From "Managing Stress"

www.jbpub.com/managingstress/exercises/view.cfm
(If any exercise gets distressing, stop.)
Chapter Title
1 The Nature of Stress
2 The Physiology of Stress
3 Stress and Disease
4 Toward a Psychology of Stress
5 The Stress Emotions: Anger and Fear
6 Stress-Prone and Stress-Resistant Personalities
7 Stress and Human Spirituality
8 Cognitive Restructuring
9 Behavior Modification
10 Journal Writing
11 Art Therapy
12 Humor Therapy (Comic Relief)
13 Creative Problem Solving
14 Communication Skills
15 Time Management
16 Additional Coping Techniques
17 Diaphragmatic Breathing
18 Meditation
19 Hatha Yoga
20 Mental Imagery and Visualization
21 Music Therapy
22 Massage Therapy
23 Tai Chi Ch'uan
24 Progressive Muscular Relaxation
25 Autogenic Training
26 Clinical Biofeedback
27 Nutrition and Stress
28 Physical Exercise

Copyright © 2001 Jones and Bartlett Publishers

PTSD workbook


Managing Traumatic Stress Through Art: Drawing From the Center
By Barry M. Cohen, M.A., A.T.R., Mary-Michola Barnes, M.A., A.T.R., and Anita B. Rankin, M.A.
Foreword by Joan A. Turkus, M.D.
This workbook is a valuable, practical, and above all useful contribution to the abuse recovery field. Through a series of artwork exercises, survivors of trauma are offered an opportunity to enhance present-day mastery in a grounded, creative, and gentle way. The more I read, the more excited I got about being able to recommend this fine workbook to clients and workshop participants.
-Nancy J. Napier, M.F.C.C., author of Recreating Your Self: Help for Adult Children of Dysfunctional Families and Getting Through The Day: Help for Adults Hurt as Children
Three art therapists have collaborated to produce this unique workbook. Designed especially for trauma survivors, Managing Traumatic Stress Through Art introduces inventive ways to understand, manage, and transform the aftereffects of trauma. This dynamic workbook consists of carefully structured step-by-step art projects, augmented by tear out images, and writing experiences.
The book's first section, Developing Basic Tools For Managing Stress, is devoted to establishing a safe framework for trauma resolution. The second section, Acknowledging and Regulating Your Emotions, helps the trauma survivor to make sense of overwhelming emotional experiences. The final section, Being and Functioning in the World, focuses on self and relational development, leading into the future.
Managing Traumatic Stress Through Art will inspire survivors to explore the aftermath of traumatic stress as it affects self-image, relationships with others, and functioning in the world. The 26 projects in this book encourage creative growth and help to establish a sense of personal safety, while exploring and honoring feelings of anger, fear, shame, and sadness. The art experiences are broad enough to be of value to survivors of a wide variety of traumatic experiences, ranging from childhood abuse to accidents to disabling mental illness.
This workbook offers an opportunity to everyone, regardless of previous experience or artistic talent, to manage symptoms of traumatic stress in a creative, life-affirming way.
"This beautifully written guidebook for victims of trauma is a remarkable achievement in the effort to empower the survivor....and the authors are exquisitely sensitive to the needs of their audience for safety and structure. This will be useful to survivors, therapists, and counselors in all areas of traumatic stress."
-David Read Johnson, Ph.D., Director, Outpatient Services, National Center for PTSD, VA Medical Center, West Haven, CT
"I am wildly enthusiastic about this book. I think it's one of the best things I've ever seen for survivors....It provides survivors with a realistic and hopeful process, utilizing art, that guides them from honoring the past to releasing emotions safely to building an array of healthy coping strategies to a sense of empowerment and hope."
-Eliana Gil, Ph.D., Director, Center for Advanced Clinical Development, Springfield, VA
"The authors convincingly demonstrate that art making and writing can be an essential part of the process of healing from severe trauma in one's life....This is a valuable resource."
-Cathy A. Malchiodi, M.A., A.T.R., L.A.T., L.P.C.C., Director, Institute for the Arts and Health and Editor, Art Therapy
"This wonderful workbook offers trauma survivors an intelligent, safe, and enjoyable way to bring artwork into their personal healing process. I highly recommend it."
-Margot Silk Forrest, editor, The Healing Woman
Title: Managing Traumatic Stress Through Art
Author: Barry Cohen et al
Price: $22.95
Format: Paperback
Number of Pages: 192
All information on these pages
© the Sidran Institute, 1995-2002

More information at www.patiencepress.com
bookstore


PTSD Self-Help Book


Kelly Mack first suggested this book:

"Post-Traumatic Stress Disorder Sourcebook"
Author(s): Glenn Schiraldi
ISBN: 0737302658
DOI: 10.1036/0737302658
Format: Softcover, 446 pages.
Pub date: January 1, 2000
Copyright: 2000
$18.95 US
Product Line: McGraw-Hill/Contemporary Books
Related Titles by Category:
• Health & Fitness -- Reference
• Self-Help -- General
Description

