CNA Training Advisor Volume 11 Issue No. 7
July 2013
Post-Traumatic Stress Disor der Have you ever experienced a trauma? For many people, a traumatic experience can affect them for the rest of their life and can lead to post-traumatic stress disorder (PTSD). These traumatic events can be anything from combat or war exposure to serious accidents to natural disasters. Once experienced, such an event can change a person’s life forever. In this lesson, you will learn about who can suffer from PTSD and what can cause the disorder; the symptoms of PTSD, which include reexperiencing, avoidance, and hyperarousal; and how PTSD is diagnosed and treated, including information on medications and therapy treatments. The lesson will also discuss ways that you can comfort a resident who is suffering from PTSD and some strategies to use when caring for a resident with this disorder. As a CNA, you likely spend the most time with your facility’s residents, so it is important to understand how to communicate with residents with PTSD. Have a good day of training, and stay tuned for next month’s issue of CNA Training Advisor on vaccines.
A focus on communication
Quiz answer key
A resident who suffers from PTSD may be getting various forms of treatment, including medications or group therapy. Group therapy often encourages residents to talk about their feelings, and as a CNA you should be prepared for those conversations. It is important to communicate with residents about the issues they are facing. You can do this by offering emotional support, being understanding and encouraging, and listening carefully when they tell you how they are feeling. That said, it is also imperative to understand when it is the right time to communicate and be aware of certain situations or topics that may trigger PTSD symptoms.
1. d
6. a
2. b
7. c
3. c
8. a
4. c
9. d
5. d
10. b
Program Prep Program time Approximately 30 minutes Learning objectives Participants in this activity will be able to: • Explain why someone might suffer from post-traumatic stress disorder (PTSD) • Name some of the symptoms a resident with PTSD might experience • List some strategies CNAs can use when caring for residents with PTSD Preparation • Review the material on pp. 2–4 • Duplicate the CNA Professor insert for participants • Gather equipment for participants (e.g., an attendance sheet, pencils, etc.) Method 1. Place a copy of CNA Professor and a pencil at each participant’s seat 2. Conduct the questionnaire as a pretest or, if participants’ reading skills are limited, as an oral posttest 3. Present the program material 4. Review the questionnaire 5. Discuss the answers
see also
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Post-Traumatic Stress Disor der This document contains privileged, copyrighted information. If you have not purchased it or are not otherwise entitled to it by agreement with HCPro, any use, disclosure, forwarding, copying, or other communication of the contents is prohibited without permission.
editorial advisory board Associate Editorial Director Todd Hutlock
Editor Casey Pickering
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Post-traumatic stress disorder (PTSD) is a mental health disorder that can occur after you have been through a trauma. When in danger, it’s natural to feel afraid. A trauma is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others’ lives are in danger. You may feel afraid or feel that you have no control over what is happening. This fear triggers many split-second changes in the body to prepare to defend against the danger or to avoid it. This fight-or-flight response is a healthy reaction meant to protect a person from harm. But in PTSD, this reaction is changed or damaged. People who have PTSD may feel stressed or frightened even when they’re no longer in danger. Who gets PTSD Anyone can get PTSD at any age. This includes war veterans and survivors of physical and sexual assault, abuse, accidents, disasters, and many other serious events. If you have gone through an event that could have caused injury or death, you can develop PTSD. Examples of these events might include: • Combat or war exposure • Child sexual or physical abuse • Terrorist attacks • Sexual or physical assault • Serious accidents, such as a car wreck • Natural disasters, such as a fire, tornado, hurricane, flood, or earthquake Most people associate PTSD with a dangerous event, but not everyone with PTSD has been through a dangerous event. Some people get PTSD after a friend or family member experiences danger or is harmed. The sudden, unexpected death of a loved one can also cause PTSD. Many factors play a part in whether a person will develop PTSD. For example, there are several risk factors that make a person more likely to get PTSD. Other factors, called resilience factors, can help reduce the risk of the disorder. Some of these risk and resilience factors are present before the trauma and others become important during and after a traumatic event. Risk factors for PTSD include: • Living through dangerous events and traumas • Having a history of mental illness
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Post-Traumatic Stress Disor der
• • • • •
Getting hurt Seeing people hurt or killed Feeling horror, helplessness, or extreme fear Having little or no social support after the event Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
Resilience factors that may reduce the risk of PTSD include: • Seeking out support from other people, such as friends and family • Finding a support group after a traumatic event • Feeling good about one’s own actions in the face of danger • Having a coping strategy, or a way of getting through the bad event and learning from it • Being able to act and respond effectively despite feeling fear Researchers are studying the importance of various risk and resilience factors. With more study, it may be possible someday to predict who is likely to get PTSD and prevent it. PTSD symptoms PTSD can cause many symptoms. These symptoms can be grouped into three categories: reexperiencing, avoidance, and hyperarousal. • Reexperiencing. Reexperiencing symptoms may cause problems in a person’s everyday routine. They can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger reexperiencing. Reexperiencing symptoms include: –– Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating –– Bad dreams –– Frightening thoughts • Avoidance. Things that remind a person of the traumatic event can trigger avoidance symptoms.
