MIRECC Presents Archive

MIRECC Presents Archive

April 17, 2024: Population-based Screening for Suicide Risk: Promises and Limitations
Steve Dobscha, MD

Purpose Statement: Reducing death by suicide is among the highest priorities for VA mental health care. How and when clinicians assess suicide risk can have an impact on patient willingness to engage in treatment. This seminar will review evidence-based strategies for screening for suicide risk and provide recommendations for clinical practice.

Learning Objectives

1. Review key elements of the evidence base supporting population-based screening for suicide risk.
2. Describe overall benefits and limitations of suicide risk screening
3. Identify “best practices” for screening for suicide risk and apply to one’s practice

April 3, 2024: Predictors of PTSD treatment utilization and optimizing treatment for those at risk of poor outcome 
Rebecca Sripada, PhD

Purpose Statement: Clinical practice guidelines for PTSD provide recommendations for enrolling patients in evidence-based psychotherapy (EBP). Unfortunately, uptake and engagement in EBPs for PTSD remain low and strategies are needed to optimize treatment outcomes. This seminar will provide contemporary data about factors that predict who will engage in and those most likely to experience a sub-optimal response from treatment. The focus of the seminar will be on optimizing strategies to enhance successful participation in treatment for PTSD.

Learning Objectives:

1. Understand who is likely to receive evidence-based treatment in VA
2. Understand who is likely to complete an adequate dose of evidence-based treatment
3. Describe the factors that put Veterans at risk of suboptimal response to evidence-based treatment

March 20, 2024: The ongoing legacy of COVID: Relationships between COVID-19 infection, prior history of traumatic stress, and the risk of long term symptoms (aka Long COVID)
Rebecca Hendrickson, PhD

Purpose Statement: The purpose of this continuing education lecture is to explore the relationships between COVID-19 infection, a history of traumatic stress, and the heightened risk of experiencing long-term symptoms. Emerging research findings will be discussed to provide healthcare professionals with a comprehensive understanding of how past traumatic experiences may intersect with COVID-19 infection to exacerbate the likelihood and severity of persistent symptoms. Attendees will learn strategies for addressing the overlap between persistent physical symptoms related to PTSD and COVID-19.

Learning Objectives:

1. Understand the potential common underlying mechanisms by which traumatic stress and physiologic stress may both cause lasting changes in physiology.
2. Understand the potential for a history of traumatic stress to increase the risk of persistent symptoms after a subsequent stressor
3. Feel comfortable talking about the potential overlap between persistent physical symptoms related to PTSD and physical symptoms related to COVID-19 infection in a way that is validating of patients experiences, and recognizes the complex interplay between central and peripheral stress-response systems.

March 6, 2024: Adapting and pilot testing a family-involved intervention to increase initiation and completion of evidence-based psychotherapy for PTSD
Megan Shepherd-Banigan, PhD

Purpose Statement: Evidence-based psychotherapies (EBPs) for PTSD are highly effective, yet uptake and adherence to these interventions is low. Incorporating family into PTSD treatment may be one strategy to improve engagement and treatment completion. This seminar will describe the process of adapting a behavioral intervention to include family members in PTSD treatment and provide early results from this intervention. This session will provide clinicians with strategies to effectively implement family-involved interventions for PTSD, ultimately with the goal of improving outcomes for veterans with PTSD.

Learning Objectives:

1. To state the potential importance of family involvement in Veteran mental health care.
2. To describe the process of adapting a behavioral intervention to test in a clinical setting.
3. To consider the advantages and disadvantages to family involved interventions for Veterans with PTSD

February 21, 2024: Racism, Systemic Oppression, and Health Disparities: How to engage in effective allyship and build anti-racist practice
Sarah Súñiga, PhD
Malinda Trujillo, PhD

Purpose Statement: As a healthcare provider, it is imperative we understand how systemic oppression manifests as health disparities and our role in maintaining these disparities. Being an effective ally and engaging in anti-racism requires significant self-reflection, vulnerability, humility, equity, and familiarity with power and privilege. During this seminar, the speakers will explore and define racism, race-based trauma, systemic oppression, and health disparities. The session will explore steps and skills for becoming an effective and conscious ally as a healthcare provider, as well as anti-racism skills and resources.

Course Learning Objectives:

1. Define racism, race based trauma, and systemic oppression and their impact on veterans of color.
2. Define health disparities and their impact on veterans of color.
3. Identify skills and resources for becoming an ally within healthcare systems.

 

January 17, 2024: CogSMART / Compensatory Cognitive Training for Veterans with Mental Health Conditions
Elizabeth W Twamley, PhD

Purpose Statement: Compensatory Cognitive Training (CCT) is an evidence-based treatment designed to improve cognitive functioning and quality of life for Veterans who experienced mild traumatic brain injury (mTBI). Emerging data suggest CCT may also improve cognitive functioning among veterans with PTSD and other mental health conditions. This lecture will provide an overview of compensatory and restorative interventions to improve cognitive functioning in people with psychiatric disorders, mild TBI history, and mild cognitive impairment related to aging.

Course Learning Objectives:

1. Describe compensatory and restorative interventions to improve cognition in people with psychiatric disorders.
2. List domains of cognitive functioning targeted in Compensatory Cognitive Training.
3. Describe how to link cognitive strategies with individual rehabilitation goals.

December 20, 2023: Women veterans at acute risk for suicide: Care needs and preferences
Lauren Denneson, PhD

Purpose Statement: There are gender differences in the acute care needs of veterans at risk of suicide, though little empirical information is available to guide care. The purpose of this lecture is to review the care needs of women veterans at acute risk of suicide. Participants will gain insights and strategies for customizing mental health treatment to enhance intervention effectiveness. The lecture will address gender-specific risk factors, enabling clinicians to recognize and navigate challenges unique to gender. Additionally, participants will understand the dynamic nature of risk and resilience over time, examining how these factors evolve in both women and men experiencing acute suicide risk.

Course Learning Objectives:

1. Describe the stated care preferences of women veterans at acute risk of suicide
2. List risk factors for suicide that are more common among acute-risk women than men
3. Describe how risk and resilience changes over time in acute-risk women and men

December 6, 2023: Barriers to the Use of Medications for Opioid Use Disorder and How to Overcome Them
Jessica Wyse, PhD

Purpose Statement: Opioid use disorder (OUD) remains a crisis in the United States and among veterans treated in Veterans Health Administration (VHA). For those with OUD, receipt of medications for opioid use disorder (MOUD) is associated with substantial improvements in morbidity and mortality. Unfortunately, many patients with OUD do not receive treatment and those who do often discontinue MOUD at high rates. This seminar will provide contemporary data about the multifaceted barriers that hinder engagement and retention in treatment for OUD. Through a critical examination of the social, systemic, and individual impediments, this lecture will provide healthcare professionals with a comprehensive understanding of OUD treatment challenges and provide evidence-based strategies designed to bolster treatment engagement and retention.

Course Learning Objectives:

1. Understand the benefits of medications for the treatment of opioid use disorder
2. Define barriers to engagement and retention in treatment for opioid use disorder
3. Identify strategies to improve opioid use disorder treatment engagement

November 15, 2023: Who to, when to, and how to address Obstructive Sleep Apnea (OSA) among Veterans: Strategies for mental health clinicians
Yeilim Cho, MD

Purpose Statement: Obstructive sleep apnea (OSA) occurs in one-third to one-half of veterans with mental health conditions. This seminar will provide mental health clinicians with a comprehensive understanding of OSA and its clinical implications. During this session, participants will gain insights into the epidemiology, risk factors, and clinical manifestations of OSA, enabling them to identify and assess OSA in their clients. This will emphasize the bidirectional relationship between OSA and conditions such as depression, anxiety, and cognitive impairments. By equipping mental health professionals with the knowledge and tools to diagnose and treat OSA, this lecture aims to enhance the overall well-being and treatment outcomes of their patients.