For the millions who suffer from the effects of a traumatic experience, this book offers help and hope and provides the diverse elements needed for lasting recovery. Trauma can take many forms, from the most disturbing of circumstances such as witnessing a murder or violent crime to the subtle trauma of living with the effects of abuse or alcoholism. Deep emotional wounds often seem like they will never heal, but Schiraldi has helped and witnessed survivors recover, grow, and find happiness.
By helping people recognize the coping mechanisms and by dealing directly with the effects of a traumatic experience, there is a great reason for hope. The Post-Traumatic Stress Disorder Sourcebook is a guide for both survivors and their loved ones, helping them to see that on the other side of their pain is recovery and growth.
Explains the psychic defenses that can go into effect to protect a victim from further emotional harm
Provides information on triggers and the debilitating effects of post-traumatic stress disorder
Addresses how the healing process can begin and how fear diminishes through a variety of medic and non-medicinal treatment methods.
Contents
Part I: About PTSD
Chapter 1. PTSD Basics
Chapter 2. Making Sense of the Bewildering Symptoms: Understanding Anxiety and Dissociation
Chapter 3. Associated Features
Chapter 4. Frequently Asked Questions
Part II: About Healing, Recovery, Growth
Chapter 5. Principles of Healing, Recovery, and Growth
Chapter 6. Treatment Approaches: Professional, Medication, Group, and Self-Managed
Part III: Preparations
Chapter 7. Stabilization and Balance
Chapter 8. Taking Care of Your Health
Part IV: Managing Symptoms
Chapter 9. Affect Management
Chapter 10. Reducing General Arousal
Chapter 11. Breathing Retraining
Chapter 12. About Relaxation
Chapter 13. Progressive Muscle Relaxation
Chapter 14. Autogenic Training
Chapter 15. Meditation
Chapter 16. Managing Anger
Chapter 17. Eye Movement
Chapter 18. Intrusion Management
Part V: Treatment
Chapter 19. Principles of Memory Work
Chapter 20. Cognitive Restructuring
Chapter 21. Confiding Concealed Wounds
Chapter 22. Resolving Guilt
Chapter 23. Thought Field Therapy
Chapter 24. The Rewind Technique
Chapter 25. Traumatic Incident Reduction (TIR)
Chapter 26. Eye Movement Desensitization and Reprocessing (EMDR)
Chapter 27. The Counting Method
Chapter 28. Dream Management and Processing
Chapter 29. Healing Imagery
Chapter 30. Healing Rituals
Chapter 31. Grieving Losses
Chapter 32. Making Sense of Trauma: Coming to Terms with Suffering
Chapter 33. Hypnosis
Chapter 34. Expressive Art Therapies
Chapter 35. Life Review
Chapter 36. Building Self-Esteem
Chapter 37. Unfinished Business: Resolving Anger
Chapter 38. Prolonged Exposure
Chapter 39. Complementary Approaches
Part VI: Moving On
Chapter 40. Transitioning
Chapter 41. Intimacy and Sexuality
Chapter 42. Meaning and Purpose
Chapter 43. Spiritual and Religious Growth
Chapter 44. Happiness, Pleasure, and Humor
Chapter 45. Relapse Prevention
Chapter 46. Summing Up
Appendices
Appendix 1. The History of PTSD
Appendix 2. Assessing Abuse
Appendix 3. The Brain and Memory
Appendix 4. Psychiatric Disorders
Appendix 5. 72-Hour Emergency Preparedness
Appendix 6. Time Management
Appendix 7. Rape and Sexual Assault Facts and Myths
Appendix 8. Medication Facts and Guidelines
Appendix 9. Victim, Survivor, Thriver
Appendix 10. Resources
Author Biography

Glenn R. Schiraldi, Ph.D., has served on the stress management faculty at the U.S. Pentagon and the University of Maryland, where he received the Outstanding Teacher Award in the College of Health and Human Performance. He is the author of various articles and books on human mental and physical health, including Conquer Anxiety, Worry and Nervous Fatigue: A Guide to Greater Peace; Hope and Help for Depression: A Practical Guide; Facts to Relax By: A Guide to Relaxation and Stress Reduction; and Building Self-Esteem: A 125-Day Program. He serves on the Board of Directors of the Depression and Related Affective Disorders Association. He is a graduate of the U.S. Military Academy, West Point, and holds graduate degrees in Health Education from Brigham Young University and the University of Maryland.

Myths and Facts About PTSD


Posttraumatic stress disorder, or PTSD, is a complex disorder that is often misunderstood. PTSD may develop following exposure to extreme trauma -- a terrifying event or ordeal that a person has experienced, witnessed, or learned about, especially one that is life-threatening or causes physical harm. The experience causes that person to feel intense fear, horror or a sense of helplessness. Not everyone who experiences a traumatic event will develop PTSD, but many people do.

MYTH: PTSD only affects war veterans.

FACT: Although PTSD does affect war veterans, PTSD can affect anyone. Almost 70 percent of Americans will be exposed to a traumatic event in their lifetime. Of those people, up to 20 percent will go on to develop PTSD. An estimated 1 out of 10 women will develop PTSD at some time in their lives.
Victims of trauma related to physical and sexual assault face the greatest risk of developing PTSD. Women are about twice as likely to develop PTSD as men, perhaps because women are more likely to experience trauma that involves these types of interpersonal violence, including rape and severe beatings. Victims of domestic violence and childhood abuse are at tremendous risk for PTSD.

MYTH: People should be able to move on with their lives after a traumatic event. Those who can't cope are weak.

FACT: Many people who experience an extremely traumatic event go through an adjustment period following the exposure. Most of these people are able to return to leading a normal life. However, the stress caused by trauma can affect all aspects of a person's life including mental, emotional and physical well-being. Research suggests that prolonged trauma may disrupt and alter brain chemistry. For some people, a traumatic event changes their views about themselves and the world around them. This may lead to the development of PTSD.

MYTH: People suffer from PTSD right after they experience a traumatic event.

FACT: PTSD symptoms usually develop within the first three months after trauma, but may not appear until months or years have passed. These symptoms may continue for years following the trauma, or, in some cases, symptoms may subside and reoccur later in life, which is often the case with victims of childhood abuse.
Some people don't recognize that they have PTSD because they may not associate their current symptoms with past trauma. In domestic violence situations, the victim may not realize that their prolonged, constant exposure to abuse puts them at risk.

http://www.sidran.org/ptsdmyths.html

PTSD AFFECTS WOMEN TOO NOT LIMITED TO MILITARY COMBAT PERSONNEL

WHAT IS PTSD?
PTSD is an anxiety disorder resulting from emotional distress resulting from a traumatic experience, and according to mental health professionals, define this condition as an ordeal that goes over the usual scope of a person’s experience that is notably distressing to anybody. It is a real illness requiring treatment.

WHAT CAUSES PTSD?
People who have experienced or witnessed a life threatening such as surviving acts of terrorism , war or battle, and on a personal level an individual who has been a victim of a cruel crime, domestic violence where a family member has been hit or harmed by a parent or a spouse, or sometimes by belligerent siblings, sexual trauma. Other provoking stimuli surviving an auto and airplane accidents, natural disasters. Or any event where a person believes, they might die. And it can trigger symptoms of depression, anxiety, anger of periodic distressing nightmares.

