03-01. General. What follows are very simplified descriptions of several treatments for PTSD. An attempt has been made to use Medical jargon only where required as part of a direct quote. If the meaning of a quote is unclear, please refer to appendix B for a simpler definition.
The first short section describes the lack of understanding or real treatment of PTSD prior to the Vietnam war. The next section explains several ongoing treatment methods, and the final section details current treatment options taking place at local VA Medical Centers and Vet Centers. (A list of VA facilities can be found in appendix G).
It is beyond the scope of this manual to cover every conceivable treatment method. Treatments are often individualized and may change on a daily basis. This chapter explains the treatments which are the most widely recognized at the time of this writing.
03-02. General. Up until September of 1994 I find no evidence that the military participated in any type of “trauma relief” briefings. In 1994 two Field Manuals were released. FM 8-51 (Combat Stress Control) and FM 22-51 (Leaders Manual for Combat Stress Control). If used properly by the chain of command these Field Manuals may reduce PTSD in future generations of combat soldiers. To bad it took so long to recognize the problem. In FM 8-51, chapter 3, paragraph “f”, it states, “The most important preventive measure for PTSD is routine after-action debriefing in small groups” and in FM 22-51, chapter 6, paragraph “f” it states, “…The after-action review should be conducted as soon as it is safe for the leader to bring his team together……The after-action debriefing process shares the after-action review’s concerns with details of what happened. It goes further by actively encouraging the team members to share and talk out their emotional responses to the event….The objective of after-action debriefings following traumatic incidents is to promote “healing” by opening up, “cleaning and draining” any unpleasant or painful memories.” FM 22-51 even encourages “Follow Up After-Action Debriefings as explained in chapter 6, paragraph “g”,…..”Prior to redeployment home, units should schedule time for everyone to verbally review the high and low points, talk through any unresolved issues, and conduct memorial ceremonies, if appropriate.”
None of this was done for veterans of WWI, WWII, Korea, Vietnam, nor the Persian Gulf or Iraq, to the best of my knowledge.
A perfect example is given in the article by DR. John Russell Smith, entitled “Veterans, Combat and Stress.” He quotes from several actual case histories taken from a U. S. Army psychiatrist’s notebook written in Vietnam during the period 1965-66:
Case 15. “This is a 35 year old Sergeant First Class with an advisory team in the Delta. His complaints are of fatigue and shortness of breath for about two months. Two months ago, it turns out, he had some near misses from sniper fire and mortar rounds. Then while wading in a river with the commander of his Team, he suggested they stop for a rest, which the Major agreed to. In about 10 seconds, a mortar round landed in front of them, about where they would have been if they had not stopped to rest. Patient and the Major talked about how lucky they were to have stopped. He then forgot about the incident. A shortness of breath, which led him to have to STOP AND REST frequently….(emphasis in original text)”.
Dr. Smith goes on the say that “Most of these men were not hospitalized, not evacuated, not treated, and were sent back to duty within a few hours” and that “The primary mission of the psychiatrist in the military is to preserve troop strength, not help individuals…”
It’s encouraging to know that most civilians working in high trauma contact jobs like Emergency Medical Technicians and Police Officers participate in programs that allow them to talk through a trauma almost immediately following the incident.
03-03. General. The types of individual therapy methods listed here are for informational purposed only. I am not recommending any of them, that decision must be made by the individual survivor and therapist.
03-04. Abreaction. This is a method of directly confronting the patient with the traumatic event using hypnotherapy, sodium amytal interview, and ventilation. Hypnotherapy involves the hypnosis of the patient and unconscious questioning about past events. Sodium amytal is a sedative, sometimes called “truth serum” which causes a person to talk freely and without inhibition. Ventilation is just allowing the patient to talk freely without medication or hypnosis.
03-05. Implosive Therapy or Imaginal Flooding. The idea is to have the patient recall the traumatic memories so many times that they loose their potency. This treatment is normally preceded by training in muscle relaxation, behavioral skills and problem solving. Though proven effective I feel this method is the most “brutal”.
