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Can animals suffer from PTSD?

In the early hours of the last day of May, one of the hugest explosions ever to shake Afghanistan resounded across the capital city of Kabul. The impact of the tanker truck bombing, an insurgent attack that claimed more than 150 lives and injured at least 700 others, was felt several miles away. The explosion broke windows and cracked ceilings a mile and a half from the blast’s epicenter in a central area near embassies and the presidential palace. My house is located in that periphery, and I woke to the thunderous sound and the shaking of windows and walls. I was unhurt, and there was no lasting damage to my home, but the experience was difficult to get over. Although I have lived and worked as a journalist in Afghanistan for three years, I have found that one never gets used to violent conflict. But as strenuous as it was for me, it seemed to be even more so for my cat, Lola. About 20 minutes after the blast, I found her hiding in the bathroom, cowering behind the radiator. It took almost an hour of petting and hugs to calm her down. This was, after all, one of the biggest explosions Afghans had ever experienced — and that included Lola, who was a kitten when I found her in my garden the year before. For the next week, Lola seemed edgy. Small sounds would startle her, and she followed me everywhere. She would caterwaul when I left the house and be clingy when I returned. She was eating less and losing weight. It took me a while to realize she might not be only physically unwell. Could Lola, I wondered, have post-traumatic stress disorder? Lola looks out a window. (Chris Jones) She certainly wasn’t the first animal to be visibly shaken by one of Afghanistan’s violent attacks. Hannah Surowinski, the director of an animal shelter in Kabul called Nowzad, told me she frequently sees the sort of anxiety and stress that I was observing in Lola. “Like people, animals react to trauma in many different ways,” Surowinski said. “How it presents itself in that animal is individual to them,” The U.S. military has seen this reaction to stress in its working dogs. Its veterinarians say that about 5 percent of those that have served in Afghanistan and Iraq suffer from “canine PTSD,” which can make some dogs aggressive, timid or unable to do their jobs. The diagnosis, known as C-PTSD, is still debated among some in the veterinary field. But research on PTSD in animals is growing, said Stacy Lopresti-Goodman, an associate professor of psychology at Marymount University in Arlington, Va. She has studied the topic for much of the past decade, and she told me there is good reason to believe that Lola and other critters might respond to trauma in the same ways people do. “Given similarities in brain structures responsible for stress responses, animals exhibit symptoms which resemble those of PTSD in humans,” she explained. Lopresti-Goodman pointed to her own research on hundreds of chimpanzees used in biomedical research, about one-quarter of which displayed symptoms of PTSD for years after their retirement. Scholars have also documented PTSD symptoms in parrots that were captured in the wild, kept as pets and then abandoned. Others have detected such symptoms in African elephants. One 2013 study focused on complex, kin-based groups of elephants in two national parks in Kenya and South Africa that had witnessed “disruptive” events such as mass culling, poaching, translocation to other areas or captures of their species. Some, the researchers wrote, displayed behaviors similar to PTSD in humans. Much like in humans, though, symptoms of stress and anxiety in animals can differ for every animal — and, of course, the patients cannot describe them. But Lopresti-Goodman said they are observable reactions to events and objects that might remind the animal of the traumatizing event. Some animals might pace, weave their heads back and forth, bite themselves or even eat their own feces, she said. Other signs are self-calming techniques, such as excessive licking, rocking or hiding. So is what any pet owner might chalk up to depression — a loss of interest in socializing, eating or playing. Lopresti-Goodman recalled one chimpanzee named Poco, who lived at a chimpanzee sanctuary in Kenya, where she studied symptoms of PTSD in orphans of the bushmeat trade. Many of the sanctuary’s residents were captured as infants and later sold as pets may have witnessed their families being slaughtered for meat. Poco “was captured after his family was killed and kept in a tiny cage suspended from a ceiling for years,” Lopresti-Goodman said. Even decades after his rescue and relocation in 1995, Lopresti-Goodman said, he remains “easily startled, always on guard, often socially withdrawn, clasps himself and rocks, and can often be found poking himself with sharp thorns.” That wasn’t atypical, she said. Even after successfully integrating into a large social group in semi-natural habitat, some of the chimps still carried emotional scars from the trauma they suffered when they were young. The good news is that stress and anxiety disorders among animals can be treatable. Prescription medications, such as antidepressants or anti-anxiety drugs, are available for animals. But Lopresti-Goodman said she prefers an approach that prioritizes “reestablishing safe