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Many of these children suffer severe deficits in the development of awareness of self and body image, and show a mental fixity on sexual themes and distortions of the body. Without such inexplicable adaptive clout on the part of abused children, they may go downwards into a sense of abysmal nothingness, 25 the demise of consciousness. The traumatized child, additionally, is exposed, in this the bizarre relational dynamics to secrecy, threats of exposure to vilification, humiliation, and moral condemnation , threats of abandonment, fear of repeated sex-based and physical injuries, and further degradation.

These children are constantly wary when adults come near, and when they are away from home may fear returning home and may become runaways. Adept at reading adult inner states of evil, selfish indulgence, idiosyncrasies, instability, potential violence, irritability, and episodes of sexual arousal, these children find a way to survive. Indeed, the children hide their true self, subterraneously, and are in a persistent state of near-adrenergic burnout.

Associated with this state are paranoid expectations of attacks. This state of being chronically revved-up with terror-driven paranoid expectations, is akin to living in a internal police state. Abusive adult relationships deprive the child of genuine, unconditional regard, affection, and psychological protection from being overwhelmed by environmental impingements. Many feel they have seen, felt, and understood too much about human cruelty and wanton carnal indulgencies. DES is comprised of such self disorder symptoms 30 as distortions in self perception as in a negative view of self as damaged, with little or no redeemable qualities , deficits in affect regulation e.

Here, the serious nature of the abuse at an early age makes the child vulnerable to fragmentation of the identity system, leading to a the major post-traumatic outcome, dissociative identity disorder DID. Ostensibly helpful to therapists and victims is the notion that, intermingled with dissociative pathology, are highly valued adaptive functions of dissociation: It 1 conserves energy by facilitating automatic action to responses, 2 offers efficiency of effort, 3 handles irreconcilable conflicts, 4 helps escape the pain of traumatic reality, 5 isolates catastrophic experiences, 6 directs discharge of emotions, and 7 submerges individual identity for the group identity.

In DID the structure of the immature self is strained and overtaxed by repetitive influx of powerful life-threatening and soul destroying stimuli from the abusing milieu. Each sensory modality may serve as a triggering pathway to a network of terrifying memories and chilling emotional reactions within the survivor. Thus, sounds, tastes, odors, and bodily sensations may activate their own reliving of latent traumatic memories into active reexperiencing of the trauma in the immediate present.

Intrusive symptoms in the person with PTSD resonate echoes of haunting experiences of the past that drive out things that are important to self and others transpiring in the here-and-now. This trauma fixity on warding off intrusion induces the feeling of being trapped in traumatic history of abject misery, and emotional confinement. This sense of being trapped goes together with no real sense of being safe in a world perceived as abandoning in its failure to ameliorate and offer meaningful solutions to traumatic distress and threats to psychological breakdown.

They are often unable to express positive feelings, or participate joyously in social or communal settings. Traumatized people often give others the impression of being totally focused on self, a narcissistic stance that many family members and friends find overly self-indulgent and very perplexing.

Normal, unconstricted and freely expressed range of human emotions is available to most people. Emotions give color to life and experience. But when trauma strikes, the victims typically develop intolerance for strong emotions, while their emotional lives become constricted, suppressed, repressed, or dissociated. The relative wide range of existing emotions is shrunken down and narrowed so the victims appear to be restricted to experiencing only negative, dysphoric emotions like terror, rage, irritability, and depression.

Interpersonally, the individual comes across to others at home, on the job, and in the community as aloof, vulnerable, listless, lacking in energy, and as disinterested in them or in the immediate environment. They come across unequivocally as people with something on their minds, but closed to interpersonal transactions. Reenactments in some ways are about the need for connection for the purpose of forcing an indifferent and unresponsive environment into at least tacit affirmations that the trauma did occur and did awful damage to the self.

Avoidance and numbing are probably the most harmful of all trauma symptoms in that they devastate and damage human growth and development. These symptoms, moreover, deprive the victim of the rich, life-expanding influence of diverse stimuli. Developmental unfolding that ordinarily leads to a progressive increase in personal power and maturation, with actualizing potential, is possible only when the individual is exposed to an increasingly diverse quantity and quality of stimuli, emanating, radiating, and irradiating, from the interpersonal, physical, and spiritual worlds.

One consequence of the tendency in SA and CSA victims to employ denial and mental suppression of memories, dissociation, and occurrence of general CNS dysregulation is the inducing of such psychosomatic symptoms, as pelvic pain, discomfort during intercourse, inability to reach orgasm, vaginismus, and other symptoms, like gastrointestinal ulcers, migraine, and eating disorders.

Some survivors may numb the pain by abusing food bulimia and anorexia nervosa , using alcohol and drugs, 39 or may overwork, or may experience a combination of these. When the male child or adult is the target of CSA or SA, the emerging gender and even established self identities of these victims become shattered, diffused, and a persistent psychological burden. They are inclined to talk less about the traumatic episodes, first, because this is characteristic of most traumatized individuals, irrespective of gender.

Second, society sanctions male nonresponsiveness to trials and tribulations. Thus, sexually traumatized boys tend to feel particularly stigmatized and ashamed, are more reluctant to share thoughts and feelings about the abuse, and tend not to seek mental health services of any kind. Society sees the sexually traumatized male child, adolescent, or adult as undeserving of respect and of the good things of life. While adolescents and adults of both sexes abused in the early years by their mothers feel the abuse meant they were homosexuals, boys abused by their fathers experience profound humiliation, shame and anger, fearing they are homosexuals, and wondering whether their fathers also homosexual.

