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Welcome to PTSD 101. This class will give a general overview of PTSD for those beginning to work with our veterans and first responders in the Equine Assisted Psychotherapy (EAP/EFP)or Equine Assisted Learning (EAL/EFL) field. This class can also be used for 3 annual education hours for the ESMHL.
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|Section 1: Important tab info in order to see content|
Navigating this course- Important!Preview
Presented by: (Please see www.horserhythm.org for more details)
Sahika Riley,MPAS, PA-C, Founder of HRF is a Physician Assistant (PA-C) and a 9-1/2 year Veteran of the United States Air Force. She is currently completing her PhD in Integrative Medicine. She is a Faculty Assistant Professor and an Adjunct faculty at three universities P.A. and D.O. programs.
She served overseas during Desert Storm as a Communication/Navigation system specialist for the A-10 aircraft. She spent her second half of her military career as a Physician Assistant in Family Medicine and Internal Medicine where she was the Officer in Charge for Surgical Case reviews and the Assistant Director for the Acute Care Clinic. She holds both a Masters Degree in Physician Assistant Studies with a specialty in Family Medicine and a Bachelor in Medicine from University of Nebraska.
She understands the results of war and not only physical but the emotional lasting affect it can have on our troops. Sahika is a disabled Veteran and has a compassion for those serving, to utilize Equine Assisted Services for those veterans in need. She fully supports the research and has seen firsthand the healing affect that horses have on people. It was her horses that kept her ”connected” after serving and it was Equine Assisted Psychotherapy that carried her through her mental challenges after battling Cancer. Sahika is a Survivor and opens her heart and experiences and is excited about introducing the successful world of Equine Assisted Therapy to her fellow Veterans.
She is a certified therapeutic riding instructor with PATH, Intl. and is EAGALA certified as both an Equine specialist and a Mental Health professional.
Thera-Teach Course development. Thera-Teach is the brain child of Michelle Weed. She is a PATH Intl Registered Instructor, ESMHL, Mentor and Standards Course Faculty. Finding the annual education hours necessary for retaining her certifications was difficult without travelling. Thera Teach was born from the idea of bringing the experts to the participants- online, at their convenience, with interaction and at an affordable price.
Michelle is a USAF spouse of 25 years, which includes 17 assignments across the country and overseas. From her experiences, she sees the need for support of family and children of our military, and strives to develop programs to reach those families in need.
Michelle has worked in equine assisted activities for 16 years at multiple centers across the country and overseas. Her areas of interest are curriculum building and mentoring centers for accreditation. She has been honored as Region 10 Instructor of the Year for PATH Intl. 2010, and Volunteer Education Leader for PATH Intl 2012. She has a degree in Health Sciences, Health Education from Excelsior College.
|Section 2: Understanding PTSD|
Understanding PTSD and Diagnostic Criterion Introduction
Combat/Operational Stress Reaction
“The expected and predictable emotional, intellectual, physical, and/or behavioral reactions of Service members who have been exposed to stressful events in war or military operations other than war. Combat stress reactions vary in quality and severity as a function of operational conditions, such as intensity, duration, rules of engagement, leadership, effective communication, unit morale, unit cohesion, and perceived importance of the mission.” (DoD Dictionary of Military Terms)
Acute Stress Disorder-
a mental disorder that can occur in the first month following a trauma. Rate of 6-33%%. (Dept of VA)
Also called Acute Reaction Disorder and Acute Stress Reaction
DSM -5 Criteria for diagnosis of PTSD
Diagnostic and Statistical Manual of Mental Disorders 5
Criteria for PTSD from DSM-5
Specific to adults and children over 6 years of age
History of exposure
Symptoms from each of the four symptom clusters/ criteria(ion)
Two specifications of reaction
Criterion A- Stressor
Criterion B- Intrusion
Recurrent intrusive memories
Flashbacks (dissociative reactions)
Criterion C- Avoidance
Persistent effortful avoidance of stimuli
Criterion D- Negative alterations
Negative alterations in cognitions and mood that began or worsened after event. Persistent (2 required)
Inability to recall event accurately
Negative self thoughts
Blaming of self or others
Decreased interest in activities
Feeling alienated from others
Constricted affect- inability to experience positive emotions
Criterion E- Alterations in arousal and reactivity
Irritable or aggressive
Self destructive or reckless behavior
Exaggerated startle response
Problems in concentration
Don’t confuse with TBI symptoms
Criterion F- Duration
Persistence of symptoms for over one month (B,C,D and E)
Criterion G- Functional significance
Criterion H- Exclusion
Disturbance not due to other reasons
Preexisting mental disorder
If with dissociative symptoms
If with delayed expression
Views from the veterans perspective. Is it effective? What do they gain from it?
This veteran is a volunteer who was willing to share his stories. He understands what the veteran may be going through and uses that understanding to help demonstrate what the ES and the MHP may see in arena exercises at their facilities.
|Section 3: Arena exercises|
Problem based counseling can be best explained by the two underlying theories- Cognitive theory and Behavioral theory. These theories are many times used together in Cognitive Behavioral Therapy (CBT). The initial concern in therapy is to help the client analyze behavior, define problems, and select goals.
