Mindfulness Based Stress Reduction for Veterans with PTSD

A significantly greater awareness of the prevalence and effects of post traumatic stress disorder (PTSD) has become a reality thanks in no small part to the wars in Iraq and Afghanistan and the over 2 million veterans who were a part of those conflicts. According to the Veterans Affairs Administration (VA), it is widely accepted that approximately 20% of those returning veterans meet the criteria to be diagnosed PTSD (National Center for PTSD, 2018). Due to this, there has been a significant amount of research dedicated to recognizing the symptoms as well as the different ways to treat these symptoms in order for the veteran to live a healthy life. The leading modes of treatment are traditional talk therapy and medication programs that combined, have shown significant results in reducing the symptoms these veterans face. In addition to traditional methods, emerging treatments are making headway that seek to satisfy the same results through alternative means.

One major area that is gaining prominence as part of a multi-disciplinary approach is Mindfulness Based Stress Reduction (MSBR) which focuses on ways, “…to notice not only the things that surround you, but also to pay attention without judgment to sensations that happen within the body, regardless of how painful they seem,” (Rousseau, 2019, p. 25). This non-judgmental acceptance of in the moment thought allows the client to focus on the small moment between stimulus and action, and rather than reacting, accept the stimulus. MSBR utilizes breathing techniques, meditation and activities like yoga which promote mental stability and a peacefulness within oneself (Whole Health for Life, 2017).

This approach has shown positive results in the decline of symptoms within veterans during active participation in MSBR (Polusny, 2015). When successful, MSBR removes the judgement or expectation the veteran has from the stimulus, which would normally trigger a reaction, by helping them stay in the moment rather than refer to previous experiences to formulate future expectations. Studies on the effects of MSBR in PTSD symptom reduction has shown positive results, with one particular study achieving a 50% reduction in symptoms in its patients (Polusny, 2015). This same study further revealed that after 2 months of not practicing MSBR, the same patients saw their symptoms return to pre-study levels. While this study shows that MSBR cannot act as a stand-alone treatment, there is significant promise in its effect to enhance traditional forms of therapy and should be considered for incorporation into the overall treatment of veterans with PTSD.

References:

National Center for PTSD. (2018, July 24). Retrieved April 22, 2019, from https://www.ptsd.va.gov/understand/common/common_veterans.asp

Polusny, M. A., Erbes, C. R., Thuras, P., Moran, A., Lamberty, G. J., Collins, R. C., . . . Lim, K. O. (2015, August 04). Mindfulness-Based Stress Reduction for Posttraumatic Stress Disorder Among Veterans: A Randomized Clinical Trial. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26241597

Rousseau, Danielle. (2019). Module : Pathways to Recovery: Understanding Approaches to Trauma Treatment [Class Handout]. Boston, MA: Boston University, CJ702.

Whole Health For Life. (2017, December 11). Retrieved April 22, 2019, from https://www.va.gov/PATIENTCENTEREDCARE/Veteran-Handouts/Introduction_to_Mindful_Awareness.asp

After the War

One of the first topics of discussion in this course was the PTSD soldiers experienced after coming back from deployment. This is a sad topic to study, but widely known as something veterans deal with after voluntarily serving our country. I decided to look into the treatment of PTSD for veterans as my topic for the documentary review. After watching Frontline: The Wounded Platoon, I was appalled at how veterans were being treated once they came home. It wasn't just the treatment at home that needed to be repaired, but the treatment abroad as well (Buchanan & Edge, 2010).

After watching this documentary, I felt a sense of discourse between the healthcare I believed soldiers and veterans were receiving and the healthcare that they are actually receiving. I was under the impression that soldiers abroad got the medical care they needed, whether it be from a physical injury during battle or with difficulty processing traumas that they had endured. Unfortunately, that wasn't the case. Many times, soldiers were given a few antidepressants and sleeping pills and sent back out. The way it was depicted in the documentary was that there weren't enough soldiers fighting; they had to keep every single one that they had on the battlefield, no matter what the cost or emotional toll was. It was awful seeing what traumas the soldiers were going through while abroad, all for the safety and the freedom we have here (Buchanan & Edge, 2010). What I saw were practitioners and a healthcare system that cared more about the war than the individuals fighting it.

Not only were they not properly treated abroad, when they got back things didn't get much better. Many of the veterans in this specific platoon were unable to receive military benefits due to the amount of time they spent enlisted. If they remained enlisted and working on base, they'd get benefits that often did not meet their mental illness needs; having to wait weeks to get an appointment or not being able to get their medications. Since they couldn't get the help they needed, they started to self medicate. For many men from the Platoon that were still active duty military, the self medication spiraled into addictions they couldn't get out of. They'd end up being dishonorably discharged for continuously failing drug tests, not showing up for work, or being under the influence at work (Buchanan & Edge, 2010). Now, this would be understandable if the men had been given treatments for their addiction, or treatments for the PTSD that ultimately caused the incidence of addiction, or even offered any sort of mental health treatment. But the fact that these men weren't given any sort of accessible treatment at all over the course of their service, after asking for it while abroad and at home, is disgraceful. They served their country because they wanted to, and they ended up with two disorders that they now cannot properly heal from due to the ignorance and oblivion by their system and providers.