As boys grow and interact with siblings, peers, and others at school and community, their developmental need to identify with male peers takes on particular urgency. Sexual trauma blocks the fulfillment of this normal, societally-sanctioned tendency. Sexually abused males have been observed to also suffer encopresis, and other medical conditions, engage in risk-taking and acting-out behaviors, and feel stigmatized and filled with rage and feelings of revenge.

Because of the diffuseness of his own gender identity, the abused boy or youth flounders around, unsure of himself, as self-doubt, anxiety, and the need to identify with other males, and, at the same time, counter-identify with them, become a painful and distressing reality. Young molested male children feel degraded, and may thus take on hyperaggressive behaviors, an exaggerated display of pseudo-male prowess, offering protection to his fragile self-esteem, and wounded male narcissism.

Mental illnesses among hostile and suspicious boys and girls as well may be rooted in childhood sexual abuse. Jerome Frank, formerly of Johns Hopkins in Baltimore advanced the highly valued concept of the assumptive world , in his book Persuasion and Healing. People who are fortunate enough to avert having to suffer severe traumatization tend to naturally see the world as meaningful and consistent, as reliable, and trustworthy, while having a positive view of self. The search for meaning, then, becomes another important feature of the competently managed treatment enterprise with sexual trauma victims.

In the presence of these profound changes in the assumptive world of the survivor, anxiety flares up, efficient mental regulation dwindles, as withdrawal and cynical distrust of others intensify. The environment and its cultural institutions are now experienced as depriving, inconsistent, threatening, and as potentially traumatizing. Often, rather than addressing these issues in therapy, both therapist and client at conscious, preconscious, and subconscious levels of awareness collude to keep this scorching, unpalatable issue off the table of therapeutic explorations.

Since blame and blaming is so central in trauma, not bringing this issue up might limited the long-term value of the overall treatment enterprise. Many victims talk about how they have changed since the traumatic episode, and how they get angry like their perpetrators, how they feel like hurting others, to force them to realize just how painful their ordeals are. For some victims, their pretrauma view of self as continuous from one moment to the next was lost, and replaced with behavioral and attitudinal reenactment learned from the abuser.

Victims are often unaware of these traumadynamics. When victims come for assistance, they bring their internal reality with them characterized by profound trauma-based narcissistic injury, mortification, and sense of failure. Additionally, the therapist exudes confidence, is wise, warm, and caring deeply for the welfare of the patient. The therapist works conscientiously to engage and help transform the skeptical, distressed, and cynical victim to a true believer in self and process the trauma treatment , convinced that it is possible to gain power to live a life of abundant contentment, joy, and happiness.

Therapists also require that the survivor learn that while on the therapeutic highway it is important to focus on the car's windshield--looking ahead, while using the rear view mirror i. In general, conceptually, traumatherapeutic strategies and goals include: 1 balancing overstimulation that comes both from the therapeutic relationship and from induced reliving of traumatic memories , with recuperative self-soothing, and 2 dealing with the internalized victimizer presence. The past is gone, the future is not yet, and therapy itself is not life. Additionally, victims lost the belief that other people typically strive for honesty, fairplay, and goodness.

This is especially true for victims of interpersonal traumatic violence as in physical and sexual abuse, assault, torture, and combat. For these victims the biochemical imprinting of person-engineered violence, sadistic madness, and cruelty are important issues for therapists and their clients to apprehend in traumacare. The therapeutic relationship is a key factor in working internalized violence, sadism, and seduction impulses to resolution.

Sally is a year-old single, unemployed Caucasian female who has a long history of physical, sexual, and emotional abuse that began in early childhood when she was about four to five years old. Her first recollection of sexual abuse is from her father whose physical abuse at times bordered on torture. Sally was the only child born to her parents. Her mother suffered from depression and would often be emotionally and physically unavailable to family members, while her father was an alcoholic with an inconsistent work history.

She describes her life as being very confusing, with events and experiences that do not logically connect together. Sally is unable to give a coherent history of her life: she experiences enormous gaps in her memory as she attempts to recollect her history. She did not know the date, location, or how she came to be there. This had happened many times in her life. She told her therapist she would notice writings throughout her apartment that looked different than her own handwriting about which she has no previous knowledge.

Moreover, she conceded she has many objects of clothing that she did not even like, and did not know why they were in her closet. People were heard to call her by the wrong name. This was very confusing for her. And, to her chagrin, found her confusion made even worse when people became angry with her, saying that she lies, and could not be trusted to tell the truth. The victim also stated hearing voices inside her head, but stated the voices did not sound like her own, and also would experience annihilation anxiety.

As is so well known in the post-trauma lives of sexually abused women, Sally also reported a history of abusive relationships with men for many years. When she begins to remember painful memories associated with her father and other abusive men, she become anxious, then loses time. She reports not having any friends with whom she could talk, and get support and perspective. She lives a life devoid of pleasure, and refuses to use mood-altering substances. She fears substance-induced vulnerability and increase in the sense of fragmentation.

This results in the formation of distinct coherent identities in the context of altered states of consciousness. This means that conscious functions go on without the benefit of integrative coordination and connection so critical to healthy personal daily functioning. For they are trained to identify and evaluate trauma problems, and then skillfully intervene in illuminating past traumatic events and offering hope, resilience, and control. Wayne is a year-old divorced Caucasian male. He and his wife were married for four years and have one child.

He presents with a history of depression, addiction to heroin, cocaine, and marijuana. He states that he has been using substances since early adolescence. He complained of nightmares, intrusive thoughts, sleep disturbance, and feelings of anger, and paranoia. Wayne was born into an intact family in ; he is the youngest of four children. His father, who was physically abusive to all members of the family, had several addictions that included substance abuse and compulsive gambling.