Course Learning Objectives:

1. Understand the high prevalence of sleep-disordered breathing in Veteran
2. Understand whom and when to treat OSA in Veteran
3. Understand current challenges and strategies in treating OSA in Veteran

November 1, 2023: Cultural aspects of PTSD assessment and treatment
James Boehnlein, MD

Purpose Statement: By identifying and reviewing the influence of cultural factors on the experience, expression, and recovery from PTSD, this session seeks to empower mental health clinicians with culturally sensitive and informed strategies for assessment and treatment. Through a review of diverse cultural perspectives and coping mechanisms, attendees will acquire the knowledge and skills needed to conduct more effective assessments, develop tailored treatment plans, and foster trustful therapeutic alliances with veterans and refugees. This lecture aims to enhance the cultural competence of mental health practitioners, promoting more inclusive and culturally responsive approaches to PTSD care.

Course Learning Objectives:

1. List the most important elements of a comprehensive cultural formulation
2. Identify the role of culture in PTSD clinical assessment among diverse populations, including refugees and Veterans
3. Discuss how culture influences PTSD treatment and outcomes

October 18, 2023: Addressing loneliness and social disconnectedness as a transdiagnostic risk factor
Lisham Ashrafioun, PhD

Purpose Statement: This lecture will explore the impact of loneliness and social disconnection as transdiagnostic risk factors for mental health impairment. By examining the pervasive impact of these psychosocial risk factors across various mental health conditions, this session aims to equip clinicians with a comprehensive understanding of the relationship between loneliness, social isolation, and mental well-being. This lecture will provide contemporary data on behavioral interventions and practical strategies to equip attendees with the skills necessary to identify, address, and mitigate the adverse effects of loneliness, ultimately fostering more effective approaches to mental health care.

Course Learning Objectives:
1.    Define loneliness and social isolation
2.    Understand the relationship between loneliness and behavioral and physical health conditions
3.    Identify cognitive-behavioral approaches of addressing loneliness

 

October 4, 2023: Neuropsychiatric aspects of Long COVID
Jordan Anderson, DO

Purpose Statement: Those who have been infected with COVD-19 can experience long-term effects from their infection, known as Long COVID. The purpose of this lecture is to provide mental health clinicians with a specialized and comprehensive understanding of the neuropsychiatric aspects of Long COVID. By focusing on the intersection of mental health and neurology in the context of post-acute COVD-19 syndrome, this presentation aims to equip attendees with the knowledge and tools necessary to assess and effectively treat the unique neuropsychiatric challenges experienced by individuals with Long COVID.

Course Learning Objectives:

1. Review common neuropsychiatric symptoms of Long COVID
2. Identify comorbidities of Long COVID and their impact on treatment
3. Discuss management strategies for Long COVID care

 

May 17, 2023: PTSD at End of Life: Presentations and Approaches to Alleviating Distress
Zachary Sager, MD

Purpose Statement: As with other mental health conditions, PTSD may present differently at the end of life, and may co-exist with other conditions. This presentation will describe various ways that PTSD may present clinically later in life, and it will discuss approaches to alleviating distress for Veterans with late-life PTSD.

Course Learning Objectives:

1. Identify various ways in which PTSD may present differently at end of life compared to other points in a Veteran’s life course.
2. Describe how PTSD may overlap with other forms of distress at end of life.
3. Discuss approaches to addressing PTSD-related distress at end of life.

 

May 3, 2023: Unique Readjustment Concerns for Newly Separated Women Veterans
Dawne Vogt, PhD
Tara Galovski, PhD

Purpose Statement: The initial period after military discharge is a vulnerable time for veterans and may be particularly challenging for women veterans, who have been found to have worse post-military readjustment outcomes in prior research. This current study drew from a nationally representative sample of participants from the Veterans Metrics Initiative (TVMI) Study to examine the extent to which women veterans experience unique readjustment challenges during the first three years after leaving military service. In this presentation, Dr. Vogt will describe findings of this study, after which Dr. Galovski will discuss clinical implications of study findings for the social support that is available to women veterans during their transition from military service to civilian life.

Course Learning Objectives:
1. Identify areas of health and well-being that reflect unique concern for women Veterans after leaving military service.
2. Describe how women Veterans’ health and well-being changes over the first three years after military service.
3. Describe the role of social support in improving Veterans’ transition experiences.

 

April 19, 2023: Veterans Justice Programs: Program Overview and Early Intervention and Prevention Strategies
Matt Stimmel, PhD
Katharine Stewart, MSW, LCSW

Purpose Statement: Mental health conditions can contribute to Veteran encounters with the criminal justice system, and there can be multiple challenges for Veterans related to those encounters. This presentation will describe for clinicians some of these challenges, and discuss various resources, such as Veterans Justice Programs, that are available to assist Veterans in navigating the criminal justice system.

Course Learning Objectives:
1. Identify key concepts related to the demographic and clinical profile of Veterans in the criminal justice system.
2. Describe the role of Veterans Justice Programs in linking Veterans to services.
3. Describe innovative practices for facilitating access to services for justice involved Veterans encountering law enforcement and first responders.

April 5, 2023: Neurobiology of Addiction and Recovery
Christopher Blazes, MD

Purpose Statement: Addiction often co-exists with many medical and psychiatric conditions in VA. Addiction treatment and recovery can often be improved by an understanding of the underlying dynamics of addiction. This presentation will describe the neurological pathways of addiction and recovery, and their clinical relevance for designing and implementing successful treatment and long-term recovery.

Course Learning Objectives:

1. Describe the neurologic pathways in the reward circuit, both for addiction and recovery.
2. Identify and define incentive salience.
3. Discuss practical ways to help patients with addiction form functional neurologic pathways through behavioral changes.

 

March 15, 2023: Combining Outreach on Social Media with Video-Based Training in Suicide Prevention for Veterans’ Family and Friends
Alan Teo, MD
Aaron Call, EdM

Purpose Statement: Suicide prevention continues to be a central priority for VA mental health services. Clinicians play an important role in suicide prevention, but the Veteran’s family and social network also can be very important in optimizing the effectiveness of suicide prevention. This presentation will discuss a novel training for family and friends of Veterans to develop and enhance skills that will allow them to effectively help Veterans who are important in their lives. The important role of social media outreach in suicide prevention also will be discussed.

Course Learning Objectives:

1. Describe gatekeeper training, and why Veterans’ family and friends are an appropriate target for gatekeeper training.
2. Describe VA S.A.V.E. and the skills taught in it.
3. Discuss several strategies to enhance outreach via social media to Veterans at risk for suicide.

February 15, 2023: Treating PTSD in the Context of Cognitive Impairment
Jeffrey Gregg, PhD

Purpose Statement: PTSD can exist throughout the lifespan, and individuals with PTSD are significantly more likely than the general population to be diagnosed with dementia in later life. But evidence-based approaches for assessing and treating PTSD have been designed and tested among individuals without cognitive impairment. So, this presentation will provide practical suggestions for clinicians for adapting assessment and treatment for late life PTSD based on research evidence and clinical experience.

