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Cpt (cognitive Processing Therapy)

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I am 100% total for PTSD. (not permanent) I should be getting my annual VA letter scheduling me for a re-exam any day.

I have taken the 6 month Coping Skills and it didn't do any good. Have been going to alumni group every two weeks for a couple of years and it provides only temporary relief.

Now the VA psyc wants me to begin the CPT (cognitive processing therapy). I told him I would consider it but wanted to first give it some thought. In researching CBT it doesn't sound as if I probably want to do it. However if I turn it down will this give the VA reason to reduce my rating? Also I am 63 years old and the first re-exam I had, the examiner said it was too early to determine if the Coping Skills will work. Well they didn't work and last year the next examiner said to wait another year. How long does a former grunt have to wait and try different things? Any comments or opinions on what I should do or about the program would be appreciated.


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I think you should consider trying it. I tried CPT and while it makes sense on paper, I didn't find that the coping skills worked for very long. I'd feel safe in the group or with the therapist, but out in the real world I just get too rattled too quickly to remember what I'm supposed to be doing.

Last week my VA therapist said that there is no cure for PTSD, the best you can do is develop coping skills to help you lead a normal life. He has PTSD himself. It's funny, because in the office he seems very together and in control, and he managed to go through college and he has a good job now.

But our session was at the end of the day, and as usual it took me a while to get myself into my car and ready to drive away. I happened to look across the parking lot and I almost didn't recognize him. His shoulders were hunched and his head was down and his body language looked nothing like the competent professional I'd just been talking to.

Made me wonder what I must look like.

Sorry, I digress. I think that you have to convey to your therapist that you are willing to try it, but maybe not just yet. Don't flat out refuse to try it. I don't know why, I just don't think it's a good idea. It takes a long time to reach a comfort level where you can start really doing some work. Sometimes that level never gets reached at all. I'm sorry, I think I'm just babbling now. :)

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I agree you should leave your options open . You need to have your Psych Doc explain everything to you about it.

I had to sign a contract , stating i would show up and do the assignments as required for the full 12weeks.

Well i lasted 6 weeks and i haven't been back for 4 weeks now. I did my sessions one on one with my therapist.

I would come out of there and be jacked up for the next 2-3 days. Those 2-3 days at home would be hell for my family and me. It would take 2-3 days for the family to get settled again and then it would be time for another session.

Right now i don't know what i'm going to do. Go back or drop out of the program ? There is alot of homework and writing assignments with this. I was not prepared for that aspect of it. Every day your supposed to reread your most traumatic event paper and also do stuck point logs. Everyone is different , so you need to do what you feel is right for you.

I just want you to get the facts , straight from somebody who has / is doing it.

Good Luck ,

Sgt Sandman

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Its unlikely that the VA will reduce a rating because a Veteran refused treatment.

My opinion but the VA Shrinks have a treatment of the hour that they want us to do mostly cause they probably have special deals concerning research and make money on it.

You can go to Vet Center and get group if you want that.

Or you can try it out and if it works or helps stay with it or drop out it is really your decision and no ones elses

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Sandman i just completed my 12 weeks and it was hell and I know the feeling of the 2-3 days of feeling screwed up. I went kicking it seemed up to the 6 week. Then I learned how to control my breathing and do some techniques that help to reduce my anxiety a bit. It was hard getting out the house because I am not real social and dont like groups, crowds, etc. The docs worked with me even when I couldnt remember assignments and sometimes missed session because I truthfully would forget. There was time I rolled in late and shuffled. They still worked with me. I hated the meetings but in the end I think that I'm a little better for it. Every bit counts just like each day. Just take a little at time. You'll get there. I asked the same question of my psych and she said no they do not take your rating but is my understanding that if you are not actually rated yet by the VA that this class helps to verify your rating. If you already rated it will not decrease you by dropping out. You may not have been ready, or at the point where this type of treatment works not everything is for everyone. We had few people in our group that dropped as well and I would still see them coming to the VA. It also helped me with getting out more out of my home. Which I probally needed. However, I still work on my stuck points every now and then when I remember too. Hope this helps some.You can always try agian.