When Wayne was six, his parents divorced and he lived with his mother and siblings. Three years later, his mother remarried a man who also had a history of substance abuse and physical aggression. It was at this time that the stepfather began to sexually abuse 9-year-old Wayne, his older brother, and his sister.

He stated that his mother treated him kindly, but was emotionally detached and unavailable due to the abuse and threats that she received from her husband. The sexual abuse continued until Wayne was in his early teens, and the physical and emotional abuse continued until he moved out of the house. Wayne's stepfather would force the children to engage in sexual activities with each other for his entertainment, as well as his drinking companions whom he would bring home. When Wayne was approximately 14 years old, his older brother sexually abused him. One day their mother caught them engaged in felatio.

She proceeded to utter Biblical fire and brimstone rhetoric, indicating their behavior was sinful and wrong. Many years later when Wayne confronted his older brother about the abuse, the brother pulled out a Bible and started to preach to Wayne. At that point, Wayne remembered his mother's non-supportive Biblical "intervention" years before in which he felt let down and angry with her. He attacked his brother to harm him mortally, but their sister intervened and prevented Wayne from harming his brother any further.

He left the house and broke all contact with his siblings until the mid-phase of his therapy.

Melanie Tonia Evans

Wayne was suspended from school several times for fighting because he was teased, ridiculed, and made fun of. Wayne describes his time in High School as being isolated, depressed, and as not fitting in with the other students. Wayne graduated from High School at age He reported that throughout his adult life, including the military that he would get in violent conflicts with people around him.

As a result of the physical and sexual abuse and degradation he endured while growing up, and made worse by peer teasing throughout his High School years, Wayne decided to join the United States Marine Corps as a way to escape and gain self-respect and bolster his self-esteem. He also thought that by joining the Marines he would prove to himself and others that he was a real man and not some passive queer. At the beginning of the next six weeks of training he was sexually assaulted early one morning by three members of his training unit.

The three people who assaulted him threatened him with death if he told anyone about this event. They also told him that they would turn any story he told around and tell others that he solicited them. Throughout the three years he spent in the Marine Corps he never mentioned the sexual victimization episode. It was after the assault that Wayne was frequently reprimanded for fighting and not acting as a member of the team. He was often reprimand for his physical appearance and the sloppy way he kept the living quarters designated for him. Wayne was also brought up on disciplinary charges before the Captain for drinking, fighting with other soldiers, and for his general military attitude and outlook.

During the evaluation process, Wayne further revealed that since leaving the military memories have surfaced from the past, and he found himself falling into a self-destructive mode observed in persistent use of drugs and alcohol. However, when he was sober for any period of time, his paranoia, nightmares, and flashbacks would increase and devastate his conscious experience. As his anxiety level would rise, his paranoid aggression would become indiscriminatively focused on anyone around him at the time. He would be highly suspicious of people he saw as "intruding into my space. Tanya is a year-old, single woman of African American heritage who was referred by a neurologist after finding no organic basis for her lack of sensation from her waist down.

This symptom began when she became engaged to be married in five months. The conversion symptom occurred after the plans had been made and the date for the wedding set. Tanya began to remember the brutal rape she had endured when she was 20 years of age.


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The details were vague, and had remained shrouded in amnesia and other dissociation-based processes. But rage, disgust, humiliation, and shame were ever-present in her life since the episode. Tanya was an executive secretary at a large advertisement firm at the time of the rape. This was the first time the victim had experienced a conversion reaction, the first time in therapy, with no history of previous traumatization. Getting and holding onto good jobs were elusive. Since the rape, Tanya had been involved in self-destructive behaviors, multiple sexual partners, to include group sex, and sadistic sex acts.

Tanya was born into an intact family with two brothers and two sisters, a fact that was not lost to her unconscious mind. Growing up she felt loved and appreciated by both parents during her entire childhood and adolescent years. She believed her view of self, family, and community had been shaped by her experiences with racism.

Low self-esteem and self-loathing, and shame and guilt were early issues brought into the therapy. It is important to note that, despite the clinical and scientific advances in trauma treatment, clinicians still rely on clinical wisdom and available knowledge about trauma dynamics to do their best traumawork. For over a century the treatment enterprise with trauma victims had been conceptualized in terms of a series of phases, originating in the ground-breaking work of Jean Pierre.

This prescriptive approach 73 employs techniques that range from behavioral, cognitive, cognitive-behavioral, existential, and psychodynamic schools of therapy. Even though intrusion and arousal symptoms appear to be the most behaviorally and emotionally dramatic and distressing to survivors due to the high levels of disintegrative anxiety, clinical experience has shown that another class of symptoms of PTSD may be even more insidious, and more damaging to the self.

These defenses retard development by anesthetizing emotional engaging, and by robbing the self of the surprise that comes from the courage to be, 77 the daring to take growth-enhancing risks. These defenses, moreover, are about strict, dissociation-based control over developmentally critical spontaneous engagements with the world of persons, and natural and non-natural, animate and inanimate features of the environment.

The present proposed multiphase, developmental model was designed to manage the multiplicity of problems victims and survivors endure in wake of overwhelming events. The basic function of Phase 1 is stabilization: helping the survivor to learn how to reduce traumatic stress responses, particularly arousal and emotional reactivity set in motion by instigating environmental devices. This phase promotes in the survivor a sense of internal security in and outside the treatment relationship as well as developing trust.