HOW DO YOU KNOW IF YOU HAVE PTSD?
A person could have PTSD and never know it, as symptoms can start at once and after the trauma event that stimulated it. Or it can be delayed for a long time, affecting an individual months or even years after the event. symptoms are not unusual and, unrestrained, could slip to more critical difficulties in daily life such as social problems and with family members, friends, co-workers; brushes with the law; and even substance abuse. And PTSD can happen to anyone at any age, even children.
Symptoms of PTSD are:
Feeling of detachment from other people. Become angry very easily. Always on lookout for danger, have a hard time trusting or getting close to people, and may discover the inability to express loving feelings. Incapable of working or take care of the children at home, unable to enjoy life wholeheartedly and substance abuse such as alcohol or drugs.
Flashback incidents, and they happen without warning. For instance, a sound, an image, a certain odor, anniversaries of the event are trigger mechanisms for the agonizing memory to happen in full force, causing the person to relive the situation once more in familiar surroundings.
Reason why an individual lives it all over again is because of the psychological experience is so horrifying and so different from day by day affairs they can’t fit it into what they know about the world. So to understand what occurred, their mind continues to invoke the memory, as if to further to comprehend the situation and make it blend in.
Still feel fearful most of the time. A person jumps and feels very upset when something happens without warning. Anxiety or dread shakes up in mind or made to feel apprehensive or a reason to be alarmed.
Nightmares are also common. You often have nightmares or scary thoughts and frightening recalls of the horrifying event and it also happens without warning. For example, increased frighten feeling consisting of being jumpy, jittery, shaky, difficulty concentrating or sleeping. And another problem is difficulty in sleeping, and muscles are tense.
Avoidance is a different copy mechanism in addressing the mental state related pain. It is when a person purposely keeps from anything or stay away from places that reminds them of the horrifying event. Most often issues that are not presently linked to the injury are also sidestepped. For example going out in the evening if the trauma occurred at night.
Another way of to ease anxiety is struggling to push down painful thoughts. Which leads to numbness, where a person has a problem in having both fearful and pleasant or loving feelings. And they develop a mental block to remember decisive details of the traumatic event.
Feel guilt and shame because you lived, they died. A lot of people blame themselves for things they felt they did or did not do to survive. A person feels this way because during the situation that caused the trauma, they acted in a way that they would have not otherwise have done. Also, sometimes other people place the blame on the individual for the hurt.
It is and indication a person is taking responsibility for what happened. Yet this may make a person feel somewhat more in control, it can also lead to feelings of helplessness and depression.

SEEKING HELP
A time comes when an individual has a need to seek more help to overcome the traumatic event. Those who have encountered first hand with nerve-wracking events, and people with emotional problems are more disposed to seek professional help.
For some, asking for help from health care professionals is not easy, as it is hard for them, as well as being impossible for others. Main reason why they don’t seek help is because they believe they have not sought help with a long-lived stumbling block, why should they do it now.
Yet, most folks when they have a physical ailment, they do not procrastinate to pursue Medical treatment, yet some people prefer to maintain the mental matters blocked. Many a time, those with emotional difficulties may speculate whether they actually require support and question whether anyone could conceivably make a change in how they think. And you wonder if you are the only person with this illness. The answer is no.
And a lot of people don’t want to talk about the issue because they refuse to talk about themselves because it is too painful to recall the agonizing occurrences that might have reinforced their tribulations. Though these thoughts are common, when they finally decide to seek help, their concerns normally breaks down to emotions of comfort and less mental anxiety when relief is finally looked for.

HOW IS PTSD TREATED?
Tell the doctor about the frightening images, depression, hard time in sleeping, and anger. Convey to the doctor if these problems keep you away from living every day life. Also ask the doctor for a check up to be sure that you don’t have some other illness.
Doctor may give medications to help the person feel less afraid and tense. Yet it could take a few weeks for the medicine to take affect.
Relating your experience to a specially trained doctor or counselor helps many people who have PTSD. This therapy can help an individual work out their terrible experience.
People can learn how to manage PTSD, and the medical personnel are there to help.

How can treatment help PTSD?
On the Internet, to and look for the VHA Facilities Locator link under “Health Benefits and Services” or go to
VA Medical Centers/Hospitals and Readjustment Counseling Services (Vet Centers) have professional staff who are able to treat PTSD. The provide mental health services for veterans and therapy is suited to individuals established on an evaluation, including a physical exam, interviews and standards weighing the magnitude of the PTSD. Care may consist of “out patient day program or a day hospital. Group therapy” and medication can also be used.
Treatment can help the veteran to know symptoms of PTSD and present life difficulties and learn to manage in a more effective manner with traumatic memories.
Ways you can cope:
Family, friends, church or other community resources can help, and join or begin a support group, as their support has a prominent role in recovery. By talking about your encounters in elating how you feel it gives you an opportunity to air out your feelings about the event rather than keeping them bottled up. And makes it easier to deal with disturbing events in a support group.
Continue to interact with people, and help others.
Instead of lacking interest in everyday activities, get back in the daily routine.
Find and take the time to grieve if need to.
Establish small goals before attempting large matters. Take one day at a time.
Eat a balanced diet, as stress poses an more of a demand on one’s health.
Take a break and go for a walk, stretch, exercise. A useful way to lessen stress.
Make sure you receive a lot of rest and sleep, as more sleep is needed when feeling strained .
Relax and find an activity that you like doing.
Stay away from stressful events.

PTSD LINKS
DEPARTMENT OF VETERANS AFFAIRS
http://www.va.gov/

Veterans Administration Facilities Directory
Listing of all 50 states
http://www.va.gov/sta/guide/division.asp?divisionId=1
In these listings includes VA Medical Center/Hospital
Outpatient Clinic
Community Based Outpatient Clinic
Vet Centers/Veteran’s Outreach Centers — Gulf War vets are also included.
I don’t remember all the categories, but I do know Vietnam, Grenada. I know there are others.
Note: VA website has a lot of information to check out.
MILITARY VETERANS (POST TRAUMATIC STRESS DISORDER)
PTSD REFERENCE MANUAL
http://www.ptsdmanual.com/
NATIONAL CENTER FOR PTSD
HELP FOR VETERANS WITH PTSD AND THEIR FAMILIES
http://www.ncptsd.org/facts/veterans/fs_help_for_vets.html
NATIONAL INSTITUTE OF MENTAL HEALTH
Can find free information online at
http://www.nimh.nih.gov
ON-LINE CONSUMER HEALTH PUBLICATIONS INDEXED BY KEYWORD
http://www.nih.gov/health/consumer/conkey.htm
TREATMENT OF PTSD
http://www.ptsdsupport.net/treatments.html
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTE OF HEALTH
http://www.nih.gov/health/consumer/conkey.htm
Letters across page for PTSD, click on page or scroll down