03-06. Stress Inoculation Training (SIT). The focus here is to teach the patient to be more assertive and less passive. This treatment is used with patients who have become passive due to guilt and fear of the event recurring. Patients are taught to manage anxiety, control negative thoughts or images and to better cope with their disorder. This “teaching” rather than counseling technique has been proven effective in reducing anxiety, PTSD symptoms and depression.
03-07. Cognitive Behavioral Treatments. The patient is helped through confronting intrusive memories. The idea is to have the patient confront the traumatic memories/images and assist him/her in relaxation techniques.
03-08. Prolonged Exposure. This method embraces the reliving and confrontation school of thought (again a brutal but effective method) and uses 9 sessions in which information is gathered, a treatment is mapped out, exposure to the traumatic memories takes place and closure is hopefully achieved.
03-09. Eye Movement Desensitization Reprocessing (EMDR). In this method a therapist moves his/her finger from side to side in front of the patients eyes in a rhythmic motion. The exact reason this method works is not quite understood yet. It is, however, proving to be both effective and long lasting. Because this treatment is so promising, EMDR is covered in depth in chapter 4. (Also see below)
• “EMDR has been listed as an effective treatment by the American Psychiatric Association, Departments of Defense and Veterans Affairs, International Society for Traumatic Stress Studies, and numerous international agencies. See list below.
• More than a dozen controlled clinical trials support the use of EMDR for trauma such as that resulting from natural disaster, and EMDR has been used successfully to treat war- and terrorism-related trauma.
• With little modification, EMDR has been used successfully in response to a variety of mass-casualty events, and can be integrated with educational formats.
• EMDR has an impact on intrusive imagery (such as nightmares and flashbacks), numbing, and hyperarousal symptoms of PTSD, as well as on associated grief and depression.
• In several direct comparisons with cognitive-behavioral therapy, EMDR offers equivalent effects more quickly (fewer sessions or no homework), process analyses indicate less distress for individuals undergoing treatment. (WWW. Emdr.com)
03-10. Shock therapy. The best article I found on this subject is located at:
www.cerebromente.org.br/n04/historia/shock_i.htm. This technique is still practiced. Last year I was scheduled for a session, but talked my way out of it.
03-11. Dynamic/Supportive Psychotherapy. This is the primary treatment now being used by the Department of Veterans Affairs. The process usually involves talking about the traumatic experience(s), helping the patient to come to terms with guilt, and facilitating behavioral changes designed to help the patient to adapt to the disorder.
03-12. General. The main goals of group therapy are to counter the sense of isolation and social withdrawal, loss of control, and mistrust which affects most PTSD affected veterans. In addition the groups allow participants to support others, share traumatic experiences with those who have “been there”, and help decrease the sense of loneliness experienced by many trauma survivors.
The definition and inclusion of PTSD in the DMV-III, in 1980, grew out of group therapy sessions known as “rap groups” that Vietnam veterans participated in during the early 1970’s.
03-13. Guided. The clinician uses a round robin or random system to urge participants into sharing recent experiences and feelings. While seeming to offer no objective results, a sense of belonging is established and participants soon discover that the others in the group have experienced worse traumatic events than they experienced themselves.
03-14. Free Style. These groups are moderated, but not guided, and any subject is acceptable for discussion. Again, a sense of belonging is established and participants soon establish much needed friendships. Much like the Guided approach the individual “heals” at his/her own pace without any seeming objective results.
03-15. Cognitive-Behavioral. This is the most structured process, using individual and group relaxation and assertiveness training in order to achieve defined therapeutic goals.
03-16. General. Because PTSD has had, and can still have such an impact on the family of the survivor, family therapy is becoming more common. Since the wife, or husband, often has no idea of what is going on inside the partner, many marriages affected by PTSD end in divorce. Specific treatment has been established to include improving communications, educating family members on the causes and effects of PTSD, and improving coping skills. It is not uncommon for the spouse of a person with PTSD to suffer from PTSD as the result of living with a person with PTSD.