Additionally, the victim learns how to effectively contain unbidden, spontaneous memories and induced emotional reactivity. A systematic life-history review and data collection were conducted for each survivor mentioned in the case studies above by the trauma professional. In this phase, survivors are introduced to such techniques and procedures as trauma education imparting knowledge about trauma and PTSD, and the normalizing of the stress response for victims and families , grounding, centering, visualization, and relaxation skills training to control fear and anxiety , breathing retraining slow abdominal breathing , and positive self-talk exchanges with negative thinking.

Homework is essential for survivors at each of the three phases of the treatment. In this phase homework assignment included writing autobiographical narratives from childhood to the present time; and letters to perpetrators for Sally, Wayne, and Tanya. These behavioral and cognitive techniques provide anti-reactivity control to help survivors cope with the trigger-induced subjective sense of being overwhelmed by emotions driven by traumatic thoughts, images, sounds, physical sensations, taste, and smell.

The treatment of victimized women needs to include reality-based self-defense training to prevent future revictimization. Since the first phase is conceived as critical to attaining subsequent phasic developmental resolutions, 80 the therapist ensures that survivors have grasped the basics and are progressing to advanced levels of stress management skills before they move to the next phase where the emotionally evocative power of direct exposure requires preparation.

This acquired sense of security reinforces confidence early in the efficacy of the process, and offers courage to continue this most difficult and essential work. As an aspect of Phase 1 treatment, psychopharmacologic agents such as SSRIs, Nefazodone, Venlafaxine, tricyclic antidepressants, or mood stabilizers have proven to be useful with survivors in therapy.

Sally, Wayne, and Tanya were also encouraged to keep a log for recording contemporary reality and distorted dimensions of everyday life. This includes identifying and writing down specific cues that instigate dissociative reliving, and feelings, fantasies, thoughts, aspirations, triumphs, and actions. Writing journaling facilitates cognitive and emotional processing of trauma now widely accepted as having healing properties for mind and body.

For many survivors, the first phase begins a transformation in which good feelings are no longer evanescent, but stay around a while and endure. Levels of threat posed by suicidal and homicidal ideation and self-injurious behaviors are continually monitored, and a contract for safety is formulated for these survivors, particularly for Sally.

The therapist helped Sally develop a lifespan continuum from birth to the present, constructing a cognitive-affective-experiential bridge of the identity system that spans pretraumatic-to-post-traumatic histories. For DID survivors therapy requires the capacity of both patient and therapist to go into the unknown, facing the portents and threats posed by disintegrative anxiety. Management of DID illness in patients can be very daunting to both survivor and therapist, especially in the context of severe fragmented personality identities.

This phase also attends to the special needs or concerns of each alter, and develop meaningful strategies to meet these divergent needs and perspectives. This focus would continue in Phase 3 where strong, split-off emotions connected to trauma-based internalization of violence that may undergird her passivity, forcing her into, what Karen Horney referred to as the self-effacing solution could be identified, elaborated, understood, and integrated. As member of a trauma therapeutic education group for adult male survivors of incest and child abuse, he was encouraged to examine his life in a constructive way to help him better cope in the aftermath of multiple traumatic events.

As an aspect of the treatment enterprise, the group fostered a means of gaining insight through collective experiencing and mutual support. Assessment with Tanya, the third case reported above, revealed she suffered from a trauma-origin conversion reaction, in which she had lost sensation in the lower parts of trauma-related thoughts, feelings, and actions flooded her conscious experience after setting a date for her marriage. She was able to make connections between her current problems and their traumatic antecedents. The apparent conversion episode became a problem for her two months prior to trauma treatment.

Conversion represents a loss of language, and her lower body represented what was being symbolized. Due to the close culture-based values held by the family, family therapy 84 , 85 consultations were helpful to Tanya in dealing with shame, secrets, alienation, anger and distrust that had consumed the family. It was very important to Tanya that, as she began to understand the dynamics of trauma upon her life, her family would also attain this knowledge as well. Family values and perceptions dictated that Tanya should be reliably resilient rather than passively succumbing to what had happened to her.

The problem

The trauma symptoms she experienced were seen by family members as evidence of mere weakness and lack of will. They were not prepared to view her problems in psychological terms, and so resisted and ridiculed this possibility. Like many African American children, Tanya grew up using a self-inoculating coping 86 , 87 strategy to deal with an environment perceived to be difficult and inhospitable. Tanya believed that suffering was the legacy of being Black in America, and that the rape and associated violence and injustice were just another burden to be borne without complaining.

Prior to the rape, the patient had always been close to her family and visited them frequently. A brief assessment and comparison of her social network before and after the rape revealed that her visits with family members and friends decreased, and she experienced emotional indifference and disconnection from them. The many reality-based problems this survivor faced during the first phase of therapy required therapeutic adaptations to everyday life.

With this survivor and others of ethnoculturally diverse backgrounds with histories of rape, and child sexual abuse and maltreatment 91 , it is useful for practitioner to become cross-culturally sensitive. In transcultural trauma treatment some interventions may prove to be modifications of contemporary practices with Western-oriented survivors. And if a multicultural perspective were not used with her in therapy it is doubtful whether she would have remained in treatment until termination. Race and ethnocultural factors are usually omitted from the clinical trauma literature, giving the impression that they have no relevance.

We know that the field of ethnopharmacology is growing because clinicians are recognizing the reality of cross-ethnic variations and ethnospecific factors in how the body absorbs, distributes, metabolizes, and excretes drugs pharmacokinetic , and the reactions between drugs and living systems pharmacodynamics. Realization is a mental state that is an outcome of early resolution, relief, and confidence in the treatment. It shapes a level of motivation that ensures traumawork will continue, that the patient will persist and not give up.

