Managing Traumatic Stress and Combat PTSD Through The R-E-C-O-V-E-R Approach*
CREATING A CARE PLAN: STEP ONE
Step One: Begin With Self-Inventory:
(Self-Inventory Forms May Be Found On This Site. Click "Online Resources"
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APPOINTING THE BEST OFFICER TO LEAD THE RECOVERY MISSION: YOURSELF. In a previous article about the creation of comprehensive care plans, I have encouraged you not to simply embrace the suck and be satisfied. I want you to see your issues in new light - AS SUBJECT TO CHANGE. I also want you to appoint the best possible person to begin organizing your careplan, which is yourself. YOU are competent and capable to begin changing your life TODAY, if you know the steps to take. You can begin by realizing that you are unique, and that you are the only one who can provide your doctor with accurate information about what your issues are. If you go to your provider already prepared with a comprehensive description of what is going on in your life, you can save yourself a great deal of time , speed up the process of your treatment, and command your doctor's respect as a well-informed consumer of care. The best way to do this is to invest some time and effort in preparing a self-inventory. (Note: this process isnot suitable for someone engaged in substance abuse, or experiencing psychiatric emergency, or who is suicidal. Those conditions require IMMEDIATE referral to the emergency department of a hospital. If those conditions do not apply to you, then read on…)
A self inventory is like a series of "snapshots" of your life, taken daily over a period of days or weeks. If you have PTSD, Dr. Croft and I recommend that you engage in the daily process of self inventory for two to four weeks before beginning a treatment plan. This process will only take about 15 minutes a day, and will provide your doctor with vital information. Even more importantly, it will provide YOU, yourself, with vital insights that you did not have before about what is "driving your train."
A self inventory is not the same thing as diagnosis. S Only your doctor or provider is able to engage in diagnosis. However, diagnosis must be based on information that only you can provide to your doctor. Self-inventory will give you 3 kinds of information to accomplish that goal. These three kinds of information are needed so that:
● Your provider can give you proper MEDICAL CARE; and
● You can provide important forms of SELF CARE
Three goals of self inventory:
1. A daily summary of your biological /physiological status : This is a diary that can tell a great deal about how your body is working. Remember: PTSD has a biological root. You can help your doctor determine how your own, unique PTSD is rooted in your body, by creating a DAILY record of certain important functions. Many mistakes in diagnosis or medication are committed, unintentionally, because a doctor has been required to make a "snap judgment" about a patient, assuming that the way the patient presents on the day of an examination or appointment is the way he/she ALWAYS feels. But this is rarely true. Our physical condition, and our physical functions, may vary from day to day. It is critical that you be able to make a record of these things on a daily basis, so that you can identify trends in your condition. This will tell you and your doctor where to focus your attention FIRST. Often, simply attending to these biological issues (such as sleep, diet, hydration, blood pressure and heartrate) may help greatly reduce psychological symptoms of PTSD, and make further treatment easier or even unnecessary. Specific forms and instructions are found in the Online Resource tab of this site.
2. A daily summary of your state of mind and thinking processes: This means that you have kept a daily record of your own observations of things such as: your ability to concentrate or "hold onto" your thinking process; your ability to remember conversations/instructions/tasks and whether you feel "linked in" or "checked out" of your interactions with others. These are signs of how your brain is working. This is VERY critical information. Often, alterations in our state of mind may be created by things such as sleep deprivation, dehydration, or diet. If you inventory your biological status (#1), and your state of mind and thinking processes (#2), your doctor can put the two together to determine if one has something to do with the other. Specific forms and instructions are found in the Online Resource tab of this site.
3. A daily summary of your psychological processes: This is a daily summary of how your mind is processing and perceiving things. You will be able to gather a great deal of helpful information by keeping a brief daily diary of (l) the major activities you have done each day, (2) whether they were easy or difficult, (3) whether you found yourself unable to complete an activity or task, and what interfered with it (such as an argument, a flashback, or a feeling of unsafety). It is also where you can record whether you had any post traumatic stress reactions, (such as feelings of dread / rapid heartrate / extreme anxiety / fear / desire to escape from a situation, etc.), and where you were when these feelings came over you. Comparing your activity list to your list of unpleasant feelings can help you identify where your strengths are so that you can emphasize them, and where you are more vulnerable to stress reactions, so that you can work on those issues and begin to manage them. It can also help you determine whether certain environments or activities are more likely to lead to your experiencing a negative feeling. With this information in hand, you will be able to begin the process of determining what specific "triggers" are present in those environments or activities. Once you know what your "triggers" are, you can do a lot to manage them, and make progress controlling your traumatic stress reactions.
The Results Of Self Inventory: In summary, a self -inventory creates a picture of how your body, brain and mind are working, over a period of time. It will result in several advantages for you. First, it is likely to be much more accurate than a history taken from you in your doctor's office because it will describe how you function over many days, instead of just one. It will include many details that you could never hope to remember while sitting in the doctor's office. Second, Using the information that you gain from the self inventory, in combination with the information which we provide you in "I Always Sit With My Back To The Wall", you will become equipped to not only create a plan for your professional care, but also to begin rendering important forms of self care. You will also enable yourself to point your doctor toward certain problem areas so that they can be more easily corrected. Third, you (and your family) will gain a greater understanding about which steps to take first in managing your illness, because you will see the problem more clearly. And… just think… all these advantages come to you for free.
Engaging In Self Assessment: Self assessment is part two of from self inventory, but is somewhat different. A self inventory is conducted every day, over a period of days. By contrast, self assessment is "two snapshots", with the first being taken at the beginning of your self inventory period and the second being taken at the end, just before you visit your provider. A "self assessment" is just what the name implies. It means that you take the same "checklist" that your doctor or provider would administer to you, and you administer it to yourself. This uses the PTSD Checklist, which you will find in the Online Resources Section of this website.
Why is it a good idea to administer the PTSD checklist to yourself? Well, there are several reasons.
1. You will feel less anxious if you go through the checklist in the comfort and emotional safety of your home, and then bring the form into the doctor's ofice. Many people feel threatened when the checklist gets stuck on a clipboard and thrust at them in a doctor's office.
2. Because a doctor's office or clinic environment may make you nervous, you may be tempted to "cheat" on the checklist, just so that you can leave the office. This is NEVER helpful. Doing the checklist at home makes you more likely to be honest.
3. Having a loved one or spouse also do the checklist will help you to find out if your family sees things about your situation that you, yourself, may not see. This can be very helpful in recognizing, and solving, problems and issues.
4. Doing the checklist at home, before you do the self-inventory and after, will help you see the amount of self-knowledge and insight you had before the process, in comparison to the self-knowledge and insight you have after completing it.
SUMMARY: Creating a comprehensive plan of care for your PTSD involves several steps. Self inventoryingyour situation is the first step. You can take this very important step, without even "stepping" outside your house ! And you can accomplish it without feeling you have been questioned or interrogated by someone else. The only requirement is that you be honest with yourself, and consistent in performing the simple steps of self inventory and self assessment.
The results of your self inventory and self assessment can help you take the next step in creating a care plan: deciding what kind of care you want and need to pursue, and what kind of provider you need to seek it from.
"Stay tuned" to this site, where you will find future articles explaining different kinds of care for PTSD, different types of providers and their functions, different types of medications, and various formats of therapy available.
As always, we recommend that for more information, you read Chapter 4 of "I Always Sit With My Back To The Wall", either in print or in the audio version available on this site.
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