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    • To clarify: "Have ptsd rated 100% w/smc-k. Had Prostate removed w/ cancer , have all the usual residuals 60% have Tinnitus 10% , have PH which allows me to be in CAT - 1 for treatment." I assume  the 60% prostate cancer residuals are due to AO exposure in Vietnam? With 100% PTSD plus the additional 60% Prostate residuals, didn't the VA ever consider you for the SMC "S" award......?????????????????????????????? "The VA clinic transferred my PA and inserted a MD to follow my health care. my new VA doc refuses to fill meds I been taking for these last 6 yrs. VA doc wanted progress notes from my personal doc which were sent to clinic but is not sufficient proof i guess. my VA doc is demanding I go to main hosp to see mental health people" Can you tell us what meds the VA doc is questioning? Is it the Wellbutrin? Or is the doctor really questioning that you might not have had any MH treatment at all for your PTSD for some time? Is your private doctor a  psychiatrist? If so does he treat you for PTSD? This might be a Safety Issue if the lack of proper meds could cause you to have seizures. We had a vet here who 2 VAs would not give him his prescribed seizure meds. I told him to go to the VA Inspector Generals web site and file a complaint. I had no idea if they would consider it as a safety issue but they did. In less then 24 hours the veteran had his meds! What does the private doctor attribute your potential for serious brain seizures to? If we know what meds, maybe we can help more. I firmly believe that anyone who is rating and comped for PTSD should make sure they stay in treatment for it ,perferably with the VA, or with a private shrink, or at least spend quality  time at a vet center. If they dont get treatment continuously, the VA will think they are somehow completely cured,or have gotten better enough to have VA lower their compensation rating..      
    • What are you asking?  My concern honestly would be that there is note of mental health issues and childhood abuse. 
    • URGENCY: STATUS: COMPLETED Initial Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire * Internal VA or DoD Use Only * SECTION I: ---------- 1. Diagnostic Summary --------------------- Does the Veteran have a diagnosis of PTSD that conforms to DSM-5 criteria based on today's evaluation? [X] Yes [ ] No ICD code: 296.80, 303.90, 309.81 2. Current Diagnoses -------------------- a. Mental Disorder Diagnosis #1: Unspecified bipolar and related disorder ICD code: 296.80 Mental Disorder Diagnosis #2: Alcohol use disorder ICD code: 303.90 Comments, if any: currently in remission as veteran is in residential MH treatment Mental Disorder Diagnosis #3: PTSD ICD code: 309.81 b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): n/a 3. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [X] Yes [ ] No [ ] Not applicable (N/A) If yes, list which symptoms are attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses: Unspecified bipolar and related disorder - mania with psychosis that has led to hospitalizations and involuntary commitments on multiple occasions. Alcohol use disorder - alcohol dependence with 15 years of sobriety 1996-2011, relapse and use prior to most recent psychiatric admission. PTSD - recurrent intrusive thoughts of being raped in the military, social isolation, avoidance and hyperarousal. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [ ] Yes [X] No [ ] Not shown in records reviewed 4. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with reduced reliability and productivity b. For the indicated level of occupational and social impairment, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by each mental disorder? [X] Yes [ ] No [ ] No other mental disorder has been diagnosed If yes, list which portion of the indicated level of occupational and social impairment is attributable to each diagnosis: Unspecified bipolar and related disorder causes occupational and social impairment with reduced reliability and productivity. Alcohol use disorder casues occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. PTSD causes occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. c. If a diagnosis of TBI exists, is it possible to differentiate what portion of the occupational and social impairment indicated above is caused by the TBI? [ ] Yes [ ] No [X] No diagnosis of TBI SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence review ------------------ In order to provide an accurate medical opinion, the Veteran's claims folder must be reviewed. a. Medical record review: ------------------------- Was the Veteran's VA e-folder (VBMS or Virtual VA) reviewed? [X] Yes [ ] No Was the Veteran's VA claims file (hard copy paper C-file) reviewed? [ ] Yes [X] No If yes, list any records that were reviewed but were not included in the Veteran's VA claims file: If no, check all records reviewed: [X] Military service treatment records [ ] Military service personnel records [ ] Military enlistment examination [ ] Military separation examination [ ] Military post-deployment questionnaire [X] Department of Defense Form 214 Separation Documents [X] Veterans Health Administration medical records (VA treatment records) [ ] Civilian medical records [ ] Interviews with collateral witnesses (family and others who have known the Veteran before and after military service) [ ] No records were reviewed [ ] Other: b. Was pertinent information from collateral sources reviewed? [ ] Yes [X] No 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): She reported that she was born in MD, raised by her parents. She has two brothers and two sisters. She reported that she witnessed physical violence, and she was told by an older sister that she was molested, but the veteran does not have any memories of this. She has two daughters, ages 15 and 8. Her sister has custody of her oldest daughter. Her husband (separated) has custody of her 8 year old. She has sporadic contact