environments and trusting relationships.” Surowinski agreed. “In our experience, it helps if the animal is in a familiar territory with familiar faces,” she said, recalling one bombing directly outside Nowzad that sent the animals into a frenzy. “Thankfully, there were no casualties and our canine residents seemed relatively unperturbed by the event after the initial shock. The fact that they were in familiar territory with their own kennel that they could take shelter in was almost certainly a benefit.” Lola, the author’s cat, still seems nervous. (Ruchi Kumar) Many animals will turn to those self-soothing behaviors and other coping mechanisms, Lopresti-Goodman said, and it’s possible that some might become accustomed to loud noises if they become a regular occurrence — which, unfortunately, is the situation here in Kabul more than 15 years after the U.S. military intervention. Animalia newsletter Animals, people and the world they share. Sign up “We are constantly amazed by the resilience of Afghan animals and their ways of adapting to their surroundings, just like the people of Afghanistan,” Surowinski said. Lola, for her part, is doing better. My housemate and I no longer leave her alone for very long, and we’ve made sure to give her plenty of attention. But I do think she suffered from some form of post-traumatic stress. Weeks later, she still jumps at sounds as slight as the dropping of a spoon — and, of course, at the sound of gunfire. She no longer cries when we leave, but she won’t place a paw outside the front door even if it’s wide open — an impulse none of my previous cats could ever resist. She has also developed a habit of licking my hand after I’ve pet her. I believe that’s probably Lola’s way of soothing herself, so I let her do it. Ruchi Kumar is a freelance journalist in Kabul.

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Is it time to take a sick day for mental health?

A few weeks ago, Madalyn Parker messaged her team at work to tell them she was taking a couple of sick days for mental health reasons. "I'm taking today and tomorrow to focus on my mental health. Hopefully I'll be back next week refreshed and back to 100%," she wrote. Parker, 26, is a web developer for Olark, in Ann Arbor, Michigan. She has been open about her experience struggling with anxiety and depression that hasn't always responded to medication. When the company CEO, Ben Congleton, read her note, he sent a supportive reply back. "Hey Madalyn, I just wanted to personally thank you for sending emails like this. Every time you do, I use it as a reminder of the importance of using sick days for mental health – I can't believe this is not standard practice at all organizations. You are an example to us all, and help cut through the stigma so we can all bring our whole selves to work," he wrote. View image on Twitter View image on Twitter Follow madalyn @madalynrose When the CEO responds to your out of the office email about taking sick leave for mental health and reaffirms your decision. ?? 4:29 PM - 30 Jun 2017 15,948 15,948 Retweets 44,527 44,527 likes Twitter Ads info and privacy Parker said it really moved her. "When I saw his response and I read it, it brought tears to my eyes," Parker told CBS News. Parker has been with Olark since 2014 — her first and only job since graduating from college — and said she counts her blessings that she works for a company that's good to her and colleagues in this way. "Whenever you're in a marginalized group, you need that person in a position of privilege to amplify your voice and he does this," Parker said of Congleton. "This huge response blew us all away," said Parker, who posted a copy of his note on Twitter last week, with his permission. Tens of thousands of people have liked and commented on the viral post, with remarks ranging from support for Parker's honesty with her coworkers to kudos to her boss and the company as a whole for placing mental health issues on par with physical health problems. Clare Miller, director of the partnership for workplace mental health at the American Psychiatric Association Foundation, told CBS News, "We know from literature that there is a huge amount of calling in sick because of mental health issues." Royal family opens up about grappling with mental health issues Play VIDEO Royal family opens up about grappling with mental health issues Many of those sick days are due to depression, Miller said. But it's not clear how many people are doing what Parker did and actually saying that's why they're taking a sick day. In most cases it's likely they just give a vague "I don't feel well" explanation. One man tweeted back to Parker's post that he'd been fired for calling in sick for mental health reasons. Others expressed fear that their jobs would be on the line if they shared a mental health diagnosis with a boss or colleagues. Even Parker had been warned against opening up about it. "A big problem we have to talk about with this issue are the number of people who go to work but aren't fully productive because of mental illness. There are $78.6 billion in costs associated with that for depression alone," said Miller. While many employers still have a long way to go, the landscape is changing in American workplaces when it comes to toppling the stigma of mental health, said Miller. How companies can help "Employers are