11stst Sergeant’s Brief Sergeant’s Brief

LCDR Tenaya N. Watson, Ph.D.U.S. Public Health Service

Licensed Clinical PsychologistMaxwell AFB Mental Health Clinic,

42nd MDG(Slides Adapted from Neysa Etienne, Psy.D. & Chad

Morrow, Psy.D.)

RATIONALE FOR 1st SERGEANTRATIONALE FOR 1st SERGEANT“…the most important enlisted person, give them the most pay and I almost feel like making all Second Lieutenants salute them. The ones I have worked with in the past and many others, I would gladly give the first salute. The First Sergeant is the Captain’s Chief of Staff. A poor one will ruin a good troop no matter what kind of Captain they have. And many a poor Captain has had his reputation saved and his troop kept, or made good, by a fine First Sergeant”

Colonel Charles A. Romeyn,

The Calvary Journal, July 1925

SIGNIFICANCE OF A SYMBOLSIGNIFICANCE OF A SYMBOL

DIAMONDS 1st SERGEANTUNBREAKABLE LEADERSHIP STRENGTH

EXCELLENT OPTICAL CHARACTERISTICS IDENTIFY AND HIGHLIGHT

FORMED UNDER PRESSURE/HEAT SACRIFICES IN THE PROCESS

RESISTANT TO IMPURITIES/SCRATCHING

HIGHER CODE OF CONDUCT/ETHICS

HARD TOUGH MATERIAL HANDLE TOUGH SITUATIONS

GOALS OF THIS BRIEFGOALS OF THIS BRIEFULTIMATE GOAL: HELP YOU DO YOUR JOB BY MAKING AN INFORMED DECISION AS YOU SERVE YOUR AIRMAN

WE WILL COVER TWO PSYCHIATRIC CONDITIONS: -Post-Traumatic Stress Disorder (PTSD)-Suicide-Interaction between the two

CRITICAL MATERIAL TO ADDRESS : -Collateral Information-Cause-Symptoms-Treatment

PROVIDE HIGH-YIELD RECOMMENDATIONS:-Intervene-Save Lives-Empower Your Airman

WHAT IS WHAT IS PTSD???PTSD???PTSD IS AN ANXIETY DISORDER

-Emotion of Anxiety:Feeling fear, terror,

helplessness-Physiological Manifestation

Changes in breathing, body temp, heart rate

PTSD is an EMOTIONAL REACTION to a Traumatic Event-Definition of Traumatic Event

Actual threat to life or physical injury

Perceived threat to life or physical injury

Diagnostic concerns with PERCEPTION & EXPERIENCE-Any experience is unique to individual perception-Either direct experience or witness to event-Subtlety of perceptions and witnessing can block 1st Sgt action

T: traumatic eventR: re-experienceA: avoidanceP: persistent arousal

ExperiencedActualWitnessThreatened

Intense emotionsFearHelplessnessHorror

Persistently re-experienced (at least 1)Distressing recollectionsDreamsRe-occurringPsychological distress @ exposure

Physiological reactivity @ exposure

Avoidance of associated stimuli (at least 3)Thoughts/feelingsActivities/people/placesInability to recallDiminished interest in significant activities

Detachment/estranged from othersRestricted range of affect (emotionally numb)

Foreshortened future

Increased arousal (at least 2)Falling or staying asleepIrritability/outbursts of anger

Difficulty concentratingHyper-vigilanceExaggerated startle response

Longer than 30 daysClinically significant distress

ImpairmentsSocial OccupationalOther

Sleep problemsWork “sucks”Family problemsApathy & AnhedoniaAbsencesSick call/medical appointmentsChronic PainANGER

• CONSIDER CONTEXT (pre/post deployment)