03-17. Different Approaches. Because of the self isolation of many trauma survivors an effort is made to have them get involved in community projects and perform volunteer work. This often promotes self esteem and helps eliminate that feeling of being worthless because of their inability to function in most social arenas. This combined with vocational support, job training, recreational activities, and even creative arts therapies has proven successful for many PTSD sufferers. These approaches will differ with every treatment location.
I will not go into detail here about Voc. Rehab regulations. Rather I will tell you what I went through and offer some information provided by the VA. If you are as little as 10% Service connected disabled you may qualify for these benefits.
1. I submitted an on line application and was contacted by the Voc. Rehab. Representative in my area.
a. I then received a letter from the VA setting me up with an appointment with the local Voc. Rehab. Representative.
b. I received and filled out a VA Form 28-1902 and turned this in to the Vo. Rehab. Rep. On my first visit.
2. I next submitted a list of things I felt that I needed. (In my case a request for phone service, a certain kind of software and a laptop computer).
3. I was sent to a psychologist for testing. During this meeting I answered oral questions, took several written tests and several hands on tests (You may or may not be required to do this).
4. My Voc. Rehab. Representative then made the decision to deny me Vocational Rehabilitation and Employment service and offered me the Independent Living Program (ILP).
5. The Voc. Rehab. Representative then drew up a “Rehabilitation Plan”, which I was required to agree to and complete. This was done on a VA Form 28-8872. In my case the plan called for psychotherapy and marital therapy, and financial counseling. After going through half of the counseling I received software for making web pages and a brand new Dell Laptop worth some $2000.00. The plan ran from February through September of the same year. If I had violated my plan I could have been made to return my software and computer.
03-18. General. The following is taken directly from a web page maintained by the “National Center for Post-Traumatic Stress Disorder” and located on a server at Dartmouth University. It was posted by Dr. Julian Ford. The topic title is “Specialized PTSD Treatment Programs in the U.S. Department of Veterans Affairs“:
(Authors Note - Many of the above types of therapy are being used at various VA centers).
The Department of Veterans Affairs Medical Centers provide a network of more than 100 specialized programs for veterans with PTSD, working closely in conjunction with the Vet Centers operated by VA’s Readjustment Counseling Service. Each specialized PTSD program offers veterans education, evaluation, and treatment conducted by mental health professionals from a variety of disciplines (such as psychiatry, psychology, social work, counseling, and nursing).
Outpatient PTSD Programs - include three basic types of clinics in which veterans meet with a PTSD specialist for regularly scheduled appointments:
• PTSD Clinical Teams (PCTs) provide group and one-to-one evaluation, education, counseling, and psychotherapy.
• Substance Use PTSD Teams (SUPTs) offer outpatient education, evaluation, and counseling for the combined problems of PTSD and substance abuse.
• Women’s Stress Disorder Treatment Teams (WSDTTs) provide women veterans group and one-to-one evaluation, counseling and psychotherapy.
Day Hospital PTSD Programs - include two basic approaches to providing a “therapeutic community” that veterans with PTSD can participate in several times weekly for social, recreational, and vocational activities as well as for counseling:
• Day Treatment PTSD Units provide one-to-one case management and counseling, group therapy, education, and activities in order to help clients live successfully with PTSD. Treatment and socialization activities are scheduled on a several-hour-a-day basis during the day and evening hours.
• Residential (Lodger) PTSD Units also offer one-to-one case management and counseling, group therapy, education, and activities on a several-hour-a-day basis. While enrolled in daytime and evening PTSD treatment, lodger clients may live temporarily in secure quarters that do not have 24-hour nursing supervision.
Inpatient PTSD Programs - include four basic types of services conducted while veterans reside in hospital units providing 24-hour nursing and psychiatric care:
Authors note - VERY IMPORTANT - Under current regulations if you already have a service-connected disability for PTSD and you participate in a Impatient PTSD Program which has a duration of over 21 days you are entitled to receive payment of 100% (if you do not already get paid for 100%) during that time frame. A few facilities will automatically do the paperwork for you but most WILL NOT. You may be eligible for several thousand dollars. You will need to submit a VA Form 21-4138 (Statement In Support of Claim) to the Benefits Counselor at the facility or mail it to the Regional Office (RO).
