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Apr 16, 2013

http://www.goodreads.com/group/show/79924-springhill-group-counselling

Springhill Group Counselling believes it is significant that each of us needs to understand what counselling and psychotherapy is about and what they should anticipate from the procedure of therapy. Nurturing knowledge among community is a significant purpose for every organization.

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Posted: Apr 16, 2013 8:45pm
Mar 20, 2013

http://inthenews.springhillgroupcounselling.com/2013/03/20/christian-counselors-attempt-to-cure-gay-man-was-malpractice/

A gay man was tried to be converted to become heterosexual, his Christian psychotherapist found guilty of professional misconduct.

Lesley Pilkington, a Christian psychotherapist, was condemned by the professional body for counselors subsequent to an undercover journalist posing as a patient furtively recorded her during a therapy session at her home.

British Association for Counseling and Psychotherapy (BACP) ruled that she had breached the profession’s ethical code despite finding that Mrs. Pilkington’s client, Patrick Strudwick, “deliberately misled her”.

She now affronts being chastised off the association’s widely renowned professional register and is considering an appeal.

Mrs Pilkington, 60, practises “reparative therapy”, a contentious method which assumes that homosexual orientation can be “therapeutically changed” in clients who are motivated.

Back in 2009, Mr Strudwick met Mrs Pilkington at a largely Christian conference on therapy of homosexuality.  He told her he said he was unhappy with his gay lifestyle and that he wanted treatment for his same-sex attraction.

Mr. Strudwick recorded a session on a tape machine strapped to his stomach while he appeared to Mrs. Pilkington’s private practice, based at her home in Chorleywood, Herts, and

He collected evidences which he later used in a protest against Mrs. Pilkington to the BACP.  A decision by the BACP panel was made but both sides were advised to treat the issue as confidential while Mrs. Pilkington considered whether to use her right to an appeal.

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Posted: Mar 20, 2013 8:22pm
Mar 19, 2013

http://springhillgroupcounselling.blogspot.com/2013/03/universal-preschool-what-high-quality.html

“Make high-quality preschool available to every child in America”, says President Obama in his recent State of the Union Address.  This proposal he referred to research that has demonstrated long term positive effects of attending high-quality preschool programs.  The early childhood community got excited in President Obama’s support.  And it seems like a very good proposal, expanding a high-quality preschool opportunities, what could go wrong?  But the question is “What does “high-quality” mean in practice?”

According to educators and economists “high-quality” preschools means teachers are adequately paid, facilities are adequate, and the ratio of staff to children is low.  Those mentioned are really significant elements of quality and if not achieved there could be serious problems.  In reality, high-quality is otherwise as preschool educators are often very poorly paid, poorly educated themselves, and lack decent facilities.  The low salaries results to a bad quality and poor performance of the teachers.  So this proposal for ensuring universal access to high-quality preschools is aiming high for current preschoolers are already struggling with quality and funding issues.

Aside from money matters, there is a question raised about how preschool programs should be structured.  Compare to no preschool there are a lot of advantages of high-quality preschool.  And although there are a lot of researches supporting the latter, there is fewer research showing different benefits of different preschool approaches.

By means of standard preschool teaching methods the Preschool Curriculum Effectiveness Research initiative weigh against a number of promising approaches to each other and to groups.  You can see the results summarized review on the Best Evidence Encyclopedia.  And consequently only a small number of programs illustrated child outcomes superior to those achieved by other programs, by the end of kindergarten.  The best outcomes for children are planned programs that mainly focused on language and emergent literacy, giving children many opportunities to use language to work together, solve challenges, and develop positive relationships with each other.

Nowadays, early childhood education has also evolved in many ways such as technology has so far played a modest role in it, but this may change as multimedia devices become more commonly used.  Children cannot be technologically late, they must understand how the world works, and technology offers opportunities for teachers to enhance language development by engaging children with brief content that helps them to do so.  They can watch videos on DVD and educational television, things like that helps.

But this doesn’t mean that technology has to replace the early childhood learning although it may help adding the capacity for teachers to show anything they want to their children and to link to the home in ways that have not been possible in the past, and this may result in enhanced learning at this critical age, they still have to manipulate and learn from real objects.  They have to learn to work with each other, sing songs, develop coordination and creativity, and practice appropriate behaviors.

In general, the proposal was a terrific idea, expanding preschool access would really help children’s education but sure thing is it will take a lot of money and time to get in order.  This will be a great help more especially to unfortunate children and if they want to go further in this project then they should motivate immediately.

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Posted: Mar 19, 2013 8:16pm
Feb 28, 2013

There is a new strategy that was discovered to improve mood for the ”depress”, it is easier and costs nothing.  This is easy just the recollection of positive day-to-day experiences.  This can work for those who are not suffering from depression as well.  I’m sure this will change anyone’s mood.

Researchers suggest that recalling actual, detailed memories that are positive or self-affirming can help to improve the mood of people with a history of depression.

Sad to say, for people who suffer from depression, this kind of vivid memory for everyday events seems crippled by the victims.

In the new study, Tim Dalgleish, Ph.D., of the Medical Research Council Cognition and Brain Sciences Unit and colleagues hypothesized that a well-known method used to enhance memory — known as the “method-of-loci” strategy — might help depressed patients to recall positive memories with greater ease.

