedal andspeedsuptoofast)

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H. TheChickenvs.EggDebate.Arethephysiologicalandanatomicalchangestheresultof thetraumaorwerethesechangespresentprior tothetrauma,predisposingthepersonforPTSD?

V.Treatment

A. WhentoSeekHelp• Symptomsformorethanamonth• Affectingwork,relationships,“peaceofmind”• Self-medicatingwithalcohol,drugs,etc.• Progressivelyworseningsymptoms• Suicidalthoughts

B. GoodPrognosticVariables• Earlyintervention• Earlyandongoingsocialsupport• Avoidanceofre-traumatization• Healthylifestylepriortothetrauma• Absenceofpsychiatric,substanceabuseproblemspriortothetrauma

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C. MethodsofTreatment• Psychotherapy• Marital,FamilyTherapy• SupportGroups• Self-Care

VI.Conclusion

A. Whatislearnedincombatisnever,everforgotten.

B. HelpproviderscannotforgetthepainandshameofthePTSDthathidesbehindtheotherproblemsinthelivesofmenandwomenlongafterthewarisover.

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CRCS101StudyQuestions

1. Give some examples of traumatic events that people experience. How could thesedifferingeventscontributetoPTSD?

2. Briefly discuss the PTSD diagnostic criteria. Why is it important to know thisinformationwell?

3. NamesomediagnosticdifficultiesthattherapistscouldencounterwithclientssufferingfromPTSD.

4. Whataresomeco-existingconditionsthatsomemighthavealongwithPTSD,andwhyaretheseimportanttorecognizeinadiagnosis?

5. WhenshouldsomeoneseekhelpwithsymptomsofPTSD?

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CRCS102:

RiskFactorsforPTSD

JenniferCisney,M.A.andChrisAdsit,B.A.

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CourseDescriptionThere aremany different kinds of trauma on the combat trauma spectrum that people canexperience,andsomecanevenbemorepredisposedthanothersforPTSDiftheyhavecertainrisk factors. Jennifer Cisney will discuss what groups and individuals are more at risk fordevelopingPTSD,what increases the risks,andwhatcanbedoneonapreventative level forpeoplewhodofallintothehigh-riskcategories.LearningObjectives:Bytheendofthislesson,students:

1. Participants will be able to identify what groups and individuals fall into higher risk

categoriesfordevelopingPTSD.

2. Participantswillbeabletounderstandwhatincreasestheriskwithindifferenthigh-riskcategories.

3. Participants will be able to understand resiliency and what people can do on a

preventativelevel.

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I.RiskFactorsforPTSD

A. AccordingtotheSurgeonGeneral’sReportonMentalIllness,9%ofpeopleexposedtotraumaticeventswilldevelopPTSD(13%forfemales,6%formales).

B. CollectiveTrauma–ablowtothebasictissuesofsocial lifethatdamagesthebondsattachingpeopletogetherandimpairstheprevailingsenseofcommunity.

C. WhoisatincreasedriskofdevelopingPTSD?• Peoplewho,duetotheirprofessions,areexposedathigherratestoariskforPTSD.

1. Whatprofessions?

a. LawEnforcementPersonnel–10-15%b. Firefighters–10-30%c. VietnamVeterans–16%d. Iraq&AfghanistanVeterans–12-20%

2. Whatincreasestheirrisk?

a. Closeproximitytotraumaticeventsb. Severityoftraumaticeventsc. Durationofexposured. Frequentorrepeatedexposure

• Peoplewhoareexposedtoanaturaldisasterorterroristattack.

a. Traumacollectivelyaffectsanentirecommunityb. Physicaldevastation(injuryordeath)

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c. Socialdevastation d. Financialdevastation

2. Phasesofdisasterimpact

a. Pre-DisasterPhaseb. HeroicPhasec. HoneymoonPhased. DisillusionmentPhase(mostsevereproblems)

3. Terroristattacksaredifferent

a. Therewasanintentionalattackb. Thereislong-termaffectiveanger

4. With both natural disasters and terrorist attacks, there is a threat of traumareoccurrence

• Victimsofviolenceandcrime

1. 40-70%ofrapevictimswilldevelopPTSD2. Rapevictimscarryasenseofstigmathatisbothinternalandexternal3. School or workplace violence occurs in a place that carries an expectation of

safety4. Victimsof schoolorworkplaceviolencehave to return to theplacewhere the

traumaoccurred5. Oftentheperpetratorofschoolorworkplaceviolenceisapersonwithwhomthe

victimshadarelationship

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• Peoplewithpre-existingconditions

a. A high percentage of adults in today’s society experienced childhoodviolence,abuse,orneglect

b. Those with mental illness (anxiety or depression) are more apt to betriggeredintoPTSDduetotheirpredispositiontowardcomorbiddepressionoranxiety

c. Thosewithpersonalitydisorderswhichunderminesaperson’ssenseofself-

efficacy, self-esteem, or self-worth which interfere with emotional self-regulation

d. Thosewhohaverecentoraseriesofexposurestotraumaticeventswhen

therehasnotbeensufficienttimetoreturntonormal

II.ResiliencyandPrevention

A. PreventativeMedicine. Encourage lifestyle changesNOW to reducedaily life stressandinvesttimeinrelationshipswithGod,family,andfellowbelievers.

B. FactorsthatImproveTraumaResiliency• Self-disclosureofthetraumatosignificantothers• Asenseofgroupidentityandasenseofselfasapositivesurvivor• Altruisticandpro-socialbehavior• Capacitytofindmeaninginthetrauma• Connectionwithasignificantcommunityoffriendsandfellowsurvivors

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1. Explaintheconceptofcollectivetrauma.

2. DiscussthestatisticsregardingspecificprofessionsthatexposepeopletohavinghigherrisksforPTSD.Whatincreasestheirrisk?

3. What increases the risk of developing PTSD in peoplewho are exposed to a naturaldisasterorterroristattack?

4. Invictimsofviolenceandcrime,whatincreasestheriskfordevelopingPTSD?

5. What factors can increase a person’s risk for developing PTSDwhen the person haspre-existingconditions?

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CRCS103:

TraumaandAddiction

MarkLaaser,Ph.D.

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CourseDescriptionInthislesson,Dr.MarkLaaserwilldiscusstheroleofaddictioninregardstotrauma.Studentswilllearnaboutself-medicatingtendenciesandbehaviorsthatpeopleusetoescapeandnumbthe pain, the addictive cycle, factors related to tolerance, stages of addiction, and spiritualstrongholdsandbondage. After addressing theneurochemistryof addictions,Dr. Laaserwilloffertreatmentapproachestoministeringtopeoplebattlingwithaddiction.

1. Participantswillbeabletolearnabouttraumareactions,andhowtheyareimportantinunderstandingaddiction.

2. Participantswillbeabletounderstandthecriteriaforaddiction,theaddictioncycle,and

addictioninteractioninregardstotheneurochemicalaspectsofaddiction.3. Participantswill beable todiscuss treatment andhealingprocessesof anaddict, and

discoverthatthereishope.

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I.TraumaReactions

A. TraumaSplitting(Dissociation)–Anabilitytoliterallyleavethebodyandbementallyandspirituallydistant,absent,orgone.

B. TraumaPleasure–Anadrenalinerushexperiencedduringawoundingevent.

C. Trauma Blocking – Any behavior or substance used to medicate the pain ofwoundedness.

D. Trauma Reactions – The way the mind and body tells one there is woundednessinside.

E. TraumaAbstinence–Doingwhatever isnecessary toavoidthepainexperienced inthepast.

F. Trauma Shame – The feeling that because of trauma one is a bad and worthlessperson.

G. TraumaRepetition–Thefeelingthatfamiliarbehaviorissaferthannewbehavior.

H. TraumaBonding–Pickingarelationshipwithanotherpersonthatwillhelpapersontraumarepeat.

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II.Addiction

A. Criteria• Unmanageable• Createsneurochemicaltolerance• Degenerative/progressive• Createsdestructive/negativeconsequences

B. TheAddictionCycle• PreoccupationFantasy• Ritual• ActingOut• Despair

C. AddictionInteraction

D. Stoppinganaddictionisonlythebeginningofthehealingjourney.

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III.Healing

A. FiveDimensionsofRecovery• Spiritual• Relational

• Personal• Behavioral

• Physical

B. PrefrontalCortexFunctions• Attentionspan• Judgment• Impulsecontrol• Organization• Forwardthinking• Internalsupervision

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C. PrefrontalCortexProblems• Shortattentionspan• Impulsivity• Procrastination• Disorganization• PoorJudgment• Lackofempathyandinsight

D. Peoplemustbeassessedfromacomorbidordualdiagnosisperspective.

E. Post-TraumaticStressDisorderDiamondPattern• IncreasedAnteriorCingulate• IncreasedBasalGanglia

• IncreasedThalamus(Limbic)• IncreasedRightLateralTemporalLobe

F. Accountability• Involvesagroup

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• Isproactive,notreactive• Replacesunhealthybehaviorswithhealthyones

G. Intimacyproblems in amarriage arenot the result of addiction. The addiction is acopingmechanismfortheintimacydifficulties.

H. Marriedaddictsneedthreefoldrecovery:addict,spouse,andmarriagerecovery.

I. 2Corinthians10:4–“Theweaponswefightwitharenottheweaponsoftheworld.Onthecontrary,theyhavedivinepowertodemolishstrongholds.”

J. 2Corinthians10:5–“WedemolishargumentsandeverypretensionthatsetsitselfupagainsttheknowledgeofGod,andwetakecaptiveeverythoughttomakeitobedienttoChrist.”

K. SpiritualDimension• Willingness• Exploreemotionalandspiritualthirst• Selflessnessvs.Selfishness• Forgiveness• Vision

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1. Discuss each of the different trauma reactions, and why understanding these isessentialinassessment?