This message has been edited. Last edited by: CherryRead,

Major Depressive Disorder

Depression: Up and Down the Roller Coaster

By Louise from her own experience with depression
Written for Internet Mental Health
February 1998

My experience with depression leads me to describe one of its worst features: its variable symptoms. These symptoms not only make the experience of depression particularly distressing for the patient but also confuse and mislead those who deal with the depressed person. No one really wants to meet or speak with someone who is depressed. Whenever a positive change occurs, everyone hopes that it is a permanent improvement. When this proves not to be so, impatience soon appears. Depressed persons soon find that many people avoid them. Only the “normal” or “up” phases of the disease are acceptable to others. But rejection during the “down” phases can considerably add to the depression. Early Phases

In the course of a developing depression, it is common for there to be a wide variation in mood during the day. The morning is generally unpleasant. Darkness of mood prevails. Then as the day progresses, the mood lightens. By night, a person may feel quite normal. Gradually a change occurs. The dark times get longer and longer. If sleeplessness develops, the morning hours can be quite terrible. It is at this time that suicidal thoughts can appear. The individual cannot envision living in such darkness, day after day. Soon the darkness may last the whole day and also the evening. The depressed person dreads going to sleep. All that can be expected is a repetition of the same dark pattern. After a few days of this, the wish to die may become very strong. Depressed persons are not rejecting life as such. They are not rejecting any purpose that they may believe they have on earth or purpose that other people may suggest they have. Depressed persons are rejecting what they have become. “I do not recognize this person.” “I have become such a caricature of my former self!” “Look at me!” “I am completely anxious. I am afraid to be alone in my house. I am terrified when I have free time that I might have to spend at home. I am afraid to do things on my own. Anxiety makes me wring my hands incessantly. I am totally tense. I feel foolish, unable to do things that children easily do.” The death of such a creature would seem to be a blessing. At this stage of the depression, one is at the bottom of the roller coaster. Nor is there any hope of going up. During Treatment

After treatment of depression begins with antidepressants, improvement is slow. Antidepressants do not take effect until four to six weeks. During this time, the depression can continue its insidious growth. One has to cope with the side-effects of the antidepressants as well as all the darkness of the depression. The medication may help with sleep and this is a great blessing. But one is still very much on the bottom of the roller coaster. Great will-power is needed to have hope that some change will come. This period can be painful with regard to other people. Their patience may well wear thin. Most people assume that one's mental attitude is totally self-chosen. If one is not cheerful, it is by choice. During this time one is immensely grateful for a faithful friend. After some weeks the antidepressants begin to take effect. The depressed person feels less down, at first for part of the day, then for more of the day. But the mornings can still be bad and thoughts of death can still haunt. Side-effects of the antidepressants become less severe but do not disappear altogether. During this phase a person may feel that all the symptoms are some kind of horrible nightmare. “This can't be happening to me” “I was always able to be cheerful and happy.” “How I want to be off these pills and just be normal again” But the hard and painful truth has to be faced: the depression is real and will not go away by itself. One cannot just throw away the medication, however much this may seem desirable. Human nature has proved to be frail in a most painful way. During Recovery

At last some light seems to appear. “I am beginning to feel normal” “Up the roller coaster I go. And I will NEVER, NEVER go down again.” What an illusion! Depression is not a weak disease; it is one that specializes in cruel effects. Just as one begins to feel normal, the depression can return with a complete vengeance. This happened to me. On Sunday I feel normal, to some degree. I can ignore the side-effects of the antidepressants as long as I don't feel too bad. On Monday, as I face a series of decisions, I am as bad as I ever was, even at the beginning of the disease. Everything is dark. I want to die, thinking of suicide. I am anxious. I cannot make up my mind about the smallest details. I am most afraid and panic at the idea of being alone. Here I am at the bottom of the roller coaster once more. What are my choices? None, really. However much I wish to die and wish that this ridiculous person I have become to die, I know that death is not an option. I must continue with the medication and hope that I will go up the roller coaster once more. There can be no facile optimism with depression. I might want to be well NOW. Every person I meet impatiently wants me to be well and never to hear again about depression. But it is not going to be so. Recovery from depression may take months. Gradually I hope to be able to stay up the roller coaster. With other people, as I go up and down, I may have to learn to be a good actress. With some friends I will be able to speak of my pain. Depression is a roller coaster ride. It has taught me to have boundless compassion for those who are at the bottom of the roller coaster and to share their tears.

Internet Mental Health (www.mentalhealth.com) copyright © 1995-1999 by Phillip W. Long, M.D.

This message has been edited. Last edited by: CherryRead,

PANIC DISORDER

(sample story}
It started 10 years ago. I was sitting in a seminar in a hotel and this thing came out of the clear blue. I felt like I was dying."


"For me, a panic attack is almost a violent experience. I feel like I'm going insane. It makes me feel like I'm losing control in a very extreme way. My heart pounds really hard, things seem unreal, and there's this very strong feeling of impending doom."


"In between attacks there is this dread and anxiety that it's going to happen again. It can be very debilitating, trying to escape those feelings of panic."



People with panic disorder have feelings of terror that strike suddenly and repeatedly with no warning. They can't predict when an attack will occur, and many develop intense anxiety between episodes, worrying when and where the next one will strike. In between times there is a persistent, lingering worry that another attack could come any minute.
When a panic attack strikes, most likely your heart pounds and you may feel sweaty, weak, faint, or dizzy. Your hands may tingle or feel numb, and you might feel flushed or chilled. You may have chest pain or smothering sensations, a sense of unreality, or fear of impending doom or loss of control. You may genuinely believe you're having a heart attack or stroke, losing your mind, or on the verge of death. Attacks can occur any time, even during nondream sleep. While most attacks average a couple of minutes, occasionally they can go on for up to 10 minutes. In rare cases, they may last an hour or more. Panic Attack Symptoms