interested in mental health in a way I've never seen before. I've been here a long time and I'm seeing the conversation opening up a lot," said Miller, who helps companies create programs that support their employees who have conditions such as depression, anxiety, bipolar disorder, schizophrenia, addiction and PTSD. "We have a mix of things. We encourage employers to think of mental health in a variety of ways, including having good health care coverage — to use their power as purchasers to push [health insurers] for quality care and ask plans to implement things like collaborative care," she said. Uncharted: Episode 1 - The Road Ahead Play VIDEO Uncharted: Episode 1 - The Road Ahead In Parker's case, Olark uses a third-party company to help employees pick their health insurance plans. "They have tons and tons of options. I picked one that would be accepted anywhere across the country," said Parker, who was hospitalized, received counseling and required prescription medicine last year for depression. "Out of pocket, I paid less than $1,000 dollars last year," she said. Miller said a program called "Right Direction" that's focuses on depression awareness is popular. "It takes a creative approach, it's not your typical mental health campaign. When you have depression you can feel lost and alone in the woods, so we have this woodsy theme. It encourages employees to take the first step," she said. About 100 employers — large and small — currently use the program, including Kent State University, and Puget Sound Energy. The hidden reasons behind job burnout The American Psychiatric Association also offers companies a short video, developed by DuPont, that teaches employees about emotional distress and encourages them to reach out to one another. "To ask, 'Hey are you OK, can I do anything to help?' It gives permission for employees to talk with each other," said Miller. Ninety percent of employers have an employee assistance program that can help people with mental health issues — even things like free legal assistance for employees with addiction issues who have gotten into trouble, and free limited counseling sessions. Charles Lattarulo, the head of American Express' Healthy Minds program, says they're very invested in employee mental health. America's most sleep-deprived workers 27 PHOTOS America's most sleep-deprived workers "Our global mental health strategy is the belief that we can reduce stigma, that we can make this a safe place to have a mental illness. We embed mental health into the fabric of our culture," said Lattarulo. Employees in 35 countries around the globe have access to help. "There are three key things we want people to know: Mental health issues are common, mental health issues are treatable — over 80 percent get better with treatment — and we have the resources to help them," Lattarulo told CBS News. One campaign that a lot of employees embraced was called #IWillListen. It encouraged employees to listen to each other and support each other through mental health challenges. Employees who wanted to participate could wear bracelets emblazoned with "I will listen." "Employees could also make short videos in which they shared their personal story, and we kept streaming them over our intranet. They could just say, 'I am [name here] and I will listen,' or they could share their experiences," said Lattarulo. "It was an incredibly proud moment one morning when I was on the elevator and saw a half a dozen people wearing "I will listen" bracelets," he said. The company also has a 24/7 phone number employees can call to speak to a counselor, or they can submit an online request for a call back. And they get the company's top leaders involved — some have spoken about mental health awareness at meetings. Executives have also been offered meditation sessions to reduce stress. Workers on the autism spectrum, people dealing with substance abuse, those who have a parent with dementia, families who are relocated for work, and couples struggling with marriage difficulties are just some of the types of employees who've taken advantage of the support, Lattarulo said. "We believe in treating our employees the way we treat our customers," he said. Unconventional accommodations Puget Sound Energy, a much smaller company with only a few thousand employees, is another employer prioritizing its workers mental health. "The company's disability accommodation program includes cognitive and behavioral disabilities. If somebody is having issues and starting to have limitations based on that kind of problem, we find out their limitations and work with them," said Jenny Haykin, who manages the company's integrated leaves and accommodations program. How does your diet impact mental health? Play VIDEO How does your diet impact mental health? "Addiction, depression, schizophrenia, anxiety. We have a combination of things we can do to make sure employees with these issues are getting the treatment they need, but also accommodating the worksite to help them," Haykin told CBS News. One employee who suffered from depression asked Haykin if she could bring her dog in to help her mood. "We have dark, rainy winters here and she wanted a comfort animal," said Haykin, from the company's headquarters in Bellevue, Washington. While they OK animals in some cases, Haykin found "a more effective" solution, a light box