The method-of-loci strategy consists of connecting vivid memories with physical objects or locations.  An example of which are buildings you see on your commute to work every day. To bring to mindall the memories, you just have to imagine going through your commute.

An article published in Clinical Psychological Science the study is further discussed.  In the study, depressed patients were asked to come up with 15 positive memories.

The method-of-loci strategy was used by one group to create associations with their memories and the other group was asked to use a simple “rehearsal” strategy, grouping memories based on their similarities.

The participants were asked to recollect as many of their 15 positive memories as they could after working on the techniques.

Both groups were able to recall nearly all of the 15 memories.  Although the method were equally effective after the initial memory test conducted in the lab, the strategies were not equally effective in the long run.

A surprise call was made by the researchers after a week when they are already at their own homes.  They then asked them to recall the 15 memories once again and the group who used the method-of-loci passed with flying colors while those who used the rehearsal technique did not do the same as the other group.

This made a conclusion and the researchers believe these findings suggest that using the method-of-loci technique to associate vivid, positive memories with physical objects or locations may make it easier for depressed individuals to recall those positive memories.

Recalling and focusing on positive memories, rather than negative projections, may help individuals elevate their mood in the long run.  And also for all of us this may help brighten each day so you may have a great day ahead!

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Posted: Feb 28, 2013 8:29pm
Feb 25, 2013

http://www.netdoctor.co.uk/interactive/discussion/springhill-group-psycotheraphy-Can-Yoga-Reduce-Symptoms-t74090-f48.html

Yoga does the body good, and according to a new study, it may ease the mind as well.

Their findings suggest that yoga does in fact have positive effects on mild depression 

and sleep problems, and it improves the symptoms of psychiatric disorders like 

schizophrenia and ADHD among patients using medication.

The researchers focused on 16 studies that recorded the effects of practicing yoga on 

mental-health issues ranging from depression, schizophrenia, ADHD, sleep complaints 

and eating disorders to cognitive problems. They found positive effects of the 

mind-and-body practice for all conditions with the exception of eating disorders and 

cognition. Those studies involved too few participants or produced conflicting results 

to draw any meaningful conclusions.

Some of the studies included in the analysis even suggested that yoga might affect 

the body in ways similar to antidepressants and psychotherapy. For instance, yoga 

may influence brain chemicals known as neurotransmitters (boosting levels of 

feel-good agents like serotonin), lower inflammation, reduce oxidative stress and 

produce a healthier balance of lipids and growth factors — just as other forms of 

exercise do.

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Posted: Feb 25, 2013 8:24pm
Feb 10, 2013

http://www.tulsaworld.com/news/article.aspx?subjectid=12&articleid=20130210_12_0_Lsetme951280

Last September, 13-year-old Cade Poulos committed suicide in a crowded hallway at 

Stillwater Junior High.The act tragically and similarly repeated itself last week when 

15-year-old Triston Stephens shot himself in a bathroom at Coweta Intermediate High 

School.

People have been grasping for answers in the aftermath with the macabre 

understanding that when there is a shooting at a school in which a suicide is involved, 

it is often after multiple homicides have already occurred.

Kimberly Parker, director of children’s services at Counseling & Recovery Services,

said that there are no definite answers as to why a teenager commits suicide and that 

there is little research on the psychology behind the setting of the suicide.

“The setting for suicide could indicate concerns the youth had in that environment or it 

could be the youth thought it was a location where there would be less opportunity for 

someone to intervene or it could be a location of impulse,”

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Posted: Feb 10, 2013 6:04pm
Feb 6, 2013

http://springhillgroupcounselling.blogspot.com/2013/02/infant-research-neuroscience-at-work-in.html
For decades, psychotherapy has been considered “the talking cure”: two people in conversation, 

with a shared goal of relieving the suffering of the patient. From the early days of Freud to the 

current popularity of Cognitive Behavioral Therapy, the spoken word has been the central focus in 

the therapeutic alliance. In recent years, however, the advent of functional MRIs and other 

brain-scanning technologies has led to new discoveries about the workings of the brain that may 

afford clinicians innovative and exciting new ways of working with clients, beyond simply “talking.”

Judith Rustin’s Infant Research & Neuroscience at Work in Psychotherapy: Expanding the Clinical 

Repertoire brings together many of these new discoveries. In her book, published by Norton, Rustin 

summarizes key research in the areas of both infant behavior and neuroscience, and provides 

easy-to-understand examples that help clarify how rather elusive concepts—such as implicit and 

unconscious ways of remembering and communicating—can be applied in day-to-day therapeutic 

interactions.

Rustin begins with a focus on infant research, stating that “the nonverbal modes of communication 

discerned in the interactive process between infant and mother…can be used by the therapist as tools 

or techniques in treating her patients.” After summarizing much of the major research on the 

infant-mother interaction, including studies on eye-to-eye gaze, face-to-face play, and self- and mutual 

regulation, she describes her treatment of a patient called “Jack,” detailing how she applies her 

knowledge of infant research to their therapy relationship. Her description brings the reader into the 

therapy room, and provides an excellent example of the research at work.

In each of the chapters that follow, Rustin continues to first explain the current research on the brain 

and infants, then follow up with a clinical example of how she or another clinician has applied that 

research to a specific therapy client. These real-life accounts, in addition to bolstering Rustin’s theory, 

make the book more than simply a dry review of the scientific literature.