-- Pounding heart
-- Chest pains
-- Lightheadedness or dizziness
-- Nausea or stomach problems
-- Flushes or chills
-- Shortness of breath or a feeling of smothering or choking
-- Tingling or numbness
-- Shaking or trembling
-- Feelings of unreality
-- Terror
-- A feeling of being out of control or going crazy
-- Fear of dying
-- Sweating
Panic disorder strikes at least 1.6 percent of the population and is twice as common in women as in men. It can appear at any age--in children or in the elderly--but most often it begins in young adults. Not everyone who experiences panic attacks will develop panic disorder-- for example, many people have one attack but never have another. For those who do have panic disorder, though, it's important to seek treatment. Untreated, the disorder can become very disabling.
Panic disorder is often accompanied by other conditions such as depression or alcoholism, and may spawn phobias, which can develop in places or situations where panic attacks have occurred. For example, if a panic attack strikes while you're riding an elevator, you may develop a fear of elevators and perhaps start avoiding them.
Some people's lives become greatly restricted--they avoid normal, everyday activities such as grocery shopping, driving, or in some cases even leaving the house. Or, they may be able to confront a feared situation only if accompanied by a spouse or other trusted person. Basically, they avoid any situation they fear would make them feel helpless if a panic attack occurs. When people's lives become so restricted by the disorder, as happens in about one-third of all people with panic disorder, the condition is called agoraphobia. A tendency toward panic disorder and agoraphobia runs in families. Nevertheless, early treatment of panic disorder can often stop the progression to agoraphobia.
Studies have shown that proper treatment--a type of psychotherapy called cognitive-behavioral therapy, medications, or possibly a combination of the two--helps 70 to 90 percent of people with panic disorder. Significant improvement is usually seen within 6 to 8 weeks.
Cognitive-behavioral approaches teach patients how to view the panic situations differently and demonstrate ways to reduce anxiety, using breathing exercises or techniques to refocus attention, for example. Another technique used in cognitive-behavioral therapy, called exposure therapy, can often help alleviate the phobias that may result from panic disorder. In exposure therapy, people are very slowly exposed to the fearful situation until they become desensitized to it.
Some people find the greatest relief from panic disorder symptoms when they take certain prescription medications. Such medications, like cognitive-behavioral therapy, can help to prevent panic attacks or reduce their frequency and severity. Two types of medications that have been shown to be safe and effective in the treatment of panic disorder are antidepressants and benzodiazepines. text taken from ANXIETY DISORDERS: DECADE OF THE BRAIN (NIMH).


For further info,

browse the tAPir Links
or join the discussion at the tAPir BBS

http://www.algy.com/anxiety/clinks/clinks.cgi
© 1993 - 2000 tAPir

2003 Edition

Survivor Benefits

Dependency and Indemnity Compensation (DIC)
DIC Payments to Surviving Spouse | DIC Payments to Parents and Children
Special Allowances | Restored Entitlement Program for Survivors

Death Pension

Dependency and Indemnity Compensation (DIC) payments may be available for surviving spouses who have not remarried, unmarried children under 18, helpless children, those between 18 and 23 if attending a VA-approved school, and low-income parents of deceased service members or veterans. To be eligible, the deceased must have died from: (1) a disease or injury incurred or aggravated while on active duty or active duty for training; (2) an injury incurred or aggravated in line of duty while on inactive duty training; or (3) a disability compensable by VA. Death cannot be the result of willful misconduct. If a spouse remarries, eligibility for benefits may be restored if the marriage is terminated later by death, annulment or divorce.
DIC payments also may be authorized for survivors of veterans who were totally service-connected disabled when they died, even though their service-connected disabilities did not cause their deaths. The survivor qualifies if: (1) the veteran was continuously rated totally disabled for a period of 10 or more years immediately preceding death; (2) the veteran was so rated for a period of at least five years from the date of military discharge; or (3) the veteran was a former prisoner of war who died after Sept. 30, 1999, and who was continuously rated totally disabled for a period of at least one year immediately preceding death. Payments under this provision are subject to offset by the amount received from judicial proceedings brought on account of the veteran's death. The discharge must have been under conditions other than dishonorable.

DIC Payments to Surviving Spouse

Surviving spouses of veterans who died after Jan. 1, 1993, receive $948 a month. For a spouse entitled to DIC based on the veteran's death prior to Jan. 1, 1993, the amount paid is $948 or an amount based on the veteran's pay grade. See the "Tables" section of this booklet for more information.

DIC Payments to Parents and Children

The monthly payment for parents of deceased veterans depends upon their income. There are additional DIC payments for dependent children. A child may be eligible if there is no surviving spouse, and the child is unmarried and under age 18, or if the child is between the ages of 18 and 23 and attending school. See the "Tables" section of this booklet for more information on DIC for children.

Special Allowances

Surviving spouses and parents receiving DIC may be granted a special allowance to pay for aid and attendance by another person if they are patients in a nursing home or require the regular assistance of another person. Surviving spouses receiving DIC may be granted a housebound special allowance if they are permanently housebound. The current allowances for spouses are shown in the "Tables" section of this booklet.
Restored Entitlement Program for Survivors
Survivors of veterans who died of service-connected causes incurred or aggravated prior to Aug. 13, 1981, may be eligible for special benefits. This benefit is similar to the benefits for students and surviving spouses with children between ages 16 and 18 that were eliminated from Social Security benefits. The benefits are payable in addition to any other benefits to which the family may be entitled. The amount of the benefit is based on information provided by the Social Security Administration.

Death Pension

Pensions based on need are available for surviving spouses and unmarried children of deceased veterans with wartime service. Spouses must not have remarried and children must be under age 18, or under age 23 if attending a VA-approved school. Pension is not payable to those with estates large enough to provide maintenance. The veteran must have been discharged under conditions other than dishonorable and must have had 90 days or more of active military service, at least one day of which was during a period of war, or a service-connected disability justifying discharge for disability. If the veteran died in service but not in line of duty, benefits may be payable if the veteran had completed at least two years of honorable service. Children who became incapable of self-support because of a disability before age 18 may be eligible for a pension as long as the condition exists, unless the child marries or the child's income exceeds the applicable limit. A surviving spouse may be entitled to higher income limitations or additional benefits if living in a nursing home, in need of aid and attendance by another person or permanently housebound.
The Improved Pension program provides a monthly payment to bring an eligible person's income to a support level established by law. The payment is reduced by the annual income from other sources such as Social Security paid to the surviving spouse or dependent children. Medical expenses may be deducted from the income ceiling. Pension is not payable to those who have assets that can be used to provide adequate maintenance. Maximum rates for the Improved Death Pension are shown in the "Tables" section of this booklet.