Course Learning Objectives:
1. Describe the relationship between PTSD and cognitive functioning
2. Discuss potential adaptations for evidence-based assessment and treatment of PTSD for older adults with mild cognitive impairment
3. Identify environmental approaches for management of PTSD symptoms among individuals with moderate to severe dementia

 

February 1, 2023: Diagnosis and Treatment of Functional Movement Disorders
Lee Neilson, MD

Purpose Statement: Movement disorders are encountered across a wide range of clinical settings, often associated with an underlying neurological condition or as an adverse effect of medications. However, functional movement disorders, which are abnormal motor behaviors inconsistent with known neurological disorders, can make accurate diagnosis and effective treatment more complicated. This presentation will describe effective methods for recognizing functional movement disorders and will highlight the essential elements of comprehensive treatment. 

Course Learning Objectives:

1. Describe the most prominent features of the history and exam that can rule in a diagnosis of a functional movement disorder
2. Summarize the pathophysiology of functional movement disorders
3. Discuss a multi-modal approach to treatment and identify good prognostic indicators

 

January 18, 2023: I'm Not an Addict: Patient Experiences with Taper and Discontinuation of Long-Term Opioid Therapy
Travis Lovejoy, PhD

Purpose Statement: Pain co-exists with many health conditions, and pain management for chronic illnesses is one of the most challenging tasks for health care providers. With opioid treatment, that challenge is even greater. This presentation will describe potential outcomes after discontinuation of long-term opioid therapy and help clinicians to sort through some of the challenges for providers and patients, including impacts on the provider-patient relationship. 

Course Learning Objectives:

1. Quantify pain outcomes following discontinuation of opioid therapy
2. Identify potential negative sequalae of universal opioid discontinuation
3. Describe patient-provider relationships following discontinuation of opioid therapy

 

December 7, 2022: Traumatic Brain Injury and Sleep Disorders: Pathophysiology and Clinical Management
Kent Werner M.D., PhD

Purpose Statement: Traumatic Brain Injury (TBI) has been increasingly recognized among those who have served in combat, and it is frequently associated with other conditions such as PTSD and depression. Problems with sleep are encountered in all of these conditions. This presentation will discuss sleep disorders among those who have experienced traumatic brain injury and will summarize for clinicians current evidence-based treatments for sleep disorders among Veterans with TBI.

Course Learning Objectives:
1. Describe the impact of traumatic brain injury (TBI) on sleep among those who have experienced combat
2. Discuss potential mechanisms for sleep disorders in TBI patients
3. List potential therapies for sleep disorders in TBI patients

November 16, 2022: The Role of Family Members in PTSD Treatment
Johanna Thompson-Hollands, PhD

Purpose Statement: The symptoms and behavioral challenges experienced by Veterans with PTSD also influence their social functioning and interpersonal relationships. Research has shown that there are important bidirectional impacts between the social environment and PTSD symptoms. This presentation will focus on family-inclusive treatment and include perspectives from Veterans, family members and VA clinicians. This presentation also will include specific recommendations for optimizing family-inclusive care, as well as outlining a number of brief protocols that have been developed for Veterans and family members.

Course Learning Objectives:
1. Describe the rationale for incorporating family members or other support persons into a Veteran’s PTSD treatment
2. Discuss common goals that veterans and family members have for family-inclusive treatment
3. Identify one or more protocols to support brief family involvement in treatment

November 2, 2022: How to Reduce Veteran Suicides by Helping Veterans with Other Than Honorable Discharges to Obtain VHA Services
Brian Meyer, PhD
Matt Stimmel, PhD

Purpose Statement: Suicide prevention remains one of the top priorities for VA mental health care. This can be attained by clinical or systems-related interventions. One of the ways of intervening at the systems level is to allow Veterans with Other Than Honorable discharges to access VA mental health services. This presentation will illustrate how including this high risk subgroup in suicide prevention strategies can lower the suicide rate among Veterans.

Course Learning Objectives:
1. Describe the link between Other Than Honorable discharges and suicide
2. Identify at least four reasons why Veterans are given Other Than Honorable discharges
3. Identify at least three methods for getting Veterans with Other Than Honorable discharges the services they need

 

October 19, 2022: Caring for Veterans with Psychosis: an Overview of Evidence-Based Pharmacological and Psychosocial Interventions for Veterans with Schizophrenia
Olaoluwa Okusaga, MD
Jared Bernard, PhD

Schizophrenia is encountered in a wide variety of mental health settings, including VA. Evidence-based assessment and treatment of schizophrenia continues to evolve as basic and clinical science innovations present clinicians with more treatment options. This presentation will focus on the process of deciding among a large number of effective treatment options for schizophrenia, and will highlight the integration of pharmacological and psychosocial treatment methods.

Course Learning Objectives:
1. Explain the importance of ruling out secondary psychosis during the initial evaluation of a Veteran presenting with psychotic symptoms
2. Describe how to decide on specific antipsychotic medications and other somatic treatments for Veterans diagnosed with schizophrenia
3. Discuss the concept of recovery and how its principles are utilized in evidence-based psychosocial interventions

 

October 5, 2022: Moral Injury: An Overview of Conceptual, Definitional, Assessment, and Treatment Issues
Brett Litz, PhD

The idea that people can be lastingly harmed by their own transgressive behavior and can suffer because of others’ moral failures is as old as humanity, yet these concepts have only recently been considered as clinically relevant social, biological, spiritual, and psychological problems. The term that is used to describe these transgressive harms and the outcome of those experiences is moral injury. This presentation will enhance clinicians and researchers knowledge about how to define, assess, and treat moral injury.

Course Learning Objectives:
1. Define moral injury
2. Discuss how to assess moral injury using a moral injury assessment instrument, and distinguish moral injury from moral distress and PTSD
3. Describe the phenomenology, clinical needs, and methods for helping those suffering from moral injury.

June 1, 2022: Factors Associated with Evidence-Based Psychotherapy Utilization and Mental Health Symptoms among Veterans with Co-Morbid PTSD and Substance Use Disorder
Vanessa Somohano, PhD

VA has been a national leader in developing evidence-based psychotherapies for treatment of PTSD, which often co-exists with other conditions such as depression and substance use. For optimal treatment it is essential to consider how these conditions influence each other, along with the utilization and effectiveness of treatment modalities. This presentation will focus on current use of evidence-based psychotherapies in VA for coexisting PTSD and substance use disorders, including patterns of initiation and utilization that have implications for effective clinical care.

Course Learning Objectives:

1. Characterize demographics and health service utilization among Veterans who receive VA care and have co-morbid PTSD-SUD
2. Identify factors associated with PTSD evidence-based psychotherapy initiation among Veterans with comorbid PTSD-SUD
3. Describe health services factors and interventions that may enhance treatment initiation among at-risk veterans with comorbid PTSD-SUD

 

May 18, 2022: Systematically Testing the Evidence on Marijuana
Devan Kansagara, MD

The use of marijuana for medical conditions remains controversial, and it remains a dilemma for clinicians and the clinician-patient relationship. This presentation will provide current evidence-based guidelines for clinicians for how to discuss marijuana with their patients, including a discussion of mental health effects and potential harms of cannabis. The presentation also will discuss a recently developed web-based resource about the health effects of cannabis.

Course Learning Objectives:

1. Summarize the mental health effects of cannabis, including a focus on conditions such as PTSD and cannabis use disorder
2. Discuss strategies to reduce potential harms of cannabis in patients who choose to use cannabis for medical or recreational purposes
3. Describe the elements of a new web-based resource for clinicians and researchers about the health effects of cannabis

May 4, 2022: Benzodiazepines: The Disturbing Truth
Christopher Blazes, MD

One of the primary prescribing quality improvement goals in VHA in recent years has been to reduce benzodiazepine prescribing. Although benzodiazepines can be effective for certain conditions if carefully prescribed and monitored, they also can have considerable adverse effects if improperly prescribed. This presentation will provide an overview of best practices for benzodiazepine prescribing, including a discussion of safe detoxification and tapering protocols, and potential lingering clinical effects even after withdrawal.