If men on the Platoon were granted veteran's benefits after serving, they had better odds of being able to dodge the addiction that came with untreated PTSD in their dis-benefited counterparts. The VA does not employ nearly enough mental health professionals to aid in the combat of mental illness' post-war (Brancu, et al., 2014). Part of this is a broader mental health practitioner deficit, but the VA should be creating incentives to educate and employ those who wish to become mental health professionals.

This mental health practitioner and professional deficit is detrimental for the country, but more importantly struggling veterans. They want help, but when they go to seek it through their benefits received by the government, it is inaccessible. This is a giant issue, and I hope to one day be able to help fix it by becoming a practitioner. It makes me sick to my stomach to think that these men and women aren't able to get the help they need after they have sacrificed so much for our country. The military healthcare system needs a major overhaul if it wants to take care of it's members like those members are taking care of our freedom.

References

Brancu, M., Thompson, N. L., Beckham, J. C., Green, K. T., Calhoun, P. S., Elbogen, E. B., . . . Wagner, H. R. (2014). The impact of social support on psychological distress for U.S. Afghanistan/Iraq era veterans with PTSD and other psychiatric diagnoses. Psychiatry Research,217(1-2), 86-92.

Buchanan, C. (Producer), & Edge, D. (Director). (2010, May 18). The Wounded Platoon [Television series episode]. In Frontline. Arlington, VA: PBS. Retrieved from https://www.pbs.org/video/frontline-the-wounded-platoon/

The Real Cost of Diamonds

They are a status symbol that Americans love most particularly in engagement rings. But the people who are mutilated in order for these diamonds to be mined often have no ring finger upon which to place any ring, because amputations are rampant as a method of torture and mutilation among countries fighting for control of diamond mines. A particularly horrific practice that took place during the civil war in Sierra Leone, a conflict that was funded by the sale of diamonds mined by enslaved civilians, was the act of asking a victim whether they would like to wear short sleeves or long sleeves for the rest of their lives. Called “short sleeved and long sleeved amputations…victims were asked to choose between short sleeves, meaning amputation of the arm at the shoulder, or long sleeves, amputation of the hand at the wrist” (Al Jazeera, 2009). The mutilations did not end there: “By the time Sierra Leone’s civil war ended in 2001, thousands of people had been killed and tens of thousands more had had their arms, legs, noses or ears cut off” (Al Jazeera, 2009). Although conflicts over diamonds may have ended in Sierra Leone, they continue in many other countries, including the Central African Republic, Zimbabwe, and Angola. To date, approximately 3.7 million people have been killed to put that special sparkle in America’s favorite jewelry (Brilliant Earth).

Called “conflict diamonds” or “blood diamonds,” diamonds that are mined in situations violating human rights are combated by the Kimberley Process, which classifies as illegal any diamonds that are sold in order to generate funds for rebel groups fighting their governments (Baker, 2015). However, there are still many diamonds being sold legally that have a history of bloodshed. “Unfair labor practices and human-rights abuses don’t disqualify diamonds under the protocol, while the definition of conflict is so narrow as to exclude many instances of what consumers would, using common sense, think of as a conflict diamond…when, in 2008, the Zimbabwean army seized a major diamond deposit in eastern Zimbabwe and massacred more than 200 miners, it was not considered a breach of the Kimberley Process protocols. ‘Thousands had been killed, raped, injured and enslaved in Zimbabwe, and the Kimberley Process had no way to call those conflict diamonds because there were no rebels’” (Baker, 2015). Clearly, the Kimberley Process is not an effective way to prevent groups from profiting from conflict diamonds.

The major concern with conflict diamonds is human suffering. The trauma endured by those innocent civilians who are enslaved, tortured, mutilated, raped, and killed in order to keep these diamond mines operating is incalculable. And yet many people still have not heard of conflict or blood diamonds. Every year, millions of Americans flock to jewelry stores to purchase diamonds for loved ones, friends, family members, and significant others. Barely any of us stop to think about whether or not people were killed in order for us to wear these diamonds around our necks and on our fingers. Throughout this course, we have explored the many negative ways that trauma impacts the lives of various victims. We have devoted time to victims of genocide, sexual assault, child abuse, war, and terrorism, but we have not touched on the topic of the men, women, and children who are killed or abused every day in order to sell an item that many of us probably own. To so many of us, diamonds are a symbol of love. We refer to them as “a girl’s best friend,” and shower the women in our lives with them. But to the people who are tortured, abused, and killed every day to mine these stones, diamonds are a symbol of suffering and hate. So many people are unaware of the tragedy that creates so many diamonds.

I have seen my classmates oppose trauma and human rights abuses all semester, and I believe unequivocally that they would all be opposed to paying for a piece of jewelry that is the cause of so much suffering. Yet I do not believe that we are all aware of the tragic history behind these stones. I cannot walk down the street without seeing someone wearing a diamond, yet when I bring this topic up, the majority of diamond owners have never heard of a conflict diamond or a blood diamond, and cannot say whether they are wearing a conflict-free diamond, or whether people were killed and abused to create their beloved piece of jewelry. I implore you: it is the duty of those of us who do know to spread the word about conflict diamonds. In his famous Nobel Peace Prize acceptance speech, Auschwitz survivor Elie Wiesel said: “What all these victims need above all is to know that they are not alone, that we are not forgetting them, that when their voices are stifled we shall lend them ours, that while their freedom depends on ours, the quality of our freedom depends on theirs…Our lives no longer belong to us alone; they belong to all of those who need us desperately” (Wiesel, 2006, pp. 120). So let us do our research before buying a diamond for a loved one to ensure that no one suffered to create this symbol of love, and let us tell all those who may not be aware to do the same. We owe it to our fellow human beings, and by doing so we will be letting these victims know that their suffering is intolerable to us, and that we will not stand by silently and encourage it to happen.