2. Whatarethefourstagesoftheaddictioncycle?

3. Whatarethefivedimensionsofrecovery,andwhichoneiscentraltotheothers?

4. Explain the roleof theprefrontal cortex in a traumatizedperson. What about in anaddict?

5. Discuss the spiritual dimension of recovery. What should one examine within thisdimension?

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CRCS104:

SuicideAssessmentandPrevention

KevinEllers,D.Min.

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CourseDescriptionThislessondiscussestheimportanttopicofsuicideassessmentandprevention.Dr.KevinEllersaddresses the issuesofsuicidebeingaby-productof traumaticevents, risk factors relatedtosuicide attempts, precipitating factors that would influence a person attempting suicide,warning signs, and effective intervention techniques. Students will begin to understand thedynamicsofsuicideandwhatcaregiverscandotohelp.

1. Participantswillbeabletodispelsuicidemythsandidentifyriskfactorsofsuicide.

2. Participantswill be able to understandmotivations for suicide, and identify some life

eventsthatcantriggersuicide.3. Participants will be able to recognize signs of a suicide crisis and how to effectively

provideintervention.

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I.Suicide

A. Definition – A conscious act of self-induced annihilation, best understood as amultidimensionalmalaise inaneedful individualwhodefinesan issue forwhichtheactisperceivedasthebestsolution.

B. SurvivorReactionsFollowingSuicide• Focusinearlymonthsoncontrollingtheimpactofthedeath• Overwhelmingneedtomakesenseofthedeath• Markedsocialuneasinessandstigma• Eventualrealizationofpurposefulnessinlifefollowingthesuicidedeath

C. Thereisnoevidenceoftotalcondemnationfoundinbiblicalaccountsofsuicide.

D. Mostofthesenseofcondemnationpeopleexperienceissocietal.

E. DispellingMythsAboutSuicide• Manytimes,asuicidalpersonhasmadeuphis/hermindandcometotermswiththe

decision,resultinginanimprovementinhis/hermoodpriortocommittingtheact.• It isnot true thatapersonwhohasbeensuicidalatone time in lifewillalwaysbe

suicidal.• It is not true that people who are suicidal always intend to actually die; it is

sometimesacryforhelp.

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• Itisnottruethatsuicideishereditary.• Itisnottruethatifthereisnonote,thereisnosuicide.

F. RiskFactors• Gender

1. Malesare4timesmorelikelytocompletesuicide2. Femalesaretwiceaslikelytoattemptwithoutcompletingsuicide

• Age

1. 85yearsofageorolder2. 75-84yearsofage

• Depressionormentalillness

1. 30%ofdepressioninpatientshaveattemptedsuicide2. 90%ofpeoplewhocommitsuicidehavediagnosablementalillness3. Changeinneurotransmittersorbrainchemistry

• Previousexposuretosuicide

1. Pasthistoryofattemptingsuicide2. Geneticpredisposition

• Substanceabuse• Irrationalthinking/impulsivity

• Compromisedsocialsupportnetwork

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• Emotionalloss• Marginalizedindividuals(loners)

G. Motivations• Lossorchangeinanimportantrelationship• Avoidorendperceivedpain

• Escapeanintolerablesituation• Gainattention• Manipulateorpunishothers• Becomeamartyr

H. LifeEventsthatCanTriggerSuicide• Suicideofalovedone• Deathofalovedone• Diagnosisofaseriousillness• Lossofhealth

• Divorceorseparation• Divorceand/orremarriageofparents

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• Lossofemployment• Lossofcherishedpossessions• Retirement• Financialdifficulties• Legalproblems/arrest• Victimsofcrime,sexualabuse,orassault• Witnessofviolence• Poorgrades• Collegerejection• Sexualityconcerns• Physicalabuse

• Substanceabuse

II.SuicideCrisis

A. Asuicidecrisisisatimelimitedoccurrencethatsignalsimmediatedangerthatsuicidemaybeimminent.

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B. SignsofaSuicideCrisis• Aprecipitatingevent

• Intenseaffectivestates• Changesinbehavior

C. WarningSignsofSuicide• Unrelentinglowmood

• Sleepproblems• Makingaplan• Givingawayprizedpossessions

D. The emotional crisis that usually precedes a suicide is often recognizable andtreatable.

E. ContinuumofSuicidalBehavior• Ideation

• Gesture

• Attempt

• Completion

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F. MajorPredictorsofSuicidalBehavior• Istheirplanspecific?

• Availabilityofmeans• Lethalityofmethod• Previousattempts• Whatresourcesareavailable?

III.Intervention

A. SpecificQuestionstoAsk• “Haveyoubeenthinkingofhurtingorkillingyourself?”

• “Whendidyoulastthinkseriouslyaboutcompletingsuicide?”• “Doyouhavethemeansavailable?Haveyoueverattemptedsuicide?”• “Hasanyoneinyourfamilyevercompletedsuicide?”

• “Whataretheoddsthatyouwillleaveandkillyourself?”• “Whathasbeenkeepingyoualivesofar?”

• “Whatdoyouthinkthefutureholdsforyou?”

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B. EffectiveIntervention–WhattoDo• Donotpanicoroverreact.Remaincalm.

• Remainwiththem.Bepresentandrespecttheirfeelingsandthoughts.• Helpthemreframetheirthoughts.

• Emphasizethetemporarynatureoftheirproblem.• Keepyourselfsafe.Suicidalpeoplearenotrational.• Explorealternativesandresources.

C. EffectiveIntervention–WhatNottoDo• Donotgetintoalecturingorarguingsituation.

• Donotoverlookthesigns.• Donotexpressasenseofshock.• Donotofferemptypromises.

• Donotbeoverlycheery.• Donotdebatemorality.• Donotleavethemaloneorassumetheywillgetbetter.• DonotremaintheONLYpersonhelping.

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1. DiscussthemythsofsuicidethatDr.Ellersmentionedinthelesson.

2. Whataresomeoftheriskfactorsofsuicidethatcaregiversshouldbeawareof?

3. Giveexamplesoflifeeventsthatcantriggersuicide.

4. Whataresomeofthewarningsofasuicidecrisis?

5. Discuss the elements of effective intervention. What should one do and whatshouldonenotdo?

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CRCS105:

TreatmentProtocols

DavidJenkins,Psy.D.andMichaelLyles,M.D.

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CourseDescriptionThislessonwillexposestudentstothewiderangeoftreatmentoptionsintermsoftheoryandpractice,includingcognitivebehavioralapproachestotreatment,exposuretheories,systematicdesensitizationmethods,EMDR,medicalprotocol,andother related factors.StudentswillbeexposedtoabroadstrokeateverythingthatneedstobeconsideredwhentreatingapersondealingwiththedifficulteffectsofPTSDasaprocessinhelpingsomeonemovefromabsolutebrokennesstoabundantfreedom.

1. Participantswillbeabletounderstandthreebasicstructuresofthebraininvolvedwith

people who are dealing with PTSD, and examine three symptom clusters that willexplainwhattheymaybeexperiencing.

2. Participantswill be able to understand threebasic treatmentprinciples, regardless of

the mode of counseling/therapy involved, that must be considered when treatingpeopledealingwithPTSD.

3. Participantswillbeabletounderstandthethreebroadtreatmentdomainsofexposure,

cognitivebehavioral,andmedicaldomains.

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I. ThreeBasicStructures

A. Amygdala–Anorganinthebrainthatdealsprimarilywithprocessingintensefear.B. Hippocampus–Apartofthebrainthatisinvolvedwithmemoryprocessing.C. The HPA Axis – A hormonal type of system that is involved in themaintenance of

stressresponse.D. Fear,memory,andmeaningare locked in toapattern togetherandare responsible

forthinking,concentration,judgment,smell,hearing,etc.E. Theamygdalaandhippocampusaretieddirectlytoemotionalandthoughtsystemsin

thebrain–relatedtothemanyspecifictriggersforPTSD.

II.ThreeSymptomClusters

A. Re-Experiencing - Can come in the form of recollections, dreams, nightmares,flashbacks,andphysical/psychologicalreactivity.

B. Avoidance/Numbing - Can come in the form of avoiding situations, places, and/or

peoplethatremindthepersonof thetraumaticevent inordertomanageresponse,detachment/feeling estranged, blanking out, and not being able to recall importantaspectsoftheevent.

C. Hyperarousal/Hypervigilance - Can come in the form of sleep difficulty, irritability,

angry outbursts, difficulty with concentration, always being on the lookout, andexaggeratedstartleresponse.

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D. Ifsomeoneisbeingaffectedbythesesymptomclusters, it isvery importanttohavefamilyorsocialsupportandinvolvement.

III.ThreeBasicTreatmentPrinciples

A. Address symptoms and co-morbid conditions. (Co-morbid conditions are otherconditions thatgoalongwithPTSD; commononesareMajorDepression, substanceabuse,andspecificanxietydisorders).

B. Improveadaptivefunctioningandreturntheclienttoastateofsafetyandtrust.

C. Limitgeneralizationofinitialtraumaandprotectagainstrelapse.

IV.ThreeBroadTreatmentDomains

A. Exposure. A domain that involves facilitating the confrontation of feared objects,situations,images,andthingsthatareassociatedwiththetraumaticevent.• Exposureworksbyhaving thepersonpurposefullywith things thatare troubling to

him/herlongenoughthatthefearresponseandthestartleresponseinthesymptomclustersariseinaprotected,secure,andsafeenvironment.Thepersonneedstostayactivelongenoughinthatsituationsothatadifferentresponsecanstarttohappen.

• Exposurecanbeimaginative,becausePTSDeventscanbesovividandbroughtthatpeoplecanactuallyblockoutregularvisualprocessing.

• Exposure can also be invivo (live), requiring the counselor to have the person go

throughtheactualsituationorexperienceinaplacethatevokesthePTSDsymptoms.Theclientremainsexposedtostimuliforaresponsetoactivateandthenisalteredinthedirectionofrecovery.