Course Learning Objectives:

1. Summarize the historical perspective of benzodiazepine prescribing and how prescribing patterns were influenced
2. Discuss the evidence behind detoxification and tapering protocols for benzodiazepine discontinuation, including alternative approaches for taper/withdrawal management
3. Describe the post-acute withdrawal syndrome for benzodiazepines

April 20, 2022: Addressing Mental Health Needs of Aging Veterans in Rural Communities
Bret Hicken, PhD

VA continues to expand access to care to rural Veterans, including aging Veterans who are particularly vulnerable to the adverse effects of isolation.  This presentation will address ethical and clinical issues related to providing mental health care for older Veterans in rural areas. Attendees will learn about cultural, sociodemographic, and structural issues that impact mental health care in older Veterans, consider ethical issues that arise when caring for this population, and discuss options for addressing these issues to improve access to mental health care.

Course Learning Objectives:

1. Identify key sociodemographic and health characteristics of older rural Veterans
2. Discuss challenges that older rural Veterans experience related to accessing mental health care
3. List strategies for addressing access issues, including ethical challenges, related to access to mental health care in rural areas

 

April 6, 2022: MDMA-Assisted Psychotherapy for PTSD
Christopher Stauffer, MD

There continues to be important ongoing research in VA that studies potentially effective treatments for PTSD, including various psychotherapeutic modalities. This presentation will explore current and upcoming research that focuses on medication-assisted psychotherapy for PTSD using the stimulant MDMA. The presentation will include a discussion of the rationale for using MDMA in assisted psychotherapy for PTSD, potential benefits and risks, and will explore current and future implications for PTSD research and clinical care in VA. 

Course Learning Objectives:

1. Summarize MDMA-assisted psychotherapy for PTSD clinical trial outcomes
2. Describe access and the pathway to FDA approval for MDMA-assisted psychotherapy
3. Discuss current and upcoming VA studies of MDMA-assisted psychotherapy

 

March 16, 2022: Prazosin for Posttraumatic Headache Randomized Controlled Trial in Veterans and Active-Duty Service Members
Murray Raskind, MD
Cindy Mayer, DO

Head injury and concussion are not uncommon in combat situations, and often co-exist with PTSD. Posttraumatic headache is the most common symptom following concussion, and it can be debilitating for Veterans and for active-duty personnel. Headache is commonly encountered in general medicine and mental health clinical settings, so it is important for clinicians to be able to recognize and treat a symptom that so profoundly influences quality of life. This presentation will summarize the current scientific and clinical understanding of posttraumatic headache and will review current data supporting the use of prazosin, which is also effectively used for PTSD nightmares, for treating posttraumatic headache.

Course Learning Objectives:

1. List the most important clinical features of posttraumatic headaches;
2. Describe the pathophysiology of posttraumatic headaches; and
3. Discuss how prazosin is helpful for treating posttraumatic headaches.

 

March 2, 2022: Trauma, PTSD, and Perinatal Health
Yael Nillni PhD

The number of women Veterans being treated in VA has continued to increase in recent years, including women of childbearing age. Therefore, it is important for clinicians to have greater awareness of conditions that can adversely affect healthy pregnancies and maternal functioning in the postpartum period. Trauma, including PTSD, is an important variable that may influence perinatal and postpartum outcomes. This presentation will review some associations between trauma, PTSD, and perinatal outcomes and discuss potential effective treatments for perinatal PTSD and postpartum depression. 

Course Learning Objectives:

1. Identify the associations between trauma, PTSD, and perinatal outcomes
2. Discuss potential mechanisms explaining the association between PTSD and perinatal outcomes
3. Summarize treatments for perinatal PTSD and postpartum depression

February 16, 2022: The Elephant in the Room: Treating PTSD When Clinicians Have Strong Reactions to Patients’ Sociocultural Views 
Brittany Hall-Clark, PhD

In clinical settings within VA, including settings where evidence-based PTSD treatments are used, clinicians can sometimes encounter difficult situations in which patients express strong opinions about sociocultural issues that run counter to those of the clinician. This presents challenges for the clinician in appropriately caring for the patient with PTSD, but not compromising their own views or ignoring their own emotional reaction. This presentation will assist clinicians in developing strategies for managing their reactions and continuing with effective clinical care. 

Course Learning Objectives:

1. Identify strategies PTSD clinicians can utilize if they have strong reactions to a patients’ sociocultural views
2. Discuss how to develop a case formulation of patients’ views either within or outside of a trauma framework
3. Describe how to use case formulation to decide when and how to address patient views within PTSD evidence-based treatment

 

February 2, 2022: Meeting the Challenge of the Methamphetamine Crisis 
Dominick DePhilippis PhD

Methamphetamine misuse is at crisis levels in the United States, and the effects of methamphetamine use among Veterans is encountered in clinical settings within VA. Treatment of methamphetamine dependence is challenging, but fortunately several psychosocial treatments have empirically demonstrable efficacy in helping patients recover. This presentation will review the scope of the methamphetamine crisis and effective treatments for it.

Course Learning Objectives:

1. Describe the scope of the methamphetamine crisis
2. Identify effective, evidence-based treatments for stimulant use disorder
3. Discuss the behavioral principles upon which effective Contingency Management practice is based

 

January 19, 2022: Evaluating and Treating Nightmares
Catherine McCall, MD
Ami Student, PsyD

This live virtual knowledge-based training will describe nightmares. Nightmares are one of the most encountered symptoms of posttraumatic stress disorder (PTSD), but also are encountered in other sleep disorders. Because nightmares can so profoundly disrupt sleep and contribute to psychological distress, it is important for clinicians to know various options for nightmare treatment. Therefore, this presentation will discuss the etiology, assessment, and treatment of nightmares in clinical settings. Education and training is needed for an evaluation of the baseline mechanism of sleep disturbance among veterans with PTSD; inconsistency between subjective and objective findings in these patients; and especially an assessment of sleep-targeted medical and psychological intervention on the improvement of sleep disturbance as well as PTSD symptoms.

Course Learning Objectives:

1. Summarize the prevalence and pathophysiology of nightmares
2. Describe how to evaluate nightmares
3. Discuss best practices for treatment of nightmares

 

December 15, 2021: Compensatory Cognitive Training and CogSMART for Veterans with Neuropsychiatric Conditions
Elizabeth Twamley, PhD

Cognition can be impaired in many neuropsychiatric conditions, including traumatic brain injury, serious mental illnesses, and mild cognitive impairment associated with aging.  This presentation will describe Compensatory Cognitive Training (CCT) and Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) for individuals with these neuropsychiatric conditions. These interventions focus on teaching strategies to improve organization, attention, learning, memory, cognitive flexibility, problem-solving, and planning, rather than extensive drills and practice. Results from randomized controlled trials will be reviewed, and key components of the intervention will be described and demonstrated.

Course Learning Objectives:

1. Describe compensatory and restorative interventions to improve cognition in people with psychiatric disorders
2. List domains of cognitive functioning targeted in Compensatory Cognitive Training.
3. Discuss how to link cognitive strategies with individual rehabilitation goals

 

December 1, 2021: Co-occurring mTBI and PTSD: Shared Mechanisms and Evidence of Cognitive Inefficiency
Holly Rau, PhD

PTSD and mTBI are frequently encountered co-existing conditions in the care of combat Veterans. For optimal patient care, it is important for clinicians to identify when the conditions co-exist so that an effective, comprehensive treatment plan can be developed. This presentation will highlight both unique and overlapping symptoms of each disorder that impair Veteran functioning, and it will discuss their clinical relevance in developing an effective approach to treatment.