Realization regulates treatment- and social-destroying emotional reactivity, and bolsters stability without which progressive awareness and integration may not occur. This state of mind energizes subsequent treatment phases, and offers the necessary acceptance and, commitment from which flow motivation to complete the therapeutic work. It is an outgrowth of hard, successful trauma work during the first phase of therapy. It refers to a specific point victims reach when they conceive vividly as real the traumatic past, the present trauma realities, and the prospect of a future beyond trauma.

The survivor, no longer victim, brings into concrete existence new, healing affirmations that have been so elusive prior to therapy. This is the time when fear of breakdown is transformed into anticipation, courage, and optimism that Phase 2 will be an adventure not a portent of awful things to come. Basically, the objective of this phase is less about recovering memories and more about processing memories to release intrinsic meaning, and to build control, and mastery. On the contrary, the result was usually brought about by the convergence of several traumas, and often by the repetition of a great number of similar ones.

This memory work emphasizes a cognitively-engaged mastery viewed as superior to mere emotionally-based abreaction, because mastery brings about integration of narrative memory. This phase attempts to accomplish one fundamental task, the processing of trauma memory. In this process, memory is the actual focus of the treatment. The techniques used in this phase are referred to collectively as direct therapeutic exposure DTE. Memory processing made it possible for Sally, Wayne, and Tanya to transform narrative trauma memory into consensually-validated information that could now be part of their autobiographical memory and history.

To enhance integration and achieve a stable sense of self it is necessary for conflicts between and among alters be identified and processed toward integration. The post-trauma striving to achieve a cohesive self is accompanied by life-affirming ideals and high, realistic ambition, accompanied by a progressive dissolution of disjunctive walls within the self. While Phase 2 focused on trauma memory processing, this phase centers attention on processing relational representations or relational processing.

What happens to victims after exposure to brutal rape and CSA is a negative transmutation that derives from having internalized the overwhelming violence, sadism, and cruelty of the perpetrator. This internalization is not a neutral event: there are significant consequences for the victim, the therapist, and for the course of treatment and recovery.

Cognitive-behavioral procedures are used in the early part of the phase, and are geared to deal with trauma-based relational schemas. Psychodynamic techniques are employed in later parts of the phase to deal with internalized violence and transgression. Emphasis on relational dynamics of sexual trauma in this phase is referred to here as direct relational exposure DRE. Accessing and processing trauma relational information may contribute to the progressive mobilizing of trauma-arrested development. These relational dynamic that are sufficiently powerful to alter neuronal pathways may not be amenable to resolution through cognitive-behavioral techniques alone.

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The Effects Of Post Traumatic Stress Disorder After Narcissistic Abuse | Melanie Tonia Evans

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Business case analysis of Ready Reserve Force recapitalization options. Transfer of excess naval vessel to Bahrain. Members of panel conducting review of military aviation readiness in support of the National Defense Strategy. Study on phasing out open burn pits. Improving small business loan programs for employee-owned business concerns. Comptroller General of the United States review of effect of other-than-honorable discharges on veteran employment outcomes.

Comptroller General study on availability of long-term care options for veterans from Department of Veterans Affairs. Department of Defense Cyber Scholarship Program scholarships and grants. Coordination of efforts to negotiate free trade agreements with certain sub-Saharan African countries. Syrian war crimes accountability. Clarification of limitation on the transfer of the F—35 to Turkey. Report on Honduras, Guatemala, and El Salvador.

Report on arms embargo on Cyprus. Technical corrections to certain cyberspace matters. Tier 1 exercise of support to civil authorities for a cyber incident. Report on strengthening NATO cyber defense. Briefing on cyber education and training. Report on development of long-range stand-off weapon. Prohibition on modification of civil penalties under export control and sanctions laws and prohibition on certain telecommunications equipment. Release of restrictions, University of California, San Diego.

Additional amounts for inertial confinement fusion and high yield program. Ineffectiveness of title XXXV. Authorization of the Maritime Administration. Concurrent jurisdiction. United States Merchant Marine Academy policy on sexual harassment, dating violence, domestic violence, sexual assault, and stalking. Electronic records on mariner availability to meet national security needs. Small shipyard grants. Domestic ship recycling facilities.

Sea year on contracted vessels. GAO report on national maritime strategy. Multi-year contracts. Use of State Maritime Academy training vessels. Navigation system study and report. Superior National Forest Land Exchange. In this Act, the term congressional defense committees has the meaning given that term in section a 16 of title 10, United States Code.

The budgetary effects of this Act, for the purposes of complying with the Statutory Pay-As-You-Go Act of , shall be determined by reference to the latest statement titled Budgetary Effects of PAYGO Legislation for this Act, jointly submitted for printing in the Congressional Record by the Chairmen of the House and Senate Budget Committees, provided that such statement has been submitted prior to the vote on passage in the House acting first on the conference report or amendment between the Houses.

Funds are hereby authorized to be appropriated for fiscal year for procurement for the Army, the Navy and the Marine Corps, the Air Force, and Defense-wide activities, as specified in the funding table in section Not later than 30 days after the date of the enactment of this Act, the Secretary of Defense shall certify to the congressional defense committees whether deployment of an interim, fixed site cruise missile defense capability is necessary.