References:

Al Jazeera. (2009, April 9). Sierra Leone ex-rebels sentenced. Retrieved April 19,

2019, from

https://www.aljazeera.com/news/africa/2009/04/2009481329795926.html

Baker, A. (2015, August 27). Blood Diamonds. Retrieved April 19, 2019, from

Blood Diamonds

Brilliant Earth. (n.d.). Blood Diamonds and Violence in Africa. Retrieved April 19,

2019, from https://www.brilliantearth.com/conflict-diamond-trade/

Wiesel, E. (2006). Night. New York: Hill and Wang.

More Than Just Mans Best Friend

It is inevitable, people will experience trauma throughout their lives. Working through the trauma is important. One of the newest and growing areas to help people work through the trauma that they have experienced is the use of animals. Now this is not a new concept in the world, it even goes as far back as the 1700s when they were used in asylums. Matuszek, S. (2010, July). Animal-Facilitated Therapy in Various Patient Populations:... : Holistic Nursing Practice. Retrieved from https://journals.lww.com/hnpjournal/Fulltext/2010/07000/Animal_Facilitated_Therapy_in_Various_Patient.3.aspx.
When it comes to treating trauma with animals there are two different categories, Animal-assisted activities or “AAA” and animal-assisted therapy or “AAT”. Animal Therapy for PTSD. (2016, October 06). Retrieved from https://strengthtoheal.org/animal-therapy-for-ptsd/. When describing AAA, the dogs are used in casual activities that involve dogs being around people that are going through trauma. Animal Therapy for PTSD. (2016, October 06). Retrieved from https://strengthtoheal.org/animal-therapy-for-ptsd/. There is no target for people that take part in AAA, there are just events with animals for people going through trauma. (Animal Therapy for PTSD). While on the other hand AAT is a program to help people work through trauma with the assistance of a dog that has been trained and it is targeted to improve a person in the physical, social, emotional and/or cognitive functioning. (Animal Therapy for PTSD).
I think that animal based therapy could be extremely beneficial to people who have experienced serious trauma in their lives. One area that has seen some beneficial results is the interviewing of child victims in sexual assault cases. Walsh, D., Yamamo, M., Willits, N. H., & Hart, L. A. (2018, February 23). Job-Related Stress in Forensic Interviewers of Children with Use of Therapy Dogs Compared with Facility Dogs or No Dogs. Retrieved from https://www.frontiersin.org/articles/10.3389/fvets.2018.00046/full. Now the result is not just based on the children, but on the people, who have to conduct the interviews. (Walsh, 2018). Obviously this area is a very delicate subject to be discussing with children. So, anything that can help the kids relax and answer questions about a terrible experience in their life. In the study the 32 people that used dogs in their practice none of them reported that the dog was less helpful in their interviews than working without a dog. (Walsh, 2018).
Now the benefits of using animals to help with trauma experienced by people is not only beneficial for people working with children that are sexual assault victims. One of the other areas that has seen a benefit is veterans dealing with PTSD. Animal Therapy is Making Strides in the Treatment of Post Traumatic Stress Disorder |. (2011, December 19). Retrieved from https://www.elementsbehavioralhealth.com/trauma-ptsd/animal-therapy-ptsd-treatment/. There are a lot of veterans who deal with PTSD after they come back from overseas. These dogs help people express feelings and emotions as well as do things without using aggression.
These ideas to use animals especially dogs is something that should be used more and more. Speaking from personal experience when you come home and your dog is there and happy to see you it makes any bad day just a little bit better. Now, I have not been in combat or sexually assaulted, but working in the Public Defender’s Office in the domestic violence courtroom has created some more stress in my life. Having a dog would help bring that stress level down without having to do things like drink. Having another being that is relying upon you can make you forget about your own stresses.
At the end of the day dealing with trauma is a personal journey. There are some things that will work for people and some things that will not. The important part is that people who do go through a traumatic experience acknowledge that they are going through something and learn to work through it. I think that the use of animals is something that all people need to consider. I think that it is beneficial because you could have a service animal without it really having it known to everyone. Having issues is not something that everyone wants to have out in the open so having an animal that helps take care of those issues quietly is beneficial.

Animal Therapy for PTSD. (2016, October 06). Retrieved from https://strengthtoheal.org/animal-therapy-for-ptsd/
Animal Therapy is Making Strides in the Treatment of Post Traumatic Stress Disorder |. (2011, December 19). Retrieved from https://www.elementsbehavioralhealth.com/trauma-ptsd/animal-therapy-ptsd-treatment/.
Matuszek, S. (2010, July). Animal-Facilitated Therapy in Various Patient Populations:... : Holistic Nursing Practice. Retrieved from https://journals.lww.com/hnpjournal/Fulltext/2010/07000/Animal_Facilitated_Therapy_in_Various_Patient.3.aspx.
Walsh, D., Yamamo, M., Willits, N. H., & Hart, L. A. (2018, February 23). Job-Related Stress in Forensic Interviewers of Children with Use of Therapy Dogs Compared with Facility Dogs or No Dogs. Retrieved from https://www.frontiersin.org/articles/10.3389/fvets.2018.00046/full.