for the employee, and encouraged her to connect with her doctor to be sure she was getting enough of certain vitamins. "She started feeling better," Haykin said. When one pregnant employee who was told she should go on bed rest was worried about missing work, Haykin had a recliner shipped in so that she could do her job at the office but still follow doctor's orders. Another employee who began to experience manic episodes was frightening other colleagues, so while the company helped the employee get the proper care, they also educated the ill employee's worried colleagues about the condition to help reduce stigma and fear. Worst sick day excuses 27 PHOTOS Worst sick day excuses "We have 3,000 employees. In the last nine years, we've had 1,000 people engage in health and mental health services," Haykin said. When working isn't working Many workers don't have that kind of support, though. A 2016 Work and Well-being survey of 1,501 workers by the American Psychological Association revealed that less than half thought their company supported employee well-being. One in 3 said they felt chronically stressed on the job. In a follow-up blog post, Parker's boss commented on the viral tweet and how mental health is still a bad word on the job. "It's 2017. I cannot believe that it is still controversial to speak about mental health in the workplace when 1 in 6 Americans are medicated for mental health," Congleton wrote. Parker knows many employees may feel it's taking a big risk to speak up about mental health at work — some of the responses to her tweet revealed that. She was hesitant to share her situation at first, too. "I definitely played up my perkiness and put on my best self at the interview. I did well on the job, and then my meds stopped working," she said. When she first talked with one of her bosses about her condition, it was at a conference. "I pulled him aside and said this is what I deal with. I like my job, I'm not lazy, I care about the work," she said. And he responded with compassion. "He didn't say anything about my performance. He said, I wonder who else at the company feels like you do. We need to talk with them and tell them to take care of their health. I was blown away by that," said Parker.

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Pain Management and Opioid Use with Veterans and Service Members

Military service brings a risk for serious injury, and with it, the possibility of severe or chronic pain. Such pain may be treated with prescription medication – sometimes opioids – which carry a risk for overuse or misuse. SAMHSA has been working with the U.S. Department of Defense (DoD) and the U.S. Department of Veterans Affairs (VA) to enhance informed prescribing practices and prevent misuse that can result in overdose or even death. Controlling Pain Injuries incurred during military service can be complex and the management of chronic pain requires attention. According to Friedhelm Sandbrink, M.D., VA’s Acting National Program Director for Pain Management, up to 75 percent of older veterans experience chronic pain. Prevalence of severe pain is strikingly more common in veterans than in the general population, particularly in younger veterans and in veterans who served during recent conflicts. Complicating matters even more are co-occurring disorders experienced by veterans, such as posttraumatic stress disorder and traumatic brain injury, for which additional psychotropic medications may be prescribed. Medication interaction is an important consideration. “The challenge for those prescribing medications in the military and in the VA is to find the right balance to get the pain under control and to keep the patient safe,” said Dr. Sandbrink. “We want to ensure that patients are finding relief and taking medications as prescribed, and that we are aware of other sedating medications or alcohol use that could increase the risk of overdose.” He added, “in order to find the right balance, we nowadays rely less on medication and make much greater use of other approaches, including behavioral therapies, physical therapy and integrative health modalities, and emphasize physical and mental function.” Providers outside the military systems and VA are accessed by more than half of those who serve, so they also need to be aware of population-specific guidance for veterans and service members. This is particularly true for members of the National Guard and Reserve, whose home communities may not include military supports. The High Risk Of Relapse – For individuals in recovery from a substance use disorder who relapse, the risk of overdose is greatest. Tolerance of a drug during sobriety decreases, so if a person resumes at the same dosage as before recovery, that use can be lethal. For this reason, it is important to educate family members on the possibilities of misuse and how to respond. The DoD currently has a pilot project called Building Healthy Military Communities that addresses the unique needs of geographically dispersed service members and their families that may affect readiness, resiliency, and wellbeing. SAMHSA also supports this work to address the mental health needs of service members and their families in communities throughout the U.S. Interagency Task Force The DoD, VA, and HHS participate in the Interagency Task Force on Military and Veterans Mental