The Army shall deploy an interim, fixed site cruise missile defense capability, in anticipation of delivery to the Army of the Indirect Fire Protection Capability IFPC , by the deadlines as follows:. Two batteries by not later than September 30, Two additional batteries by not later than September 30, In deploying the interim capability pursuant to subsection b , the Secretary of Defense shall afford a priority in locations for deployment to air bases and significant fixed site locations in Europe and Asia for the purpose of the protection of such bases and locations against potential cruise missile threats.

In order to meet the deadlines for deployment specified in subsection b , the Army—. Notwithstanding subsection k of such section b, the Secretary of Defense may enter into a multiyear contract under this section for up to three years. The Secretary may not exercise the authority provided under subsection a or b until the Secretary of Defense submits to the congressional defense committees the report and confirmation required under subparagraphs A and B , respectively, of section b i 2 of title 10, United States Code. A contract entered into under subsection a shall provide that any obligation of the United States to make a payment under the contract for a fiscal year after fiscal year is subject to the availability of appropriations or funds for that purpose for such later fiscal year.

Subject to section b of title 10, United States Code, the Secretary of the Navy may enter into one or more multiyear contracts, beginning with the fiscal year program year, for the procurement of E—2D Advanced Hawkeye AHE aircraft. Notwithstanding subsection k of such section b, the Secretary of Defense may enter into a multiyear contract under this section for up to five years.

Authority for advance procurement and economic order quantity. The Secretary may enter into one or more contracts for advance procurement associated with the E—2D AHE including economic order quantity for which authorization to enter into a multiyear procurement contract is provided under subsection a. A contract entered into under subsection a shall provide that any obligation of the United States to make a payment under the contract for a fiscal year after fiscal year is subject to the availability of appropriations for that purpose for such later fiscal year.

Section of the National Defense Authorization Act for Fiscal Year Public Law — , as amended by section of the National Defense Authorization Act for Fiscal Year Public Law —91 , is further amended by striking or fiscal year and inserting , fiscal year , or fiscal year Except as provided under subsection b , none of the funds authorized to be appropriated by this Act or otherwise made available for the Department of Defense for fiscal year may be used for the procurement of new Navy port waterborne security barriers.

The Secretary of the Navy may waive the prohibition under subsection a not less than 30 days after submitting to the congressional defense committees—. Subject to section b of title 10, United States Code, the Secretary of the Navy may enter into one or more multiyear contracts, beginning with the fiscal year program year, for the procurement of up to Standard Missile-6 guided missiles. The Secretary may enter into one or more contracts for advance procurement associated with the missiles including economic order quantity for which authorization to enter into a multiyear procurement contract is provided under subsection a.

None of the amounts authorized to be appropriated by this Act or otherwise made available for the Department of Defense for fiscal year may be used to exceed the total procurement quantity listed in revision five of the Littoral Combat Ship acquisition strategy unless the Under Secretary of Defense for Acquisition and Sustainment submits to the congressional defense committees the certification described in subsection b.

The certification described in this subsection is a certification by the Under Secretary that awarding a contract for the procurement of a Littoral Combat Ship that exceeds the total procurement quantity listed in revision five of the Littoral Combat Ship acquisition strategy—. The term revision five of the Littoral Combat Ship acquisition strategy means the fifth revision of the Littoral Combat Ship acquisition strategy approved by the Under Secretary of Defense for Acquisition and Sustainment on March 26, Authorization To procure nuclear refueling materials.

Pursuant to section a of title 10, United States Code, as added by section of this Act, the Secretary of the Navy may procure naval nuclear reactor power units and associated reactor components for the following aircraft carriers:. John C. Stennis CVN— Harry S. Truman CVN— Ronald Reagan CVN— George H. Bush CVN— Any contract entered into under subsection a shall provide that any obligation of the United States to make a payment under the contract for a fiscal year after fiscal year is subject to availability of appropriations for that purpose for that later fiscal year.

Not more than 75 percent of the funds authorized by this Act or otherwise made available for the Marine Corps for fiscal year for the Amphibious Assault Vehicle Product Improvement Program AAV PIP may be obligated or expended until the Secretary of Defense has submitted to the congressional defense committees—. Prohibition on availability of funds for retirement. Except as provided by subsection d , none of the funds authorized to be appropriated by this Act or otherwise made available for fiscal year for the Air Force may be obligated or expended to retire, or prepare to retire, any E—8 Joint Surveillance Target Attack Radar System aircraft.

In addition to the prohibition in subsection a , the Secretary of the Air Force may not retire, or prepare to retire, any E—8C aircraft until the Under Secretary of Defense for Acquisition and Sustainment submits to the congressional defense committees the certification described under paragraph 2. The prohibitions in subsections a and b shall not apply to individual E—8 Joint Surveillance Target Attack Radar System aircraft that the Secretary of the Air Force determines, on a case-by-case basis, to be nonoperational because of mishaps, other damage, or being uneconomical to repair.

Not later than days after the date of the enactment of this Act, the Secretary of the Air Force shall submit to the congressional defense committees a report on the long term modernization of the B—52H aircraft, including an estimated timeline and requirements as an integrated aircraft system of—. Not later than December 30, , June 30, , and December 30, , the Secretary of the Air Force shall submit to the congressional defense committees a series of updated program status reports for the EC—H Compass Call Recapitalization Program.

The reports required under paragraph 1 shall include—. Defense-wide, joint, and multiservice matters. Subject to section b of title 10, United States Code, the Secretary of the Air Force may enter into one or more multiyear contracts, beginning with the fiscal year program year, for the procurement of C—J aircraft and, acting as the executive agent for the Department of the Navy, for the procurement of C—J aircraft.

