understanding ptsd in student veterans: practical...

Understanding PTSD In Student Veterans: Practical Guidance for the Classroom SettingShannon Kostuck, LCSWClinical Social WorkerWil l iam S. Middleton Memorial Veterans HospitalVITAL Program for Academic Leadership

Educational Stats of Veterans by Gender

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Student Veterans•45.6% report significant symptoms of PTSD

•23.7% report “severe” depression

•46% report presence of suicidal thoughts

Milwaukee, WI November 2-4, 2016WACRAO/WASFAA JOINT CONFERENCE3

What is PTSD??•Cluster of symptoms that follow exposure to a potentially traumatic event

•Marked by clear cognitive, behavioral, and physiologic changes

•Can be chronic if untreated and greatly affects quality of life

•NOT a sign of weakness, lack of resiliency, or lack of preparation


Example: Combat Exposure in Iraq

95%93%

89%86%86%

80%77%

69%65%

50%48%

38%22%22%21%

14%14%

8%0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Seeing Dead Bodies/RemainsShot At/Receiving Small Arms Fire

Being Attacked/AmbushedReceiving Artillery, Rocket, Mortar Fire

Knowing Someone Killed/Ser. InjuredClearing/Searching Homes

Shooting/Directing Fire at EnemyIll/Injured Women/Child Couldn't Help

Seeing Dead/Serious Inj. AmericansHandling/Uncovering Human RemainsResp. for Death of Enemy Combatant

Participating in Demining OpsBuddy Shot/Hit Near You

Engaged in Hand-to-Hand CombatSaved Soldier/Civilian LifeBeing Wounded or Injured

Responsible for Noncombatant DeathClose Call/Hit but Saved by Gear

Hoge, et al, 2004, NEJM

Four Main Types of PTSD Symptoms


Re-experiencing:•Intrusive thoughts or memories about the trauma

•Nightmares

•Flashback

•Distress when reminded of the event (5 senses)

•Physiological reactions

Four Main Types of PTSD SymptomsAvoidance:• Avoidance of trauma-related thoughts, feelings, or conversations

• Uncontrolled conversation topics

• Avoidance of trauma-related places, people, or activities • Crowded area• Limited exit options• Unknown/unfamiliar people• Places were scanning for danger is restricted




Arousal Symptoms• Impaired sleep

• Irritability or outbursts of anger

• Difficulty concentrating/focusing

• Hypervigilance

• Feeling jumpy or easily startled


Negative alterations in thoughts and mood:• Difficulty remembering aspects of event

• Exaggerated beliefs or expectations about self, others, or the world (“No one can be trusted”)

• Loss of interest in past enjoyable experiences

• Feeling detached or cut-off from others

• Emotional numbness


“Natural Recovery” vs PTSD


Psychological Processes Involved in Maintenance of Symptoms of PTSD


Important Considerations•Post-traumatic stress symptoms fall on a continuum

•Accommodations may not be necessary or welcomed

•Mental Health stigma is significant within military populations

•Student Veterans with PTSD are taking charge of their recovery by simply attending school


Supporting Student VeteransIn Higher Education


Initial MeetingAsk Questions-Do not pretend like you know.

As Faculty/Staff of Institution:• Consider your thoughts and emotions related to Veterans-

especially Women Veterans• Consider your attitudes and beliefs about foreign policy and

people who serve in the military• Consider your comfort level in teaching students who have been

in the military• Consider your comfort level teaching students with physical and

mental health challenges• Consider that students have different experiences and views • Be aware of challenges facing Women Veterans

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Consider, but do not assume.

Best Practices in the Classroom

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• Cast a Wide Net– Meet the needs of an array of students– Make information available in different formats– Anticipate different learning styles

• Be Flexible– Let students sit where they want– Group work may be difficult– Provide quiet space and extra time for exams– Have a variety of office hours

Consider obstacles and be as flexible as possible.Both In and Out of the Classroom

When to Reach Out to the Student

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• Early Signs may include changes in :– Behavior– Appearance – Performance

Be aware, notice.

• Warning Signs may include:– Hopelessness about the future– Difficulty concentrating or making decisions– Jumpiness, constant alertness– Troubling memories, dreams or flashbacks– Self-blame or withdrawal– Insomnia– Increase drug/alcohol usage or eating– Feeling nervous, helpless, fearful, or numb– Irritability or agitation

Approaching Students Individually

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• Conversation Starters– “I’ve noticed…”– “Are you a Veteran?”– The “Thank you” issue: Its different for everyone. It

may be best to say, “I respect what you’ve been through and I’m glad you’re here”.

– It may be helpful to both of you to ask about their job while in the military and where they went.

Show interest but let them take the lead.

• Avoid– Pressuring about specifics– Minimizing challenges they might face– Making assumptions about political views– Singling them out without permission

Show interest but don’t be pushy.

•NEVER ask a veteran if they have killed or how many people a veteran may have killed.

•NEVER force a veteran to share their experiences if they do not want to.

•NEVER assume that a veteran has PTSD and if they do NEVER treat them differently.

•Make yourself available should they need help but don’t force yourself on them.

Steps to Avoid

http://www.ptsd.va.gov/

PTSD Resources

http://www.ptsd.va.gov/

Thank you!

Should you have any additional questions or concerns please feel free to contact:

Shannon Kostuck, LCSWClinical Social WorkerVITAL Program for Academic Leadership608-246-6307

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