Health, created in 2013 to ensure that veterans, service members, and their families can access the services and supports that they need. SAMHSA represents the U.S. Department of Health and Human Services on this Task Force. Through this partnership, SAMHSA provides a number of resources to DoD and VA providers, including: Online trainings and webinars, including medication-assisted treatment training, that not only educate prescribing professionals, but also family members who might need to administer medication if overdose occurs. SAMHSA review of Management of Substance Use Disorder and Management of Opioid Therapy for Chronic Pain Clinical Practice Guidelines and the subsequent development of new areas, including: patient-centered care, substance use disorder and co-occurring conditions, engagement strategies, addiction-focused medical management, accreditation standards, shared decision-making, and management of substance use disorders in DoD healthcare settings. The Service Members, Veterans, and their Families Technical Assistance Center (SMVF TA) that provides technical assistance to states and territories and offers policy academies, where all three departments work together to determine ways to strengthen behavioral health supports at the state level. Video modules on safe opioid prescribing practices. SMVF TA Center Logo Screening, brief intervention, and referral to treatment (SBIRT) training to recognize and mobilize if someone may be at risk for or have a substance use disorder. MAT-X mobile app to support medication assisted treatment of opioid use disorder. SAMHSA and Veterans Affairs in Action Dr. Karen Drexler, M.D., the National Mental Health Program Director for Substance Use Disorders in the VA, explained that, “SAMHSA resources and trainings are excellent. We are currently using many SAMHSA resources such as the PCSS-MAT and PCSS-O to educate Veterans, their families and clinicians about the best approaches to care.” SAMHSA has been instrumental in training the prescribing workforce in the military to limit the length of opioid and other pain medication use, recognize the signs of misuse, be aware of treatment options, and understand DEA waivers to prescribe Buprenorphine (medication-assisted treatment to help people reduce or quit their use of opiates, such as pain relievers like morphine). SAMHSA uses evidence-based practices to develop these trainings that have substantially reduced dosages to stay within the recommended ranges and have encouraged providers to limit opioid use to three months. “SAMHSA’s contribution on the Task Force has led to some specific advancements that support military service members, veterans, and their families,” said Cicely Burrows-McElwain, SAMHSA’s Military and Veteran Affairs Liaison. “In addition to reviewing the clinical practice guidelines, SAMHSA also worked with the other agencies to relay and report prescription drug information to Prescription Drug Monitoring Programs which helps to prevent over prescribing and overmedicating.” The VA also worked to eliminate the co-pay on drugs like naloxone that are used if someone overdoses, making it much more accessible to patients and their families. Dr. Drexler’s experience with SAMHSA’s trainings and work on the Task Force has changed the way she thinks about treatment. She explained that she had a patient with multiple medical problems that increase the risk for overdose such as sleep apnea and emphysema who was stable on medication-assisted treatment for opioid use disorder, but life stressors led him to relapse to benzodiazepine use. “Every time he came in, he was intoxicated, so we couldn’t have a meaningful discussion about treatment and I was especially concerned about overdose because he lived alone.” The SAMHSA training encourages providers to think creatively about care and who to involve in overdose prevention and education. As a result, Dr. Drexler reached out to her patient’s sister and shared information learned in the SAMHSA training and prescribed a naloxone rescue kit. Educating his sister helped her to assist in limiting his access to illicit pills. “My very next visit with him, he was alert, and I was able to have a meaningful talk with him about recovery and safety.” “The federal coordination made it possible to look at risks and safety concerns across an entire spectrum of federal efforts,” said A. Kathryn Power, M.A., Executive Lead for SAMHSA on the Interagency Task Force. “The coordination, weekly communication, and measured positive outcomes all point to better care for military service members and veterans. That has been, and continues to be, our driving force.” Although advancements have been made to better equip treatment providers with information and training to prevent circumstances that could lead to addiction, opioid misuse continues to be a serious public health concern. Providers in the DoD and VA continue their efforts to address pain and limit opioid use, while discussing potential associated risks with military service members, veterans, and their families. SAMHSA’s work with the Task Force, and work done to support states across the country through the SMVF TA Center, will ensure that the support, resources, and training to improve care and prevent substance use disorders is accessible no matter where military service members and veterans go for care.