The Secretary of the Air Force may enter into one or more contracts for advance procurement associated with the C—J aircraft, including economic order quantity, for which authorization to enter into a multiyear procurement contract is provided under subsection a. The multiyear contract authority under subsection a includes C—J aircraft for which funds were appropriated for fiscal year Beginning not later than October 1, , and on a quarterly basis thereafter through October 1, , the Under Secretary of Defense for Acquisition and Sustainment shall provide to the congressional defense committees a briefing on the progress of the F—35 Joint Strike Fighter program.

Each briefing under subsection a shall include, with respect to the F—35 Joint Strike Fighter program, the following elements:. An overview of the program schedule. A description of each contract awarded under the program, including a description of the type of contract and the status of the contract. An assessment of the status of the program with respect to—. The Secretary of the department in which the Coast Guard is operating may, in consultation with the Secretary of the Navy, enter into a contract or contracts for the procurement of up to six polar-class icebreakers, including—.

Funds are hereby authorized to be appropriated for fiscal year for the use of the Department of Defense for research, development, test, and evaluation, as specified in the funding table in section Program requirements, restrictions, and limitations. Chapter of title 10, United States Code, is amended by inserting after section the following new section:.

The Secretary of Defense shall establish a competitive, merit-based program to accelerate the fielding of technologies developed pursuant to phase II Small Business Innovation Research Program projects, technologies developed by the defense laboratories, and other innovative technologies including dual use technologies. The purpose of this program is to stimulate innovative technologies and reduce acquisition or lifecycle costs, address technical risks, improve the timeliness and thoroughness of test and evaluation outcomes, and rapidly insert such products directly in support of primarily major defense acquisition programs, but also other defense acquisition programs that meet critical national security needs.

The Secretary shall issue guidelines for the operation of the program. At a minimum such guidance shall provide for the following:. The issuance of one or more broad agency announcements or the use of any other competitive or merit-based processes by the Department of Defense for candidate proposals in support of defense acquisition programs as described in subsection a. The review of candidate proposals by the Department of Defense and by each military department and the merit-based selection of the most promising cost-effective proposals for funding through contracts, cooperative agreements, and other transactions for the purposes of carrying out the program.

No project shall receive more than a total of two years of funding under the program from funding provided under subsection d , unless the Secretary, or the Secretary's designee, approves funding for any additional year. Mechanisms to facilitate transition of follow-on or current projects carried out under the program into defense acquisition programs, through the use of the authorities of section e of this title or such other authorities as may be appropriate to conduct further testing, low rate production, or full rate production of technologies developed under the program.

Projects are selected using merit-based selection procedures and the selection of projects is not subject to undue influence by Congress or other Federal agencies. Treatment pursuant to certain congressional rules. Nothing in this section shall be interpreted to require or enable any official of the Department of Defense to provide funding under this section to any earmark as defined pursuant to House Rule XXI, clause 9, or any congressionally directed spending item as defined pursuant to Senate Rule XLIV, paragraph 5. Subject to the availability of appropriations for such purpose, the amounts authorized to be appropriated for research, development, test, and evaluation for a fiscal year may be used for such fiscal year for the program established under subsection a.

The Secretary may transfer funds available for the program to the research, development, test, and evaluation accounts of a military department, defense agency, or the unified combatant command for special operations forces pursuant to a proposal, or any part of a proposal, that the Secretary determines would directly support the purposes of the program. The transfer authority provided in this subsection is in addition to any other transfer authority available to the Department of Defense.

The table of sections at the beginning of chapter of such title is amended by inserting after the item relating to section the following new item:. The table of contents in section 2 b of such Act is amended by striking the item relating to section Not later than days after the date of the enactment of this Act, the Under Secretary of Defense for Research and Engineering shall prescribe procedures for the designation and development of technologies that are—. The procedures prescribed under subsection a shall include the following:.

A process for streamlined communications between the Under Secretary, the Joint Chiefs of Staff, the commanders of the combatant commands, the science and technology executives within each military department, and the science and technology community, including—. Procedures for the development of technologies proposed pursuant to paragraph 1 B , including—. During fiscal years and , the Secretary of the Army shall carry out a set of activities to identify and develop personal equipment to provide enhanced protection against injuries caused by blasts in combat and training.

The Secretary shall undertake all actions required of the Secretary under this section jointly with the Director of Operational Test and Evaluation. For purposes of the activities required by subsection a , the Secretary shall establish a process to continuously solicit from government, industry, academia, and other appropriate entities personal protective equipment that is ready for testing and evaluation in order to identify and evaluate equipment or clothing that is more effective in protecting members of the Armed Forces from the harmful effects of blast injuries, including traumatic brain injuries, and would be suitable for expedited procurement and fielding.

The goals of the activities shall include:. Development of streamlined requirements for procurement of personal protective equipment. Appropriate testing of personal protective equipment prior to procurement and fielding. Development of expedited mechanisms for deployment of effective personal protective equipment. Identification of areas of research in which increased investment has the potential to improve the quality of personal protective equipment and the capability of the industrial base to produce such equipment.

Such other goals as the Secretary considers appropriate. As part of the activities, the Secretary shall establish research partnerships with appropriate academic institutions for purposes of assessing the following:. The ability of various forms of personal protective equipment to protect against common blast injuries, including traumatic brain injuries. The value of real-time data analytics to track the effectiveness of various forms of personal protective equipment to protect against common blast injuries, including traumatic brain injuries. The availability of commercial-off the-shelf personal protective technology to protect against traumatic brain injury resulting from blasts.