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• Exposure methods can be repeated over time in a series of interventions or in aprolonged fashion, where there is a lengthy session or repeated sessions over alonger period of time. The key is that the counselor does not want to activate aresponseandthenshutitdowntoosoon,whetherhe/shegoestherepeatedrouteorthe prolonged exposure route. The counselor wants to prevent the person fromescapingthepainfulfeelingsuntiltheyareprocessedinthesession,orthecounselorrunstheriskofreinforcingtheavoidance/numbingsymptomcluster.

• Exposurecanbeparticularlyeffectivewithintrusivesymptoms.• Anexampleofanexposuremethod issystematicdesensitization,whichoccurs ina

graded way, where the counselor helps a person process through a hierarchy ofanxioussymptomswiththegoalofhelpingreplaceananxiousresponsewithamorerelaxed,restfulresponse.

• AnotherexampleisIntensiveExposure,whichisnon-graded.Ifacounselorchooses

touse flooding, thepersonwouldbeplaced inasituationandthen lockeddown–the person would stay there until the response settles down and then could beprocessed.Ifthecounselorusesimplosion,whichissimilartoflooding,thecounselorwould also fold in longer term content, meanings, and symbolic types ofinterpretationstosomeofthosesymptoms.

B. Cognitive-Behavioral Strategies. A domain that involves working with themodificationofmaladaptivethoughts,beliefs,andassumptions.

• There are key cognitions that tend to result from a tragic event. Some distorted

assumptions are that protection from risk or harm is not under control, that theworld is only dangerous andunpredictable, and that the person is inadequate andincapable.

• The results from the violation of key assumptions are the belief in personalinvulnerability, the perception of the world as meaningful and predictable, and apositiveviewofself.Thesebecomeviolatedandleadtothosenegativecognitions.

• Thepurposeofcognitive-behavioralstrategiesistolineupthesecognitionswiththe

truthandarespectful,honestviewofselfandothers. Peopleoftentaketoomuchresponsibility for a situation, such as a disaster like Hurricane Katrina, and a greatamount of focus is going into a scenario that is not productive that they are notcorrectlymanagingthethingsthatactuallyareundertheircontrol.

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• Part of treatment involves lining up thoughts, behaviors, and feelingswith reality-based living. Thisprocesshelps restoreasenseofdignityandresponsibilitywithintheperson.Thiscanalsohelpplacethemonapathtowardsrecovery;peoplebegintorealizethattheymuststilldealwiththesituationbutthattheyareactuallycapableofdealingwithit.

• Ahallmarkindicatoroftraumaistheshatteringofaperson’sworldview.Anecessarypartoftreatmentinvolvesrestoringtruth-basedbeliefsaboutGod,theself,andtheworld,andthosearethekeycomponentsofhelpingrestoretheshatteredworldview.

• Oneoftheproblemswithcognitive-behavioraltechniquesisthatifcounselorsfailto

address the avoidance/numbing issues, then the clientswill tend to avoid the verysituations that canbehelpful for them to confront so that they can challenge andrestore somesenseofnormalcy. Ifpeoplearedissociative/numbingout/detachingrelationships,thatposesachallengewhenworkingwithsomeoneusingthiskindoftherapy.

• OnespecifictechniquethatcanbeutilizedisEMDR(EyeMovementDesensitization

Reprocessing).• EMDR is an information processing type of model that addresses how traumatic

eventstendtobypassnormalmemoryandhowitconsolidates.• EMDRhelps activatememories thatwereencoded through the limbic system first.

Thisissimilartothememoryformingprocessworkingbackwards.• EMDR involves accessing, processing, and resolving traumatic memories through

desensitization of emotional stress, reformulation of associations and beliefs, andreliefofphysiologicalarousal.

• EMDR involves visualizing the worst moments of trauma while holding in mind

currentnegativecognition,emotions,andsensationsconcerningthetraumaticevent.• Theclient isattendingtoaconcurrentstimuluswhile thesenegativecognitionsare

kept in mind. The counselor is tracking finger movements; the eyes moving areserving as a type of distraction while visualizing the worst moments, allowing thememoriestobeprocessed.Thisallowsdistancefromtraumaticimages,allowingnewthoughtsandimagestocometomind.

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• EMDRinvolvesreportingnewimagesthroughoralorwrittencommunication.• EMDRseemstooverlapwithexposuredomains.

C. Medical. Research shows that there are medications that can help with thetreatmentofPTSD.Thesemedicineshelptore-normalizebrainfunction.However,manypeoplewillresistmedication,whilenotrecognizingthattheyarealreadyself-medicating with means that are almost certainly more damaging than prescribedmedicalinterventions.

• Antidepressants

1. Enhanceserotoninlevelsinthebrain.(Serotoninisahormoneinthebrainthat

occursnormally,andantidepressantshelpthebrainhavehigherserotoninlevels,ornormalserotoninlevels,dependingonthepatient)

2. HavethebesttrackrecordintreatingpatientswithPTSDsymptoms3. Helpsreducethestressfulexperience4. Themain side effects are the potential to gainweight, a possible decrease in

libido,andthepotentialforupsetstomachiftakenwithoutfood5. Non-addictive,non-habitforming,butmustbetaperedifcomingoff

• AdrenalineBlockers1. Blockalphaandbetaadrenalineblockersinthebodyandbrain,butparticularly

inthebody2. Adrenalinecannotworkunlessithasaplacetoattachonnerveandmusclecells3. Adrenaline Blockers work to block the receptors so that adrenaline does not

havesuchaneffectonthebody,suchasahighbloodpressureorhighpulse• MoodStabilizers

1. CanhelpthedramaticmoodswingsthatapersoncangetwithPTSD

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2. SomeonewithPTSDcouldexperiencemoodswingswith littleprovocation,andthesedrugsforcepeopletogothroughthegradualpaceofanormalmoodswing

3. Examplesofmoodstabilizersareanticonvulsantsandtranquilizers,andnoneof

thesedrugsareaddictive• Anti-anxietyMedications

1. These drugs can help with anxiety, but they are also addictive and can have

withdrawalsymptoms2. There is also an added risk of overdose if someone drinks alcohol on top of

takingthesemedications

V.OtherApproaches

A. DualRepresentationTheory• This theory addresses how memories are formed, stored, and accessed, and

examines theeffectsofdifferent typesofmemoriesand theeffects theyhaveastheyworkthemselvesoutinaperson’slife.

• Itfocusesonverballyaccessiblememoryandsituationallyaccessiblememory.

B. Insight-OrientedMethod• Psychodynamic types tend to look at preexisting, unconscious methods that got

overwhelmedthroughtrauma.• Hypnotherapy focuses on using a relaxed, hypnotic state to work out repressed

materialandintegrationofatraumaticevent.

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C. GroupTherapy• Thisapproachcanoccurinanumberofdifferenttypesofdomains.

• It has several strengths, including the bonding that occurs in people that haveexperiencedevents,feedback,support,andsecurity.

• Group therapy can be a helpful context as one part of restoring the person to

wholeness.

VI.EffectiveTreatment

A. TendstoAddressTwoCoreDomains:

• Memory• EmotionalRegulation

B. Involves

• Detailed,RepeatedExposuretoTraumaticInformation• ModificationofMaladaptiveBeliefsaboutEvents,Symptoms,andBehaviors

VII.BestPracticeGuidelines

A. Focusonscreeningandassessment.• Defining clearly what the symptoms are, how it affects a person’s life, and the

resourcesavailabletoapersoniscrucialforeffectivetreatment.

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• Thecounselingprocess isgoingtobepainful fortheperson,andproperscreeningand assessment can be a helpful process to motivate them to move forward ineffectivecounseling.

• Useastep-wiseprocessandhaveasafetyplan.

B. Establishapathwaythatmakessenseandprovidearationale.• Helpthepersonhaveasenseofwhat thedestinationanddirection is,andhavea

“hereandnow”focus.• Thecounselormusthaveempathyandreflectivelisteningskills,aswellastheability

tobecreativeandflexible.• Thecounselorshouldhaveamultidisciplinary,comprehensiveapproach.

C.RememberthatpeoplearecreatedintheimageofGod.

• Uniqueness(Autonomy)• Oneness(Connection)• Openness(Influence)

VIII.Conclusion

A. Romans8:28-30–“AndweknowthatGodcausesallthingstoworktogetherfor

goodtothosewholoveGod,tothosewhoarecalledaccordingtoHispurpose.ForthosewhomHeforeknew,Healsopredestinedtobecomeconformedtotheimageof His Son, so thatHewould be the firstborn amongmany brethren; and thesewhomHepredestined,Healsocalled;andthesewhomHecalled,Healsojustified;andthesewhomHejustified,Healsoglorified.”

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B. Romans8:35-39–“WhowillseparateusfromtheloveofChrist?Willtribulation,ordistress, or persecution, or famine, ornakedness, or peril, or sword? As it iswritten,“Foryoursakewearebeingputtodeathalldaylong;wewereconsideredassheeptobeslaughtered.” But inall thesethingsweoverwhelminglyconquerthroughHimwho lovedus. For I amconvinced thatneitherdeath,nor life,norangels,norprincipalities,northingspresent,northingstocome,norpowers,norheight,nordepth,noranyothercreatedthing,willbeabletoseparateusfromtheloveofGod,whichisinChristJesusourLord.

C. Most people, particularly in the United States, experience traumatic events intheir lives. The good news is that most people recover without the need forprofessionalassistance. Recoveryispossibleandexpected;peopleareresilient.Post-traumatic growth is astounding, because there is the potential that whenpeopleare shatteredand theirworldview falls apart, they findout they canbebetter than they were before. There is hope in the midst of suffering andseparation.

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1. Discussthethreesymptomclusters,andgivedetailsregardingtheirimplicationstopeopledealingwithPTSD.

2. What are the three basic treatment principles that counselors should use,regardlessofthemodeoftherapythatisinvolvedintreatingtheclient?

