1. Best Practices:
PTSD Student Veterans
LT Cliff Overby II, M.M.
Jillian Jo Overby, M.Ed.

2. Definition of PTSD
• An anxiety disorder resulting from
exposure to an experience involving direct
or indirect threat of serious harm or death;
may be experienced alone (rape/assault)
or in company of others (military combat)
(www.ncptsd.va.gov)

3. National Center for PTSD
• 7.8% of Americans experience PTSD
• Women are at TWICE the risk to
experience PTSD
• 30% of combat veterans experience PTSD
– Approximately 50% of Vietnam veterans
experience symptoms
– Approximately 8% of Gulf War veterans have
demonstrated symptoms (Duke and Vasterling 2005)

4. Relevance of Topic
• Individuals with traumatic stress reactions may
not seek mental health care but do seek out
other health and social services
• Only 1/3 of Iraq war veterans accessed mental
health services first year of post-deployment
(Hoge, Auchterloine & Milliken, 2006)
• Impact manifests across the lifespan
• Each veteran will have a unique set of
social, psychological, and psychiatric difficulties

5. Signs and Symptoms
• Three variations of stress disorders that
may be experienced:
– Immediate
– Acute
– Chronic
• Depends on a variety of
individual, contextual, and cultural factors.

6. Immediate: “Combat Fatigue”
• Immediate psychological and functional impairment that
occurs in war-zone/battle or during other severe
stressors during combat
• Caused by stress hormones
• Features of stress reaction include:
– Restlessness
– Withdrawal
– Stuttering
– Confusion
– Nausea
– Vomiting
– Severe suspiciousness and distrust

7. Acute Stress Disorder (ASD)
• Anxiety occurring within one month after exposure to
extreme traumatic stressor
• Total duration of disturbance is two days to a maximum
of four weeks (i.e. occurs and resolves within one month)
• Symptoms include:
– One re-experiencing symptom
– Marked avoidance
– Marked anxiety
– Evidence of significant distress or impairment
• ASD is considered a predictor of PTSD, though not a
necessary precondition (APA 1994)

8. Chronic: PTSD
• Post Traumatic Stress Disorder is the chronic phase of
adjustment to a stressor across lifespan
• Symptoms include:
– Recurrent thoughts of the event
– Flashbacks/bad dreams
– Emotional numbness (“It don’t matter”); reduced interest or
involvement in outside activities
– Intense guilt or worry/anxiety
– Angry outbursts and irritability
– Feeling “on edge,” hyper-arousal/hyper-alertness
– Avoidance of thoughts/situations that remind person of the
trauma (APA 1994)

9. Duration of PTSD
• To meet criteria for PTSD, symptom
duration must be at least one month
– ACUTE PTSD: duration of symptoms is fewer
than three months
– CHRONIC PTSD: duration of symptoms is
three months or more
• Often the disorder is more severe and
lasts longer when the stress is of human
design (i.e. war-related trauma) (APA 1994)

10. Coexisting Problems
• Veterans with PTSD are also at risk for:
– Depression and anxiety
– Substance abuse
– Spectrum of severe mental illnesses
– Aggressive behavior problems
– Sleep problems like nightmares, insomnia, or
irregular sleep schedules
– Acquired brain injury
• Traumatic Brain Injury (TBI) (www.ncptsd.va.gov)

11. Where Are They?
• Student veterans with PTSD are difficult to
identify:
– Onset of symptoms may not occur for months to
years after trauma
– Professionals may misdiagnose or not recognize
symptoms
– Individual psychosocial factors may interfere with
individuals seeking help
– Avoidant behaviors may result in an inability for
others to recognize the need for treatment

12. Identifying At-Risk Students
• Symptoms of at-risk individuals:
– History of psychiatric problems
– Poor coping resources or capabilities
– Past history or trauma/mistreatment
– Acute Stress Disorder (ASD)
– Isolated
– Finically burdened
– Limited or no respite from work, family, or social
demands
– Stigma or faulty belief systems around seeking help

13. Potential Consequences of PTSD
• Physiological Concerns:
– Physical complaints are often treated symptomatically
rather than as an indication of PTSD
• Self-Destructive/Dangerous Behaviors:
– Substance abuse
– Suicide attempts
– Risky sexual behavior
– Reckless driving
– Self-injury (www.ncptsd.va.gov)

14. Potential Consequences of PTSD
• Social and Interpersonal Problems:
– Relationship issues
– Low-self-esteem
– Alcohol and substance abuse
– School and employment problems
– Homelessness
– Trouble with the law
– Isolation (www.ncptsd.va.gov)

15. Implications for Students
• Impact on well-being
• Employability
• Challenges for military reservists
• Military versus civilian life issues
• Job turnover and maintenance
• Failing grades
• Steady employment or school attendance is one
predictor of better long-term functioning