The book goes on to discuss studies on memory, the mind-body connection, the fear system, and mirror 

neurons and shared circuitry. Since Rustin believes that focusing on the spoken narrative “can 

sometimes limit our vision to other possibilities for understanding and intervention,” she illustrates in 

each example how attending to bodily responses and emotions—both her clients’ and her own—can 

provide insights that might otherwise be missed.

The ideas in Rustin’s book are not intended to replace traditional psychotherapy; rather, she says, 

“they just provide additional pathways for understanding and intervening in a way that offers additional 

sources of fluidity and elasticity to the therapeutic relationship and clinical process.” Rustin does an 

excellent job of reviewing the literature and giving detailed examples of how to apply infant research and 

neuroscience in a clinical setting with adults. She makes it clear that each therapeutic dyad is unique, and 

that the examples she provides are just one of many ways that the research can be applied. By opening our 

concept of therapy and demonstrating new applications of research, Rustin has contributed an important

 addition to a growing body of work.

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Posted: Feb 6, 2013 5:54pm
Feb 5, 2013

http://www.mumsnet.com/Talk/bloggers/1675965-Psychosocial-Rehabilitation-of-the-War-springhill-groups

Psychosocial Rehabilitation of the Combatants

A combat veteran’s transition to civilian society from combat is fraught with complications in familial and interpersonal relations, vocational endeavors, and, at times, adherence to societal and legal boundaries (Fairweather & Garcia, 2007). In Sri Lanka a large number of ex combatants transited to civil society without any prier screening process. Many of them have readjustment problems. Psychosocial rehabilitation of the war veterans have been recognized as a crucial component in Sri Lanka. A range of social, educational, occupational, behavioral and cognitive interventions would be needed to address the needs of the combatants who were affected by the war.
Rehabilitation is an ecological approach that aims at the long term recovery and maximum self-sufficiency. In 1996 the World Health Organization came out with a consensus statement on psychosocial rehabilitation. The WHO defined psychosocial rehabilitation as a process that facilitates for individuals who are impaired, disabled or handicapped by a mental disorder to reach an optimal level of independent functioning in the community. Many physically and psychologically traumatized combatants need psychosocial rehabilitation to recover. Warren (2002) of the view that addressing the broader emotional, social and economic needs of survivors is a critical aspect of the rehabilitation process. Support survivors in becoming reintegrated into all aspects of community life, including education, employment, recreation, and social and political activities. Psychosocial Rehabilitation practices help war veterans re-establish normal roles in the community, independence and their reintegration into community life. These interventions should help to manage behaviors, perceptions and reactions to the physical / psychological injury or condition which may hold back the process of recovery or maintenance of the veteran’s well-being.

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Posted: Feb 5, 2013 3:57am
Feb 3, 2013

The Eelam War in Sri Lanka has produced a large number of veterans with complex physical and psychological traumas over the last three decades. The war trauma has created potent barriers to their lives and these barriers obstruct recovery and personal growth. Combatants with war trauma experience problems in their living, working, learning, and social environments. The Psychosocial well-being of these combatants were not adequately addressed during the war and in the postwar period. The veterans who became the casualties of the Eelam War need effective Psychosocial Rehabilitation to acquire functionality, recovery and reintegration.

In the aftermath of the Eelam War a large number of combatants sustained physical and psychological wounds. The most common psychological injuries experienced by soldiers were Adjustment Disorder, Posttraumatic Stress Disorder and major depression. Combat related psychological ailments increased over the past three decades in Sri Lanka. According to the 2008 The World Health Organisation report and survey that was conducted with the help of the Ministry of Health revealed a high incidence of mental illness in Sri Lanka. The Mental Health experts suspect a strong correlation between the armed conflict and surge of mental illnesses. A large number of Sri Lankan combatants have experienced the profound effects of war trauma that drasticaly impacted their metal health and long-term functioning.The four year study on Sri Lankan soldiers who experienced war trauma reveals that PTSD is emerging among the combatants. (Fernando & Jayatunge, 2011).

Post war researches of the Vietnam, Iraq and Afghanistan wars have shown that the combat exposure could negatively affect the mental health of the combatants. Hoge et al.(2004) indicate that exposure to combat results in considerable risk of mental health problems, including PTSD, major depression, substance abuse, impairment in social functioning, an inability to work, and the increased use of health care services.

Combat Related PTSD among the Sri Lankan Combatants

The studies have shown that PTSD could be a disabling condition that affects the war veterans. Norris et al. (2002) indicate that Posttraumatic Stress Disorder (PTSD) represents a common, if not the most prevalent, mental health problem in community studies in post-conflict areas.

The prolonged war in Sri Lanka has triggered widespread psychological trauma among the soldiers. Unlike the soldiers of WW2 , Korea or Vietnam the Sri Lankan combatants experienced combat for a longer period. Some soldiers were constantly in the operational areas for over 10 years. The psychological wounds of the Eelam War were underestimated for a long time and it took many years for the Sri Lankan Military Authorities to recognize the impact of combat trauma especially the PTSD. Based on rough estimations 8-12 % of Sri Lankan combatants are suffering from combat related PTSD (Jayatunge, 2010). Many victims experience intrusive thoughts, flashbacks, nightmares, intense rage, apathy, cynicism, alienation, depression, mistrust and reduced life interests. These psychological scars affect in their daily lives making them dysfunctional and vulnerable.