• Specialized Inpatient PTSD Units (SIPUs) provide trauma-focused evaluation, education, and psychotherapy for a period of 28 to 90 days of hospital admission.
• Evaluation and Brief Treatment of PTSD Units (EBTPUs) provide PTSD evaluation, education, and psychotherapy for a briefer period ranging from 14 to 28 days.
• PTSD Residential Rehabilitation Programs (PRRPs) provide PTSD evaluation, education, counseling, and case management emphasizing resuming a productive involvement in community life. PRRP terms tend to be 28 to 90 days. I attended this program at Sheridan, Wyoming in February of the year 2000. What follows are my observations and recommendations:
This is what I would call a “soft-core” program as the emphasis is towards helping the PTSD survivor cope with every day life through education and relaxation training (There is no requirement to talk about the stressor stuff). The Staff at the Sheridan, Wyoming VAMC I attended were outstanding, caring individuals and I would recommend that location to anyone. I learned many new things and share them below. I will say here that our group had anywhere from 4 to 10 people in it at any one time. People arrived and departed at different times, normally about 2 per week.
One of the friends I made while participating in the program, Ed, made a very profound statement during the week before we were scheduled to leave. While walking back to our rooms at the end of the day he said, “If you can figure out what is wrong with yourself, the VA will help you.” This can be taken in several ways. What he meant was “Until” you identify your own problem (say PTSD) VA cannot help you, nor can you help yourself.
I recommend you ask the following questions before you arrive at the VA facility:
1. Do they have washing machines or some sort of laundry service?
2. Do they supply wash powder and personal soap?
3. Do they provide towels?
4. Can you keep your automobile on the hospital grounds (if you will be driving yourself)?
5. Can someone pick you up from the bus, train station, or airport if you use public transportation?
6. If you travel by car and put in for travel pay will the facility you are going to be at pay travel for both ways? (Some facilities now only pay you to return home and have you file a claim at your home facility for the amount owed to get you to the treatment facility. You can also ask your home facility if you can file for advanced travel pay.)
7. If individual electrical appliances are allowed in the rooms (radio, TV, laptop computers)?
8. What drugs are you NOT suppose to bring (I was informed that I could not bring a certain Valium type drug that was prescribed for my anxiety. Indeed I had to stop taking the drug 30 days prior to arrival)
9. Ask about in room personal property security. Will you need to bring a lock?
10. Ask if they have Internet access. If you need to check your email I would advise you to set up a free account with Yahoo, Altavista or one of the other search engines. (The library at the VAMC I entered had a library with Internet and I also used the public library downtown.)
The following is a list of items I recommend you take with you:
1. Three changes of pants and shirts, other than the set you have on.
2. Flip flops for the shower.
3. Moccasins for casual ware in the evenings (some facilities have a leather or craft shop where you can make a pair).
4. Eight pairs of socks.
5. Three additional sets of underwear (Minimum).
6. Comfortable shoes.
7. A coat for winter.
8. A sweat suit for after hours (many inpatient programs will provide pajamas and robes).
9. Towel (if not provided).
10. Several dollars in change for vending machines.
11. Writing paper, envelopes and stamps.
12. Pre-paid phone card. If you plan on calling home it is usually cheaper to purchase prepaid phone cards than calling collect or direct from a pay phone.
Personal stuff:
1. Razor and blades.
2. Tooth brush and paste.
3. Comb.
4. Shaving soap.
5. Deodorant.
6. Shampoo.
The following is a list of optional things you may wish to take (at your own risk):
1. A radio or small TV with head phones.
2. Swim suit (most facilities have pools and many provide suits if you do not have one)
3. Coffee cup (the facility I went to provided a free plastic cup)
4. Pen/pencil and not pad (study material will be provided)
5. A bag of candy to munch on after hours, if your diet allows.
6. Catch-up work. Since you will usually have weekends off you might bring along a couple of projects to work on. If part of your reason for going to the facility is to relax then disregard this item.
7. You should also be prepared to identify all of the medications you are currently taking (either write down the name, dosage, Dr., etc. or bring them with you when you check in).