Teens and Trauma

Growing up, I was always around the topic of mental health. In the state of the North Carolina, my mother worked with individuals who suffered from mental health issues and helped them find jobs that properly fit them and their mental health status. My father owned a couple of group-homes for delinquent children who often found themselves in trouble with the law, school, and family. I did not pay much attention to my parents and their jobs at the time, but after taking this course a lot of memories of conversations, terms, and even people came back to me. 

Around my pre-teen years, my father owned and managed a group-home for troubled teenagers in the area. Soon after my father opened his first group-home he realized that these young men were not dangerous, harmful, or delinquent. He found them to be the opposite of that. He did mention that there is a barrier at first but once they trust in someone they are caring, helpful, respectful and fun to be around. Although these teens were able to behave for the majority of the time, they did suffer from PTSD. They had triggers and when they were triggered you could see the bad habits and emotions surface. My father was the only one could calm them down, and I believe its due to the fact that they trusted him and he knew how to reach them. Despite their short-comings when triggered, my father still had faith and trust in the young men. He trusted them enough to where he was comfortable bringing me around them to do small activities like play video games, or play basketball. Out of respect for my father they had a high level of respect for me as well. What made them like me, even more, was the fact that I was not rude, judgmental, or treated differently from them. My father treated us all the same; he treated us like we were people.

Basketball seemed to be the common ground for all of us and most importantly, a safe haven. My father made going to the gym to play basketball a reward for the boys. They had to do their homework before going, they had to behave fairly well in school, do their chores around the house, and make sure they were respectful and grateful for the opportunity to be able to go play basketball and of course, it was good exercise and fun for everyone. NAMI (National Alliance on Mental Illness) of North Carolina would provide opportunities for the young men to participate in things outside of basketball like game nights, venting seminars, and therapy sessions; all in which the young men usually did not enjoy. In my opinion, the state provides these opportunities to actually help with the young men’s trauma issues. The young men typically did not know the people that were trying to help them very well, which led to a lack of trust, which led to the young men not engaging and listening to the therapist or activity at hand. 

The group-home keeps the young men out of trouble, helps them with school, helps them develop good habits, and allows them to be in their safe haven; doing what they love to do all with the guidance of an individual who truly cares about them. The group-home situation is great for the young men but there is one problem. The state ends funding for these young men at the age of 18, disallowing them to continue living in the group-home. At the age of 18, these young men end up moving back home. Home is where these young men were physically, sexually and verbally abused along with being traumatized by poverty, crime, and abandonment. I had the opportunity to interview Joe McCauley, owner and founder of a group-home in North Carolina, YouthExtension, to get some insight on how he feels about the cut off age. He stated, “I have seen numerous young men make progression throughout their time period in my [group-]homes, and when they turn 18 I really worry. They are released back into the wild where they starved, beaten up, cursed out, and got in trouble. Years of training these young men to do the right things and putting them in a safe environment goes down the drain as soon as they arrive back on their doorstep.” My father agrees with this statement and says he can do nothing but pray and hope the young men have changed their ways by the time they turn 18-years-old. When they are out on their own, they are not going to be able to go to their local gym and just play with friends. They have to pay to get in most indoor gyms, they are not protected by their group-home leader, and they could easily find themselves in trouble. All in which they did not have to worry about prior to being 18. After taking this course and understanding how PTSD works, there is not a lot of hope for these young men because they never overcame their trauma; the group-homes only pushed their trauma aside. Group-homes have trouble trying to help the young men face their trauma because they do not want the young men to feel uncomfortable, do not want to touch sensitive subjects, and they do not want to trigger them. Group-homes employees are not required to be therapists so, therefore, to keep the peace, they do the best they can with avoiding the mental issue of PTSD. 

After brainstorming I came up with an idea that I thought could work long-term for the young men for when they are in the group home and when they are 18 and have to be back home. The simple idea of planting came to mind. It is a skill that has to be learned and developed throughout time and experience. To further my idea, I did some research on the health effects of planting. Turns out there are a lot of positive effects for mental health that are useful especially for this group of young men. According to Psychology Today, there are 10 great reasons why planting is good for a person’s mental health, but there are five that stood out to me the most: 

1. “Looking after plants gives us responsibility" 
2. “Gardening allows us to be nurturers”
3. “Some aspects of gardening allow us to vent anger and aggression…”
4. “Working in nature releases happy hormones.”
5. “...whilst others [Gardening] allow us to feel in control”

These five statements listed are vital in a group-home young man’s life and could act as a form of CBT. If they are able to learn how to plant and have some enjoyment for it then they are a little better off than they would be without it. I asked Joe McCauley about the idea of his clients planting as an extra-curricular activity and he absolutely loved it. For his group-home, he could easily set-up a small garden in the back and provide each young man with their own section to plant. Another option for Joe McCauley and his group-home could be community gardens. Depending on the city, there are usually community gardens where the public is allowed to come and plant different things, which would be great for the young men to be able to get away from the house and be involved with the community. To push the idea even further I thought about how planting could benefit the young man outside of their mental health. There are plenty of job opportunities in the agricultural field. If they continue to learn about gardening and the science of it, they could not only grow their own foods and feed themselves, but they can also make a living out of it. Most importantly, this is a skill or opportunity they can take beyond the group-home that could be there safe haven or place of comfort.