3. Discusscognitive-behavioralstrategies.

4. What are the four classes ofmedications that Dr. Lyles discussed, and how cantheyhelpapersonsufferingfromPTSD?

5. Discuss what is involved for effective treatment, regardless of type orcombination.

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CRCS106:

TheJourneyfromTraumatoTransformation

GaryBeikirch,Ph.D.and

LoreenBeikirch

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CourseDescriptionIn this lesson, students will be exposed to the story of Sergeant Gary Beikirch, a man whoreceived theMedal ofHonor for his service in Vietnam. TheMedal ofHonor is the highestawardforvalorinactionagainstanenemyforcewhichcanbebestoweduponanyoneservingintheU.S.ArmedForces,andthedeedforwhichitisawardedistobeoneofpersonalbraveryor self-sacrifice so conspicuous as to clearly distinguish the individual for gallantry above hiscomrades, and must involve risk of life. Gary Beikirch, along with his wife Lolly, shares hisexperiences of healing and restoration from combat related PTSD, providing backgroundinformation,aswellasthereasonsregardingwhycounselingisimportanttoanyonesufferingfromtraumarelatedPTSD.

1. Participantswill beable tobeexposed toaprimary source storyofa soldierwho

experiencedcombattraumafromtheVietnamWar.

2. ParticipantswillbeabletoreflectonthehealingprocessthatbroughtGaryBeikirchtoasenseofrestorationfromPTSD.

3. Participantswillbeableto learntheBeikirchs’perspectiveonhowtoengagewith

PTSDsufferersoftrauma,whethercombatrelatedornot.

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I.BackgroundInformation

A. DateofAction:April1,1970inKontumProvince,Vietnam.

B. SergeantGaryBeikirchwasamedicwiththeGreenBeretsinacampnearCambodia.Thoughhewaswoundedtwiceinanintense,devastatingattack,herefusedtreatmentand asked to be carried as he searched for others who were injured. When anincomingrocketcametowardshim,oneofhis15-year-oldfriendsshieldedhimfromfurtherinjury,butlosthisownlifeintheprocess.

C. After being airlifted by helicopter to a hospital, Sergeant Beikirch woke up in thehospitalwithachaplainbyhisside,askingifhewantedtopray. Afterayear inthehospital,Beikirchreturnedtocivilianlife,becameaChristian,andenteredseminary,determinedtoreturntoVietnamasamissionary.

D. The VietnamWar left him so emotionally scarred that hemoved to a cave in NewHampshireandlethishairgrowbelowhisshoulderswhilepursuinghisstudies.WhenthemilitarylocatedhimtolethimknowthathewasaMedalofHonorrecipientandtoinvitehimtoWashingtonforthepresentation,thingsbegantochange.

E. Followingtheceremony,BeikirchcompletedaseminarydegreeaswellasaMastersincounseling. Hedecided thatGodwantedhim tohelp children, andheworkedasaschoolcounselorinaRochestermiddleschool.

II.ExperiencesLeadingtoPost-TraumaticStressDisorder

A. IntensityofImpact

• Didnothaveastablehomelifeasachild

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• Special forces traininghelped self-confidence and gave theopportunity to expandcreativenessandresourcefulness

• Living with the people in Vietnam created the first real connection in developingmeaningful relationshipswithpeople,especially the15-year-oldmountainboywhobecamebodyguard

• SymptomsofPTSDfromthesefactorsincludedguilt,nightmares,andrage

B. DeathofaFriend• DeyowasBeikirch’s“battlebuddy”;itwasafriendshipforgedincombat.• InVietnam,itwasveryimportanttoknowwhocouldandcouldn’tbetrusted.• TheintensityofApril1stwasdifferentthanallotherdays.Therewasmuchguiltand

personalpain,becauseasamedic,Beikirchconsideredithis jobtotakecareofthepeople.

• After Beikirch was wounded, Deyo carried him around for hours so that Beikirch

could service those being killed. Beikirch was shot three times, and Deyo waswoundedaswell.

• Finally,DeyoshieldedBeikirchfromanincomingrocket,anddidnotmoveafterthe

rocketexploded.Inbattle,therewasnotimeforrageoranger.However,foryearsafter,hisdeathtriggeredrageandguiltthattookalongtimetobringhealing.

C. EventsintheHospital

• Beikirch considers his worst battle moment a few days after April 1, laying in ahospitalbed inan Intensivecareward, listeningatnight to thesoundsofgroaningandpeopledying.

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• ItwastheworstpartbyfartoBeikirchbecausehefoundhimselfgoingunconscious3or4timeshimself,andhewastryingtokeephimselffromdying,buthiseyeswouldcloseanyway.

• Beikirchfeltafearful,helplessfeelingbecausethereisnopowerindeath.Itwasthe

mosttraumaticexperienceofhislife.• Ecclesiastes 8:8 – “No man has authority to restrain the wind with the wind, or

authorityoverthedayofdeath;andthereisnodischargeinthetimeofwar,andevilwillnotdeliverthosewhopracticeit.”

• “Becoming a Green Beret was such a tremendous accomplishment for me andprovidedsuchameaningandsignificancetomylifethatIhadneverfeltbefore,butitdidn’tmeanathingwhenIwasdyingandtryingnottodie.”

D. SearchingforGod

• In the hospital, therewas a chaplainwho talked about prayer andhelpedBeikirchhaveanawarenessthatGodwasthereandthatHecared.Thechaplaingavehimacross.

• Beikirchenteredcollege,andswitchedhismajortopre-med,stillsearchingforthat

Godthatheknewwasreal.• Afterfourmonthsofcollege,hewaswearingafatiguejacketandwalkedbyastudent

unions. Beikirch was joked and spit on, and finally could not take the criticismanymore.

• BeikirchtraveledtoNewEngland,searchingformeaninginlife,lookingforasenseof

purpose.

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• HissearchledhimtoafriendwhoeventuallysharedChrist,andhegotinvolvedinamemory system of Scripture, learned more about God, enrolled in a seminary inNorthernNewHampshire,butstillhaddifficultybeingaroundpeople.BeikirchknewthatGodhadforgivenhim,butheplacedabarrieraroundpeopleandkeptthematadistance.

• Gary lived in a cavewhile going to seminary, but eventually receiveda letter from

Lollywhobecamehiswifethreemonthslater.E. Lolly’sView

• Lolly was in love, and she did not realize the significance of the issues her new

husbandwasdealingwith.• When they moved to Maine, she realized that he had major issues, even though

therewasnotatermforitsuchasPTSD.• Gary,Lolly,andtheirtwokidsmovedintoashackwithnorunningwater,electricity,

ortoiletfacilities.• Garywasanassociatepastoratthetime,goingthroughhisownhealingprocesswith

nonameforhisbattle,livinginthewoodswithareluctanceoftalking.Itwasastrainonanearlymarriage.

• Lolly knew that Gary loved her and that Godwanted them to stay together. She

couldnotrelyonherownunderstandingofwhatwashappeningbuthadtoclingtowhatGodwassayingaboutthemarriage.

• Proverbs3:5-6–“TrustintheLordwithallyourheartanddonotleanonyourown

understanding. In all your ways acknowledge Him, and He will make your pathsstraight.”

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F. Gary’sHealingProcess

• ComingtoChristandfeelingthehealing, renewingpowerofChrist inhis lifewasahugestepinhishealingprocess.

• Vietnamdestroyedeveryaspectofhislife,includingbehavior,thoughts,feelings,and

values. Garyhatedhimselfforsomeofthethingsherememberedhimselfdoing inVietnam,andfeltthathecouldnotforgivehimself,leadingtoself-hate.

• IdentifyinghisproblemasPost-traumaticStressDisorderhelped.• GodworkingwithhimandLollyasacouplealsofurtheredthehealingprocess.

G. Lolly’sHealingProcess• The twobiggestcontributing factors toLolly’shealingprocessof secondary trauma

werethesoledependencyontheWordofGodandtheHolySpiritasherComforter.• GarywenttothecavetofallinlovewithGod,butfoundthathehadtocomeoutof

thecavetoloveotherpeople.HelovedLolly,buthewasdetachedfromthefamily.• SheencouragedGarytofightthebattlewithinhimself.

III.BecomingCounselors

A. Garyenteredgraduateschooltobecomeaschoolcounselor.Heletdownwallswitha

compassionatefriendinschool,whichwasahugestepforhim.B. Learning to have a ministry of presence was important for both Gary and Lolly.

Learningtobetherewhenpeoplearereadyandstandingwiththemforthelonghaulcanoftenrequirewalkingthroughthepain.

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C. Working on their marriage, being a couple, and working together in ministryencouragedGaryandLollytobecomecounselorstogether.

IV. Advice for Counselors Across America Engaging with PTSD Sufferers ofCombatTraumaorTraumainGeneral

A. Haveaministryofpresence.

B. Betheretolisteninanaccepting,non-judgmentalenvironment.

C. Sharethegriefandguilt.

D. UnderstandRomans8:28–“AndweknowthatGodcausesallthingstoworktogetherforgoodtothosewholoveGod,tothosewhoarecalledaccordingtoHispurpose.”

E. Understandthathealingtakestime.• Medication for the purpose of forgetting can mask the problem. Forgetting isn’t

gettingbetter.• Gettingbetter isbeingable tocry. It isbeingable toopenoneselfup tosomeone

and let that person become a part of one’s life. It is being able to heal and takewhat’shappenedandturnitaroundtobuildstrengthsinlife.GettingbetterislettingGodturnthingsaround.

F. Knowhowone’schurchcanreachouttothemilitary.

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V.BottomLinetoCounselorsorSufferersofTrauma

A. PutProverbs3:5-6intopractice–trustintheLordandallowHimtodirectone’spaths.

B. Understand thatPTSDand its impactonbehavior are very real. God’s interventioncanhealdespitethebiology.

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1. WhatstoodoutaboutGaryBeikirch’sexperiencesonApril1,1970thatprobablyledtohisdevelopmentofPTSD?