Combat Trauma and the Social Impact

The Eelam War had immense effects on society and it has wreaked the social fabric. For nearly three decades the entire nation experienced the bitter realities of the war. The traumatic events of the Eelam War emotionally touched most of the members of the society. The armed conflict in Sri Lanka created a collective trauma. Fear, grief, sorrow: have become the overriding emotions of war.

Complex situations that follow war and natural disasters, have a psychosocial impact on not only the individual, but also on the family, community and society., Just as the mental health effects on the individual psyche, can result in non-pathological distress as well as a, variety of psychiatric disorders like Post Traumatic, Stress Disorder (PTSD); massive and widespread, trauma and loss can impact on family and social processes, causing changes at the family, community and, societal levels (Somasundaram, 2010).

The impact of fear, physiological arousal, horror, survival guilt and hopelessness in combat cannot be underestimated. It has a long lasting effect and sometimes these destructive feelings could be transformed on to the society by the combatants. When violence seeps into everyday life, then there is always the possibility that as a society comes out of conflict the residue of violence will remain. Violence generally continues to exist within the social fabric of societies coming out of conflict for decades to come (Hamber , 2004). The war trauma has made the combatants dysfunctional and opened doors for various psychosocial problems. These psychosocial problems have domino effects that can last for many years.

 War Trauma and Stigma

The combatants with war trauma have self-blame and guilt that always work against their psychosocial wellbeing. The heart of trauma is shame, guilt rejection and isolation. The soldiers with PTSD and other combat related stress conditions feel highly subjugated over their symptoms. Many feel that these symptoms are signs of weakness, cowardice and no longer are they able to perform military duties with honor and dignity. Howell (2006) of the view that many combatants affected by the war trauma tend to conceal their condition for fear of retribution in the form of intolerance, stigmatization and job loss.

Stigma refers to negative attitudes (prejudice) and negative behavior (discrimination) toward combatants with battle trauma. Stigmatization is manifested by bias, distrust, stereotyping, fear, embarrassment, anger, and avoidance. Combatants with battle stress feel ashamed of themselves and become highly sensitive to the comments by their buddies and commanding officers. The stigma is worse than the illness itself. The stigma is a serious obstacle and it prevents them seeking treatment. Many officers and soldiers with combat stress conditions take deliberate efforts to hide their posttraumatic symptoms such as hyper vigilance, nightmares and avoidance.

Creamer & Sing (2004) argue that the diagnosis of PTSD provided a degree of legitimacy for sufferers of postwar mental health problems and reduced the need for pejorative terms such as, “inadequate personality” or non-specific descriptors such as, “anxiety neurosis” that were used widely until then. Nevertheless many combatants with PTSD find that there is a huge stigma associated with PTSD. Therefore some experts insist to use the term Posttraumatic Injury (PTI) instead of Posttraumatic Stress Disorder (PTSD) to eliminate the sigma and prejudices. Tick (2005) of the view that the psychiatric construction of PTSD that itself turns combat trauma into a chronic condition, and burdens the individual veteran with the consequences of political decisions to go to war. By jettisoning communal responsibility, it exacerbates the veteran’s sense of communal alienation and personal dehumanisation, and it leaves him or her with the shame of being weak.

The officers and the soldiers who suffer from physical and psychological ailments of battle trauma can experience low self-worth, low self-esteem and and sense of inability to command their subordinates. Fairweather & Garcia (2007 ) identifies stigma as a potential negative impact to service member’s career, paired with shame and fear of judgment is a concerning barrier to treatment and rehabilitation. Stigma inhibits service members from seeking and receiving treatment and rehabilitation. Tull (2011) provides the results of one study that was done with the United States service members returning from Bosnia, 61% strongly agreed with the idea that disclosing a psychological problem would harm their career. In addition, 43% strongly believed that admitting a psychological problem would cause other people to not want to be around them.

 The Post War Period and Psychosocial Health

The World Health Organization (WHO) defines mental health as “a state of well-being in which the individual realizes his or her own abilities can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community. War trauma negatively affects the mental health parameters. Odenwald et al. (2007) have shown that consequences of war-related trauma cause enormous suffering and problems adjusting to post-war life in many parts of the world.

After facing traumatic combat events the soldiers experience hopelessness, low self-fulfillment, rage, guilt, sense of emptiness, alienation and whole range of negative emotions. War has a catastrophic effect on the health and well-being of nations (Murthy& Lakshminarayana, 2006). Wars can change the psychological makeup of the combatants making them vulnerable to psychological disorders. Recent research suggests that military employees are at risk for acquiring PTSD (Danckwerts & Leathem, 2003).

The armed conflict in Sri Lanka ended in 2009 and the Sri Lankan Armed Forces militarily defeated the LTTE. But the military victory came with a huge human and social cost. Over 300,000 members of the Sri Lanka Armed Forces (including the Police Force) had been directly or indirectly exposed to combat situations during these three decades. Following the thirty year armed conflict in Sri Lanka many combatants underwent traumatic battle experiences that caused immense physical, emotional, and psychological distress. These experiences were events outside the range of usual human experience. Some combatants were diagnosed with combat related PTSD and other battle related psychological trauma. It has been estimated that there are a large number of combatants with undiagnosed combat related psychological ailments and many are without any kind of treatment. Stigma, lack of information, lack of resources etc. have prevented them getting professional help. For many veterans the combat stress has become an insidious disease – existing without marked symptoms but ready to become active upon some slightest psychological trigger.