with her 15 year old. She sees her 8 year old once/month. She was not married to her oldest daughter's father. She married in 2005. She was living with her husband in 2013, he left in January 2013, then she was homeless (living in her car), then stayed with her brothers for a while. She reported that she talks to her sister, but noted that her sister has distanced herself because of the veteran's difficulty complying with medication. b. Relevant Occupational and Educational history (pre-military, military, and post-military): Pre-military: She reported that she graduated from high school in 1985 with no learning or behavior problems. She worked as a dishwasher, factory work and landscaping prior to the military. Army, 1986-1989, E-4, radio operator, honorable She reported that there were two rapes, one attempted rape (two perpetrators). She stated that in the sp ring (month unknown) of 1989 in Kentucky. It was not reported. In May 1989 in Virginia. She reported that she was raped by a peer and it was reported. She stated that they were both arrested and sent back to duty stations. She said that she tried counseling, but "to no avail." Attempted rape in Texas, an NCO on guard duty, she fought him off and it was not reported. She stated that she was depressed and suicidal, saw a psytchiatrist, given pain killers and sent back to duty. Post-military: She stated that she worked in landscaping for a while (7-8 months), then went to school in Florida. She did not get a degree. She said that she did not work for a while due to mental disorder symptoms. Last worked in 2012 - worked at hme doing phone sales from home. She left after three years due to difficulty managing mental disorder symptoms as well as speech issues. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): Family history: --She reported that there is mental illness in the family, but she is unsure of diagnoses. Pre-military: No treatment reported, however CPRS note dated 9/13/13 notes, "Veteran reports that mh sx stem back to childhood. Veteran states that at age 15 she became suicidal." Also noted at that time, Veteran also reports symptoms of PTSD stemming from childhood abuse and MST to include nightmares, hypervigilence, avoidance of crowds, difficulty sleeping, flashbacks, and extreme distress recalling the events." Military: The veteran reported that she was raped (see statement for details) and that it was reported during service. There were no records found in VBMS. Post-military: 1993 - involuntary committment to Spring Grove for 30 days, dx psychotic disorder nos. 2011-"started falling apart" "leaving my body," some loss of memory for events 2013 - present, multiple involuntary commitments over the last year - one at Perry Point VAMC and others at civilian hospitals - St Joe's, Sheppard Pratt, Univ of MD - (involuntary committment papers are in VBMS). Dx with PTSD at the VAMC in 2013. She has been treated for PTSD based upon both childhood trauma and MST since that time. Currently inpatient in PRRTP at the Baltimore VAMC since June 29, 2015, rx risperidone (injection every two weeks). In the early 1990s, she stated that she first started experiencing psychotic symptoms of "people swapping voices" when someone is talking. She denied command hallucinations. She endorsed delusions about witches conspiring against her. In 2011, she stated that she began to have flashbacks of being raped and assaulted in the military. She stated that she drank to manage the flashbacks and began to decompensate. She endorsed "being really generous with money" and feeling fearless. She stated that she has taunted police. She stated that she would start fights with shop owners and become a nuisance. She described her thoughts as initially "toddler-like, then they would become really dark." She endorsed feeling rage, both when manic and not, history of physical violence, most recently toward her brother. The veteran reported that through treatment she has learned to recognize that reduced need for sleep is a precursor to psychosis. She reported that when she is not manic, sleep is poor due to feeling like she is on guard duty at night. She stated that she would rather sleep during the day. Suicide attempts: 1985- cut wrists 1995- attached hose to exhaust of car and put hose in window- attempt aborted by a man walking by. d. Relevant Legal and Behavioral history (pre-military, military, and post-military): None reported. e. Relevant Substance abuse history (pre-military, military, and post-military): She reported that she started drinking at age 15. She stated that at the height of her alcohol use, she would drink a 12 pack of beer or 2-4 bottles of wine in a day. Two rehabs for alcohol in the mid 1990s at Ft Howard. She started AA in 1996, did not drink for 15 years, started again in 2011. She stated that she drank to manage memories of being raped in the military. She goes to AA meetings when she can. She smoked marijuana for the first time at age 15 and last used about 6 weeks ago. She reported sporadic use over the years, none during her 15 years of abstinence from alcohol. f. Other, if any: No response provided. 