Do NOT take the following items:
1. Weapons (Knives or guns).
2. Alcohol or un-prescribed drugs. (You will be allowed to take you other prescribed drugs)
3. A lot of cash (I found that I could easily survive on about $10 a week).
In processing.
Initial in-processing (This can take from one to four days)
Check in - I reported in to the Mental Health Clinic and immediately filled out several forms. One was a release form and the other mostly concerned insurance information. I also answered several personal questions (address, current phone #, etc) so the clerk could update my computer records. The VA facility in Wyoming asked if I had a “Living Will” and if I desired to update it or create a new one. I chose to create a new one.
Screening - I was next screened by a resident nurse. She asked how PTSD affected my daily life, general medical questions, and what type of medications I was currently taking. She then administered a Tetanus shot, since I had not received one for some time and “popped a bubble” under the skin on my forearm for a TB test, also because I had not had one for some time.
Exam - I was given a cursory exam by a PA and had the opportunity to bring up any physical problems I wanted to have attended to while I was in the PRRP program.
Bracelet - The front office clerk then fitted me with a patient ID bracelet.
Staff psychiatrist - I then was interviewed by a psychiatrist and all he did was check on my medication and have them all renewed so I would not run out while in the program.
Room assignment - I was next assigned to a room and given an initial briefing. I was directed to present my personal belongings for inspection (checking for weapons and drugs) and finally shown to the cafeteria.
Case Worker - I next met with my Case Worker to fill out additional papers. He asked quite a few questions pertaining to past and present PTSD symptoms. This is still considered the “screening” stage as they have the authority to Not accept you for the program.
Chaplain - The Chaplain performed a written spiritual inventory and asked if I had any special spiritual needs.
TB test - Nurse read my TB test results.
Further Screening - I spoke with another social worker (Physiologist) just before lunch. She asked life history questions about family and military career. Also about PTSD symptoms, anger, memory problems, etc..
Evaluation - I met with the PRRP staff to sign a contract that I would abide by the rules and then we discuss my schedule.
Treatment Update - I met with my case worker and several other staff to discuss my program of treatment as well as my After Care Plans (what I planned to do about treatment after I finished the program here). I was given a schedule for the week and asked if the topics I had indicated as important last week were still the ones I wanted to address during my stay.
Medication Adjustment - Visited with the head psychiatrist and decided to increase at least one of my medications because of several negative symptoms.
What did we do?
What follows is a listing of the types of classes and exercises we participated in during my stay.
Occupational and Physical Therapy (OT) - The VA facility I was at had a lapidary, free hand and paint by numbers, several types of plastic models, and a couple of computers (no internet). Most of the work you had to do in the arts and crafts area. Reported to physical therapy area. I chose to ride an Airdyne bike for 20 minutes two times a week.
Relaxation Therapy - This is the heart of the program and usually produces the most positive results. We had class and exercises on breathing techniques and breathing practice (gut breathing instead of chest breathing), a AUTOGENIC RELAXATION session, an exercise with our eyes closed while listening to a recording, we participated in Hydro Relaxation which was done in a small swimming pool (we floated around in the water for about 20 minutes with floatation devices under our heads and our knees).
We also participated in a exercise using what the instructor called the “Flex/Relax/Balloon” method (You work your way through your body, starting with your feet, and use the “Flex/Relax” technique”. The “Balloon” portion is visualization and you mentally fill the balloon with stress then watch the balloon ascend into the heavens), and finally we were given a book titled The Relaxation Stress Reduction Workbook, by Davis, Eshelman, and McKay.
General Education - This was a “hodge podge” of topics that started our day out, given by different instructors. We had classes on recognizing relapses, Schizophrenia, Bi-polar problems (a person has major emotional peaks and valleys) and major depression, and on how physical activity can benefit you in your fight against depression.
We also had classes on substance abuse, anger management and how to use anger in a positive manner, how to do a resume. cover letter, and other job finding hints, Duel Diagnosis (This is when a person has not only a mental problem (PTSD) but also an addiction problem), Aftercare (what to do to help yourself after discharge), nutrition, a discussion on Cognitive Behavior Therapy (CBT) (“you feel what you think”), and finally a very informative class on Anxiety and Depression.