War is profoundly political and social, yet terms such as, “trauma” tends to medicalize and individualize the problem (Martín-Bar”, 1994; Punamäki, 1989)., The armed conflict in Sri Lanka became extremely political and political decisions overruled the military decisions. Hence the war became a part of the political power struggle and war trauma naturally became an under discussed subject. There was no National strategy to address  combat trauma.

The Sri Lankan military authorities delayed to recognize the psychological impact of the Eelam War. Combat related PTSD was not regarded as a disabling condition that could affect the soldiers. Although the armed conflict started in way back in 1980s until 2005 the Sri Lanka Army did not give a medical discharge based on the diagnostic criteria “PTSD”. There were no strong socio political voices to address the psychological repercussions of the armed conflict. The Health Ministry had less power and minimal access to treat the soldiers with battle trauma. The health care providers did not receive adequate training to identify combat related symptoms among the combatants. These hindering factors have increased the psychological casualties among the armed forces.

Post-war situations are often characterized by the traumatization of large groups. In war, situations, people become victims of violence, destruction and displacement. Some have, experienced violence personally, others have lost relatives and friends, all, however, continue to live in an environment still marked by war and its consequences, even after, the end of the war (Scherg, 2003). The sequence of the, survivors’ post-war experiences usually, follows a pattern that includes a profound disorientation; despair and lust, for revenge (sometimes denied and/or, turned upon themselves); a process of, deep but incomplete mourning; the tentative reaching out for emotional solace in the form of new relationships and the rebuilding of a family world (Wolberg &Aronson,1975).

During the post war period in Sri Lanka delayed combat related posttraumatic reactions surfaced. Some extreme reactions manifested as self-harm, suicides and social violence. According to the Military Spokesperson of the Sri Lanka Army from 2009 to 2012 postwar period nearly 400 soldiers had committed suicide.

War related psychological symptoms could last for many years affecting individuals, their families and society. Van der Kolk et al. (1996) identified the significance of dissociation, affect, dysregulation, and somatization as “associated features” of PTSD. According to Van der Kolk and colleagues these associated features lasted for years even after full-blown, PTSD symptoms, subside. The combatants with affect dysregulation have persistent dysphoria, chronic suicidal preoccupation, self-injury, explosive or inhibited anger, compulsive or inhibited sexuality. Therefore Posttraumatic Mental Health of the combatants should be addressed appropriately. Evidence-based care system has to be introduced to increase and improve the post war psychosocial health.

Preventing Re-traumatization

Veterans affected by war trauma have a re-traumatization risk. Re- traumatisation is defiend as a situation, attitude, interaction, or environment that replicates the events or dynamics of the original trauma and triggers the overwhelming feelings and reactions associated with them. Dutton et al.( 2005) elucidate that sometimes the term “revictimization” rather than “retraumatization” is used to, designate re-experiencing interpersonal trauma again, especially later in life after an, earlier trauma.

Combat involves multiple types of life-and-death experiences associated with strong and wide-ranging emotional reactions. The emotional scars of the war remain for a long period. Traumatized veterans are a vulnerable group and measures would be needed to prevent them from re-traumatization. Many traumatized people expose themselves, seemingly compulsively, to situations reminiscent of the original trauma. These behavioral reenactments are rarely consciously understood to be related to earlier life experiences (van der Kolk, 1989).

Redeployment , working in adverse environments could trigger past traumatic memories. When the working environment becomes adverse or less supportive, there is a high tendency for the soldiers to become AWOL. A large number of Sri Lankan soldiers have become deserters over the past few decades. The numbers are exceeding over 50, 000 (AFP, 2011). Many deserters were exposed to battle events and they still relive with traumatic combat memories. A large number of traumatized combatants have joined the underworld gangs and committed crimes. Some have joined with local politicians and engaged in election related violence: the irony is many veterans who had got honorable military discharges have rejoined as security officers in private firms. van der Kolk (1987) indicates that some traumatized people remain preoccupied with the trauma at the expense of other life experiences. Effective measures must be implemented to minimize the re traumatization of combatants who underwent gruesome realities of the Eelam War.

Combatants with Traumatic Brain Injuries

Many combatants sustained traumatic brain injuries during the Eelam war due to gun short injuries and blast injures. Traumatic Brain Injuries (TBI) had become one of the signature injuries of the Eelam War. A significant number of soldiers diagnosed with PTSD and posttrumatic epilepsy during the past three decades. Frain et al.(2010) claim that veterans, as a group, face numerous problems due to the, common injuries of war. Posttraumatic stress, traumatic brain, injury, and polytrauma can all result in diminished problem-solving skills and poor self-care.

The combatants with traumatic brain injuries experience irritability , emotional liability, sensory impairments, neuro- cognitive deficits , difficulty sustaining concentration or dividing attention , word-finding or naming difficulty (anomia) , diminished verbal fluency , dysarthria ,limited capacity for insight and reasoning, Impairment of organizational and problem-solving skills. These combatants would be benefited by psychosocial rehabilitation.