Course Learning Objectives:

1. List overlapping vs. distinct symptoms of mTBI and PTSD
2. Describe three pathophysiological mechanisms involved with mTBI and PTSD sequelae
3. Discuss an alternative method for detecting subtle cognitive inefficiencies in complex clinical populations

 

November 17, 2021: Treatment Resistant Depression: How to Diagnosis It and What To Do About It
James Murrough, MD

Depression is one of the most commonly encountered mental health conditions in VA, causing significant morbidity and functional limitations if left untreated. Treatment of depression usually is very successful, but sometimes it is more resistant to treatment. This presentation will discuss some of the contributors to treatment resistance, and it will provide clinicians with suggested options for treatment-resistant depression.

Course Learning Objectives:

1. Discuss how to recognize and diagnose Major Depressive Disorder
2. Define Treatment-Resistant Depression and list the risk factors for treatment-resistance among individuals with depression
3. Describe evidence-based treatment options for Treatment-Resistant Depression

 

November 3, 2021: Perspectives on Firearm-Related Conversations in Clinical Settings
Joseph Simonetti MD, MPH

Suicide prevention continues to be a major goal for VA. Because firearms are used frequently in attempted and completed suicides, it is important for clinicians to discuss optimal firearm safety with patients. The purpose of this presentation is to provide a synthesis of current knowledge related to perspectives on conducting firearm-related conversations in clinical spaces. This presentation will be informative for clinicians and other stakeholders aiming to promote effective lethal means conversations with at-risk patients.

Course Learning Objectives:

1. Describe firearm owners’ perspectives on firearm-related conversations with clinicians
2. Identify potential barriers to firearm-related conversations with clinicians
3. Discuss potential facilitators of firearm-related conversations with clinicians

 

Oct. 20, 2021 - New Directions in Suicide Safety Planning and Lethal Means Safety “Project Life Force” – A Manualized Telehealth Group Intervention
Marianne Goodman, MD

Reducing risk for suicide continues to be one of the most important initiatives within VA. A successful program that has been developed recently is Project Life Force, which can be utilized remotely through telehealth by healthcare teams. This live, virtual, knowledge-based presentation will describe the practical and clinically effective telehealth approach that is particularly relevant for mitigation of suicide risk among rural veterans. 

Course Learning Objectives:

1. Identify specific ways in which group treatments mitigate suicide risk
2. List strategies to implement telehealth group intervention for high risk suicidal veterans
3. Discuss innovative ways to reach rural suicidal Veterans

 

Oct. 6, 2021 - Meditative Approaches for the Treatment of PTSD
Ariel Lang, PhD

PTSD is one of the most commonly encountered mental health conditions in VA treatment settings. In recent years evidence has accumulated that verifies the efficacy of various therapeutic approaches for the treatment of PTSD. This includes meditative approaches to treatment. This presentation will describe the evidence base for meditative approaches and will highlight for clinicians best clinical practices associated with meditative interventions. 

Course Learning Objectives:

1. Summarize meditation-based approaches with empirical support for the treatment of PTSD
2. List important commonalities and differences between types of meditation
3. Discuss best clinical practices around meditation

 

May 19, 2021: Use of Trauma-Focused Interventions in the Veterans Health Administration: Implications for Providing Care to Veterans with Comorbid PTSD and Substance Use Disorders
Meaghan Lewis, PhD

Evidence-based psychotherapies are now extensively used in VA for treatment of PTSD. A reality for Veterans and for clinicians is that PTSD often co-exists with other conditions such as depression, traumatic brain injury, and substance use. For optimal treatment it is essential to consider how these conditions influence each other and the effectiveness of treatment modalities. This presentation will focus on current trends for the use of evidence-based psychotherapies for coexisting PTSD and substance use disorders, including patterns of utilization and implications for effective clinical care. 

Course Learning Objectives:

1. Summarize patterns of utilization within VA of evidence-based psychotherapy, such as PE and PCT, for co-occurring PTSD and substance use disorders (SUD)
2. List common myths about treatment for co-occurring PTSD-SUD
3. Discuss clinical implications for using trauma-focused interventions to treat PTSD-SUD based on nationwide VHA administrative data

 

May 5, 2021: he Nuts and Bolts of Delivering PTSD Treatment over Telehealth
Leslie Morland, PhD
Ursala Myers PhD

This presentation will enhance clinician knowledge and skills by providing specific focus on the essentials of PTSD telehealth treatment. Enabling clinicians to provide optimal care in support of Veterans who have suffered trauma by providing discussion on the importance of VA clinicians for learning about telehealth modalities to meet the variety of patient needs. Because of the COVID-19 pandemic, telehealth has grown exponentially in VA over the past year. It is important that VA clinicians learn more about telehealth modalities so that they have several options for care delivery that can meet a variety of patient needs. This presentation will focus specifically on the essentials of telehealth treatment for PTSD so that clinicians can continue to provide optimal care during these challenging times for Veterans who have suffered trauma.

Course Learning Objectives:

1. Summarize the evidence supporting the use of telemental health treatment for PTSD
2. Describe how to deliver evidence-based psychotherapy for PTSD via telehealth
3. Identify modifications necessary to deliver treatments during unprecedented times

 

April 21, 2021: Suicide and PTSD: Navigating Risk and Tailoring Evidence-Based Treatment
Ryan Holliday, PhD

This presentation will enhance clinician knowledge and skills by providing an overview of special considerations in suicide risk assessment with focus on Veterans with PTSD with discussion of evidence-based interventions. Suicide prevention has become a top priority in VA, and enhancing the effectiveness of clinicians in preventing suicide by improving knowledge and professional skills is a major part of that initiative. This presentation will focus on special considerations in suicide risk assessment among Veterans with PTSD, and it will discuss evidence-based interventions for this Veteran population. 

Course Learning Objectives:

1. Discuss suicide risk factors among Veterans with PTSD
2. Describe the link between PTSD and suicide using leading theories of suicide
3. Summarize empirically-supported methods of assessing and intervening upon suicide risk within the context of PTSD treatment

 

April 7, 2021: Clinical Considerations for Treating PTSD and Co-occurring Minority Stress Among LGBTQ Individuals 
Nick Livingston, PhD

There has been increasing awareness in VA about the needs of minority Veterans who seek care for a variety of disorders, including PTSD. Minority Veterans often have experienced significant stress related to discrimination and prejudice in society, which is additive to other trauma that precipitated PTSD. In order to enhance clinician knowledge and skills, this presentation will focus on effective screening, assessment and treatment of sexual minority Veterans with co-occurring PTSD and minority stress.

Course Learning Objectives:

1. Describe the impact of trauma, minority stressors, and their co-occurrence on LGBTQ+ individuals
2. Identify screening and assessment tools to inform case conceptualization when working with trauma-exposed LGBTQ+ individuals who also experience minority stress
3. Discuss evidence-based interventions that can be adapted for use with trauma-exposed LGBTQ+ individuals who experience minority stress, and strategies for person-centered care

 

March 17, 2021: Insomnia: Diagnosis and Treatment 
Jonathan Emens, MD

Insomnia is a very frequent condition encountered in all health care settings, and it co-exists with many other mental health conditions. Because it is so frequently encountered and can cause significant morbidity, it is important for clinicians across disciplines to have a good working knowledge of the process of insomnia assessment, along with treatment and referral options. This presentation will provide clinicians with an overview of factors that contribute to insomnia, and it will discuss various assessment and treatment options when encountering a patient with insomnia. 