2. Discuss the behavioral changes thatwere evident inGary’s behavior after his releasefromthehospitalandreturntocivilianlife.

3. HowwasLollyaffectedthroughsecondarytraumaofPTSD?

4. DiscussthehealingprocessthatwasevidentinGaryBeikirch’slife.

5. WhatdoGaryandLollyBeikirchrecommendtocounselorswhoareengagingwithPTSDsufferersoftrauma?

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CRCS107:

War,DeadlyForceandtheBible

ToddWagner,M.A.

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CourseDescriptionWar is a difficult topic to discuss, but people in all professions need to reconcile therequirementsoftheirprofessionwiththerequirementsoffaithandbiblicaltruth.ThislessonaddresseswhatGodthinksaboutthemilitaryprofessionbydiscussingbiblicalreferencesandmoral dilemmas that soldiers often face. ToddWagnerwill help students discover a biblicalworldviewthatisconsistentwiththeScripturesregardingdeadlyforceasitpertainstowar.

1. ParticipantswillbeabletoapplyScripturetomilitaryscenarios.

2. Participantswillbeabletounderstandtheprinciplesofjustwar.3. Participantswillbeabletounderstandabiblicalworldviewregardingthegovernment’s

roleinwar.

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I.ReconcilingaSoldier’sCallingwiththeCommandment,“ThouShaltNotKill”

A. Warisnotwhatwas,shouldbe,orwillbe.War–theneedfortherestrictionofevil–iswhatis.

B. Asoldierthatdoesnotfeartheuseofdeadlyforceisadeadlysoldier.C. Warcameasaresultoftheescalationofevilinman.D. Mencanimproveinalmosteverything,exceptmorality.E. Genesis9:6–“Whoevershedsman’sblood,bymanhisbloodshallbeshed,forinthe

imageofGodHemademan.”F. Therewillnotbea“wartoendallwars”untilpeacecomesanotherway.G. Isaiah 2:4 - “And He will judge between the nations, and will render decisions for

manypeoples;and theywillhammer their swords intoplowsharesand their spearsintopruninghooks.Nationwillnotliftupswordagainstnation,andneveragainwilltheylearnwar.”

H. Revelation21:4–“…andHewillwipeawayeverytearfromtheireyes;andtherewill

nolongerbeanydeath;therewillnolongerbeanymourning,orcrying,orpain;thefirstthingshavepassedaway.”

I. Warisadivineright,privilege,andresponsibility.J. Tonotwaristorebel,aswellaswarringunjustly.

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K. Romans13:1-4-“Everypersonistobeinsubjectiontothegoverningauthorities.ForthereisnoauthorityexceptfromGod,andthosewhichexistareestablishedbyGod.ThereforewhoeverresistsauthorityhasopposedtheordinanceofGod;andtheywhohaveopposedwillreceivecondemnationuponthemselves.Forrulersarenotacauseoffearforgoodbehavior,butforevil.Doyouwanttohavenofearofauthority?Dowhatisgoodandyouwillhavepraisefromthesame;foritisaministerofGodtoyoufor good. But if you dowhat is evil, be afraid; for it does not bear the sword fornothing; for it is aminister of God, an avenger who brings wrath on the onewhopracticesevil.”

L. Governmentexistsbecausemenareevil.M. Peaceonlycomesintheheartsofallpeopleandsocietiesthrougharelationshipwith

thePrinceofPeace.N. The idea thatwar isnecessary is somethingScriptureaffirms. Becauseof rebellion,

governmentsneedtobeabletodealwithevilmen.O. Romans3:10-18P. Thereareseveral institutionsnecessaryforhumankindtowork–home,church,and

governmentallhaveauthority.Q. Micah6:8–“Hehastoldyou,Oman,whatisgood;andwhatdoestheLordrequireof

youbuttodojustice,tolovekindness,andtowalkhumblywithyourGod?”R. Whengovernmentdecidesnottofulfillitsrole,peoplesuffer.S. Lettingevilaloneandtryingtoisolateevildoesnotwork.Evilgrows.

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T. Appeasementisafailedunderstandingofhowtodealwithevil.U. Proverbs30:15-Theleechhastwodaughters,“Give,”“Give.”Therearethreethings

thatwillnotbesatisfied,fourthatwillnotsay,“Enough.”

II. WordsHelpersCanGive Individuals in theMilitarywhoareSuffering from

SoulTrauma

A. Godgivestheswordtothestatebutnottotheindividual.

B. Howthegovernmentsoftheworldarecalledtorespondtoabuse,wrong,andevilisdifferentfromhowindividualhumansarecalledtorespond.

C. Romans 12:14, 17, 21 – “Bless those who persecute you; bless and do not curse.Neverpaybackevilforeviltoanyone. Respectwhatisrightinthesightofallmen.Donotbeovercomebyevil,butovercomeevilwithgood.”

D. Ifanationdoesnothaveagoodjudiciary,theywilldiefromwithin.Iftheydon’thaveagoodmilitary,theywilldiefromwithout.

E. Onecanbeapacifistbecauseofconscience,butcannotbeapacifistbecauseofChrist.

F. Godhasordainedthatgovernmentistobeatemporalrestrainerofevil.

III.Augustine’sJustWarTheory

A. Godapprovesjustwar,butHeabhorsimperialism.

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B. TenantsofajustWar• Legitimateauthority• Justcause• Justintent• Specificandachievablegoals• Proportionalityincostandresponse• Intenttorespondtothethreatofaggression,nottoventangerassociatedwiththe

enemy• Takeeffortnottoexpandtargetsbeyondmilitaryones

IV.Conclusion

A. Godisnotjustconcernedaboutmacrojustice,butalsoaboutindividualjustice.

B. GodsaysthatjudgmentalwaysbeginswithHispeople.

C. Be part of the provision for soldiers in the execution of justice and in the recovery

processthatisunnaturaltoman.

D. Understandthatpartofgovernment’sresponsibilityisfulfillingitsduty,andGodwill

holdgovernmentsresponsiblewhowarunjustlyorwhodonotwaratall.E. Counselorsmustcomfortthosewhoengageinselflesssacrifice,puttingthemselvesat

riskforanhonorableandjustcause.

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1. Discuss the necessity of reconciling the requirements of any profession with therequirementsoffaithandbiblicaltruth.

2. Discusstheprincipleofwarexistingasaresultoftheescalationofevilinman.

3. Accordingtothepresenter,whatisthepurposeofgovernmentandwhydoesitexist?

4. DiscussthetenantsandimplicationsofAugustine’sJustWarTheory.

5. What role can counselors play in helping soldiers understand war from a biblicalworldview?

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CRCS108:

TheRealitiesofMilitaryServiceontheServiceMember

DonSnider,Ph.D.and

LTGRobertVanAntwerp

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CourseDescriptionCounselorsandcaregiversneedtobeexposedtotherealityofmilitaryserviceandits impacton the service member. Each person is unique and possesses different dynamics that willinfluencetheirreactionstoevents.Thislessonwillteachstudentsaboutdemographics,reasonspeople enlist in the service, the issues regarding family members, deployment andredeployment,woundsofwar, andhow todealwith thedeathor lossofa servicemember.Overall, this lessonwillhelp counselorsbemoreeffectivebyhelping themunderstand thesecrucialfactors.

1. Participants will be able to learn about the difficulties of reintegrating into society

followingdeployment.

2. Participantswillbeabletolearnaboutfamilydynamicsthataccompanymilitarylife.3. Participantswillbeabletobetterunderstandthechallengesofawoundedwarrior,and

howthecounselingcommunitycanhelp.

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I.MilitaryDynamics

A. CitizenSoldier–Peoplechoosetomovefrombeingcitizenstosoldiers,butthentheyplacetheiridentityassoldiersinfrontoftheiridentityascitizens.Reservecomponentsaremorecitizensoldiers.

B. Everyonewhoentersthemilitaryhasaconceptofpersonalpurposeandservice.C. Research from the early phases of the Iraq war is clearly documenting the positive

incentiveofmissiononperformance.D. Meaningofintensewartimeexperienceisfoundinthetranscendent,andnothavinga

connection to that transcendent meaning can interfere with finding meaning in ahealthyway.

E. TwoGreedyInstitutions

• Military sociologists describe two greedy institutions: the family and the military

vocation.• Boththefamilyandthemilitaryvocationhaveintensedemands.• Thereneedtobetwothingsfortheseinstitutionstothrive:

1. Consistencyincommitmentandinaction2. Predictabilityintheshortandmid-term

• However,theseinstitutionsdonothavethoseelementsrightnow;theyareintenselyneedyinstitutions.

F. Identityof soldiers is important tounderstandbecause satisfactionof servicekeepsthemonactiveduty.

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II.TheWoundedWarrior

A. Each individual warriorwill have to construct and reconstructmeaning of personalidentityonhis/herown.Inordertocontinue,theywillhavetoreorienttheiridentitysignificantlywithinthelimitationstheyhave.

B. Veterans’futurescannot–andshouldnot–bedetachedfromwhattheyhavedoneinthepast.

C. Theyneedaroundthemthatmoral,caringcommunitytohelpthemifnecessarybringclosuretoapartoftheirlifethatwasverysatisfying,drawthosesatisfactionsfromit,andmoveontoanewphaseoflifewheretheycanfindequallysatisfyingresults.

III.TheDynamicofFaith

A. Initsbroadestview,faithisanelementthatisanintertemporaldimension.

B. Faith creates expectations about the future, and in trauma situations, thoseexpectationsarechallenged.

C. ThereisafaithfulGodandthemanifestationofHiscarehereonearthisthechurch.In the church,people shouldbeable to find the loveandcare thatHewill showaspeoplefindoutwhattheyaretodonextforHim.(Service,notself).

D. Churches should display a very conscious commitment of oldermilitary veterans tobecomeapartoftheyoungerveterans’livesthatarereturning.