Home Loan Guaranties

A VA loan guaranty to acquire a home may be available to an unmarried spouse of a veteran or servicemember who died as a result of service-connected disabilities, or to a spouse of a servicemember who has been officially listed as missing in action or as a prisoner of war for more than 90 days. Spouses of those listed as prisoners of war or missing in action are limited to one loan.

Dependents' Education

Monthly Payments | Work-Study | Counseling Services | Special Benefits
Educational Loans | Home Loan Guaranties | Montgomery GI Bill Death Benefit
Educational assistance benefits are available to spouses who have not remarried and children of: (1) veterans who died or are permanently and totally disabled as the result of a disability arising from active military service; (2) veterans who died from any cause while rated permanently and totally disabled from service-connected disability; (3) service members listed for more than 90 days as currently missing in action or captured in line of duty by a hostile force; (4) service members listed for more than 90 days as currently detained or interned by a foreign government or power.
The termination of a surviving spouse's remarriage - by death, divorce, or ceasing to live with another person as that person's spouse -will reinstate Dependents' Educational Assistance benefits to the surviving spouse. Benefits may be awarded for pursuit of associate, bachelor or graduate degrees at colleges and universities - including independent study, cooperative training and study abroad programs. Courses leading to a certificate or diploma from business, technical or vocational schools also may be taken.
Benefits may be awarded for apprenticeships, on-the-job training programs and farm cooperative courses. Benefits for correspondence courses under certain conditions are available to spouses only. Secondary-school programs may be pursued if the individual is not a high-school graduate. An individual with a deficiency in a subject may receive tutorial assistance benefits if enrolled halftime or more. Deficiency, refresher and other training also may be available.
Monthly Payments: Payments are made monthly. The rate is $670 a month for full-time school attendance, with lesser amounts for part-time training. A person may receive educational assistance for fulltime training for up to 45 months or the equivalent in part-time training. Payments to a spouse end 10 years from the date the individual is found eligible or from the date of the death of the veteran. VA may grant an extension. Children generally must be between the ages of 18 and 26 to receive education benefits, though extensions may be granted.
Work-Study: Participants must train at the three-quarter or full-time rate. They may be paid in advance 40 percent of the amount specified in the work-study agreement or an amount equal to 50 times the applicable minimum wage, whichever is less. Participants under the supervision of a VA employee may provide outreach services, prepare and process VA paperwork, and work at a VA medical facility or perform other approved activities. They may also help at national or state veterans' cemeteries in addition to assisting in outreach services furnished by State Approving Agencies.
Counseling Services: VA may provide counseling services to help an eligible dependent pursue an educational or vocational objective.
Special Benefits: An eligible child over age 14 with a physical or mental disability that impairs pursuit of an educational program may receive special restorative training to lessen or overcome that impairment. This training may include speech and voice correction, language retraining, lip reading, auditory training, Braille reading and writing, and similar programs. Certain disabled or surviving spouses are also eligible for special restorative training. Specialized vocational training also is available to an eligible spouse or child over age 14 who is handicapped by a physical or mental disability that prevents pursuit of an educational program.

Educational Loans

Loans are available to spouses who qualify for educational assistance. Spouses who have passed their 10-year period of eligibility may be eligible for an educational loan. During the first two years after the end of their eligibility period, they may borrow up to $2,500 per academic year to continue a full-time course leading to a college degree or to a professional or vocational objective that requires at least six months to complete. VA may waive the six-month requirement. Loans are based on financial need.

Montgomery GI Bill Death Benefit

VA will pay a special Montgomery GI Bill death benefit to a designated survivor in the event of the service-connected death of an individual while on active duty or within one year after discharge or release. The deceased must either have been entitled to educational assistance under the Montgomery GI Bill program or a participant in the program who would have been so entitled but for the high school diploma or length-of-service requirement. The amount paid will be equal to the participant's actual military pay reduction (discussed on "Education and Training" of this booklet), less any education benefits paid.

Federal Benefits for Veterans and Dependents

2003 Edition

Survivor Benefits

Dependency and Indemnity Compensation (DIC)
DIC Payments to Surviving Spouse | DIC Payments to Parents and Children
Special Allowances | Restored Entitlement Program for Survivors

Death Pension

Dependency and Indemnity Compensation (DIC) payments may be available for surviving spouses who have not remarried, unmarried children under 18, helpless children, those between 18 and 23 if attending a VA-approved school, and low-income parents of deceased service members or veterans. To be eligible, the deceased must have died from: (1) a disease or injury incurred or aggravated while on active duty or active duty for training; (2) an injury incurred or aggravated in line of duty while on inactive duty training; or (3) a disability compensable by VA. Death cannot be the result of willful misconduct. If a spouse remarries, eligibility for benefits may be restored if the marriage is terminated later by death, annulment or divorce.
DIC payments also may be authorized for survivors of veterans who were totally service-connected disabled when they died, even though their service-connected disabilities did not cause their deaths. The survivor qualifies if: (1) the veteran was continuously rated totally disabled for a period of 10 or more years immediately preceding death; (2) the veteran was so rated for a period of at least five years from the date of military discharge; or (3) the veteran was a former prisoner of war who died after Sept. 30, 1999, and who was continuously rated totally disabled for a period of at least one year immediately preceding death. Payments under this provision are subject to offset by the amount received from judicial proceedings brought on account of the veteran's death. The discharge must have been under conditions other than dishonorable.

DIC Payments to Surviving Spouse

Surviving spouses of veterans who died after Jan. 1, 1993, receive $948 a month. For a spouse entitled to DIC based on the veteran's death prior to Jan. 1, 1993, the amount paid is $948 or an amount based on the veteran's pay grade. See the "Tables" section of this booklet for more information.

DIC Payments to Parents and Children

The monthly payment for parents of deceased veterans depends upon their income. There are additional DIC payments for dependent children. A child may be eligible if there is no surviving spouse, and the child is unmarried and under age 18, or if the child is between the ages of 18 and 23 and attending school. See the "Tables" section of this booklet for more information on DIC for children.