Alcohol and Substance Abuse

According to the Harvard Medical School addiction is characterized by frequent use of a substance/process (usually daily) and by the fact that a, great deal of the individual’s behavior is focused on using the object of their addiction, obtaining the object and talking about the object or paraphernalia associated with the object’s use. Jacobsen et al. (2001) point out that 22-43% of people living with PTSD have a lifetime, prevalence rate of substance use disorders and the rate for, veterans is as high as 75%. The studies based on Vietnam and Afghan veterans in the US reveal that alcohol and substance abusers could be potential health hazards that go hand in hand with combat trauma. Analysis of data collected in a 1977 U.S. national epidemiologic study of substance abuse revealed that Vietnam veterans had substantially higher levels of alcohol consumption and binge drinking, than comparable groups of Vietnam “era” veterans with no Vietnam service other veterans and non-veterans (Boscarino, 1981).

Alcohol, tobacco and cannabis abuse are most prevalent problems among the Sri Lankan combatants and these practices lead to a significant health risk. Many veterans use alcohol and other substances to reduce the impact of intrusive memories, nightmares and break the social isolation. Alcohol and substance abuse have caused intense health, economical and family problems and the veterans need effective coping strategies to overcome the negative influence. Psychosocial rehabilitation can reduce the harm caused by alcohol and substance abuse and increase abstinence.

Domestic Violence

Sri Lankan women generally enjoy a higher degree of gender equality than, many women in other countries in the region (UN- Human, Development Report 2001). However in the recent past there have been upsurge in acts of domestic violence and violence against women in Sri Lanka. The impact of the armed conflict on women in Sri Lanka has been felt in different ways by women of different ethnicities and social classes and by, women living in different areas of the country (OMCT 2002). According to the Police Women and Child Protection Bureau of Sri Lanka anywhere from 8,000 to 10,000 cases of domestic violence are reported to police annually. Domestic violence has become a pervasive societal problem in Sri Lanka with the Eelam War.

Combat trauma is a collective ordeal and both soldiers and their families face the psychosocial repercussions of war. Often the families experience frustration, anxiety, marital problems, and behavioral problems. When the stress is overwhelming spouses emotionally distancing themselves from their husbands creating a deep void in the family communication. Combat trauma has created significant unhappiness, stress and conflict in marriages and families. Many spouses and children have become the secondary victims of the war.

Many studies have shown that combat trauma linked to domestic violence. A number of studies have found that veterans’ PTSD symptoms can negatively impact family relationships and that family relationships may exacerbate or ameliorate a veteran’s PTSD and comorbid conditions (Price & Stevens, 2010). Jordan et al. (1992) indicate that Male veterans with PTSD are more likely to report marital or relationship problems, higher levels of parenting problems, and generally poorer family adjustment than veterans without PTSD.

Combat Trauma and Alteration in Self Perception

Complex posttraumatic conditions (Malignant PTSD) often develop in the aftermath of chronic cumulative trauma. During the War the soldiers were exposed to insidious traumatization. There are a number of Sri Lankan combatants diagnosed with Malignant PTSD or DESNOS (Disorder of Extreme Stress Not otherwise Specified) and they have affect dysregulation, pathological dissociative symptoms ,somatic effects etc.

Many experts agree that trauma disrupts the development of self, capacities such as boundary regulation, affect modulation and tolerance, and, identity. Combatants with battle trauma often have altered self-perception. The victims feel a sense of helplessness, shame, guilt, and stigma. Many post combat reactions lead to drastic personality changes among the soldiers. They experience a paralysis of initiative, a sense of defilement with alienation. They preoccupy with morbid and traubled relationships sometimes thinking of revenge. They have mistrustful attitude toward the world and lack of trust cut them from reaching the support services and mental health care providers. Social withdrawal, feelings of emptiness and estrangement make them disconnected from the family and loved ones. There can be marked personality changes in which Horowitz (1986) described &ldquoost-traumatic character disorder that is resulted following long term exposure to trauma. Combat trauma has many residual effects that change their self-perception. Combat trauma could leave permanent scars. Solomon (1993) concluded that the trauma of combat leaves marked stress residues among combatants; hence war becomes internalized and continues to cast a shadow on the lives of veterans.

Psychosocial Rehabilitation of the Combatants

A combat veteran’s transition to civilian society from combat is fraught with complications in familial and interpersonal relations, vocational endeavors, and, at times, adherence to societal and legal boundaries (Fairweather & Garcia, 2007). In Sri Lanka a large number of ex combatants transited to civil society without any prier screening process. Many of them have readjustment problems. Psychosocial rehabilitation of the war veterans have been recognized as a crucial component in Sri Lanka. A range of social, educational, occupational, behavioral and cognitive interventions would be needed to address the needs of the combatants who were affected by the war.

Rehabilitation is an ecological approach that aims at the long term recovery and maximum self-sufficiency. In 1996 the World Health Organization came out with a consensus statement on psychosocial rehabilitation. The WHO defined psychosocial rehabilitation as a process that facilitates for individuals who are impaired, disabled or handicapped by a mental disorder to reach an optimal level of independent functioning in the community. Many physically and psychologically traumatized combatants need psychosocial rehabilitation to recover. Warren (2002) of the view that addressing the broader emotional, social and economic needs of survivors is a critical aspect of the rehabilitation process. Support survivors in becoming reintegrated into all aspects of community life, including education, employment, recreation, and social and political activities. Psychosocial Rehabilitation practices help war veterans re-establish normal roles in the community, independence and their reintegration into community life. These interventions should help to manage behaviors, perceptions and reactions to the physical / psychological injury or condition which may hold back the process of recovery or maintenance of the veteran’s well-being.

