trauma informed care for posttraumatic stress …...trauma informed care for posttraumatic stress...
TRANSCRIPT
![Page 1: Trauma Informed Care for Posttraumatic Stress …...Trauma Informed Care for Posttraumatic Stress Disorder and Military Sexual Trauma in the Veteran Population Paul Decancq, Psy.D](https://reader033.vdocuments.mx/reader033/viewer/2022052800/5f100a057e708231d4472459/html5/thumbnails/1.jpg)
Trauma Informed Care for
Posttraumatic Stress Disorder and
Military Sexual Trauma in the
Veteran Population
Paul Decancq, Psy.D..
Chelsey Wilkes, PhD
Canandaigua VA Medical Center
Paul.Decancq@ va.gov
1
![Page 2: Trauma Informed Care for Posttraumatic Stress …...Trauma Informed Care for Posttraumatic Stress Disorder and Military Sexual Trauma in the Veteran Population Paul Decancq, Psy.D](https://reader033.vdocuments.mx/reader033/viewer/2022052800/5f100a057e708231d4472459/html5/thumbnails/2.jpg)
Military Culture
2
![Page 3: Trauma Informed Care for Posttraumatic Stress …...Trauma Informed Care for Posttraumatic Stress Disorder and Military Sexual Trauma in the Veteran Population Paul Decancq, Psy.D](https://reader033.vdocuments.mx/reader033/viewer/2022052800/5f100a057e708231d4472459/html5/thumbnails/3.jpg)
Military Culture
3
Above the waterline:
behaviors, customs,
traditions (uniform, salute,
rank)
![Page 4: Trauma Informed Care for Posttraumatic Stress …...Trauma Informed Care for Posttraumatic Stress Disorder and Military Sexual Trauma in the Veteran Population Paul Decancq, Psy.D](https://reader033.vdocuments.mx/reader033/viewer/2022052800/5f100a057e708231d4472459/html5/thumbnails/4.jpg)
Military Culture
4
Below the waterline: hidden
culture – more enduring and
powerful.
Beliefs, values, assumptions,
judgments.
Guiding ideals that are kept
for life. Known as the
warrior ethos.
![Page 5: Trauma Informed Care for Posttraumatic Stress …...Trauma Informed Care for Posttraumatic Stress Disorder and Military Sexual Trauma in the Veteran Population Paul Decancq, Psy.D](https://reader033.vdocuments.mx/reader033/viewer/2022052800/5f100a057e708231d4472459/html5/thumbnails/5.jpg)
Understanding the “Military Culture”
• Warrior Ethos
• I will always place the mission first.
• I will never accept defeat.
• I will never quit.
• I will never leave a fallen comrade.
![Page 6: Trauma Informed Care for Posttraumatic Stress …...Trauma Informed Care for Posttraumatic Stress Disorder and Military Sexual Trauma in the Veteran Population Paul Decancq, Psy.D](https://reader033.vdocuments.mx/reader033/viewer/2022052800/5f100a057e708231d4472459/html5/thumbnails/6.jpg)
Moral Injury
Two definitions:
• Betrayal of what is morally correct by someone in a
position of authority in a high-stakes situation
(Jonathan Shay)
• “Perpetrating, failing to prevent, bearing witness to,
or learning about acts that transgress deeply held
moral beliefs and expectations.” • *Litz et al., 2009. “Moral injury and moral repair in war veterans: A preliminary model and
intervention strategy.” Clinical Psychology Review, 29,695-706.
![Page 7: Trauma Informed Care for Posttraumatic Stress …...Trauma Informed Care for Posttraumatic Stress Disorder and Military Sexual Trauma in the Veteran Population Paul Decancq, Psy.D](https://reader033.vdocuments.mx/reader033/viewer/2022052800/5f100a057e708231d4472459/html5/thumbnails/7.jpg)
Relationship between PTSD and Moral Injury
7
![Page 8: Trauma Informed Care for Posttraumatic Stress …...Trauma Informed Care for Posttraumatic Stress Disorder and Military Sexual Trauma in the Veteran Population Paul Decancq, Psy.D](https://reader033.vdocuments.mx/reader033/viewer/2022052800/5f100a057e708231d4472459/html5/thumbnails/8.jpg)
PTSD Moral Injury
Cause Real or perceived threat
to life
Leadership betrayal/
Violation of moral values & expectations
PTSD VS. MORAL INJURY
![Page 9: Trauma Informed Care for Posttraumatic Stress …...Trauma Informed Care for Posttraumatic Stress Disorder and Military Sexual Trauma in the Veteran Population Paul Decancq, Psy.D](https://reader033.vdocuments.mx/reader033/viewer/2022052800/5f100a057e708231d4472459/html5/thumbnails/9.jpg)
PTSD Moral Injury
Cause Real or perceived threat
to life
Leadership betrayal/
Violation of moral values & expectations
Individual’s role at the time of the event Witness/Victim Perpetrator/
Witness/Victim
PTSD VS. MORAL INJURY
![Page 10: Trauma Informed Care for Posttraumatic Stress …...Trauma Informed Care for Posttraumatic Stress Disorder and Military Sexual Trauma in the Veteran Population Paul Decancq, Psy.D](https://reader033.vdocuments.mx/reader033/viewer/2022052800/5f100a057e708231d4472459/html5/thumbnails/10.jpg)
