p.p1 discouragement, distrust, etc. These ever changing emotions that

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Ben reported current pass/vague thoughts of suicide ideation. Ben states that he has thoughts  daily ” i would be better off dead”, though he denies intent and plan at this time. Ben reports having a interrupted suicide attempt nearly 5 years ago that due to feeling overwhelmed with PTSD symptoms, while dealing  with several psychosocial stressors at once.  Ben reports his psychosocial stressors are less stressful now, though his PTSD and depression  symptoms are still a struggle. Ben states 2 months ago he felt an episode of depression that was concerning , though it was not the same level of severity 5 years prior.  Ben says , he does not want to go back in that “dark place” (seven years ago) and that’s one reason why he’s seeking help. Pt reports “I’m scared that i could end up in the same situation again”.  Ben denies being on psychotropic medications at this to help manage mood. Pt is not imminent danger to self, therefore not needing to be hospitalized.  Because Ben has multiple risk factors, Pastor decided to complete a safety plan with Ben to utilize between now and point of establishment with counselor.  By completing this , Ben and Pastor will collaborate in addressing actions plans to specific triggers that invoke hopelessness and depression .  
Spiritual Conflict: One of Ben’s spiritual conflicts including anger towards God.
Trauma will hit in our fallen world – whether it is something that makes headlines, like a disaster or terrorist attack, or something more personal, like abuse, a loved one’s death, or an accident. The result of trauma is people wanting to make sense of it. For many, their becomes a existential / spiritual conflict of : Why would God let this happen ? Why did God take that person and not me? Is God really good? Does God love me? Has God abandoned me? These questions and the feelings they may provoke are normal. Some of these emotions towards God include anger, resentment, bitterness, discouragement, distrust, etc.
     These ever changing emotions that come along with trauma can manifest various behaviors that further hinder one’s spiritual life. The most obvious one is that the client may display unwillingness to attend religious services, attributed to anger at God (Kok, pg 15). In addition,  the client may refuse to participate in spiritual exercises such as prayer because anger toward God (Kok, p.15).  Furthermore, the client could possibly express feelings of abandonment by God. According to Kok (1998), another manifestation that surfaces is that the client “frequently make cynical, negative comments about God, religion, and spiritual things.”  This anger could even include blaming God for painful events of life such as death by a loved one, disappointment in love life, serious illness or injury, natural disasters, etc (Kok, p.15). 
Clinical trauma sxs: 
       PTSD is preceded by some extreme event that affects the person at a psychic level to the point that their quality of life is impacted (Vilens, preface i). Post traumatic is, by definition, a survivor of trauma; the more extreme the trauma, the greater the stress on the individual. Stress can cause damage to the human psyche and manifest itself in undesirable and, sometimes, uncontrollable behaviors that distort a normal lifestyle. Trauma can describe both a physical trauma and an emotional or psychological trauma and both may occur at the same time. When a person breaks an arm in an accident there is both physical damage and pain that affects the psyche as well. However, the effects on a person’s psyche can be magnified if the arm is broken as a result of a violent attack such as a battlefield encounter or act of terrorism. Some traumas do not injure the body at all. Someone could be witness to an act of violence or suffer the threat of injury or insecurity to the point that stress begins to cause damage (Doron, p. 3).
     The Diagnostic and Statistical Manual of Mental Disorders defines PTSD as both “a life threatening event or danger of serious injury, or danger to the physical integrity of self or others” and “the person’s response to the event included intense fear, helplessness, and/or horror” In addition, the event is re-experienced. The person may suffer nightmares, flashbacks, panic attacks from cues similar to the event (sounds, smells), or a debilitating obsession with the memory or their perceptions and thoughts about the event. This may lead to avoidance of people, places, or an inability to relate to life in general. They may block the memory from their conscious self and lose the ability to feel emotions in any significant way. Their sense of hope and optimism for the future may be impaired. They can go sleepless, have anger issues, or be compulsive to an extreme. Fear and anxiety dominate their life (Doron, pp. 17-18).
        Studies show Veterans with PTSD have significantly higher domestic violence issues, marital conflict, and behavior issues with children.  Many family members can start to feel resentment that the partner isn’t over these issues yet. Family can also start to withdrawal from the person with PTSD to avoid their anger and anxiety issues. The veteran in return feels misunderstood and judged, therefore exacerbating pt’s trauma symptoms. (family) 
         Anger issues are prevalent among veterans for a few reasons. Hyperarousal is a symptom of trauma, and can make veterans vulnerable to high alertness, frustration, exhaustion ,  startle response, and sleep deprivation. Anger management is often a byproduct of this symptom. Depression is common issue for PTSD clients— this could be a result of pro-longed anxiety symptoms, grief,  guilt, etc. Anger issues are prevalent among those who are dealing with depression. Men have a tendency to lash out more, in comparison to women who have the tendency to have more crying spell when depressed.  Anger often is the presenting problem that leads veterans to seek help because of the family turmoil it is bringing. (anger)
        Another common problem is pt’s increase isolation due to his anxiety symptoms and due to his depression symptoms. This behavioral is an attempt to being relief to anxiety when around others, or possibly avoiding others to prevent oneself from lashing out. Though this often brings some immediate relief , which reinforces pt’s maladaptive behaviors, there is no long-term gain. Studies have shown that isolation can increase depression symptoms over time.  (isolation ) 
       Lastly, depression and trauma symptoms have significant overlap, but severity level of symptoms of poor concentration , sleep disruption,  hopelessness, isolation, and anger is something pastors should be mindful of as well. When depression or trauma symptoms  get to the point that it’s severely disrupting their day-to-day functioning , and limits their ability to engage with pastoral counseling and/or clinical counseling , then that’s when outside interventions such as as a trial of psychotropic medications could be beneficial . (sxs for medication)

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