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Spiritual Care Handbook on - HealthCare Chaplaincy

The Rev. Brian Hughes, BCC The Rev. George Handzo, BCCThe Handbook on Best Practices for the Provision of Spiritual Care to Persons with Post Traumatic Stress Disorder and Traumatic Brain InjurySpiritual Care Handbook on PTSD/TBIByCopyright StatementThis work was prepared at the request of the Government. Title 17 105 provides that Copyright protection under this title is not available for any work of the United States Government. Title 17 101 defines a United States Government work as work pre-pared by a military service member, employee, or contractor of the United States Government as part of that person s official views expressed in this document are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the of ContentsIntroduction-------------------- ---------------------------------------- ----------------------------------4 Figure I- Stress Continuum ModelSection I: Definitions & SymptomsChapt

The Rev. Brian Hughes, BCC The Rev. George Handzo, BCC The Handbook on Best Practices for the Provision of Spiritual Care to Persons with Post Traumatic Stress

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Transcription of Spiritual Care Handbook on - HealthCare Chaplaincy

1 The Rev. Brian Hughes, BCC The Rev. George Handzo, BCCThe Handbook on Best Practices for the Provision of Spiritual Care to Persons with Post Traumatic Stress Disorder and Traumatic Brain InjurySpiritual Care Handbook on PTSD/TBIByCopyright StatementThis work was prepared at the request of the Government. Title 17 105 provides that Copyright protection under this title is not available for any work of the United States Government. Title 17 101 defines a United States Government work as work pre-pared by a military service member, employee, or contractor of the United States Government as part of that person s official views expressed in this document are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the of ContentsIntroduction-------------------- ---------------------------------------- ----------------------------------4 Figure I- Stress Continuum ModelSection I: Definitions & SymptomsChapter I - What is Post-Traumatic Stress Disorder?

2 ---------------------------------------- -----6 Chapter II - PTSD Diagnostic Criteria ---------------------------------------- ----------------------8 Stressor Intrusive Recollection Avoidant / Numbing Hyper-Arousal Duration Functional Significance Chapter III - What is Traumatic Brain Injury? ---------------------------------------- ------------10 TBI Symptoms Mild TBI Moderate to Severe TBI Coping and Social Support Some Tips for Working with People with TBIS ection II: Overarching PrinciplesChapter I - Definitions ---------------------------------------- ---------------------------------------1 6 Compassion Fatigue Coping Countertransference Cure vs.

3 Heal Desired Clinical Outcome Intentional Ministry of Presence Mission Moral Distress Moral Injury Spirituality Spiritual Care Intervention Spiritual Concerns, Spiritual Distress, Spiritual Despair Spiritual Community Transference Trauma Victim TriangleChapter II - Integrate and Collaborate with the Mental Health Team------------------------- 201 Chapter III - Herman s Stages of Recovery ---------------------------------------- -------------------------22 Safety Remembrance & Mourning ReconnectionChapter IV - Be a Nonanxious Presence ---------------------------------------- -----------------------------30 Chapter V - Be a Nonjudgmental Presence ---------------------------------------- ------------------------- 31 Chapter VI - Sensitivity to Differences in Religion.

4 Culture and Gender ---------------------------32 Woman African American Hispanic/Latino/Latina Asian American/Pacific Islander Native American GenerationalChapter VII - Need for Self-Care ---------------------------------------- --------------------------------------36 Section III: InterventionsChapter I - Group Work Spiritual Care Interventions--------------------------- -------------------------------39 Rationale for the Use of Groups Types of Groups Tips on Groups The Twelve-Step Approach to PTSDC hapter II - Spiritual Care Interventions- TBI------------------------------------- ---------------------------- 46 1. Intentional Ministry of Presence2.

5 Spiritual Reframing3. Focus on Spiritual Gratitude & BlessingChapter III - Spiritual Care Interventions- PTSD------------------------------------ --------------------------49 Basic Interventions1. Intentional Ministry of Presence ---------------------------------------- -------------------------------------492 . Meaning Making ---------------------------------------- ---------------------------------------- ---------------503. Grief Work ---------------------------------------- ---------------------------------------- ----------------------55 Specific Chaplain Interventions1. Clinical Use of Prayer ---------------------------------------- ---------------------------------------- ---------582.

6 Healing Rituals ---------------------------------------- ---------------------------------------- -----------------623. Confession Guilt Forgiveness Work (Ventilative Confession) --------------------------------------64 4. Percentage of Guilt Discussion------------------------------ ---------------------------------------- ---------695. Life Review Spiritual Autobiography Work ---------------------------------------- ---------------------7126. Scripture Paralleling / Education------------------------------- ---------------------------------------- ----737. Reframing God Assumptions, Examining Harmful Spiritual Attributions -------------------------- 768.

7 Encouraging Connection with a Spiritual Community------------------------------- -------------------78 Specialty Interventions1. Spiritual Mantram Repetition ---------------------------------------- --------------------------------------80 2. Creative Writing--------------------------------- ---------------------------------------- ---------------------84 Interventions Requiring Special Training1. Sweat Lodge Apache Warrior Ritual ---------------------------------------- ----------------------------852. Psychic Judo - Going With the Negative Emotions ---------------------------------------- -------------873. Interpersonal Psychotherapy (IPT) ---------------------------------------- --------------------------------884.

8 Trauma Incident Reduction (TIR) ---------------------------------------- ---------------------------------91 Section IV: AppendicesAppendix I - Evidence Grading ---------------------------------------- --------------------------------------94 Appendix II - Bibliography---------------------------- ---------------------------------------- ----------------95 Appendix III - Telephone Interviews ---------------------------------------- ------------------------------1073 IntroductionAs of the beginning of April, 2009, there have been approximately 5,000 casualties in the Over-sees Contingency Operation (accessed 4/5/09 at: ). This does not include those whom have been wounded in action and have returned or not returned to duty.

9 Over million service members have been involved in the Overseas Contingency Operations, and most return home changed in some way. The life threat, loss, fatigue, and inner conflict that many service members experience are expected human responses to extremely abnormal events. These challenges elicit reac-tions and responses from each person, most of which are normal reactions and responses to such abnormal events. For many, the difficulty comes in seeking to reset to somehow turn off the military skills and coping strategies that may have served them well in combat, yet no longer are healthy or with purpose once the service member re-turns home (Oliver, 2008) The research surrounding traumatic stress is still quite young.

10 The research connecting traumatic stress and spiri-tuality is consequently quite sparse. As such, many of the Spiritual Care Interventions recommended are based on the opinion and experience of expert clinicians who have been professionally ad-dressing the Spiritual and emotional needs of those with PTSD and TBI; rather, than in-depth social research. To simplify the presentation, sev-eral terms are used generically. God should be understood to refer to whatever the person s concept of a higher power is, including: God, Yah-weh, Allah, etc. Ser-vice member, Sailor, Marine, Soldier, Air-man, and veteran are used synonymously to refer to anyone who has been in combat as a member of a uniformed military service.


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