Open Group and Specialty Track Meetings - These were held at different times of the day, the first being permeated by a schedule update. All of these classes related in some way to PTSD. We had classes on trust, grieving, an open discussed on assertiveness verses aggressiveness, the causes of PTSD and the symptoms. We also had classes on medications and reading the labels, the effects of sleep depredation, the many changes in our lives that were bringing PTSD to the forefront after so many years, - a discussion on seeking a purpose for your life and learning how to love again, giving up hate, guilt, anger, and anger management.
General Recreation - We went bowling once a week and went on several field trips to nearby museums and points of interest.
Job Skills - Job Skills Session One - Next group was pertaining to job skills. Took a timed written test (to be explained later).
Job Skills Session Two- We watched two videos on interview techniques for disabled people and basic interview preparation techniques.
Job Skills Session Three - The instructor returned and interpreted a couple of tests we took earlier. They both were designed to show you fields of employment you should pursue because of your interests.
Job Skills Session Four - We watched a video on how to behave at a job interview.
Spirituality - This was a voluntary class for those feeling the need for spiritual renewal.
Spirituality Session One - The Protestant Chaplain gave an acceptable class on GUILT. This is another topic that gives many PTSD survivors problems without them knowing it. I will study GUILT and GRIEVING together and expand in my Manual.
Spirituality Session Two - Lively discussion on Guilt and forgiveness. Most of us carry a lot of guilt because we survived, we did not do enough in Vietnam, and one man spoke of his guilt for having to use the VA system when he did not feel he had done enough in Vietnam to deserve treatment. Forgiveness was discussed in the context of forgiving the Government for sending us to Vietnam, forgiving ourselves if we had done something in combat that we would not have otherwise done.
Conversation - Conversation Session One - This is a basic communications skills class designed to help those of us who have trouble meeting people and engaging them in conversation.
Conversation Session Two - Talked about maintaining a conversation after starting one with other people.
Therapeutic Challenges - Session One - We spent some two hours on team building, interaction Games. One was a trust walk where one person was blindfolded and the other talked him/her through a field littered with small plastic balls. Another was the design of a “Space Module”, containing a raw egg that a team of four had to design and make using straws and masking tape. The egg was dropped from a height of 10 feet to see if it would break (all four designs in our overall group safely sustained the drop).
Session Two - We participated in a “Trust Walk” (yes they still do that!). Broke into pairs and first walked our partner close to a wall without hitting it then went on a longer walk outside and had blindfolded person stop to feel different items as well as having him/her walk over different types of terrain.
Out Processing and Stuff
Find out who the records specialist is who can send you copies of your file. Sometime close to when you are about to leave Submit a VA Form 10-5345 (Records Release) and have that person mail you a copy of your “Discharge Summary”. You may also have that person mail a copy to a Service Representative, a lawyer, or the like, but it may take twice the 20 or so days one copy will take.
Drop by the pharmacy to make certain you have picked up all of your medications and ask for a FREE pill holder/organizer.
I found it helpful to get a phone listing of the staff I had worked with.
Final Comments
This was a helpful and rewarding experience. I went into the program wanting some positive changes and I feel I have made progress in that direction. The staff were supportive and caring (not just the program staff but everyone I came in contact with at the facility).
A thing that may have some bearing on your disability, if you already have one, is the GAF (Global Assessment Functioning) evaluation. To gage your progress and the success of the program you will probably have a GAF done when you arrive and after you complete the program. This is a subjective evaluation usually performed by a psychiatrist or psychologist and measures your current social adaptability. The danger lies in the fact that if you were last evaluated at say 40 and the doctor now evaluates you at 60, because you show progress, you could feasibly be reevaluated by your Regional Office and given a lesser disability. The only advice I can offer is even if you feel better and are more capable of dealing with your disabilities (anger, anxiety, depression, etc.) make certain you tell your case worker or psychiatrist of your continued feelings and worries and problems. I am not advocating that you lie or embellish the truth, just be certain you express your feelings as they relate to your condition, if they are still bothering you. This same GAF score, which by the way runs from 0 - 100 with 0 representing a completely dysfunctional person, can help you with your disability claim or if you reopen your claim, if the score is low enough.