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E. Networkingwithinafaithcommunitytoveteransofdifferentgenerationsshouldnotbeoverlooked.

F. Thereisanintenseintersectionbetweengrowingspiritualityandhighereducation.

G. Repetitivedeploymentshavedeepenedthedesireandwillingnesstoexplorespiritualmeaning.

H. The potential for spiritual growth and maturation for this “Generation Y” istremendouslyuntouched.

IV.TheServiceMember

A. Themajorityofyoungpeopleenterthemilitaryforeducationalbenefits,butduetothetraining,thereisachangethatmovesservicememberstowardselflessservicetocountry.

B. CharacterizingtheSacrifice• Self-effacing• Woundsofwar• Impactonfamilies

C. FamilyDynamics• About50%ofU.S.soldiersaremarried.

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• About50%ofAmericansoldierscomefrommilitaryfamilies.

D. ReflectionsontheChallengesofWoundedWarriors• Thereisusuallyasoul-searchingaboutwhattheypersonallydidandwhatothersdid

forthem.

• Medications,andmemoriesmayalsobefactors.• Helperscanlisten,puttheirarmsaroundthem,andpraywiththem.

E. There are differing responses toGodwhen something traumatic happens, includingelements of anger, guilt, false guilt, bitterness, and some do have a willingness topray.

F. NationalGuard/ReserveForces• There isadifferencewhentheycomehome,becausetheyhavedifferentdynamics

thattakeplaceinlivinginthecommunity.• Howtohelpthemreturnhomeascontributingcitizens?

1. Supportgroupsareveryimportant.2. Alotofservicemembersfindthatthedynamicsoftheirfamilieshavechanged

whentheyreturnfromtoursofduty.3. Isolation is one of the worst things; people need to reach out to the service

membersandsupportthem.4. Achurchcanbeeffective inthe lifeofareturningwarriorbyallowingthemto

joinupwithothersofsimilarexperiences.

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V.UnseenWoundsofWar

A. People should build the relationship with service members before they deploy, orwhiletheyaredeployed.Itisdifficulttocomebackandbeinatotallyforeigngroup,sothissortofoutreachwouldinspirequickerintegrationintothecommunity.

B. Unseenwoundsarethechallengesforthelong-term.

C. TodaypeoplehaveabetterunderstandingofPTSD.

D. RealityofDeathandImpactonaServiceMember• Manyyoungpeoplethinktheyareinvincible.Whenthatisshakenbythedeathofa

friend,thereisanadditionalburden.Theywillask,“Whydidithavetohappen?”• AgreatpartofthesolutionistofindpurposethatonlyGodcanhelpapersonfind.• Thesoldiersshouldgetbackwiththeirunitsasquicklyastheycantogetbackinthat

purpose.VI.GuidancetoCounselorswithinChurchesonDealingwithCombatTrauma

A. Beforehelping,beeducatedaboutthemake-upofthesoldier.

• Theyplacethemissionfirst,neveracceptdefeat,neverquit,andneverleaveafallencomrade.Thesearethefourpillarsofsoldiers.

• Beingdefeatedintheirmindscausesthemtosearchtheirsoulsandask“Whatcould

Ihavedonedifferently?”• Counselorsneedtounderstandthebasicframework.

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B. Soldiersknowhowtobeunderauthority.Thismeanscounselorscanuseadifferentapproachwiththem.

C. Takeopportunitiestogooutandbephysicallyengaged.

D. Havesoldiersbeapartofsomethingthatismakingadifferenceforothers.

E. Getthemoutwheretheycanmingle,talk,andfeellikeanormalperson.

F. Bepersistent,hanginthere,andbethereforthelonghaulsothatsoldierscontinuetofeelthesupport.

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1. Discusstheconceptof thetwogreedy institutions. Whatcanthismeanforamilitaryfamilyonapracticallevel?

2. What are someof thedynamics and issues that awoundedwarriormight facewhenreturninghome?

3. Discuss the element of faith, and how it is important in understanding a person’sidentityandpurpose.Howcanthisapplytothemilitary?

4. What are some challenges that the National Guard and Reserve troops might faceregardingreintegrationintosocietyaftercombat?

5. Whatcancounselorsandthechurchdotohelpservicemembersandtheirfamilies?

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CRCS109:

TheRealitiesofMilitaryLifeforFamilies

LTGRobertVanAntwerp;PaulaVanAntwerp;

RosemarieHughes,Ph.D.

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CourseDescriptionInthislesson,studentswillgainauniqueperspectivefromapaneldiscussingfamilylifeonthehome front. There are unique challenges that military families will face, such as secondarytrauma within the family, challenges of separation, the overall lifestyle and culture of themilitary, difficulties of deployment, homecoming realities, and the possibility of having awoundedsoldierreturnhome.Thislessonwillopenstudents’eyestothestrugglesthatvariousmilitaryfamiliescanfaceandprovidepracticalwaystoprovideencouragementforthem.

1. Participants will be able to understand some of the unique challenges posed on

militaryfamilylife.

2. Participants will be able to listen to Lieutenant General Robert Van Antwerp andwifePaula’spersonalstoryregardingfamilylifeinthemilitary,providingapersonalperspectivetostudents.

3. Participantswill be able to gain insight onhowa counselor can approachmilitary

familieswhoarestruggling.

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I.FourMainAreasofGeneralKnowledge

A. MilitaryCultureandSystem

• No40hourworkweek.

• Noentitledholidays.• Nochoiceofnextdutystation.• Behavioral expectations. Military children are subject to different behavioral

expectationsandoftenhigherstandardsthantheirpeers.• Militaryculturerunsthefamily’slife.• Themilitary does not take into account a child’s needs when a servicemember is

orderedtomove.• The way the parent remaining at home handles the deployment is the key to the

child’swell-being.

B. RealitiesofDeployment• Childrenhavetoadapttoaparentgoingawayforalongtimeonaregularbasis.• Anxietylevelsmayincreasethattheservicememberreturnsafely.• Themediamayexacerbatetheanxiety,especiallywithinchildren.• The spiral of deployment has grown, becoming longer and having a shorter

turnaroundtime.• Familiesareexperiencingdeploymentfatigue.

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• Technologyissuchthatfamiliescanuseemail,video,andcellphonestostayintouch.• Thedeployedparentshouldbekeptpsychologicallypresentwhilephysicallyabsent.• Therearealsopossibleproblemsofdeployment.

1. FatherRemoteness&DifficultyReintegrating

2. ChildAbuse(EmotionalorPhysical)3. EmotionalDifficultiesforChild4. Pre-DeploymentStress5. ParentificationofChildren6. HomeParentMayBecomeOverwhelmed7. FinancialDifficulty

C. Homecoming

• Usuallyahappyoccasion,butthechildcanbenegativelyaffected.• The reality is that being back with the family means there are spousal and family

demandsthatdidnothavetobedealtwithwhendeployed.• It isimportantnottoputunrealisticexpectationsonthefirstdayorweekbackfrom

deployment;reacquaintingandreorientationneedstooccurnaturally.• Thecoupleneedstobeflexibleandadaptable,bringingresiliencetothefamily.

D. TheWoundedWarrior

• In the currentwar in Iraq, there aremoremissing limbs andhead injuries reportedthaninperhapsanyotherwarthantheCivilWar.

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• Thisissuerequiresanunanticipatedadaptationbyspousesandchildren.• Therearelong-rangeconcernsaswell.

1. Familyneedstobeabletoreturntonormal2. Theinjuredspousewillhavethequestionofwhetherornothe/shewillbeableto

returntotheservice3. Thequestionoftheavailabilityofthemilitarytocareforneeds

4. Thepossibilityofthelossofincome5. An injured spouse will be unable to do what he/she used to because of new

caregivingneeds

• If the service member returns with or develops PTSD, there is a strong chance ofsecondarytraumatizationofthespouseandchildren.

II.OtherConsiderations

A. The child’s position in the family is important, because experiences can be differentdependingontheageofthechild.

B. Retirementcanalsobeanat-risktimeforthefamily.

III.InternetResources

A. http://www.militaryministry.org(Alsowww.ptsdhealing.organdwww.careandcounsel.infofromMilitaryMinistry.)

B. http://www.militaryonesource.com

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C. http://deploymentlink.osd.mil/deploymentTips.jsp

D. http://www.cfs.purdue.edu/MFRI/pages/military/deployment_support.html

E. http://militaryfamily.com/Military-Family-Resources.htm

IV.TheVanAntwerps’Perspective

A. CultureasanArmyFamily• Passionateaboutthecontributionthattroopsmake• Thereisauniquebondthatallpeopleintheservicehave• Cannotpicturelifeoutsidethemilitary

• Feelacommitmenttodoeverythingtheycantohelpyoungersoldiersandfamiliesinwaysthataredifficultforthem

B. ViewofYoungMilitaryFamilyChallengesandOpportunities• Youngmarriedsaretakingchallengesonwithanunparalleledjointness• Ayoungwife/husbandofasoldiermusttakeontheadventureoftheotherperson• Society tends to focuson thenegative, but it is a noble task; younghusbands and

wivesstandingbehindtheirspousesisinspiring.• “There’snothingharderthanlovingasoldier.”

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• “YoureyeshaveseenmyunformedsubstanceandinYourbookwereallwrittenthedaysthatwereordainedforme,whenasyettherewasnotoneofthem.”

• Re-enteringthefamilycanbeastressfultimeandcantakemonths,especiallyifthere

isaninnerwoundwithinthesoldier.

C. SubjectofSeparation• FortheVanAntwerps,DesertStormwasadifficultdeployment.• Communication is key; though the couple is separatedphysically, the soldier isnot

unapproachable.• Makedecisionsjointly,andcontinuethingsthatholdafamilytogether.• Regarding multiple deployments, try to take every deployment as a brand new

adventuresotherearenotcumulativeeffects.• Havepurposeandhopeonthehomefront.