Overall, I believe there is no ultimate answer to fix everything for these group-home young men. I also believe there are good intentions from both the group-home side and NAMI. The group-home is there to make these young men feel as comfortable as possible by placing them outside of the place of trauma, teaching them beneficial traits, and guiding them along the way. The best example of how a group-home fulfills these qualities is through basketball. Basketball was a reward which implemented structure and discipline, it is also a way the young men can have fun, exercise, compete, and bond. NAMI has more of the approach to help their PTSD. Providing therapists, and seminars are all in an attempt to help these young men face their trauma in hopes of overcoming it. Even though both branches have good intentions, these young men still end up heading down the wrong path because of their inability to function outside of their trauma in their home circumstances. These young men usually do not pursue higher education or find stable jobs, but find themselves in trouble with the law instead. Planting, however, will provide a skill set in which they can benefit from during their time at a group-home and beyond. In a perfect world, these young men could make a living out of the agricultural world, but the most important part of this skill is to help their mental illness as well as keeping them occupied, thinking, productive and out of trouble all as a form of cognitive behavioral therapy. Planting may not completely resolve their trauma, but it provides them with an activity that can allow them to make something of themselves and have a positive impact on the community. In my opinion everyone, even successful people, live with some type of trauma, whether it is something minor or major, but they made the best out of their situation; these young men can do the same. Again, planting may not cure their trauma, but it for sure can be the foundation to a life worth-while.

Works cited:

Rayner, S. (n.d.). Petal Power: Why Is Gardening So Good For Our Mental Health? Retrieved September 5, 2018, from https://www.psychologytoday.com/us/blog/worry-and-panic/201505/petal-power-why-is-gardening-so-good-our-mental-health

Joe McCauley, Founder of YouthExtension. Personal Interview

Debriefing post critical incidents

In the field of law Enforcement, we are no strangers to stress. Day in and day out we encounter calls to service that the common person truly can not understand at times. Officers patrol their beats and typically deal with individuals every single day who are having their WORST day. Anyone can look at that thought and understand that this job is stressful and could potentially be taking a toll on the individual. Individual, I believe that is a word that the public might forget when thinking of police. Behind the uniform and badge is a person who has thoughts, feelings and emotions just like everyone else.

An article from PoliceOne that I have recently reviewed titled, How critical incident stress debriefing teams help cops in crisis, made me think of how we as police officers help individuals day in and day out but seem to forget about some people. Those people our ourselves and our brother and sister officers. Time and time again after these critical incidents we typically never debrief about the situation in regards to emotions. Humor and get togethers like "choir practice" or drinking after work seems to be our release.

This is where the idea of Critical Response Teams come into play. My department for example has one, but it seems that these are only used for major incidents such as an officer involved shooting. Although those types of incidents are extremely critical, the monotonous grind of shift work can also take its toll. As stated by Mcgill, "The officers can take back control over their emotions and flashbacks that may be interfering with their lives, and they are forced to admit that they do not have total control over all situations. In addition, these debriefings can be used to educate family members of the normal reactions that may occur in the officers as their minds recover from a traumatic incident." (Mcgill 2015) We know how important this topic is. We need to begin to take care of ourselves now more than ever in today's society. It is an interesting time for Law enforcement and the men and women who carry out these duties not only need to worry about the public's well-being, but our own as well. 

https://www.policeone.com/health-fitness/articles/8554063-How-critical-incident-stress-debriefing-teams-help-cops-in-crisis/

Preventing vicarious trauma from leading to compassion fatigue in trauma workers.

Patrick Potter

08-14-18

Vicarious traumatization describes the pervasive changes that can occur within a trauma worker over time as a result of their intimate work with a traumatized population.  The changes in the workers can include change in self, spirituality, world views, interpersonal relationships, and overall behavior.  The common term used for suffers of this vicarious trauma experienced in their profession is compassion fatigue.   (Way, 2004) Its crucial to the well-being of the traumatized person that the trauma worker, no matter in what capacity doctor, clinician, police officer, or EMT, recognizes the symptoms of vicarious trauma and begins to resolve the symptoms to ensure that they are effective in handling the traumatized population that they are entrusted with.

Compassion fatigue compromises the trauma workers capabilities to care for persons who are victims of traumatic events.  Avoidance of the traumatized population, intrusive thoughts or dreams of distressing symptoms may affect the trauma worker facing compassion fatigue.  These symptoms may parallel the post traumatic stress symptoms that many of the traumatized clients they are dealing with are facing.    If the symptoms of compassion fatigue in their career field go unchecked and the trauma worker faces additional stress in the home environment burn out may occur.  Burn outs main symptoms are emotional exhaustion, sense of ineffectiveness, work dissatisfaction, detachment, sleep disorders, difficult concentrating, social withdrawal, poor judgment, and interpersonal conflicts.  (Gallagher, 2013) Compassion fatigue therefore revolves around the traumatized person and the trauma worker while burnout results from the stress of the trauma workers interaction with their environment.