Course Learning Objectives:

1. Summarize factors that predispose individuals to insomnia and perpetuate sleeping difficulty
2. Discuss medical and psychiatric morbidity related to insomnia
3. List pharmacologic and psychotherapeutic treatment options and their expected efficacy

 

March 3, 2021: Culturally Responsive Case Formulation
Gayle Iwamasa, PhD

Culture is a major component of personal identity and values, and it strongly influences attitudes towards illness and receptivity to medical and mental health care. This presentation will discuss how to incorporate cultural awareness into mental health assessment and care, and will discuss essential elements of a culturally responsive case formulation. 

Course Learning Objectives:

1. Define culturally responsive mental health services
2. Explain why VA mental health providers should provide culturally responsive services
3. List integral components of a culturally responsive case formulation

 

February 17, 2021: Around the Spring: Studies in Bipolar Onset
Sean Stanley, MD

Bipolar Disorder is encountered in a variety of inpatient and outpatient mental health treatment settings, and it can be a challenging condition to accurately diagnose because of the significant variation in symptoms at onset and frequent overlap of symptoms with other psychiatric conditions. This presentation will help clinicians to enhance their understanding of the presentation and natural course of Bipolar Disorder so that treatment approaches can be more accurate and effective.

Course Learning Objectives:

1. Discuss the consistency of Bipolar Disorder diagnoses over time
2. Describe the early course of symptoms in patients later diagnosed with Bipolar Disorder
3. Summarize the evidence for interventions in populations at high risk of developing Bipolar Disorder

 

February 3, 2021: Cannabis Use Disorder and Withdrawal
Garth Terry, MD, PhD

Cannabis is one of the most commonly used substances and its use now has been legalized in many states. However, cannabis use can lead to abuse and dependence, and adversely affect treatment of, and recovery from, a variety of psychiatric disorders. This presentation will discuss several clinical aspects of cannabis use, including recognition and treatment of cannabis use disorder, cannabis withdrawal, and important characteristics of comorbidity.

Course Learning Objectives:

1. Discuss the symptoms and clinical presentation of cannabis use disorder
2. Describe cannabis withdrawal symptoms and their potential overlap with comorbid clinical disorders
3. Summarize a treatment plan for patients presenting with cannabis use disorder, cannabis withdrawal, and/or cannabinoid hyperemesis syndrome

 

January 20, 2021: Management of Behavioral Symptoms in Alzheimer’s Dementia
David Mansoor, MD

Alzheimer’s dementia is a common clinical condition among older Veterans. Behavioral symptoms are some of the most difficult symptoms for caregivers and clinicians to manage, and they contribute to morbidity and adversely affect safety. This presentation will discuss effective assessment and treatment of behavioral symptoms, including evidence-based behavioral and pharmacological options.

Course Learning Objectives:

1. Summarize the epidemiology of behavioral symptoms in Alzheimer’s dementia
2. List characteristic target behaviors for treatment of Alzheimer’s dementia
3. Discuss pharmacological approaches to the management of Alzheimer’s dementia

 

December 16, 2020: Medicolegal Causation in Suicide
Michael Freeman, PhD

Suicide prevention is a core VA goal, and the effectiveness of clinicians in preventing suicide requires both knowledge and professional skills. An important element of improving knowledge and skills includes enhancing awareness of factors that contribute to suicidal behavior. Using a specific case to illustrate the multifactorial nature of suicide causation and prevention, this presentation will examine suicide causation from both medical and legal perspectives.

Course Learning Objectives:

1. Summarize basic principles and steps of a medicolegal causation analysis (INFERENCE model)
2. List important factors that make suicide causation multifactorial
3. Discuss how the causation model is applied to the investigation of a specific suicide case that followed an improperly dispensed medication

 

December 2, 2020: Morally Distressing Events in Healthcare Workers During the Coronavirus (COVID-19) Outbreak
Sonya Norman, PhD

Unprecedented contexts, such as a pandemic, may cause some healthcare workers to experience morally distressing events -- experiences that contradict personal or shared values or expectations. Feelings resulting from these experiences can include guilt, shame, distress or intrusive thoughts or images, anger, and reduced readiness.  This webinar will help mental health providers understand how working in the current pandemic might result in experiences of morally distressing events.  Strategies that workers, coworkers, and leaders can use to reduce the potential for morally distressing events and strategies that mental health care providers can use to reduce distress will be discussed.

Course Learning Objectives:

1. Define morally distressing events and understand how the current pandemic may increase the potential for frontline healthcare workers to experience morally distressing events
2. List common feelings and behaviors associated with morally distressing events
3. Describe strategies that have the potential to reduce morally distressing events, including self-care, coworker support, and help from leaders

 

November 18, 2020: Supporting Veterans with Dementia and Caregivers During the Era of COVID-19
Kaci Fairchild, PhD
Marcela Otero, PhD

COVID-19 has presented numerous challenges for Veterans and their families, including Veterans with dementia and co-existing medical conditions that increase stress and social isolation. This presentation will provide clinicians with an overview of the special challenges faced by these Veterans and their caregivers and will include a discussion of practical resources that can guide clinicians in their care and support.

Course Learning Objectives:

1. Describe the unique presentation of COVID-19 in older Veterans with dementia and associated comorbid medical conditions.
2. Identify the issues that Veterans with dementia and their caregivers face during the challenges caused by COVID-19.
3. Discuss and provide VA and community-based resources for supporting Veterans with the dementia and their caregivers during COVID-19.

 

November 4, 2020: Clinical Considerations for Intimate Partner Violence in the COVID-19 Era
Katherine Iverson, PhD
Julia Caplan, LCSW

COVID-19 has presented numerous challenges to society, including increasing stress for individuals and families. Greater stress and increased isolation of families have contributed to an increase in intimate partner violence (IPV), which already had been a significant threat to health and safety.  This presentation will explore how the assessment and treatment of IPV has been affected by COVID-19, and will provide clinicians with guidelines and practical tools for addressing the needs and concerns of Veterans and their partners in this unique time. 

Course Learning Objectives:

1. Describe different types of IPV, risk factors for experiencing violence, and unique issues related to the COVID-19 pandemic
2. Identify the goals and evidence-based strategies for IPV screening, assessment, and intervention, including ways to alter these processes in the context of COVID-19
3. Discuss clinical considerations and strategies for telehealth, safety plans, clinician safety, and documentation within COVID-19 limitations

 

October 21, 2020: Sustaining Healthcare Worker Well-Being & Patient Care During a Prolonged Crisis -- Finding Structure in the Chaos of COVID-19
Joshua Morganstein, MD

Effectively serving Veterans requires a stable working environment and attention to the well-being of management, clinicians and staff. The current COVID-19 pandemic challenges policymakers, managers, and clinicians to create the safest and most effective clinical environment to optimize effective Veteran care and Veteran well-being. This presentation will highlight effective practices from other high stress environments that are relevant to VA healthcare and will identify leadership actions that can facilitate the health and well-being of clinicians serving Veterans during the pandemic.