16. Recommended Accommodations
for the Instructor:
• Give information in writing
• Provide detailed, regular feedback and guidance
• Provide positive reinforcement
• Provide clear expectations and consequences
• Allow for flexible start time
• Combine small breaks into one larger break during long
class sessions
• Allow for breaks during short classes
• Plan uninterrupted work time

17. Recommended Accommodations
for the Student:
• Divide large assignments
• Allow music via headset
• Count one occurrence for all PTSD-related absences
• Allow for work at home
• Extended time on tests and assignments (allow make up
work in event of absence)
• Provide additional time for new responsibilities
• Restructure assignments during times of stress

18. Recommended Accommodations
for the Classroom:
• Reduce distractions
• Lighting
• Identify and remove environmental triggers
• Allow presence of a support animal
• Allow student to complete assignments from home
• Provide a note-taker
• Provide PTSD Awareness training to
students, faculty, staff, and administration

19. Recommendations for
Student Activities:
• Coping can be easier when involved in social activities
• Encourage students with PTSD to participate in student
activities
• Keep in mind all recommended accommodations for the
classroom and the student
• Work with the Student Activities Director
• Help student find a “mentor” or “buddy” to participate in
activities with
• PARTICIPATE in student activities yourself!

20. Recommendations when Dealing
with High Emotions:
• Allow telephone calls during class time to contact doctors
or counselors
• Use stress management techniques
• Allow frequent breaks
• Develop strategies with the student for dealing with
conflict

21. Dealing with Angry Students
• Anger is often the most troublesome problem
• Attempt to understand anger from the student’s
perspective
• Intervene
– Recognition
– Establish boundaries/rules
– Follow emergency procedures if necessary
• Preemptively discuss the advantages and disadvantages
of anger expression in the classroom
• Seek consultation
• Refer to counselors/student services for further
assistance

22. Procedures to Follow:
• Specific procedures to follow if a student
demonstrates PTSD symptoms during
your class:
– Display calmness
– Provide reassurance
– Orient to place
– Take a break
– Guide
– Recommend an appropriate referral

23. Take Home Points
• Essential Features of PTSD:
– Re-experiencing symptoms (nightmares, intrusive thoughts)
– Avoidance of trauma cues
– Numbing/detachment from others
– Hyper-arousal
• A variety of factors including personal, cultural, and
social characteristics, coping abilities, experiences in
war, and the post-deployment/civilian environment all
contribute to the level, severity, and duration of stress
factors
• Work with students individually to find accommodations
that fit both the needs of the student and the classroom

24. References
• American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
American Psychiatric Association: Washington, D.C.
• American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition, Text Revised. American Psychiatric Association: Washington, D.C.
• Cozza, S.J., Benedek, D.M., Bradley, J.C., Grieger, T.A. (2004). Topics specific to the psychiatric treatment of
military personnel. In Iraq War Clinician’s Guide (2nd Ed.). http://www.ncptsd.va.gov/war/guide/index.html
• Duke, L.M. & Vasterling, J.J. Epidemiological and methodological issues in neuropsychological research on
PTSD. In Neuropsychology of PTSD: Biological, Cognitive and Clinical Perspectives. Vasterling & Brewin, Eds.
The Guilford Press: 2005.
• Harvey, A.G., & Bryant, R.A. (1998). Predictors of acute stress following mild traumatic brain injury. Brain
Injury, 12, (2): 147-154.
• Harvey, A.G. & Bryant, R.A. (2000). Two-year prospective evaluation of the relationship between acute stress
disorder and posttraumatic stress disorder following traumatic brain injury. The American Journal of
Psychiatry, 157, (4): 626-628.
• Hoge, C.W., Castro, C.A., Messer, S.C., McGurk, D. (2004). Combat duty in Iraq and Afghanistan, mental health
problems and barriers to care. The New England Journal of Medicine, 35, (1): 13-22.
• Hoge, C.W., Auchterloine, J.L., Milliken, C.S. (2006). Mental health problems, use of mental health services, and
attrition from military service after returning from deplloyment to Iraq or Afghanistan. Journal of the American
Medical Association, 295, 1023-1032.
• Insurance Information Institute. http://www.iii.org.
• National Center for PTSD. http://www.ncptsd.va.gov
• Prins, A., Ouimette, P., Kimerling, R., Camerond, R.P., Hugelshofer, D.S., Shaw-
Hegwar, J., Thraikill, A., Gusman, F.D., Sheikh, J.I. (2004). The primary care PTSD screen (PC-PTSD):
development and operating characteristics. Primary Care Psychiatry, 9 (1), January 2004, 9-14.