Special Allowances

Surviving spouses and parents receiving DIC may be granted a special allowance to pay for aid and attendance by another person if they are patients in a nursing home or require the regular assistance of another person. Surviving spouses receiving DIC may be granted a housebound special allowance if they are permanently housebound. The current allowances for spouses are shown in the "Tables" section of this booklet.
Restored Entitlement Program for Survivors
Survivors of veterans who died of service-connected causes incurred or aggravated prior to Aug. 13, 1981, may be eligible for special benefits. This benefit is similar to the benefits for students and surviving spouses with children between ages 16 and 18 that were eliminated from Social Security benefits. The benefits are payable in addition to any other benefits to which the family may be entitled. The amount of the benefit is based on information provided by the Social Security Administration.

Death Pension

Pensions based on need are available for surviving spouses and unmarried children of deceased veterans with wartime service. Spouses must not have remarried and children must be under age 18, or under age 23 if attending a VA-approved school. Pension is not payable to those with estates large enough to provide maintenance. The veteran must have been discharged under conditions other than dishonorable and must have had 90 days or more of active military service, at least one day of which was during a period of war, or a service-connected disability justifying discharge for disability. If the veteran died in service but not in line of duty, benefits may be payable if the veteran had completed at least two years of honorable service. Children who became incapable of self-support because of a disability before age 18 may be eligible for a pension as long as the condition exists, unless the child marries or the child's income exceeds the applicable limit. A surviving spouse may be entitled to higher income limitations or additional benefits if living in a nursing home, in need of aid and attendance by another person or permanently housebound.
The Improved Pension program provides a monthly payment to bring an eligible person's income to a support level established by law. The payment is reduced by the annual income from other sources such as Social Security paid to the surviving spouse or dependent children. Medical expenses may be deducted from the income ceiling. Pension is not payable to those who have assets that can be used to provide adequate maintenance. Maximum rates for the Improved Death Pension are shown in the "Tables" section of this booklet.

Home Loan Guaranties

A VA loan guaranty to acquire a home may be available to an unmarried spouse of a veteran or servicemember who died as a result of service-connected disabilities, or to a spouse of a servicemember who has been officially listed as missing in action or as a prisoner of war for more than 90 days. Spouses of those listed as prisoners of war or missing in action are limited to one loan.

Dependents' Education

Monthly Payments | Work-Study | Counseling Services | Special Benefits
Educational Loans | Home Loan Guaranties | Montgomery GI Bill Death Benefit
Educational assistance benefits are available to spouses who have not remarried and children of: (1) veterans who died or are permanently and totally disabled as the result of a disability arising from active military service; (2) veterans who died from any cause while rated permanently and totally disabled from service-connected disability; (3) service members listed for more than 90 days as currently missing in action or captured in line of duty by a hostile force; (4) service members listed for more than 90 days as currently detained or interned by a foreign government or power.
The termination of a surviving spouse's remarriage - by death, divorce, or ceasing to live with another person as that person's spouse -will reinstate Dependents' Educational Assistance benefits to the surviving spouse. Benefits may be awarded for pursuit of associate, bachelor or graduate degrees at colleges and universities - including independent study, cooperative training and study abroad programs. Courses leading to a certificate or diploma from business, technical or vocational schools also may be taken.
Benefits may be awarded for apprenticeships, on-the-job training programs and farm cooperative courses. Benefits for correspondence courses under certain conditions are available to spouses only. Secondary-school programs may be pursued if the individual is not a high-school graduate. An individual with a deficiency in a subject may receive tutorial assistance benefits if enrolled halftime or more. Deficiency, refresher and other training also may be available.
Monthly Payments: Payments are made monthly. The rate is $670 a month for full-time school attendance, with lesser amounts for part-time training. A person may receive educational assistance for fulltime training for up to 45 months or the equivalent in part-time training. Payments to a spouse end 10 years from the date the individual is found eligible or from the date of the death of the veteran. VA may grant an extension. Children generally must be between the ages of 18 and 26 to receive education benefits, though extensions may be granted.
Work-Study: Participants must train at the three-quarter or full-time rate. They may be paid in advance 40 percent of the amount specified in the work-study agreement or an amount equal to 50 times the applicable minimum wage, whichever is less. Participants under the supervision of a VA employee may provide outreach services, prepare and process VA paperwork, and work at a VA medical facility or perform other approved activities. They may also help at national or state veterans' cemeteries in addition to assisting in outreach services furnished by State Approving Agencies.
Counseling Services: VA may provide counseling services to help an eligible dependent pursue an educational or vocational objective.
Special Benefits: An eligible child over age 14 with a physical or mental disability that impairs pursuit of an educational program may receive special restorative training to lessen or overcome that impairment. This training may include speech and voice correction, language retraining, lip reading, auditory training, Braille reading and writing, and similar programs. Certain disabled or surviving spouses are also eligible for special restorative training. Specialized vocational training also is available to an eligible spouse or child over age 14 who is handicapped by a physical or mental disability that prevents pursuit of an educational program.

Educational Loans

Loans are available to spouses who qualify for educational assistance. Spouses who have passed their 10-year period of eligibility may be eligible for an educational loan. During the first two years after the end of their eligibility period, they may borrow up to $2,500 per academic year to continue a full-time course leading to a college degree or to a professional or vocational objective that requires at least six months to complete. VA may waive the six-month requirement. Loans are based on financial need.

Montgomery GI Bill Death Benefit

VA will pay a special Montgomery GI Bill death benefit to a designated survivor in the event of the service-connected death of an individual while on active duty or within one year after discharge or release. The deceased must either have been entitled to educational assistance under the Montgomery GI Bill program or a participant in the program who would have been so entitled but for the high school diploma or length-of-service requirement. The amount paid will be equal to the participant's actual military pay reduction (discussed on "Education and Training" of this booklet), less any education benefits paid.

The Twelve-Step Approach to PTSD

Written by Joel Brende, MD
Mercer University School of Medicine


Step One (Power)

Our first step is to accept the fact that we have become powerless to live meaningful lives.
Even though we had the power to survive against the worst combat conditions, we must admit we have become powerless to win the battle against a new enemy—our memories, flashbacks, and combat instincts. Some of us have become powerless over the continuing wish to gain revenge over those sudden impulses to hurt those who cross us or unsuspectingly annoy us. We even hurt those who try to love us, making it impossible to love and care for our friends and family. So we isolate ourselves and cause others to avoid, dislike, or even hate us. Our attempts to live meaningful lives and fight this psychological and emotional hell which imprisons us seems to be in vain. We now find ourselves powerless to change it.