Course Learning Objectives:

1. List psychological and behavioral health impacts of pandemics and other disasters on individuals and communities
2. Identify promising practices from other high stress occupations to enhance organizational sustainment
3. Describe organizational and leadership actions that enhance personnel well-being and functioning

 

October 7, 2020: Keeping Veterans Engaged in Treatment -- A Veteran Cultural Competence Approach
Joseph Geraci, PhD

Transitioning from a life on the front lines to a life sitting at a desk is a challenge for many veterans returning from service. What makes this transition even harder is the difference in civilian and veteran experiences, creating a divide that makes it difficult for these two groups to relate in professional settings. This presentation will discuss ways that clinicians can narrow the cultural gap between Veterans and themselves in order to enhance Veteran engagement in treatment, improve treatment outcomes, and assist Veterans in their transition to civilian life. This is particularly important during an era when a new generation of clinicians is entering VA who have not had military experience and do not know military culture.

Course Learning Objectives:

1. Identify the key functions and roles that Servicemembers fill, as described through the Warrior’s Journey
2. Identify how military roles impact Veterans’ lives
3. Assess the impact of military experiences and roles which impact Veterans
4. Improve ability to serve Veterans by applying this knowledge to improve practice

 

June 3, 2020: Posttraumatic headaches: Current concepts in pathophysiology, diagnosis, and management
Cynthia Mayer, DO

Chronic headaches can occur after trauma and can co-exist with traumatic brain injury and chronic PTSD, causing significant discomfort for patients and impairing optimal functioning. This presentation will summarize the current status of clinical care and research related to posttraumatic headaches and discuss guidelines for assessment and treatment.

 

April 15, 2020: The role of religion/spirituality in mental health outcomes for PTSD
Zhen Cheng, PhD

Religion and spirituality have become increasingly important in psychiatric assessment and treatment. They can be an important part of cultural heritage, and they also can be important in healing and social supports. This presentation discussED the relevance of religion and spirituality in clinical outcomes for mental health conditions, including PTSD.

 

April 1, 2020: Treatment engagement and retention in patients with PTSD
Shannon Kehle-Forbes, PhD

Despite the development of evidence-based, effective treatments for PTSD within VA, treatment engagement and retention continue to be challenging, but they are essential for effective treatment. This presentation will explore some of the factors that influence engagement and retention and provide clinical suggestions for optimizing treatment engagement and retention.

 

March 18, 2020: Evidence for glymphatic dysfunction in Alzheimer’s Disease: Sleep, waste, and neurodegeneration at the crossroads of the Central Nervous System
Jeff Iliff, PhD

Alzheimer’s Disease continues to be an important contributor to morbidity and mortality among Veterans. The glymphatic system, a brain-wide network that facilitates the clearance of waste products, has been demonstrated to fail in the aging brain and in the young brain after traumatic brain injury. Impairment of glymphatic function may link brain trauma early in life with the development of dementia in later years. This clinically relevant presentation will explore the implications of impairment of glymphatic function for vulnerability to Alzheimer’s Disease.

 

March 4, 2020: Dialectical Behavioral Therapy (DBT) for treating PTSD
Melanie S. Harned, PhD, ABPP

Dialectical Behavior Therapy (DBT) was originally developed to treat chronically suicidal and self-injuring individuals with multiple mental disorders and pervasive emotion dysregulation. From its inception, DBT has highlighted the role of trauma as a common etiological factor and posttraumatic stress disorder (PTSD) as an important treatment target for many patients who receive this treatment. In this talk, the basic structure and procedures of the DBT Prolonged Exposure (DBT PE) protocol will be outlined and the clinical challenges encountered during its development will be discussed. In addition, research findings supporting the safety and effectiveness of the integrated DBT and DBT PE protocol treatment will be presented.

Outcome/Objectives:  

1. Understand the rationale for integrating PTSD treatment into DBT.
2. Outline the basic structure and procedures of the DBT Prolonged Exposure protocol for PTSD.
3. Review research findings evaluating the safety and effectiveness of the treatment.

 

February 19, 2020: Dissociation, Somatization, and Other Challenging Presentations of PTSD
Abigail Angkaw, PhD

Challenging presentations of PTSD, particularly dissociation and somatization trauma reactions, sometimes lead clinicians to hesitate offering evidence-based PTSD treatment. This course will help clinicians identify and understand dissociation and somatization presentations as trauma reactions within a PTSD case conceptualization framework, and will include reviewing clinical suggestions to support first-line evidence-based PTSD treatment for Veterans with these challenging presentations.

Outcome/Objectives:  
1. Describe how individuals with PTSD may present with dissociation and somatization;
2. Discuss the rationale for not immediately excluding individuals with PTSD and dissociation or somatization reactions from evidence-based treatments for PTSD;
3. Identify methods to address dissociation and somatization PTSD reactions within evidence-based PTSD treatment.

 

February 5, 2020: Clinical and administrative applications of the PTSD-Repository Clinical Trials Database
Maya O’Neil, Ph.D., Jessica Hamblen, PhD, Tamara Cheney, MD

The development and use of evidence-based treatments for PTSD remains an important VA mission. This requires PTSD research that can inform and positively impact patient care. This presentation will highlight the relevance and effective use of the national PTSD repository for VA clinicians, educators, and researchers.

Outcome/Objectives: 
1. Understand the rationale behind developing the PTSD-Repository;
2. Identify key patient, study, and outcome variables included in the PTSD-Repository;
3. Learn how to use the PTSD-Repository for clinical, administrative, educational, or research purposes.

 

January 15, 2020: Unconventional interventions for PTSD: State of the evidence
Paul Holtzheimer, MD, MSCR

Currently, several nonpharmacologic biological treatments are being investigated for the treatment of trauma. This presentation will explore the current evidence base for the use of these treatments, such as stellate ganglion block and hyperbaric oxygen, in PTSD treatment.

Outcome/Objectives: 
1. describe various proposed non-pharmacologic biological treatements for PTSD
2. discuss the regulatory processes that provide safety oversight for these interventions; and
3. identify the safety and efficay data for focal brain stimulation in PTSD treatment.

 

December 18, 2019: Focal Brain Stimulation for PTSD
Paul Holtzheimer, MD, MSCR

Currently, several nonpharmacologic biological treatments are being investigated for the treatment of PTSD. This presentation will focus on the current evidence base for a particularly promising clinical treatment, focal brain stimulation, including potential benefits and risks.

Outcome/Objectives: 
1. Describe the neural circuit paradigm that supports the use of focal brain stimulation for PTSD;
2. Summarize the rationale for using focal brain stimulation to treat PTSD; and
3. Identify the safety and efficay data for focal brain stimulation in PTSD treatment.

 

December 4, 2019: Lethal means safety: How clinicians can have the conversation
Bridget Matarazzo, PsyD

Lethal means safety is an important part of suicide prevention and risk assessment, one of the highest mental health priorities in VHA. This presentation will provide practical guidelines for clinicians for discussing lethal means safety with their patients in order to lower suicide risk.

Outcomes/Objectives:
1. Explain the importance of discussing lethal means safety with patients
2. Identify patients with whom providers should discuss lethal means safety
3. Discuss safe storage practices for firearms and medications

 

November, 2019: Quality of Care and Patient Outcomes Following Discontinuation of Long-Term Opioid Therapy in High-Risk Patients
Travis Lovejoy, PhD

The effective treatment of chronic pain is one of the greatest challenges for clinicians. Just as challenging is tapering and discontinuation of long-term opioids. This presentation will discuss these challenges that clinicians face with high-risk patients, and will offer perspectives on clinical outcomes and optimizing quality of care after opioid discontinuation.