Promoting Recovery

Often the combatants with disturbing battle memories find it difficult to achieve a complete recovery. They are troubled by whole range of negative emotions that affect their cognition and behavior. The traumatized veterans easily go in to negative stress coping methods such as alcohol and substance abuse. Frequently the physical and psychological wounds that they had received from the battle ground make them highly dysfunctional. These traumas create various barriers making the veterans vulnerable. Inability to reintegrate and connect with the families and communities generate a sense of isolation and mistrust. The combatants feel that they are unable to find peace with themselves. These factors hinder their recovery.

Psychosocial rehabilitation helps the veterans to move towards recovery. Recovery is a journey of healing and transformation enabling the wounded veteran to live a meaningful life in a community of his choice while striving to achieve his or her full potential. Anthoney et al. (2012) defines recovery as a deeply unique process of changing one’s attitudes, values, feelings, goals, skills, and or roles.

Almost every traumatized veteran is capable of recovery. Studies show that in the West 60-90% of trauma victims can help themselves, by balancing the, protective factors (e.g. normal living conditions, social and cultural support mechanisms) and risk factors, (e.g. length of traumatic experiences, being wounded) in their lives (Kleber & Brom, 1992). Although in Sri Lanka mental health services are not advanced like in the developed countries culture and traditional healing systems acted as strong catalysts for recovery. The recovery process depends on several factors and individual resilience, support services and post combat environment play an important role. It is widely acknowledged that recovery from trauma is facilitated by emotional disclosure within a socially supportive environment (Pennebaker, 1992).

Adding  Case Management Services

A case management service has been introduced into Veteran’s rehabilitation programs in a number of Armies. In general terms Case management is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s holistic needs through communication and available resources to promote quality costeffective outcomes. Case management address the concerns regarding the wider psychosocial needs of veterans and their families.  Case management helps to coordinate the community services for veterans by allocating a professional to be responsible for the assessment of need and implementation of care plans. It provides ongoing support in areas such as housing, employment, social relationships, and community participation.

Using ACT Teams

Assertive Community Treatment is a team treatment approach designed to provide comprehensive, community-based psychiatric treatment, rehabilitation, and support to persons with serious and persistent mental illness.  It was implemented by Dr. Arnold Marx in the late 1960s. The US Department of Veterans Affairs has implemented ACT across the United States to help the veterans and ACT teams are closely working with the soldiers. This multi-disciplinary Team is composed of a psychiatrist, nurses, social workers, mental health workers, a peer support worker, a program assistant, an occupational therapist, a general practitioner, and a team leader who provide a range of comprehensive and integrated community-based treatment, rehabilitation and support services assisting clients toward their recovery. Its a timely requirement that the health authorities should start using such multidisciplinary team to heal the Sri Lankan combatants who were affected by war trauma.
The Impact of Culture in the Process of Recovery in War Trauma

The culture plays a key role in the recovery process. Culture is the full range of learned human behavior patterns and it is a powerful human tool for survival. In psychosocial rehabilitation culture has been identified as a powerful tool that promotes recovery. Culture plays an important role in recovery as sources of strength and enrichment for the person and the services. Sri Lankan traditional culture does not outcast the mentally wounded. Combat trauma has been identified in the ancient history of Sri Lanka.

In every culture special attention is given to the soldiers who fought in battles. The psychological wounds of war are a universal human experience, and that, as we discover in traditional warrior cultures, there is a common structure to the requirements and processes of healing. These wounds have been named in all cultures, and described in our own western culture more than two-and-a-half thousand years ago (Brooke, 2012).

The traditional Sri Lankan culture is enriched with Buddhist Philosophy that views the human suffering in more existential perspective. Incorporating traditional cultural beliefs and values the recovery process could be accelerated. The war veterans who struck by psychological trauma archive a great personal growth.

In traditional warrior cultures combat experience sets the returning warrior on a different path of psychological development, which continues through the life span. He (or, now, she) can never return to the time of innocence and will never be “merely” a civilian again. Instead, he or she is called to take up this experience as a spiritual task in which moral character, self-sacrifice, humility, strength, and wisdom are recognizable themes. The transformation of combat trauma into spiritual meaning is the warrior’s archetypal calling ((Brooke, 2012).

Alleviating Symptoms

In Sri Lanka the combatants are treated with drug therapy ( anti depressants, mood stabilisers , anti psychotics , pain killers etc.) psychotherapy (CBT , EMDR , Rogerian therapy) traditional healing methods ( Thovilay the ancient ritual , Dehi Kapima – chasing the evil spirits) Spiritual Therapy and mediation (mindfulness and the Methha mediation or the meditation of loving kindness ). These therapeutic processes help to minimise the symptomatology that is caused by the combat trauma.

For psychosocial rehabilitation alleviating of symptoms are essential. Rehabilitation is an integrated program of interventions that empower individuals with disabilities and chronic health conditions to achieve &ldquoersonally fulfilling, socially meaningful, and functionally effective interaction” in their daily contexts ( Riggar& Maki 2004). Physical and psychological symptoms related to combat trauma often affect the veterans in massive proportions. These symptoms make them dis-empowered. Alleviating the effects of physical and emotional trauma is a significant part of psychosocial rehabilitation.