Step Two (Seeking Meaning)

Our next step is to seek meaning in having survived.
If we are to survive this new battle, we seek meaning in having survived. We want to believe we have survived for a purpose. We would like to be free from nagging thoughts telling us we should never have left the battlefield alive—the place where our comrades gave their lives in war. We want to believe our lives will serve a better purpose if we are alive rather than dead. Thus, even though we often doubt that living is better than dying, we seek to find meaning in life rather than death, and hope to find life a privilege rather than a burden.


Step Three (Trust)

Our third step is to begin to find relief by seeking help from God as we understand Him, and from persons we can learn to trust.
If we are to find relief, we seek a source of help from persons whom we can learn to trust. Many of us also would like to trust God, as individually understood, and ask Him to show
us the way out of our mental prisons, renewing our sensitivities to human emotions and spiritual qualities we fear we have lost.

Step Four (Self-Inventory)

We will make a searching, positive inventory of ourselves.
After taking the step of seeking and accepting help, we find ourselves aware of many negative qualities. In fact, although we might be willing to trust, we may fear that revealing ourselves to others will only be a negative experience. Thus, we ask a person we trust, and a higher power, to help us see our positive qualities. In that way, we can honestly evaluate the presence of both desirable and undesirable qualities.

Step Five (Rage)

We will admit to ourselves, to God, and to a person whom we trust, all our angry feelings and homicidal rage.
With an awareness that we are not alone, with improved self-esteem, and with a newfound desire to trust, we hope to understand the reason for our continuing rage. We will take the risk of revealing our angry feelings to a person we trust and God as individually understood. In so doing, we will discover that our anger is likely to be our only defense against helplessness and experiencing other emotions. Thus, this important step will help us open the door to other painful memories and emotions.

Step Six (Fear)

We will open the doors to the past and reveal to God and another person whom we trust, our frightening, traumatic memories.
After beginning to realize that anger is often a defense against fear, we will now begin to understand the link between the two. In this way, we can begin to accept the fact that fear is normal and relief from fear may be found by facing it with the help of someone we trust and of God, as individually understood.

Step Seven (Guilt)

We will ask forgiveness from God as we understand Him, and recognize we are thus free from condemnation.
We ask for and accept forgiveness from God, and a person whom we trust, for committing, participating in, or knowing about acts committed which were unacceptable in our eyes, causing suffering and grief for other persons and now causing us to feel tormented with guilt and self-blame. After having accepted forgiveness from God and from another person(s), we can now forgive ourselves. But we recognize that old habits of self-condemnation are difficult to break. Thus, self-forgiveness must be a daily matter.

Step Eight (Grief)

We seek strength and support from God and another person to finally grieve for those whom we left behind.
We seek strength to complete the grieving process for those who have died. We would like to finally be free, shedding tears without being lost in unending grief. This means also being able to understand the link between grief and all the feelings we have harbored for many years: anger at those who left us alone, guilt about surviving while others were killed, remorse for failing to save people who died, and yearnings to join those whose bodies have already been buried.

Step Nine (Forgiveness vs. Self-Condemnation)

We reveal to ourselves, God, and those we trust, all remaining suicidal or self-destructive wishes, and make a commitment to living.
We wish to expose and purge those negative forces within us which still may prevent us from making a complete commitment to life. Thus, after further self-evaluation, we reveal to ourselves, to God, and tho those whom we trust, all remaining suicidal wishes, and ask to be purged of the remaining, destructive, death forces which have ourselves and others. Then, we seek and accept God’s daily strength to make a daily commitment to living.

Step Ten (Forgiveness vs. Revenge)

We reveal to ourselves, God, and another person, all remaining wishes for revenge, and ask for God’s strength to give these up.
We seek and accept God’s strength to give up our wishes for revenge toward those who hurt us and injured or killed our friends and loved ones so we can learn the full meaning of love of God, of others, and of ourselves.

Step Eleven (Finding Purpose)

We seek knowledge and direction from God for a renewed purpose for our lives.
Having been freed from those burdens which have kept us from having meaningful and purposeful lives, we are ready to find a renewed purpose for our lives. Recognizing that God’s power also can be a source of strength to live, we will daily seek freedom from old burdens or new problems through prayer, meditation, and a daily surrender to God. In this way, we can continue to find daily freedom from the past prison of rage, guilty memories, and impacted grief, and gain a knowledge of His purpose for our lives and the endurance to carry it out.

Step Twelve (Loving and Helping Others)

Having experienced spiritual rebirth, we seek God’s strength to love others and to help those who suffer as we have.
Having had a spiritual awakening as a result of these steps, we seek to carry this message and to help all those who suffered as we have suffered.

Six Keys to Recovery:


1. Seek help from God, family, friends, and support groups.
Start by being willing to trust people again. Be selective - choose people and conversations that give guidance, and help to heal your wounds, to ease your fears, and to give you hope.

2. Accept personal responsibility for your life.
You cannot and need not change the past -- You can change what you do today.

3. Choose to forgive.
First, forgive yourself. Then one by one, forgive others. How? Here are some suggestions.


Say a prayer to specific people. Talk about your pain and then your desire to forgive.
Write a ghost letter to individuals - express your pain and then your desire to forgive.
Meditate and ask God to teach you how to forgive.
Read about forgiveness.
Write a Lesson about Forgiveness that could be presented in school.
Realize that your heart dictates your health. You must forgive in order to recover.
4. Grieve for those left behind.
There is a tremendous sense of loss and separation from life as it once was. All the rules are changed. As with any loss, a person needs time to accept and adjust to the emptiness and confusion. Crying never seems to bring relief. But it's a start. Anger, guilt, resentment, justification are all part of this process. You can say a prayer to all the things that are lost - and the people who were left behind. You can have a memorial ceremony to acknowledge and grieve for these dearly departed ones. You can write a letter to individuals to whom you wish to say "good-bye" -- speak of all unresolved issues and seal the letter. Bury it in the ground and place an ornament of some kind to mark the spot if you like.

5. Be willing to give up thoughts & feelings of revenge.
Your body, soul and mind have reached the limits of endurance. It is a vulnerable time for destructive, self-defeating thoughts and behaviors to kill you, since the trauma did not. Your choice is whether to give up, to wreak havoc, or to begin to heal. Any negative thoughts - thoughts of blame, guilt, anger, resentment, envy, hate, blood lust, or