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How Does Stress Affect You

Common responses to stress are listed below. Think about how stress affects you. Aches and Pains* Headache Backache Neck ache Stomach ache Tight muscles Clenched jaw Energy Level and Sleep* Feeling tired without a good reason Trouble sleeping Feelings Anxiety Anger Depression Helplessness Out of control Tense Other Emotional Signs Easily irritated Impatient Forgetful *Some physical signs of stress may be caused by a medical condition or by medicines you take. If you aren't sure what's causing your physical symptoms, ask your doctor if stress might be the cause. How Do You Respond? When you are under stress, do any of these behaviors apply to you? I eat to calm down. I speak and eat very fast. I drink alcohol or smoke to calm down. I rush around but do not get much done. I work too much. I delay doing the things I need to do. I sleep too little, too much or both. I slow down. I try to do too many things at once. Engaging in even one of these behaviors may mean that you are not dealing with stress as well as you could. Learn some ways you can fight stress with healthy habits. What's the link between stress and heart disease? Does chronic stress cause high blood pressure? Find out the answers to these and other questions with our FAQs About Stress.

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Dr. Streich earned her M.A. degrees and Ph.D. degree in Clinical Psychology from Adelphi University, Derner Institute of Advanced Psychological Studies. She completed her doctoral training in Clinical and Neuropsychology at the Rusk Institute of Rehabilitation Medicine, New York University Medical Center in Manhattan. Subsequent to her clinical residency, Dr. Streich completed a postdoctoral fellowship in Clinical Neuropsychology at a private practice in New York. Dr. Streich was most recently the Director of Counseling and Psychological Services at a local university for seven years and also taught undergraduate classes in Psychology. Prior to that appointment, she managed the Outpatient Substance Abuse Programs for adults and adolescents at CarePoint Health in Hoboken. Dr. Streich has done extensive work providing management on employee performance and behavior and executive coaching through her work in the Employee Assistance Program (EAP) at Hoboken University Medical Center (HUMC). During her doctoral training, Dr. Streich was appointed the position of World Trade Center Coordinator in Northern New Jersey and worked in this role for five years. During that time, she managed the September 11th project, Project Phoenix, funded by SAMHSA & FEMA. Dr. Streich provided trainings in Crisis Management to emergency responders in Hudson County and outpatient services to the Northern Hudson County community. Prior to becoming a Clinical Psychologist, Dr. Streich worked in the advertising business for ten years and her undergraduate degrees are in Advertising Communications (Associate of Applied Science) and Marketing Communications (Bachelor of Science). During that time, she worked for Mediavest, Media Planning & Buying Division of DMB&B, formerly known as Benton & Bowles. In that role, Dr. Streich directed the test marketing division for Procter & Gamble (P&G) and Burger King Corp. Dr. Streich has many years of experience in the corporate world. Dr Streich proudly serves our Veterans wtihin the tri-state area and administers compensation and pension evaluations for those who have suffered from posttraumatic stress disorder, psychiatric and mood disorders, and, traumatic brain injuries. Clinical interests include trauma, post-traumatic stress disorders, anxiety and depression, affective disorders, substance related issues, learning disabilities, relationship and interpersonal issues, disease management and couples and family counseling. Dr. Streich is a board member of the Professional Advisory Board for the Epilepsy Foundation of Northeastern New York. Dr. Streich is licensed in the states of New Jersey (#4852) and New York (#019068).

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