When examining vicarious trauma and its effects on trauma workers its important to look at the constructivist self-development theory.   This theory suggests that individuals construct their realities through the development of cognitive structure or schemas.   Schemas include a trauma workers beliefs, assumptions, and expectations about themselves, others and the world.  These preconceived schemas are then used to interpret events and make sense of new experiences.   When new information, such as working with a recent trauma victim, is experienced and the new information gathered from the interaction is incompatible with the trauma workers original schemas they can become invalidated or shattered.   In this case the schemas must be modified to incorporate the new information into the workers belief system by a process of accommodation.   This accommodation to the new information can come in the form of both negative and positive accommodations.  Negative accommodation can lead to distress while positive accommodation to new experiences can lead to post traumatic growth.  If the trauma worker makes positive accommodations to the new experience they are having they may come out of their interaction with a new appreciation for their own good fortune and a strengthened sense of optimism.  The predictors of vicarious post traumatic growth are a higher level of coherence and empathy in the trauma worker as well as social support and organizational support surrounding them. (Cohen, 2012)

Trauma workers need to understand that they must be able to simultaneously monitor their own needs while also dealing with the emotions and needs of the families and subjects they are assisting through a crisis.  There are multiple strategies which may work in order to prevent compassion fatigue and lead to post traumatic growth in a trauma worker.   Some of these strategies for managing stress involved with dealing with emotionally demanding trauma include practicing mindfulness, making personal connections with the traumatized person, rewarding self after completing a task, shedding role when leaving work, utilization of team approach for support, knowing limits, learning from experience, relieving stress through exercise, reflective writing, and developing a special place where you can get away.  (Gallagher, 2013)

Vicarious traumatization is a process that requires continual self-assessment and monitoring by the trauma worker themselves.  Organizational support should also be available to assist in both prevention of vicarious trauma in the first place and intervention when needed.  Education provided to trauma workers should identify that vicarious trauma is a normal response to working with traumatized populations.   By identifying strong self-care strategies and being able to depend on assistance at the organizational level trauma workers will be able to avoid negative accommodations from their interactions with trauma victims and even experience post traumatic growth.

References:

Cohen, Keren. Et. Al. (2012) The Impact of Trauma Work on Trauma Workers: A Metasynthesis on Vicarious Trauma and Vicarious Post Traumatic Growth.  American Phycological Association.

Gallagher, Romayne (2013) Compassion Fatigue. Canadian Family Physician.

Way, Ineke. (2004) Vicarious Trauma: A Comparison of Clinicans who Treat Survivors of Sexual Abuse and Sexual Offenders.  Sage Publications

Prison Dog Training Programs Rehabilitate Canines and Cons

Before I even began my schooling for Criminal Justice my passion was dog training, rescuing dogs and giving them a purpose. I have spent years in training courses to learn how to become a better prepared and well-rounded trainer for all dogs and I have worked side by side with many breeds for different purposes. Throughout this course a great topic we have focused on is self-care, and I realized that training dogs is where I keep myself grounded, it is my stress relief, my passion, and my therapy. And I knew that if this was something that was so therapeutic for me, then it must somehow be incorporated into the criminal justice and/or mental health fields. As we have learned so far, service dogs play a huge part in certain therapy approaches; for people with anxiety, depression, and especially PTSD. Now what about in criminal justice? Animals in general, not just dogs; show us love and compassion endlessly, they do not judge or learn hate-they teach us to put something before ourselves because simply their lives depend on us.

Omaha Correctional Center partnered with a local animal shelter that allows the prisons inmates to foster hundreds of dogs as part of their Canine Compassion Program. Even though each program has its own personal details, the basics remain the same. Dogs with behavioral issues who are not quite ready to be adopted are sent to live in a cell with the caretaker. For anytime up to 16 weeks, the inmates are responsible for walking, feeding and playing with their dogs. The inmates will also take part in formal obedience training classes, where they teach their dogs the basic commands. In order to take part in the program, the inmates have to exhibit good behavior for at least one year prior, as well keep up good behavior during the duration of the program. One inmate shared that he likes the challenge of training the dogs and working through the harder classes. It keeps him occupied and gives him a purpose during the day to work harder with his animal. A lot fo the individuals interviewed shared that they enjoy the challenge because they like the feeling of not giving up, and proving to their dogs that they can succeed. “The dogs have brought humanity into this prison setting.” Liebson, R. (2018, June 13).

Animal programs within prisons have been gaining traction in the past few years, especially from the beginning of this idea which started in 1925. “Across the country, prisons and animal shelters are forming partnerships that put inmates in charge of training unruly dogs, giving both parties a chance at a fresh start.” Liebson, R. (2018, June 13). Carol Byrnes is a professional dog trainer and volunteers with local shelters to lead obedience classes for the inmates and the dogs. She goes on to say that many of the dogs come from high kill shelters, and it ca be a life or death situation for the dogs that are allowed to come to the prisons. And this is where the beauty of the relationship between the inmates and the dogs are formed. They both have the sense of being given one last chance-they work together for a brighter future. The inmates create such a powerful bond with the dogs, they know it is there responsibility to train them in such a way that they will succeed beyond the four walls of the prison. Byrnes was initially hesitant to get involved, but she developed a passion for the program after seeing the transformative effect it had on participants, both human and canine. For inmates and dogs who start off as distant or hard to reach, “as the program progresses, they open up, they blossom, they gain confidence, they gain social skills and the ability to problem solve and negotiate difficulties,” she said.

One of the officers who oversees a different program in New Mexico State Correctional Facility, PAWS which is Prisoners and Animals Working Toward Success Program said, it has helped the inmates correct some of the behaviors that may have landed them in jail in the first place. “The men in our pods have created so much loss, not only in their lives but in their families’ lives and lots of victims’ lives,” she said. “These dogs have really shown them compassion for other living things. Empathy.” Kimberly Collica-Cox, who is an associate professor of criminal justice at Pace University in New York, has studied how the symbiotic relationship between humans and dogs can be useful in prisons. Collica-Cox helped develop a program through Pace that uses animal assisted therapy to teach incarcerated mothers better parenting skills. “What we find is that dogs can trigger feelings of safety in humans, which will allow them to sort of open up and communicate more, which can be very helpful in a correctional setting,” she said, adding that there’s a great deal of research to support these findings. This is such a powerful aspect to research, a big problem in prisons today, especially all women facilities is that some women come into prison pregnant and give birth while serving their sentence. So, they ultimately miss out on either the first months or even years of their children’s lives, which can make them feel inadequate as a parent-especially if someone else has had a helping hand in raising their children while they were away. These programs can tech them motherly skills, compassion, nurturing and so much more.

These dog and prisoner programs can be life changing, not only for the dogs, but the prisoners and the families that adopt these dogs down the line. Paws for Life is a program in Lancaster, California at one of their maximum-security prisons; where these inmates go through extensive interviews to be able to participate in the program-they also have to write an essay on why they believe they should be a candidate. And a few of their messages were extremely powerful and I thought it would be a good way to end this.

“I know some people in society may think that we as prisoners don’t have anything good left in ourselves or have redeemable qualities, or be allowed any goodness in our lives; however contrary to that thinking I know in my heart this to be the opposite. Having someone to even suggest that we as prisoners would be good candidates for the Karma Rescue (Paws for Life program) demonstrates my beliefs that we have much left yet to offer society even if we potentially will never again be a part of that society.”

My reason for wanting to be a part of Paws for Life is simple. For most of my life I lived a very selfish lifestyle which led me to prison. I see Paws for Life as a chance to save a dog’s life. I understand what it’s like to be caged up. Also, I know this could be a lifesaving program for these dogs. Plus, Paws for Life gives me the chance to give back, to do something for someone else, to give back to a society that I cheated ... I do understand that a dog trained is a dog that’s ready to be adopted, and a dog adopted is a life saved, and changed! — Travielle

I have been locked up for over twenty-two years...The biggest reason why I want to help care for, feed, train and love the dogs; I want to be a part of giving someone something that will always love them and be there for them always. A person can give as much money the he or she has to charity or person, but no amount of money can love a person or go fetch a child’s favorite toy or teddy bear. Please allow me to give a person more than words or money. — Oliver

- Fitzgerald, D. P. (2017, December 07)

And a few closing comments after the certification graduation ceremony:

Jon: “Everything has improved in my life. This program has given our hearts a chance to heal, has restored my faith in humanity. It’s made me feel like a human being, given me self worth again, that I had the ability to give back, brought me closer to my bros that I train with. We worked really hard day and night to make this happen. Every bit of this program has been an honor to be a part of.”

 John M.: “This program has saved my life. It’s pretty simple. I have been in prison for twenty plus years...The Paws for Life program came along with Karma and all of a sudden I can love again. I can feel love. I can experience emotions that I have been holding down for twenty plus years...I sleep better at night, I’m more able to speak with people, I’m a little bit more literate. All of this comes from having a dog.”

 References

Fitzgerald, D. P. (2017, December 07). Who Rescued Whom? Shelter Dogs and Prison Inmates Give Each Other a New 'Leash' on Life. Retrieved from https://www.huffingtonpost.com/dr-patricia-fitzgerald/who-rescued-who-shelter-dogs-and-prison-inmates-give-each-other-a-new-leash-on-life_b_5760042.html

Liebson, R. (2018, June 13). Prison Dog Training Programs Rehabilitate Canines and Cons. Retrieved from https://www.cleartheshelters.com/Prison-Pup-Programs-Give-Inmates-and-Shelter-Dogs-a-Second-Chance-437660633.html

Rousseau, D. (2018). Module 4: Pathways to Recovery: Understanding Approaches to Trauma Treatment. [Lecture Notes] Retrieved from https://onlinecampus.bu.edu/webapps/blackboard/execute/displayLearningUnit?course_id=_48015_1&content_id=_5919976_1&framesetWrapped=true

Van der Kolk, B. A. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Books.

Undocumented Children

Trauma exists all over the world from the youngest to the oldest person alive. However, children are more vulnerable to trauma because of their size, age, and dependency. (Rousseau, 2018) My focus is not just on the 25% of United States children who suffer trauma before their 16^th birthday however, but on the more than 2,000 children who were currently separated from their parents, the children known in the United States of America as undocumented children. The more than 2,000 kids who had no choice but to follow their parents seeking a better life and now face lifelong battles of mental health issues, the children who I strongly opposed being separated from their parents.