Traumatic stress and PTSD are often associated with physical (i.e. somatic) complaints such as headaches, stomach problems, body pain, dizziness or palpitations, etc., that do not actually relate to a physical, malfunction or disorder (McFarlane, Atkison, Rafalowicz & Papay, 1994; Van der Kolk et al., 1996). The residuals of combat trauma could become detriment to the functionality and well being of the combatants. War trauma can be cumulative and create vicious cycles. Many combatants experience war related intrusions, negative feelings, chronic tension, hyper arousal, insomnia, fatigability, medically unexplained somatic pain , emotional anesthesia, and various other symptoms. Alleviating symptoms associated with war trauma is highly essential to eliminate the functional and environments barriers that are created by war trauma.

Building Strengths

Research, indicates that the duration and the frequency of traumatic experiences negatively influences physical, mental, and spiritual coping mechanisms (e.g. Kleber & Brom, 1992). Veterans affected by war trauma experience drastic limitations in human intractions, professional situations and have problems coping with stress.

Seligman (2002) identifies strong connection between a self-defeating pessimistic attitude and susceptibility to PTSD and identifies a phenomenon which is called &ldquoost-traumatic growth,” that could affect the combatants. Soldiers with battle trauma feel disempowered and defenseless. Building strengths help the combatants to fight back their war related symptoms. Psychosocial Rehabilitation interventions build on the strengths of each person. Strengths Based practice uses peoples’ personal strengths to aid in recovery. Discovering and using individual strengths accelerates the process of recovery. Building strengths is an effective way of empowering the combatant and they can live in the community with the least amount of professional support.

 Creating Supportive Working Environment

Employment is an integral component of recovery. Employment has been seen to correlate with self-esteem and decreased stress and income has often been correlated with, disability (Richardson et al, 2002). Soldiers with war related trauma need extra support to perform their military duties. There are specific military duties that can trigger past trauma in war affected soldiers. Handling human remains, working in combative environment with fire arms can further escalate their trauma fixated memories. Therefore proper assessments have to be done to find the triggering factors. The military duties should not re traumatise the veteran who is profoundly affected by the combat stress. Rough and harsh way of handling traumatized combatants without offering administrative support could damage their psychosocial wellbeing. Healthy and empathetic working environments help war affected combatants to achieve speedy recovery.

 Vocational Rehabilitation

Very often physically and psychologically wounded soldiers cannot perform normal military duties and they need special vocational rehabilitation. Vocational rehabilitation helps maintain work activities and reduce negative symptoms. The aim of vocational rehabilitation is to provide the soldiers with the new skills and knowledge necessary to work in the military. The vocational training they master could help them after leaving the military.

Premature retirement from the military following disability conditions could lead to financial constrains. Some ex combatants find it extremely difficult to enter in to the civilian job market since they have no marketable civilian job skills. Difficulties in transition and reintegration experienced by veterans can lead to financial distress resulting from inability to maintain employment (Fairweather & Garcia, 2007). The ex combatants need to learn new skills to find a suitable employment that does not trigger their traumatic memories. The vocational training and supportive employment could help them to overcome these barriers and find meaningful jobs.

To address ex-combatants’ economic concerns, income-generating and capacity-building activities would be needed. Providing vocational skills training; and on-the-job training help them to become employable. A number of studies have now demonstrated that supported employment is an effective rehabilitation approach (Burns, Catty & Becker, et al, 2007; Bond, et al, 2008). Meaningful employment leads to improved social integration, normalized peer relationships and a source of identity (Warner, 2009). In addition vocational training and supportive employment gives them a sense of safe place and prevents re-traumatization.

Family Involvement in the Rehabilitation Process

A large number of combatants who are affected by combat stress have dysfunctional family systems. Family members often have difficulties to understand the combatant who is experiencing battle stress. Irritability and rage—angry outbursts disintegrate the family ties. The entire family is profoundly affected by the trauma based behavior of the combatant. They repeatedly focus their anger and frustration on family members. The family members may experience fear, anger, and sometimes disgust. The family members start to distance themselves from the victim. This creates a pathological style of family communication system and it adversely affects the combatant’s recovery process.

In Psychosocial Rehabilitation family is considered as a strong ally in the process of recovery. Supportive family involvement was found to be an important aspect of a soldier’s rehabilitation. Family members need help, psycho education and skill training to communicate with the combatant. Trained and empathetic family members are inimitable resources for the combatant who is suffering from war trauma. Research investigating the predictors of outcome of chronic, illness and disability has increasingly recognized the importance, of families, both in terms of their influence on the recovery of the, individual, and the effects of the illness or disability on other family members (Degeneffe & Lynch, 2006; Storer, Frate, Johnson, &, Greenberg, 1987)
Supportive Relationships

Bowlby (1973) notes that human beings are strongly dependent on social support for a sense of safety, meaning, power, and control. Supportive relationships are essential in the recovery process. Family members, relatives, friends, colleagues at the work place play a key role in combatant’s emotional wellbeing. An examination of l

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There is no better way to cope with depression than seeking for professional help.  Depression could be fatal if not treated, just like any other disease, there is cure for it.  It a medical condition that needs medical attention.  If seen the symptoms to any friends or relatives, do a favor for them and tell them they need help.

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