Behavioral therapy is based on the premise that primary learning comes from experience. Therapy often includes homework, behavioral experiments, role-playing, assertiveness, and self management training. It utilizes collaboration between the client and the therapist.
Cognitive behavior therapy (CBT) is a type of psychotherapeutic treatment that helps patients understand the thoughts and feelings that influence behaviors. CBT is commonly used to treat a wide range of disorders including phobias, addiction, depression and anxiety. It is generally short-term and focused on helping clients deal with a very specific problem. During the course of treatment, people learn how to identify and change destructive or disturbing thought patterns that have a negative influence on behavior.
The underlying concept behind CBT is that our thoughts and feelings play a fundamental role in our behavior. The goal of cognitive behavior therapy is to teach patients that while they cannot control every aspect of the world around them, they can take control of how they interpret and deal with things in their environment. People can experience thoughts or feelings that reinforce or compound faulty beliefs. Such beliefs can result in negative behaviors that can affect numerous life areas, such as family, work, and school.
CBT begins by helping the client to identify the problematic beliefs, known as functional analysis, which is important for learning how thoughts, feelings, and situations can contribute to maladaptive behaviors. The second part focuses on the actual behaviors that are contributing to the problem. The client begins to learn and practice new skills that can then be put into use in real-world situations. For example, a person suffering from PTSD might start practicing new coping skills and rehearsing ways to avoid or deal with situations that could potentially trigger a flashback or negative behavior.
Ideas to consider as you watch the exercise
In this video we will be demonstrating an exercise that we have used extensively for pre- deployment workshops.This veteran is a volunteer who was willing to share his stories. He understands what the veteran may be going through and uses that understanding to help demonstrate what the ES and the MHP may see in arena exercises at their facilities.
Take notes on the Shifts, Patterns, Unique moments, Discrepancies and Self-awareness (SPUD'S, an EAGALA-developed observation framework taught in the certification training program which can bring in potential metaphors. www.Eagala.org)
How to make this a more powerful exercise- Build the relationship- Take pictures during the workshop, and take notes of what they are doing at different points of the exercise. Stay in touch with the service member via email while they are deployed. When they are going through a difficult time in theater send them a picture of a similar moment and talk about how they overcame the particular obstacle during the exercise.
Note: This is not an actual session. This is a mock exercise.
Listen as Carmen Meridith D.H.Sc., MS, PA, and presenter Sahika Riley MPAS PA-C, process out the exercise
Part one- home
The veteran is at the "home" barrel- he has written his concerns about going to war, what emotions that he is experiencing such as anxiety and fear. The horse represents his "family". Remember the metaphor lesson from the previous sessions.
The Equine Specialist should ask questions that are horse centered as is demonstrated by PA Riley. They should be sure not to attach their own meanings to the horses actions (Self, from SPUDS). The mental health professional can suggest possible reasons for an action by horse or person as demonstrated by Dr. Meredith.
The veteran has transitioned to war, the cross rails representing the transition. He is at the "war" barrel- he has written his concerns about what will happen when he goes home, what emotions that he is experiencing such as anxiety of adjusting and fear that his support systems wouldn't be there. The horse represents his "family".
Reminder: this is a mock exercise, demonstrating how to process an EAP and topics that may come up.
Carmen Meredith PhD and USAF Veteran, and Sahika Riley MPAS PA-C USAF veteran continue to process out the exercise.
The veteran has transitioned to war and back, the cross rails representing the transition. They talk more about helping him with his support systems and reintegration. (The horse represents his "family".)
Reminder: this is a mock exercise, demonstrating how to process an EAP and topics that may come up.
Note: In this exercise the mental health professional has a wireless microphone on, when she steps away, the participant cannot hear what she is saying to you- the class participant.
The exercise: Boundaries
What is the symptom that most affects you? Written on ground poles - Can be more than one
Who is it affecting around you the most? Written on duct tape on the horse
The cone is 'safety'
Do our symptoms set our 'boundaries'?
Veterans may follow boundaries or rules strictly. Why? Have you seen this?
Metaphors- why are they powerful?
Coping skills that may be brought up in session two? Session three?
A veterans opinion on EAP
Resiliency Training and what you need to know
Interested in learning more?
Sahika Riley is Physician Assistant (PA-C) who is a 9-1/2 year Veteran of the United States Air Force. She is currently completing her PhD in Integrative Medicine. She served overseas during Desert Storm as a Communication/Navigation system specialist for the A-10 aircraft. She spent her second half of her military career as a Physician Assistant in Family Medicine and Internal Medicine. She holds both a Masters Degree in Physician Assistant Studies with a specialty in Family Medicine and a Bachelor in Medicine from University of Nebraska.
She brings to her position over 18 years in clinical practice in multiple fields of medicine. She has held faculty positions as Senior Instructor, Assistant Professor and Director of Clinical Education at Arizona School of Health Sciences, a Division of Kirksville College of Osteopathic Medicine. She has held faculty positions as Assistant Professor at Midwestern University, AZ, and Touro University, NV. She taught numerous courses from Internal Medicine to Psychiatry, and has received numerous awards for her teaching qualifications.