Outcome/Objectives
1. Describe historical trends in opioid prescribing in the U.S.
2. Identify the consequences of opioid taper and discontinuation among long-term opioid users
3. Characterize changes in patients’ pain following discontinuation of long-term opioid therapy

 

November 6, 2019: Diagnosing ADHD in Adults, and Considering Treatment Options
Whitney Black, MD

One of the most challenging psychiatric illnesses to diagnose and treat is ADHD. Symptoms can overlap with several other conditions, and accurate diagnosis is dependent on an estimation of patient functioning going back to childhood and adolescence. Moreover, treatment options include the appropriate use of controlled substances with potential for misuse. This presentation will focus on these important clinical issues, and it will include considerations particularly relevant to the care of Veterans and healthcare teams.

Outcome/Objectives
1. Identify evidence-based screening measures when diagnosing ADHD
2. Describe strategies for psychostimulant titration trials in adult patients; and
3. Describe the role for non-stimulant medications in treatment of adults with ADHD.

 

October 16, 2019: The role of psychedelics in modern psychiatry: A review of the evidence base
Melissa Buboltz, MD, Aryan Sarparast, MD, Payton Sterba, MD, Jovo Vijanderan, MD

 

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Use of these Materials and Finding VA Health Care

Please note that the health care information provided in these materials is for educational purposes only. It does not replace the role of a medical practitioner for advice on care and treatment. If you are looking for professional medical care, find your local VA healthcare center by using the VA Facilities Locator & Directory. This page may contain links that will take you outside of the Department of Veterans Affairs website. VA does not endorse and is not responsible for the content of the linked websites.

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Spanning 23% of the US land mass, VA Northwest Health Network (VISN 20) is the largest geographic region of VA. In the Pacific Northwest, VISN 20 serves Veterans in 135 counties in Alaska, Idaho, Oregon, and Washington. Operating across three time zones over 817,417 square miles, VISN 20 is home to 273 federally recognized American Indian and Alaskan Native tribes. VISN 20 also serves Veterans in Del Norte and Siskiyou counties of California and Lincoln County Montana. Veterans may be eligible to receive care from a community provider when VA cannot provide the care needed. Veterans Community Care Program (VCCP) provides health care for Veterans from providers in the local community. VCCP includes General Community Care, Urgent Care, Emergency Care, Foreign Medical Care, Home Health and Hospice Care, Indian and Tribal Health Services, In Vitro Fertilization, State Veterans Home, and Flu Shots.

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Vet Centers in VISN 20

Vet Centers in the VISN 20 Health Care Network are community-based counseling centers that provide a wide range of social and psychological services, including professional readjustment counseling to eligible Veterans, active-duty Army, Navy, Marine Corps, Coast Guard, Air Force, and Space Force service members, including National Guard and Reserve components, and their families. 1-877-WAR-VETS is an around the clock confidential call center where Veterans, service members and their families can talk about their military experience or any other issue they are facing in transitioning after military service or trauma and get connected to their nearest Vet Center.

Vet Centers provide counseling to make a successful transition from military to civilian life or after a traumatic event experienced in the military. Individual, group, marriage and family counseling is offered in addition to referral and connection to other VA or community benefits and services. If you can’t make it to a nearby Vet Center, VA offers satellite Vet Center locations and Mobile Vet Centers that may be closer to you.

Alaska Anchorage Vet Center (Anchorage, AK) Anchorage Satellite Vet Centers in Anchor Point and Homer Fairbanks Vet Center (Fairbanks, AK) Fairbanks Satellite Vet Centers in Fort Greely and Fort Wainwright Kenai Vet Center Outstation (Soldotna, AK) Wasilla Vet Center (Wasilla, AK) Oregon Central Oregon Vet Center (Bend, OR) Eugene Vet Center (Eugene, OR) Eugene Satellite Vet Centers in Florence and Reedsport  Grants Pass Vet Center (Grants Pass, OR) Grants Pass Satellite Vet Center in Cave Junction and Grants Pass Mobile Vet Center Portland, OR Vet Center (Portland, OR) Portland Satellite Vet Centers in Oregon City, St. Helens, and Vancouver, Washington Salem Vet Center (Salem, OR) Salem Mobile Vet Center

Idaho Boise Vet Center (Boise, ID) Boise Satellite Vet Center in Ontario, Oregon and Boise Mobile Vet Center Spokane Satellite Vet Centers in Couer d'Alene, Kootenai, Post Falls, Fairchild AFB, and Newport, Washington Washington Bellingham Vet Center (Bellingham, WA) Everett Vet Center (Everett, WA) Federal Way Vet Center (Federal Way, WA) Lacey Vet Center Outstation (Lacey, WA) Seattle Vet Center (Seattle, WA) Spokane Vet Center (Spokane, WA) Spokane Satellite Vet Centers in Fairchild AFB, Newport, Post Falls and Couer d'Alene, Idaho Spokane Mobile Vet Center Tacoma Vet Center (Tacoma, WA) Tacoma Mobile Vet Center Vancouver Vet Center - Washington State University, Clark County (Vancouver, WA) Walla Walla Vet Center (Walla Walla, WA) Yakima Valley Vet Center (Yakima, WA) Yakima Satellite Vet Center in Ellensburg

Veterans Crisis "988" - The Military Crisis Line is a free, confidential resource for all Army, Navy, Marines, Coast Guard, Air Force, and Space Force service members, including members of the National Guard and Reserve, and Veterans. You're not alone—the Veterans Crisis Line is here for you. For immediate help in dealing with a suicidal crisis, contact the Veterans Crisis Line: Dial 988 then Press 1. You don't have to be enrolled in VA benefits or health care to call.

Europe:
Call +1 844-702-5495 (off base) or DSN 988 (on base)

Southwest Asia:
Call +1 855-422-7719 (off base) or DSN 988 (on base)

Pacific:
Call +1 844-702-5493 (off base) or DSN 988 (on base)

A Veteran overseas may contact the Veterans Crisis Line via the chat modality at VeteransCrisisLine.net/Chat. If the Veteran prefers a phone call, they can request this within the chat venue. For TTY users: Use your preferred relay service or dial 711 then 1-800-273-8255. Are you looking for clinical care or counseling? Assistance with benefits? No matter what you’re experiencing, we’re here to connect you with resources and support systems to help. The Veterans Crisis Line is free and confidential. When you call, chat, or text, a qualified responder will listen and help. You decide how much information to share. Support doesn't end with your conversation. Our responders can connect you with the resources you need.

Find out if you can get VA health care as a Veteran

The following four categories of Veterans are not required to enroll but are urged to do so to permit better planning of health resources:

1. Veterans with a service-connected (SC) disability rated at 50% or more.
2. Veterans seeking care for a disability the military determined was incurred or aggravated in the line of duty, but which VA has not yet rated, within 12 months of discharge.
3. Veterans seeking care for a SC disability only or under a special treatment authority.
4. Veterans seeking registry examinations (ionizing radiation, Agent Orange, Gulf War/Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) depleted uranium, airborne hazards, and Open Burn Pit Registry).

Find out how to apply for VA health care benefits as a Veteran or service member. For other mental health services, contact a VA medical center for information on eligibility and treatment options.

Plan your trip to VA

In 1946, Veterans Canteen Service (VCS) was established by law to provide comfort and well-being to America’s Veterans. With our many retail stores, cafés and coffee shops across the country, we serve those who have served our country. Our Canteens are whole health spaces for Veterans to connect, relax, share and care for themselves in an environment that is their benefit. We are proud to Serve America’s Veterans and those who provide for their care.

Hospital Service Directory

To find out whether there is a van near you use the Disabled American Veterans (DAV) Hospital Service Coordinator Directory to contact your nearest HSC for information or assistance. Please remember that the DAV Transportation Network is staffed by volunteers; therefore, it is unable to cover every community.