Update. (The year 2001)
Seven year after attending the PRRP program - I have had many ups and downs during this past seven years. Hardly a week goes by that I have not applied some of the things I learned at the program. If I forget to take my medications for one day I usually go back down in the dumps. Sometimes I only forget some of my medications and I begin to feel the tuggs of anxiety.
I can still not handle any “out of the ordinary” events in my life.
I miss the care given there and the feeling of safety and often wish I could return for another tour. I may do that some day but for now my wife does not want to be left alone again for 45 days. I get the desire to return to the program now and again. I am remaining stable by going to a NP in Billings, and a general counselor here in my home town. I do not feel that I can break off from this help.
(End of PRRP program information)
• PTSD Substance Use Programs (PSUs) provide combined evaluation, education, and counseling for substance use problems and PTSD. PSU admissions range from 14 to 90 days.
03-19. Discussion. In his article “PTSD Treatment: An Outline and Review” Dr. Hadar Lubin points out that: “The effects of trauma on a person’s psychological, biological, behavioral, cognitive, and social existence are profound, pervasive, and long lasting. The complexity of symptom patterns and the extent to which trauma affects the interpersonal and social functioning of patients and their families suggests need for a comprehensive treatment approach. No one treatment modality can successfully target all PTSD symptoms or can effectively address all maladaptive responses to the traumatic event.”
(http://users.aol.com/fedprac/10lubin.htm)
03-20. Personal Experiences. One of the first things the psychiatrist at the VA recommended to me was to join a therapy group. I indicated to him that I was not a groupie, did not belong to any fraternal organizations because I had no interest in telling “war stories” and did not feel a group would help. However, I was willing to explore any avenue that might alleviate my agony so I decided to attend a couple of meetings.
At the first meeting I felt like an outsider and I almost decided not to attend again. However, I was seeking answers and so I continued attending the weekly meetings. I slowly began to learn many of the PTSD “buzz” words and began to feel accepted. I have encountered many veterans who have suffered much more than I have, and I have received a great deal of personal support from the other veterans. You will also find that once you obtain a disability for PTSD you may be required to undertake some for of therapy offered by the VA.
Since I penned the original manual I attended a PRRP program. My comments are above.
SITREP - WW II Era (1943):
The United Nations began to form; for the first time Penicillin is applied to the treatment of chronic diseases; the American Broadcasting Company (ABC) is created by Edward Noble; the books Arrival and Departure by Arthur Koestler and The Big Rock Candy Mountain by Wallace Stegner are published; the Films “For Whom the Bell Tolls” with Gary Cooper and “Sahara” with Humphrey Bogart are released; the songs “You’d Be So Nice to Come Home to” and “Mairzy Dotes” are released; The New York Yankees win the World Series by defeating the St. Louis Cardinals 4 games to 1.
WW II Era (1944):
President Roosevelt wins reelection to a fourth term with 53 percent of the popular vote;, by decision of the Supreme Court Americans can no longer be denied the right to vote because of color; the book The Golden Fleece is written by Robert Graves; Kodacolor film is introduced by Eastman Kodak; the films “Laura”, “National Velvet”, and “Lifeboat” are released; the songs “I’ll Walk Alone”, “Don’t Fence Me in”, and “Twilight Time” are released; the St. Louis Cardinals win the World Series by defeating the St. Louis Browns 4 games to 2.
WWII Era (1945):
President Roosevelt dies April 12; ball point pens go on sale October 29; Ebony magazine begins publication in November; the books Forever Amber by Kathleen Winsor, and That Hideous Strength by C.S. Lewis are published; the films “The Lost Weekend”, “The Body Snatcher”, and “Objective Burma!” are released; the songs “It’s Been a Long, Long Time”, “Let It Snow”, and “For Sentimental Reasons” are released; the Detroit Tigers win the world Series by defeating the Chicago Cubs 4 games to 3