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PTSD: Impact on Everyday Life SONIA ZIMMERMAN, PH.D., OTR/L, FAOTA PROFESSOR, OCCUPATIONAL THERAPY UNIVERSITY OF NORTH DAKOTA Trauma-and-Stressor-Related Disorders Reactive Attachment Disorder Disinhibited Social Engagement Disorder Posttraumatic Stress Disorder (PTSD) Acute Stress Disorder (ASD) Adjustment Disorders Other Specified & Unspecified Trauma-and-Stressor-Related Disorders (APA, 2013) What is Post Traumatic Stress Disorder? DSM III (1980) Trauma – outside range of usual experience Facilitated focus on Vietnam veterans Posttraumatic Stress Disorder Exposure to actual or threatened death, serious injury, or sexual violence Presence of intrusion symptoms associated with the event Persistent avoidance of stimuli associated with the traumatic events Negative alterations in cognitions and mood associated with the event Marked alterations in arousal and reactivity associated with the event (APA, 2013) Posttraumatic Stress Disorder Children under 6: Lowered threshold for diagnosis Clinically significant distress in relationships with parents, siblings, peers or other caregivers or with school behavior (APA, 2013) Posttraumatic Stress Disorder Prevalence Rates: Higher among veterans, police, firefighters, emergency personnel Highest rates (1/3 to ½) – survivors of rape, military combat and captivity, and ethnically/politically motivated internment and genocide Lower rates among children, adolescents, and older adults* More prevalent among females across the lifespan and for longer periods of time Posttraumatic Stress Disorder Functional Consequences: Social Interpersonal Developmental Educational Physical health Vocational Among community and veteran samples: Poor social and family relationships Absenteeism from work Lower income Lower educational and vocational success Acute Stress Disorder Symptoms lasting 3 days to 1 month following exposure Traumatic events Exposure to war Threatened or actual violent personal assault Natural or man-made disasters Severe accidents Acute Stress Disorder Prevalence: <20% of events that do not involve interpersonal assault 20-50% when interpersonal assault is present More prevalent among females Functional Consequences extreme levels of anxiety sleep difficulties lower energy levels reduced levels of attention to task avoidance behavior – nonattendance of medical appointments, driving, absenteeism Therapies for PTSD Psychological Therapies for PTSD Trauma-focused cognitive behavioral therapy Individual and group Eye movement desensitization and reprocessing (EMDR) Cognitive behavioral therapy Animal – Assisted Therapy and PTSD The use of trained animals in facilitating patients’ progress toward therapeutic goals (Barker & Dawson, 1998). AAT is delivered by a healthcare professional who has the skills and expertise necessary for the application of human animal interactions and is working within the scope of the profession Limited research specific to PTSD Build alliance between client & therapist Increase adherence to treatment Promote social interactions Decrease anxiety Lower psychological arousal Equine Therapy for PTSD Why horses? Equine-Assisted Psychotherapy (EAP) Horses are used as tools for military veterans to gain self-understanding and emotional growth Typically, the horses are not ridden, and are not tethered in the arena Equine-Assisted Psychotherapy Limited research evidence Remuda Ranch - experiential therapy high success rate (eating disorders) Look for: Well-qualified treatment team including mental health and equine experts Trained, licensed mental health provider with advanced training in EAP EAGALA or PATH Intl/NARHA certification Equine Specialist in Mental Health and Learning Future Equine methods show strong promise More research needed across diagnostic groups Unexpected Miracles https://youtu.be/UnOgqyR9kr8?t=8m5s Horses Help Heal Veteran’s Invisible Wounds https://youtu.be/Z7EedCwJ4ww Sharing Time: