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War - Psychological skills for surviving (coping with) traumatic events: Priority assistance to the military

ISSUP in collaboration with the University of California San Diego, Department of Psychiatry, International Technology Transfer Center - Ukraine, and ISSUP Ukraine National Chapter welcome you to a joint initiative dedicated to the ongoing war and the horrific events that resulted from Russian's attack on Ukraine.

Ukrainians are currently experiencing extremely traumatic events that will have a direct impact on their mental health for a long time to come. The purpose of these online events is to support professionals in Ukraine, to provide evidence-based available skills of first aid to people of different groups in acute and chronic stress, to teach to recognize conditions that require reference to the specialists.

Webinar 5: War - psychological skills for surviving and coping with traumatic events: Priority assistance to the military



Dewleen G. Baker M.D.

Medical School: Columbia University College of P&S (New York City)

Psychiatry Residency: University of Cincinnati, Cincinnati Ohio

Child and Adolescent Fellowship: University of Cincinnati, Cincinnati, Ohio

Dr. Baker’s clinical care and research focus on stress-related injuries and medical co-occurring disorders. Clinically, she delivers Post-traumatic Stress Disorder and mild Traumatic Brain Injury assessment and treatment, in addition to teaching in the PTSD outpatient clinic at the Veterans Affairs San Diego Hospital System (VASDHS).  Her research programs, which began with implementation of PTSD and Gulf war Illness clinical care and research in Cincinnati Ohio continued after her move to San Diego, California. She is a Professor in the Department of Psychiatry, University of California San Diego (UCSD), and Director of Neuroscience Research in the Center of Excellence for Stress and Mental Health, located in San Diego VA.  Overall, her primary areas of research have been treatment (single and multi-site trials), and investigation of factors that initiate and maintain stress-injuries.  She is Primary Investigator of the Marine Resiliency Study (MRS), a large, prospective, longitudinal study of PTSD risk and resilience factors.


Additional Question & Answer with Dr. Baker:

1. How do you manage survivor guilt?

Trauma related guilt is common in PTSD and is often associated with high levels symptoms including depression, substance use and suicidal thoughts.  Trauma-related guilt can be assessed using the Trauma-Related Guilt Inventory (TRGI) which assesses global guilt, general distress, and guilt cognitions.  Cognitive Processing Therapy that is effective at reducing PTSD and depression symptoms in civilian and veteran populations have been shown to reduce trauma-related guilt.  In CPT, individuals are taught to identify and challenge maladaptive trauma-related cognitions, such as guilt cognitions, and reappraise their traumatic experiences using available evidence.  Studies have shown that individuals are generally able to maintain symptom improvements they achieved over the course of CPT long-term. 

Good recent article on this subject is: Meade EA, Smith DL, Montes M, Norman SB, Held P. Changes in guilt cognitions in intensive PTSD treatment among veterans who experienced military sexual trauma or combat trauma. J Anxiety Disord. 2022 Jul 16;90:102606. doi: 10.1016/j.janxdis.2022.102606. Epub ahead of print. PMID: 35907274.

2. Dissociative symptoms (fugue) in ptsd dose it happens like attacks or temporary?

Dissociative symptoms can happen at the time of the trauma event, as described in my talk.  These symptoms might include feelings of time slowing down, feelings of unreality (watching the event from the outside), among others. 

Dissociative symptoms can occur in PTSD and range from the memory of the trauma event recurring with a “daydreamy quality” (mild – most common) to getting lost in the memory of the event and loosing awareness of the current surroundings (severe).  Severe dissociation in PTSD is quite uncommon.  

3. Якщо солдат має симптоми ПТСР, але звинувачує себе і вважає, що мусить страждати, як наказання, що не врятував друга. І в наслідок цього не хоче лікуватись. Що можна зробити?

If a soldier has symptoms of PTSD, but blames himself and believes he must suffer as punishment for not saving a friend. And as a result, he does not want to be treated. What can be done?

In this case, this person may benefit from individuals or a group of individuals who were in his unit who themselves may be undergoing treatment talking to the person and convincing him to join them in treatment.

4. So many addicted people keep on relapsing what could be the reason?

Sometimes the person who uses drugs or alcohol is using these drugs to dampen emotional pain – symptoms of PTSD in which case treating the PTSD symptoms with verbal treatment and medication such as serotonin reuptake inhibitors and prazosin to diminish the nightmares can sometimes help them stop using drug or alcohol.  However, sometimes the addiction is the primary problem and needs treatment by a drug abuse specialist.

5. Which psychotherapeutic approaches can be applied for those with symptoms of failure to recover?

The PTSD therapies with the best evidence for being effective are cognitive behavioral therapy and prolonged exposure therapy.  They do not cure everyone.   Some patients need medication treatment as well and could benefit from supportive therapy.   Head injury has been shown to be a risk for development of PTSD and it now being shown to potentially impede or slow recovery from the disorder.

6. PTSD AMONG CHILDREN....What remedies  of therapy you would suggest?

The first step is to make the child feel safe by getting support from parents, friends, and school, and by minimizing the chance of another traumatic event to the extent possible. Psychotherapy in which the child can speak, draw, play, or write about the stressful event can be done with the child, the family, or a group. Behavior therapy, specifically cognitive-behavioral therapy, helps children learn to change thoughts and feelings by first changing behavior in order to reduce the fear or worry.

7. Could you give more examples of techniques to reduce cortisol?

The best natural way to reduce cortisol in an otherwise healthy person is to reduce stress.   Mindfulness meditation or yoga are good practices to reduce stress.   

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