These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car. Avoidance symptoms include: –– Staying away from places, events, or objects that are reminders of the experience –– Feeling emotionally numb –– Feeling strong guilt, depression, or worry –– Losing interest in activities that were enjoyable in the past –– Having trouble remembering the dangerous event • Hyperarousal. Hyperarousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic event. They can make the person feel stressed and angry. These symptoms may make it hard to do daily tasks, such as sleeping, eating, or concentrating. Hyperarousal symptoms include: –– Being easily startled –– Feeling tense or on edge –– Having difficulty sleeping and/or having angry outbursts It’s natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. However, symptoms that last more than a few weeks and become an ongoing problem might indicate PTSD. Some people with PTSD don’t show any symptoms for weeks or months. How is PTSD diagnosed? A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD. The diagnosis is made after the doctor talks with the symptomatic person. To be diagnosed with PTSD, a person must have all of the following for at least one month: • At least one reexperiencing symptom
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• At least three avoidance symptoms • At least two hyperarousal symptoms • Symptoms that make it difficult to go about daily life, go to school or work, be with friends, and take care of important tasks It is important to remember that not everyone who lives through a dangerous event develops PTSD. In fact, most will not get the disorder. Treatments for PTSD The main treatments for people with PTSD are psychotherapy (talk/group therapy), medications, or both. Everyone is different, so a treatment that works for one person may not work for another. It is important for anyone with PTSD to be treated by a mental health provider who has experience with PTSD. Some people with PTSD will need to try different treatments to find what works for their symptoms. • Psychotherapy. Many people want to talk about their trauma with others who have had similar experiences. Psychotherapy is “talk” therapy. It involves talking with a mental health professional to treat a mental illness. Psychotherapy can occur one-on-one or in a group. Talk therapy treatment for PTSD usually lasts 6 to 12 weeks, but can take more time. Research shows that support from family and friends can be an important part of therapy. In group therapy, the resident would have the opportunity to talk with a group of people who also have been through a trauma and who have PTSD. Sharing your story with others may help you feel more comfortable talking about your trauma. This can help you cope with your symptoms, memories, and other parts of your life. • Medications. Chemicals in your brain affect the way you feel. For example, when you have depression you may not have enough of a chemical called serotonin. Selective serotonin reuptake inhibitors (SSRI) are a type of antidepressant medicine. SSRIs raise the level of serotonin in your brain. These can help residents feel less sad and worried. For some
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residents, they may be very helpful. If someone with PTSD is going through an ongoing trauma, such as being in an abusive relationship, both of the problems need to be treated. It is very common to have PTSD at that same time as another mental health problem. Depression, alcohol or drug abuse problems, panic disorder, and other anxiety disorders often occur along with PTSD. The best treatment results occur when both PTSD and the other problems are treated together rather than one after the other. The CNA’s role Working with older adults in a long-term care facility, you may care for a resident who has PTSD. Perhaps it is a veteran who suffers from PTSD as a result of his or her military service. Or maybe it is a woman who for many years was in an abusive relationship and has developed PTSD later in life. As a CNA, you will spend a great amount of time with the residents, so it is important to understand your role in caring for a resident with PTSD. If you know someone who has PTSD, it affects you too. The first and most important thing you can do is help this person get the right diagnosis and treatment. If you think your resident may be suffering from undiagnosed PTSD, share your concerns with your supervisor. Remember these tips when working with a resident with PTSD: • Offer emotional support, understanding, patience, and encouragement • Talk to the resident, and listen carefully • Listen to feelings your resident expresses and be understanding of situations that may trigger PTSD symptoms • Never ignore comments about potential self-harm; report such comments to your supervisor PTSD can be a difficult disorder for people to cope with. As a CNA, it is important to make yourself readily available to your residents and ensure that they get the proper care at your facility. H
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July 2013 Volume 11 Issue No. 7
CNA Professor Post-traumatic stress disorder Mark the correct response. Name:
Date:
1. Post-traumatic stress disorder (PTSD) can be developed when you have gone through an event such as _____.
6. Some people with PTSD don’t show symptoms for weeks or months.
a. a natural disaster
a. True
b. physical abuse
b. False
c. a car wreck 7. Who generally diagnoses a person with PTSD?
d. all of the above
a. A friend 2. Every person who experiences a traumatic event, such as combat or war exposure, develops PTSD.
b. A clinician
a. True
c. A doctor with mental illness training such as a psychiatrist or psychologist
b. False
d. The person self-diagnoses
3. What is considered a resilience factor? a. Living through a trauma b. Spending time alone after a traumatic event c. Seeking out support from other people such as friends and family
8. Medication called selective serotonin reuptake inhibitors are often prescribed to people who suffer from PTSD. a. True b. False
d. Seeing people hurt or killed 4. What is not a category of PTSD symptoms? a. Reexperiencing
9. As a CNA you should _________ when caring for a resident with PTSD. a. offer emotional support b. try talking about the traumatic event
b. Avoidance c. Flashback
c. understand situations that might trigger PTSD symptoms
d. Hyperarousal
d. both a and c
5. What would be considered an avoidance symptom? a. Being easily startled
10. Sometimes you have to ignore comments the PTSD sufferer makes about harming him- or herself.
b. Feeling tense
a. True
c. Having bad dreams
b. False
d. Staying away from places, events, or objects that are reminders of the experience
A supplement to CNA Training Advisor