PTSD Moral Injury
Cause Real or perceived threat
to life
Leadership betrayal/
Violation of moral values & expectations
Individual’s role at the time of the event Witness/Victim Perpetrator/
Witness/Victim
A reaction to… An event that happens to a
person
Acts of commission or omission
behavior of others/bearing witness
PTSD VS. MORAL INJURY
![Page 11: Trauma Informed Care for Posttraumatic Stress …...Trauma Informed Care for Posttraumatic Stress Disorder and Military Sexual Trauma in the Veteran Population Paul Decancq, Psy.D](https://reader033.vdocuments.mx/reader033/viewer/2022052800/5f100a057e708231d4472459/html5/thumbnails/11.jpg)
PTSD Moral Injury
Cause Real or perceived threat
to life
Leadership betrayal/
Violation of moral values & expectations
Individual’s role at the time of the event Witness/Victim Perpetrator/
Witness/Victim
A reaction to… An event that happens to a
person
Acts of commission or omission
behavior of others/bearing witness
Predominant emotions Fear/
horror/hopelessness
Betrayal/
shame/guilt
PTSD VS. MORAL INJURY
![Page 12: Trauma Informed Care for Posttraumatic Stress …...Trauma Informed Care for Posttraumatic Stress Disorder and Military Sexual Trauma in the Veteran Population Paul Decancq, Psy.D](https://reader033.vdocuments.mx/reader033/viewer/2022052800/5f100a057e708231d4472459/html5/thumbnails/12.jpg)
PTSD Moral Injury
Cause Real or perceived threat
to life
Leadership betrayal/
Violation of moral values & expectations
Individual’s role at the time of the event Witness/Victim Perpetrator/
Witness/Victim
A reaction to… An event that happens to a
person
Acts of commission or omission
behavior of others/bearing witness
Predominant emotions Fear/
horror/hopelessness
Betrayal/
shame/guilt
What was lost? Safety Trust/Connection/Self Concept
PTSD VS. MORAL INJURY
![Page 13: Trauma Informed Care for Posttraumatic Stress …...Trauma Informed Care for Posttraumatic Stress Disorder and Military Sexual Trauma in the Veteran Population Paul Decancq, Psy.D](https://reader033.vdocuments.mx/reader033/viewer/2022052800/5f100a057e708231d4472459/html5/thumbnails/13.jpg)
PTSD Moral Injury
Cause Real or perceived threat
to life
Leadership betrayal/
Violation of moral values & expectations
Individual’s role at the time of the event Witness/Victim Perpetrator/
Witness/Victim
A reaction to… An event that happens to a
person
Acts of commission or omission
behavior of others/bearing witness
Predominant emotions Fear/
horror/hopelessness
Betrayal/
shame/guilt
What was lost? Safety Trust/Connection/Self Concept
What is needed to heal? Restore sense of safety Forgiveness/Reconciliation/Moral Repair
PTSD VS. MORAL INJURY
![Page 14: Trauma Informed Care for Posttraumatic Stress …...Trauma Informed Care for Posttraumatic Stress Disorder and Military Sexual Trauma in the Veteran Population Paul Decancq, Psy.D](https://reader033.vdocuments.mx/reader033/viewer/2022052800/5f100a057e708231d4472459/html5/thumbnails/14.jpg)
PTSD Moral Injury
Cause Real or perceived threat
to life
Leadership betrayal/
Violation of moral values & expectations
Individual’s role at the time of the event Witness/Victim Perpetrator/
Witness/Victim
A reaction to… An event that happens to a
person
Acts of commission or omission
behavior of others/bearing witness
Predominant emotions Fear/
horror/hopelessness
Betrayal/
shame/guilt
What was lost? Safety Trust/Connection/Self Concept
What is needed to heal? Restore sense of safety Forgiveness/Reconciliation/Moral Repair
Treatment Cognitive Processing Therapy
/Prolonged Exposure
Adaptive Disclosure
Impact of Killing
PTSD VS. MORAL INJURY
![Page 15: Trauma Informed Care for Posttraumatic Stress …...Trauma Informed Care for Posttraumatic Stress Disorder and Military Sexual Trauma in the Veteran Population Paul Decancq, Psy.D](https://reader033.vdocuments.mx/reader033/viewer/2022052800/5f100a057e708231d4472459/html5/thumbnails/15.jpg)
Treatment for Moral Injury
“Moral-injury informed care:”
• Be careful to avoid re-injury through
inadvertent judging, shaming or being
dismissive
15
![Page 16: Trauma Informed Care for Posttraumatic Stress …...Trauma Informed Care for Posttraumatic Stress Disorder and Military Sexual Trauma in the Veteran Population Paul Decancq, Psy.D](https://reader033.vdocuments.mx/reader033/viewer/2022052800/5f100a057e708231d4472459/html5/thumbnails/16.jpg)
Treatment for Moral Injury (cont.)
• “What’s done is done” – Macbeth
– Better to listen, be a witness and gently offer reframing:
• The event itself is NOT ongoing
• Individuals in the event might have moved on, changed,
or passed
• Circumstances of the event might have ended
16