3. Stressors ------------ Describe one or more specific stressor event(s) the Veteran considers traumatic (may be pre-military, military, or post-military): a. Stressor #1: Rape in 1989 Does this stressor meet Criterion A (i.e., is it adequate to support the diagnosis of PTSD)? [X] Yes [ ] No Is the stressor related to the Veteran's fear of hostile military or terrorist activity? [ ] Yes [X] No If no, explain: not related to military conflict Is the stressor related to personal assault, e.g. military sexual trauma? [X] Yes [ ] No If yes, please describe the markers that may substantiate the stressor. there are no markers of the assault 4. PTSD Diagnostic Criteria --------------------------- Please check criteria used for establishing the current PTSD diagnosis. Do NOT mark symptoms below that are clearly not attributable to the Criteria A stressor/PTSD. Instead, overlapping symptoms clearly attributable to other things should be noted under #7 - Other symptoms. The diagnostic criteria for PTSD, referred to as Criteria A-H, are from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Criterion A: Exposure to actual or threatened a) death, b) serious injury, c) sexual violation, in one or more of the following ways: [X] Directly experiencing the traumatic event(s) Criterion B: Presence of (one or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred: [X] Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Criterion C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic events(s) occurred, as evidenced by one or both of the following: [X] Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). [X] Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). Criterion D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad,: "No one can be trusted,: "The world is completely dangerous,: "My whole nervous system is permanently ruined"). [X] Feelings of detachment or estrangement from others. Criterion E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following: [X] Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects. [X] Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Criterion F: [X] Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month. Criterion G: [X] The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Criterion H: [X] The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. Criterion I: Which stressor(s) contributed to the Veteran's PTSD diagnosis?: [X] Stressor #1 5. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Depressed mood [X] Anxiety [X] Suspiciousness [X] Chronic sleep impairment [X] Disturbances of motivation and mood [X] Impaired impulse control, such as unprovoked irritability with periods of violence [X] Persistent delusions or hallucinations 6. Behavioral Observations -------------------------- The veteran was seen for 60 minutes. Her VBMS file and CPRS notes were reviewed prior to the interview. It was explained to the veteran that these exams are not full psychological evaluations, but rather evaluations for rating purposes that include questions and language dictated by the VARO. The limits of confidentiality were explained to her and she agreed to participate in the C&P evaluation. She was alert, fully oriented and cooperative. She was well groomed. Her reported mood was good, her affect was flat. Speech and thought content were within normal limits. Thought processes were logical and goal-directed. No evidence or report of delusions or hallucinations. Memory and attention appeared grossly intact. Insight and judgment were intact. The veteran denied current suicidal or homicidal ideation. 7. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to PTSD (and other mental disorders) that are not listed above? [X] Yes [ ] No If yes, describe: manic and psychotic symptoms are managed at this time with risperidone (IM) 8. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 9. Remarks, (including any testing results) if any -------------------------------------------------- The veteran's bipolar disorder, when she is noncompliant with medications or using alcohol, has contributed to severe functional limitations, loss of custody of her children, loss of her home and inability to work. She is likely able to function in a work environment that is low in stress as long as she maintains medication compliance. There is no significant evidence of a military sexual trauma. Nevertheless, her PTSD symptoms are based upon trauma experienced both prior to and during the military. She has been in treatment for PTSD since 2013. Her bipolar disorder and alcohol use disorder, both of which have contributed to severe impairment in functioning, are not causally related to the PTSD. Her PTSD symptoms, when other disorders are managed, cause less impairment and have responded well to treatment. NOTE: VA may request additional medical information, including additional examinations if necessary to complete VA's review of the Veteran's application
    • Why are my post hidden? It said "Your content will need to be approved by a moderator"
    • But I also stated: "Here is an award to a show what VA needs regarding this type of claim: The entire case has to be read to understand how the BVA decided this:" My point was just seeing a 'crash' might not be a stressor for VA purposes. The BVA decision above was based on far more factors than witnessing a crash and this is why I posted the link. I added from personal experience: "Veterans who were in rescue/recovery ops after crashes, or part of the Fire team at the scene of these types of crashes often can succeed in PTSD claims, I am sure ." I forgot to add I know at least 2 vets who did, and also my husband was a volunteer in Danang for a recovery Op--1964 , I told this story before, and he went to the VA for a business loan  but was immediately diagnosed with PTSD ( 1983) because he relayed the event to someone he thought was another Vietnam  veteran while waiting for them to arrest him ( another story I already told here) They didnt arrest him at all..the "veteran" he talked to was also the 'on the site psychiatrist in Danang  at the river that same day and for many weeks more because of the nature of this horrific event, (some Marines went off the deep end mentally right away from it) and he wrote a buddy statement for my husband that , the VA accepted right away because he was also the Director of this VAMC in NJ, as well as it's head psychiatrist.My husband could still see and smell the dead for the next 30 years.It was all in the national news here in the 'world' as well.Horrible. Seeing a crash, (and I think no one got hurt at Anderson if that was the crash), might not be a sufficient stressor for PTSD....but maybe for an acquired psychiatric disorder or depression  from it.   maybe ....I am not saying it was not traumatic for is just---- will VA see it that way?.