These children were separated from days to weeks from their parents and kept in a jail like setting surrounded by other children and guards. Working at a jail, I cannot begin to phantom a child being in a place that looks anything like a jail much less many of them together with minimum supervision and absolutely no love and affection. Stories have unfolded that some kids were given medication for mental health problems when many of them could not even speak; others were given shots to calm them down. Such is the story of a 5-year-old Guatemalan born child named Adonis.

Adonis lasted ten weeks in what he now calls “kid jail.” Six days after being released to his father, Adonis was already showing signs of mental health issues. Adonis showed emotional distress when a toy syringe was showed to him and commented that he would get a shot when he misbehaved that would put him to sleep. At five years old, Adonis has a lot of vaccines to go, the trauma he has suffered from this will show every time he receives a shot. Also, Adonis has now found a “newfound fascination for knives and machetes” and constantly displays anger and wants to be isolated from everyone including his family. At only age five, if left untreated, Adonis could end up with lifelong problems or suicide.

The problem with all this, the United States of America is not providing any sort of mental help for these children. Why? Is the question, if we separated them from their parents? I understand their parents came here illegally, but does any child deserve to be separated from their parents and placed in jail for weeks at a time? The answer is no. We need to take care of these children, make sure they get the necessary care for what they have experienced.

Many lawyers are currently fighting for this to happen and a lot of psychologists and doctors are offering their services pro bono. However, the United States of America isn’t doing anything about it even though they didn’t meet the reunification deadline and are the reason these children will now face problems. I am a strong believer that we as a nation need to do more to ensure that these children receive mental health care until they get mentally better. Why? Simply because it is the humanitarian thing to do and I would hate to see one of those children turn around and create mass destruction in the United States in a few years out of anger and range.

References:

Rousseau, D. (2018). Week 2 Lecture. PDF Copy.  Boston University, Boston MA. Online Campus Blackboard.

Wan, W. 20 June 2018. The trauma of separation lingers long after children are reunited with parents. Retrieved 12 Aug 2018 from the Washington Post:  https://www.washingtonpost.com/national/health-science/the-trauma-of-separation-lingers-long-after-children-are-reunited-with-parents/2018/06/20/cf693440-74c6-11e8-b4b7-308400242c2e_story.html?noredirect=on&utm_term=.c42e0a331f75

Miller, M. 9 August 2018. “I want to die”; Was a 5-year-old drugged after being separated from his dad at the border? Retrieved 10 Aug 2018 from the Washington Post: https://www.washingtonpost.com/local/i-want-to-die-was-a-5-year-old-drugged-after-being-separated-from-his-dad-at-the-border/2018/08/08/df4cc2aa-95e1-11e8-a679-b09212fb69c2_story.html?utm_term=.21d8d4f9139f

Gomez, A. 12 July 2018 . ACLU: Trump administration should pay counseling for separated families. Retrieved 12 Aug 2018 from USA Today: https://www.usatoday.com/story/news/nation/2018/07/12/aclu-requests-trump-administration-pay-counseling-separated-families/780833002/

Self Care To Release Police Officer Stress

It always seems like a silly question when people ask "Do you take care of yourself". Of course the answer is going to be "yes, I do". But, when people ask you "What do you do to take care of yourself" is where people seem to hit a wall and not know what to say.

Self care can be defined as "any activity that we do deliberately in order to take care of our mental, emotional, and physical health. Although it’s a simple concept in theory, it’s something we very often overlook. Good self-care is key to improved mood and reduced anxiety. It’s also key to a good relationship with oneself and others." (psychcentral.com). One key thing to note is that self care is not something that you need to force yourself to do. It should give you pure enjoyment and should relax you from day to day stresses. 

It is no surprise that there is no shortage of stressful or traumatic situations when it comes to law enforcement. This could be things that they encounter on a daily basis, or things that are exaggerated by the news media outlets and social media. This causes police officers to be tired, stressed out and burned out constantly. This is where self care would come into play. Lexipol, which is a policy management software for public safety, has come up with a list of many ways that we can see police officers getting stressed or burned out. Some of these examples include: "

• Isolation and withdrawal
• Being disengaged or unmotivated
• Physical exhaustion
• Nightmares and flashbacks
• Poor hygiene or apathy about one’s physical appearance
• Loss of empathy or compassion
• Relationship issues, including divorce
• Substance misuse and abuse
• Recurrent sadness or depression
• Resistance to feedback
• Resistance to change
• Reduction in meaningful work product
• Reduced job satisfaction
• Increase in citizen complaints" (lexipol.com)

There are a few self care tools that police officers can put into effect that would help them manage their stress and burn out. One of these self care tools is to have a life outside of law enforcement. This includes making sure that they make time for their friends, family, children and significant others. They should not let work consume their lives by thinking about what happened during the work day when they clock out from their shifts. It could also be something as simple as doing an activity that they enjoy doing such as hiking, biking, running, swimming, working out, etc. Another self care tool they could implement is developing good physical health habits. This includes things like eating a balanced meal, making sure they get enough sleep and not just getting their physical activity during the work hours. A final tool they could use is practicing meditation and mindfulness. I do not work in law enforcement currently and I use meditation and mindfulness to decompress from my long school days at work.

In conclusion, there are many ways that police officers could practice self care to decompress from their stressful and sometimes traumatic work days. Using these tips and tools would be beneficial for them both inside and outside the work place because they will feel more relaxed and not as stressed out, burned out, or tired all the time.