D. WoundsofWar• Thereisaseenandunseenimpactonfamilies.• Generallythesolderwillventfrustrationonafamilymember.Inthisscenario,stay

closeandsupportive,butdonothoverortakeitpersonally.• Partofthehealing isrecognizingwhereonecanjoin inwithsomeonewhohashad

similarinjuries.• Abigchallengeiswonderingwhatcanthesoldierdoaftertheinjury.

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E. AdvicetoCounselors• Recognizethatifapersonisstruggling,thenthefamilycouldbestrugglingaswell.• If the head of the household is dealing is dragged down, then the rest of the

householdcanbedraggeddowntoo.• Thetraumacanbetransferredtoothermembersofthefamily.• Bringothersalongsidethesoldierswhohaveexperiencedthesametypesofthings.

F. ToThoseWantingtoEncourageYoungFamilies• Realizethattherecanbeatoughearly-marriedroadwithdeploymentsandtraining

times.• Don’tmissthelessonsthatcanbelearnedthroughadversity.• Familiescanbecomesostrongthroughthesedifficulties.

• Lookingattheothersideofthetunnelcangivestrength.• Itisthefamilythatultimatelymakesthesoldierstrong.

G. NateSelf’sStory(FormerArmyRanger)

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1. Discussthemilitarycultureandsystem,andwhathowthesechallengesmightaffectafamily.

2. Whataresomerealitiesassociatedwithdeployment,andhowcouldtheyaffectchildrenofamilitaryfamily?

3. Discuss some of the challenges and opportunities that are associated young militaryfamiliesarefacingtoday.

4. Whataresomepotentialwaysforafamilytobeaffectedifasoldiercomeshomefromwarwounded?

5. How can counselors reach out to soldiers and their families when they are facingdifficulttimes?

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CRCS110:

TheCombatTraumaSpectrum

ChristAdsit,B.A.andRahnellaAdsit

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CourseDescriptionThecombattraumaspectrumdoesanexcellentjobofshowingapointofpainandmatchingitupwiththerightintervention.Duringthislesson,studentswill learnfromChrisandRahnellaAdsitastheygivestudentsthebigpictureregardingwhatcombattraumaisandhowitimpactsthe livesofmany individuals.Understanding the combat traumaspectrum is the first step intreatingthetrauma,andstudentswillbecomemoreknowledgeableinthisareabytheendofthislesson.

1. Participantswillbeabletounderstandwhatcombattraumaisandhowitaffectsboth

thelivesofindividualsandalsooftheirfamilies.

2. ParticipantswillbeabletounderstandboththesimilaritiesandthedifferencesinAcuteStressDisorderandPost-TraumaticStressDisorder.

3. Participantswill be able to evaluate the Combat Trauma Spectrum and learn how to

effectivelyuseitasacounselingtool.

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I.The“BigPicture”ofCombatTrauma

A. Whenapersonis impactedbyatraumaticevent,thetrauma’sthumbprint isetchedontheperson’sbody,soul,andspirit.Thiscanaffectaperson’s:• Willtolive

• BeliefsaboutGod• Beliefsaboutthemselves• Beliefsabouttheworld• Dignity• Senseofsecurity

B. AccordingtoVeteransAffairs,80%ofOEForOIFtroopsacknowledgethattheyhaveseriousmentalhealthissues.

C. Combattrauma,orPTSD,hasbeencalledmanynamesthroughoutthecentury,which

makesitclearthatthisdisorder isnotuniquetomodernwars,but iscommontoallwars. It wasn’t until 1980 that the American Psychiatric Association formallyidentified, named, and defined the results of an extreme traumatic experience asPost-TraumaticStressDisorder.

II.WhatisCombatTrauma?

A. Combat trauma involves the responses that a service member has to the variousstressesofwar.

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B. Combattraumacanalsobereferredtoas“Deployment-RelatedStress.”

C. Soldierswhoreturnfromcombatwhowerenotdirectly involved incombatcanstillexperiencethesamedistressingsymptomsasthosewhoweredirectlyinvolved.

III.OverviewoftheCombatTraumaSpectrum

A. Pre-Deployment/Deployment/ReintegrationIssues

• Amongthemildestissuesonthespectrum• Certainlystillanxietyandadjustmentissues

B. Combat/OperationalStressReactions• These are normal reactions for anyone who goes into battle, and are not mental

illnesses• Symptoms can appear like those of PTSD, Acute Stress Disorder, or adjustment

disorders

ReactionstoStressorsIncreasinginSeverity

FirstMonthofSymptoms

Next3Months

Beyond3Months

Combat/OperationalStressReactions

AcuteStressDisorder

Post-TraumaticStressDisorder

AdjustmentDisorders

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• Symptoms tend to occur immediately after a stressful event and people recoverquicklywithoutsignificanttreatment.

C. AdjustmentDisorders• ThesearemuchmorecommonthanAcuteStressDisorderorPost-TraumaticStress

Disorder• TheyareusuallymuchlessseriousthanASDorPTSD

• These can occur when an individual is exposed to identifiable stressors causing areactionthatresultsinsignificantexcessivestressorimpairment

• Thereactioncaninvolvethreesymptoms:depression,anxiety,and/ordisturbanceof

contact• Adjustment disorders can occur up to 3 months following an event, but they are

usuallyresolvedwithin6months

IV.AcuteStressDisorderandPost-TraumaticStressDisorder

A. Themain difference in Acute Stress Disorder and Post-Traumatic Stress Disorder is

that Acute Stress Disorder encompasses an increased incidence of dissociativeepisodes,andashortenedonsetanddurationofsymptoms.

B. Itisimportanttounderstandthatphysiologically,thelowerbrainalwaystrumpsthetwohalvesoftheupperbrain.

C. Sometimespeoplekeeprelivingthetraumabecausethebrainstaysstuckinthecrisisalertmode.

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D. Theshockoftraumaphysicallyalterspartsofthebrain.

E. ThreeSymptomCategoriesofASDandPTSD• Re-ExperiencingSymptoms• AvoidanceSymptoms• ArousalSymptoms

V.AndiWestfall’sStory(FormerArmyFlightMedic)

VI.StagesofCombatTrauma

A. AcuteStressDisorder:Symptoms4weeksorlessB. AcutePTSD:Symptoms1-3monthsorlessC. ChronicPTSD:Symptoms3monthsormoreD. DelayedOnsetPTSD:Symptomsstart6monthsormoreafter

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VII.Post-TraumaticStressDisorder

A. One can acquire PTSD through combat, natural disasters, accidents, kidnapping,torture,viewinganyoftheabove,orreceivingtragicnewsaboutselforothersclosetoself.

B. NoteveryoneexposedtoaneventwillexperiencePTSD,andonlyabout5to10%of

non-combatindividualswillexperiencePTSD.C. FactorsthatContributetoanIndividualBeingLessLikelytoExperiencePTSD

• Fewer,lessintenseevents

• Attachedmeaningandsignificancetotheevent• Mentalandemotionalstateoftheindividual• Beliefinone’smission

• Theindividual’sabilitytoenvisionthegreatergood

• Positiveleadership• Teamwork/Support• Debriefingwithin72hours

D. FactorsthatContributetoanIndividualBeingMoreLikelytoExperiencePTSD• Frequent,intenseevents

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• Personalinvolvement• Oneeventoccurringontopofothercurrentstressors• Traumaticeventsinchildhood• Strongfeelingsofresponsibility

VIII.TheEffectsofDeploymentonSpouse/Children

A. Whenahusbandorwifegoesofftowar,adjustmentshavetobemadebythehome-front spouse. He/She must assume both parental roles, do all household chores,bear many emotional burdens that cannot be shared with the other spouse,understandthatvarioustemptationsaremoreaccessible,andoverallfamilylogisticsarehardertoaccommodate.

B. Oneofthemostdebilitatingproblemsishowareturningsoldiercanaffecthis/her

familywithPTSD.C. SecondaryTraumaticStress:Thetraumatizing,negativeeffectofthecombattroop’s

conditiononhisorherspouseandchildren.

IX.CombatTraumaandHowitHasImpactedMilitaryWomen

A. Therearemorethan182,000womenthathaveservedinIraqandAfghanistan.

B. ThewarinIraqhasbeencalledan“EqualOpportunityWar.”

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C. AccordingtoVeteransAffairs,womendiagnosedwithPTSDaccountedfor14%ofthetotal27,000veteranstreatedforPTSD.

D. 20%ofwomen seekingVA care since 2003 showed signs ofMilitary Sexual Trauma(comparedwith1%ofmen).

X.Conclusion

A. GodistheHealer.

B. Peoplearenot.

C. Nevertheless, God wants to partner with each individual to construct a healingenvironment.

D. Isaiah32:2–“Eachwillbelikearefugefromthewindandashelterfromthestorm,likestreamsofwaterinadrycountry,liketheshadeofahugerockinaparchedland.”

XI.Resources

A. The Combat Trauma Healing Manual. This is designed for the returning troopsuffering fromcombat trauma. It is recommended forusena small group,but canalsobeusedinself-studymode.(Availableatwww.militaryministry.org/resources)

B. When War Comes Home. This is designed for the wives of combat veterans.(Availableatwww.militaryministry.org/resources)

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1. ReverendChrisandRahnellaAdsittalkedabouttrauma’sthumbprintbecomingetchedonaperson’ssoul.Whatareasofaperson’slifecantraumaaffect?

2. Discuss the three categories of issues that were discussed as related to the CombatTraumaSpectrum.

3. ListsomedifferencesandsimilaritiesinAcuteStressDisorderandPost-TraumaticStressDisorder.

4. WhataresomefactorsthatcancontributetoanindividualbeingmoreorlesslikelytoexperiencePTSD?

5. What are some effects of deployment on a soldier’s spouse and children, and whyshouldcounselorscarefullytaketheseeffectsintoaccount?

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CRCS111:

TheMilitaryMedicalSystem,VeteransMedicalSystemandRelatedIssues

LeighBishop,M.D.,M.Aand

MG(Ret)KenFarmer

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CourseDescriptionThis lesson will help students understand the Veteran’s Affairs medical systems so thatcounselors can team with them as they partner with military veterans. The presenters willdiscusstheecosystemformilitary,especiallyforthewoundedwarrior,andhowimportantitisto provide care and compassion for families of soldiers aswell as the soldiers. Studentswilllearn about the hidden wounds of war, and how to take a holistic approach regardingtreatmentandhelpforsoldiers.

1. Participantswillbeabletolearnageneraloverviewforthemilitarymedicalsystem.

2. Participantswillbeabletounderstandvariousfactorsthatcounselorsneedtotakeinto

consideration,suchasfamilydynamicsandthewoundedwarrior.3. Participantswillbeabletolearnhowtolookattheseissuesfromaholisticapproach.

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I.TheEcosystemforMilitary

A. The Military Medical System is a very complex combination of the direct system(military hospitals and clinics) and partnerships with private sector companies toaugmentcare.

B. There is much sophistication and technology in Iraq and Afghanistan regardingmedicalhelp.

C. For injuredsoldiers,the journeygoesfromthebattlefront,toGermany,tothemostappropriatemedicalfacilityintheUnitedStates.

D. Familiesofsoldiersshouldbeprovidedcareandcompassionaswell.

E. PastoralcounselorsareoneofthecategoriesofTri-CareCertifiableProviders.

F. Thereseemstobeastigmaofseekinghealthcare,particularlybehavioralhealthcare.

G. Combat counseling teams can be a part of deployable force, to provide CriticalIncidentdebriefing,preventativecare,andsuicidepreventionprograms.

II.NationalGuardandReserveForces

A. Guardandreservistsarebeingdeployedinanunprecedentedfashion.

B. It is different for them now because the frequency and duration they have beendeployedisphenomenal.

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C. BothCongressandtheDepartmentofDefensehaveputinplaceadvantagesforthemandtheirfamilymembers.• There are new programs of coverage in military health systems that specifically

addresstheTri-CareMilitarybenefitthataren’tspecificallyaroundmilitaryclinics.• Networksarebeingexpandedtomeettheneedsofguardsmenandreservistsaway

frommilitaryhospitals.

D. Thegrowthoverthepastfewyearshasbeenparticularlyfocusedinthebroadareas.Expertsarealwayslookingforgaps,needs,andopportunitiestoexpandtomeettheneedsforpeople.

III.HiddenWoundsofWar

A. Comorbidity. Thereareoftenoutwardly visiblewounds that canhavewounds that

onecannotsee.Treatingthemtogetherisanecessarybutcomplicatedprocess.

B. Mark12:30–“AndyoushalllovetheLordyourGodwithallyourheart,andwithallyoursoul,andwithallyourmind,andwithallyourstrength.”

C. Mark12:30addressestheemotional,spiritual,mental,andphysicaldimensionsofaperson,providingaholisticapproach.

D. Thereisadirectroleforfaithinthisprocess.Fromafaith-basedperspective,GodistheHealer.

E. HowtoDealwithaWoundedWarrior• Treatthemlikeonewouldtreatanyoneelse.

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• Askthemtotalkabouttheirexperiencesandmissions.

• It is acceptable to talk to wounded soldiers about their experiences, even theirinjuries.

IV.HolisticApproach

A. Thehealingprocessdoesnotendinthehospital;rather,there isaroleforchurchesandotherorganizationstotakepartin–theyplayakeyroleinholistichealing.

B. Build trust with patients and their families. Then move on to other steps ofconnection,openness,andcaregiving.

C. Faithcontributestoresiliency.

V.TransitionintotheVASystem

A. VeteransAffairsMission–“Tocareforhimwhoshallhavebornethebattle,andforhiswidow,andhisorphan.”(AbrahamLincoln).

B. ThosewhoaredischargedfromthemilitarypriortoretirementaregenerallyeligibleforhealthcarethroughtheVASystem.

C. Those who retire from the military (or have a medical retirement) are generallyeligibleformedicalcareeitherinthemilitarysystemorpossiblyintheVA.

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D. Often,VAMedicalCentersareaffiliatedwiththefinestmedicalschoolsinthecountry.

E. NewVeterans• OIF:OperationIraqiFreedom• OEF:OperationEnduringFreedom(Afghanistan)• VeteransshouldfirstenrollinthesystembyvisitingthenearestVAhospital.• In an urgent need, returning soldiers should not let lack of enrollment stop them

fromseekingcare.• “VetCenters”–Facilitiesdedicatedtocounselingandpsychotherapyforveteransand

theirfamilies.• ReturningVeteran’sMedicalHealthScreen–Initialcontactwithpsychologistorsocial

worker for lengthy and extensive interviews regarding background, family, andmedicalhistory.

VI.VeteransandPTSD

A. Thesignatureinjuriesoftoday’seracombatarepost-traumaticstressdisorder(PTSD)andtraumaticbraininjuries(TBI).

B. Apersongroundedinfaith ismoreabletomakearapidtransitiontorecoveryfromPTSD.

C. Itcanbeverydifficultforreturningsoldierstoreconnectwithpeoplearoundthem.

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D. While the typical psychiatric care for veterans is outpatient, there are alsoopportunitiesforinpatientcare.

E. VAhelpsveteransofmanydifferentgenerations.

F. Thebiggestobstacleamongveteransforseekingmentalhealthtreatmentisthefearofaperceptionofweaknessoradetrimentaleffectontheircareers.• PTSDisnotaweaknessorcharacterproblem.• PTSDisanillness.

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1. Discuss the importance of the unprecedented deployment of National Guard andReserveforces.

2. Is there a stigma regarding military seeking healthcare, particularly behavioralhealthcare?Discuss.

3. Howshouldonetreatawoundedwarrior?

4. Whatistheroleoffaithandthefaithcommunityregardingthehealingprocess?

5. What should a new veteran do to initiate the process of becoming involved in VAhealthcareservices?

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CRCS112:

AssessmentandTreatmentProtocols

LeighBishop,M.D.,M.A.andEricScalise,Ph.D.

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CourseDescriptionThis lessonaddressesassessmentandtreatmentprotocols inthemilitary. Counselorscanbechallengedby troopscomingback fromwar,becauseoften the last thingon theirminds isamental health assessment. Students will learn the importance of teaming, partnership, andcommunity. They will learn to view these issues through a wide lens, looking at the broadapplicability of the treatmentmethodologies for themilitary in other practices thatmaynotalwaysrelatetothemilitary.

LearningObjectives:Bytheendofthislesson,students:

1. Willbeabletounderstandcriticalcoreissuesofassessment.

2. Willbeabletounderstandtheimportanceofateamapproach.3. Willbeabletolearndifferenttreatmentprotocolsthatcanbeusedafterassessment.

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I.CriticalCoreIssuesofAssessment

A. Definespecific,describablesymptoms.

B. Consultwithfamilymemberstogetacompletepicture.

C. Determine individual’sprogressionoverthetraumaspectrumtodetermine intensityoftreatment.

D. Getasenseofwhethertheindividualmightbearisktohim/herself.

II.GeneralOverviewofAssessment

A. Accurateassessmentofsymptomsdirectspropertreatment.

B. ThepresenceofcertainspecificsymptomsmayindicateTraumaticBrainInjury(TBI).

C. Itisimperativetotakeateamapproach.

D. Alwaysassesspotentialforthepresenceofsubstanceabuse.

E. Active,ongoingsubstanceabusewillunderminetreatmentofPTSD.

F. Following thorough assessment, the treatment team should coordinate to plan thetypeandintensityoftreatmentrequired.

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G. For individuals with intrusive symptoms, intensive psychotherapy will typically berecommended.

H. Educationabout the illness is critical, both for the traumatized individual aswell astheirlovedones.

I. Pre-deploymenteducationcanactasanemotionalinoculation.

J. Battlemind:Thosehabitsofmindthatonehastohavetosurvive,andtohelpone’sfellowservicememberssurvive,inthecombatzone.

K. Trauma can set intomotion certain brain chemistry changeswhich are beyond anyindividual’swilltocontrol.

III.TreatmentProtocols

A. MedicationsareusefulintreatingallbutthemostmildcasesofPTSD.

B. CommonMedications• Celexa• Prozac• Wellbutrin

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C. Jesusacknowledgedthatthesickneedaphysician.

D. ThemajorityofmedicationsusedtotreatPTSDarenotaddictive.

E. Cognitive Behavioral Therapy is one of the most effective treatments available tosufferersofPTSDandotheranxietydisorders.

F. CognitiveBehavioralTherapyseekstochangebadhabitsofmind.

G. Havingthesupportofacommunityisanimportantpartofrecovery.

H. Theadvantageofafaithcommunityisthatsupportisongoing.

I. Mentalization–Theabilityofthepatientnotonlytobegintohaveanappreciationofthementalprocessesinotherpeople,butalsotoknowthattheyareunderstoodandempathizedwithbytheircaregivers.

J. Becomeeducatedaboutthenecessaryconditions.

K. Brainscanning,particularlySPECTscanning,canbeusefulfortherapists.Thesescansshowthebrain’sactivityasopposedtoanatomy.

L. Mostpsychologicalproblemsarenotproblemswiththebrain’sanatomy,but ratherproblemswiththebrain’sfunctioning.

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1. Whatarethefourcriticalcoreissuesofassessmentdiscussedinthevideo?

2. Discusstheimportanceoftakingateamapproachinassessmentandtreatmentoptions.

3. Whyshouldonealwaysassessforthepresenceofsubstanceabuse?

4. Whatistheroleofmedicationsintreatment?

5. DiscussCognitiveBehavioralTherapyanditspurposeinrecovery.

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Nopartofthispublicationmaybereproducedinanyformwithouttheexpressedwritten

permissionoftheAmericanAssociationofChristianCounselors.

AACCPOBox739

Forest,VA24551

MemberServices:1-800-526-8673

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