ANGERANGERTHE ULTIMATE EMOTION BLOCKERTHE ACCEPTABLE EMOTIONA BONDING EMOTION: Common Enemy

THE ANGER SOLUTION- WHY BLOCK?ANGER BLOCK (-) Emotions

ANGER BLOCK (+) Emotions

Uncertainty/Confusion

Happiness

Disappointment/Distress

Fondness

Worry/Frustration

Closeness

EQUALS WEAKNESS AVOIDS LOSS

HOW DOES IT HOW DOES IT DEVELOP???DEVELOP???PTSD IS A LEARNED BEHAVIOR

HOW IS THIS BEHAVIOR LEARNED?UCS----------------------------------------UCR(Food) (Salivation)CS------------------------------------------ CR(Bell) (Salivation)UCS---------------------------------------- UCR(IED Blast) (Anxiety)CS-------------------------------------------CR(Environment) (Anxiety)

Why does IT Why does IT LASTS???LASTS???

BEHAVIOR CONSEQUENCE FUTUREDo Something Lose something

goodDo it less

Do Something Get rid of something bad

Do it more

Do Something Get something good

Do it more

Do Something Get something bad Do it less

RECOMMENDATIONRECOMMENDATION

INFLUENCE OF 1INFLUENCE OF 1stst SHIRT???SHIRT???

Acknowledge their courageCommunicate validation of symptoms Share your story if appropriateOffer to facilitate a clinic appointment

Remain non-judgmental of experience

Attempt to collaborate the next step

Treatment obstaclesTreatment obstacles1.Avoidance of trauma-related material• Triggers• Feelings• Activities• Thoughts• Images• Situations

2.The presence of inaccurate thoughts/beliefs• “The world is unpredictably

dangerous”• “I am unable to cope”

PROLONGED EXPOSURE > 60 research studies support efficacy

Inadequate evidence supporting medications as effective treatments

Early evidence suggests physical symptoms will not improve if PTSD is not adequately addressed first

Two parts of exposure• Imaginal: in the head• In Vivo: in the environment

Exposure Prolonged Exposure

Maladaptive Cognitions Cognitive Processing Therapy

National Prevalence = 8%Trauma Victims = 20-30%Vietnam Veterans = 30%Persian Gulf War I Veterans = 10%Soldiers returning from OIF:

Report one or more PTSD symptoms: 22%

PTSD Diagnosis: 12% Latest Research: All Branches• 15-17% PTSD• 25% psychological difficulties

Anyone in Theatre

Trauma exposure• High risk Groups• History of trauma exposure

Airmen exposed to trauma will recover• Data indicates 60% / 40% Split

Data is mixed on timing of treatment

PTSD symptoms & Health

Positive for PTSD symptoms Have twice as many medical visits

Miss twice as many work days

PTSD & depression

PTSD & depression account for physical symptoms more than mTBI

SECURITY FORCES EOD OSI Intel Medics Transport (helicopters) Unmanned Air Planes Combat Controller JET Multiple deployments Longer deployments

Amongst all Airmen deployed in support of OEF/OIF:Report one or more PTSD symptoms: 1.9%PTSD Diagnosis: 0.35%

Amongst all Airmen deployed on JET missions in support of OEF/OIF:Report one or more PTSD symptoms: 4.7%PTSD Diagnosis: 1%

AF PTSD discharges increased tenfold since 2001From 10 discharges in 2001 to 110 in 2007

Direct communication Ambiguity fuels the fire

Normalize Provide Personal examples (disclose appropriately)

Support : Constructive Behaviors Help-seeking behavior

Time off for appointments Healthy living

Eating, sleeping, exercise Group activities versus isolation

Discourage: Destructive Behaviors Drinking Drugs Avoidance of responsibility

Full-blown PTSD is a low base phenomena

PTSD can be effectively treated PTSD is not a remitting disorder1st Sgt’s play a significant roleConsistency/follow-throughConsult with Clinic Providers

LCDR Tenaya N. Watson, Ph.D.U.S. Public Health Service

Licensed Clinical PsychologistMaxwell AFB MHC

Commercial: 334-953-5430DSN: 493-5430

tenaya.watson@maxwell.af.mil