The extent to which the equipment determined through the assessment to be most effective to protect against common blast injuries is readily modifiable for different body types and to provide lightweight material options to enhance maneuverability. In carrying out activities under subsection a , the Secretary may use any authority as follows:. Experimental procurement authority under section of title 10, United States Code. Other transactions authority under section and b of title 10, United States Code.

Authority to award technology prizes under section a of title 10, United States Code. Any other authority on acquisition, technology transfer, and personnel management that the Secretary considers appropriate. Any activities under this section shall be deemed to have been through the use of competitive procedures for the purposes of section of title 10, United States Code. After the completion of activities under subsection a , the Secretary shall, on an on-going basis, do the following:.

Evaluate the extent to which personal protective equipment identified through the activities would—. In the case of personal protective equipment so identified that would provide enhancements as described in paragraph 1 , estimate the costs that would be incurred to procure such enhanced personal protective equipment, and develop a schedule for the procurement of such equipment. Estimate the potential health care cost savings that would occur from expanded use of personal protective equipment described in paragraph 2.

Not later than December 1, , the Secretary shall submit to the Committee on Armed Services of the Senate and the House of Representatives a report on the activities under subsection a as of the date of the report. Not later than December 1, , the Secretary shall submit to the committees of Congress referred to in paragraph 1 a report on the activities under this section, including the following:. The results of the evaluation under subsection e 1. The estimate of costs and schedules under subsection e 2. The Secretary of the Army shall develop and provide for the carrying out of human factors modeling and simulation activities designed to do the following:.

Provide warfighters and civilians with personalized assessment, education, and training tools. Identify and implement effective ways to interface and team warfighters with machines. Result in the use of intelligent, adaptive augmentation to enhance decision making. Result in the development of techniques, technologies, and practices to mitigate critical stressors that impede warfighter and civilian protection, sustainment, and performance.

The overall purpose of the activities shall be to accelerate research and development that enhances capabilities for human performance, human-systems integration, and training for the warfighter. Participants in the activities may include the following:.

Elements of the Department of Defense engaged in science and technology activities. Program Executive Offices of the Department. The private sector. Such other participants as the Secretary considers appropriate. The Secretary shall carry out this section through the Army Futures Command, the Army Research Institute, or such other component of the Department of the Army as the Secretary considers appropriate.

Infrastructure resilience. The Under Secretary of Defense for Acquisition and Sustainment and the Under Secretary of Defense for Research and Engineering shall jointly, in coordination with Secretaries of the military departments, establish not less than three activities to demonstrate advanced manufacturing techniques and capabilities at depot-level activities or military arsenal facilities of the military departments.

The activities established pursuant to subsection a shall—. The Under Secretaries may enter into a cooperative agreement and use public-private and public-public partnerships to facilitate development of advanced manufacturing techniques in support of the defense industrial base. A cooperative agreement entered into under paragraph 1 and a partnership used under such paragraph shall facilitate—. In carrying out this section, the Under Secretaries may use the following authorities:.

Section of such title, relating to centers for science, technology, and engineering partnership. Section a of such title, relating to prizes for advanced technology achievements. Section of such title, relating to centers of industrial and technical excellence. Section of such title, relating to the Manufacturing Technology Program. Such other authorities as the Under Secretaries considers appropriate. The Under Secretary of Defense for Research and Engineering shall establish activities to develop interaction between the Department of Defense and the commercial technology industry and academia with regard to emerging hardware products and technologies with national security applications.

The activities required by subsection a shall include the following:. Informing and encouraging private investment in specific hardware technologies of interest to future defense technology needs with unique national security applications. Funding research and technology development in critical hardware-based defense sectors, specifically microelectromechanical systems, processing components, micromachinery, and materials science that private industry has not supported sufficiently to meet rapidly emerging national security needs.

Developing and executing policies and actions to deter strategic acquisition of industrial and technical capabilities in the private sector by foreign entities that could potentially exclude companies from participating in the Department of Defense technology and industrial base. Identifying promising emerging technology in industry and academia for the Department of Defense for potential support or research and development cooperation.

Subject to paragraph 2 , the Under Secretary may transfer such personnel, resources, and authorities as the Under Secretary considers appropriate to carry out the activities established under subsection a from other elements of the Department. The Under Secretary may only make a transfer of personnel, resources, or authorities under paragraph 1 upon certification by the Under Secretary that the activities established under paragraph a can attract sufficient private sector investment, has personnel with sufficient technical and management expertise, and has identified relevant technologies and systems for potential investment in order to carry out the activities established under subsection a , independent of further government funding beyond this authorization.

The Under Secretary may establish or fund a nonprofit entity to carry out the program activities under subsection a. Not later than one year after the date of the enactment of this Act, the Under Secretary shall submit to the congressional defense committees a detailed plan to carry out this section. The plan required by paragraph 1 shall include the following:. A description of the additional authorities needed to carry out the activities set forth in subsection b. Plans for transfers under subsection c , including plans for private fund-matching and investment mechanisms, oversight, treatment of rights relating to technical data developed, and relevant dates and goals of such transfers.

Plans for attracting the participation of the commercial technology industry and academia and how those plans fit into the current Department of Defense research and engineering enterprise. In carrying out this section, the Under Secretary may use the following authorities:.

Fight or flight: the veterans at war with PTSD

Section of the National Defense Authorization Act for Fiscal Year Public Law —91 , relating to a pilot program on strengthening manufacturing in the defense industrial base. Section g of title 10 of the United States Code, relating to public-private talent exchanges. Section of such title, relating to Centers for Science, Technology, and Engineering Partnerships. Section of such title, relating to Centers of Industrial and Technical Excellence.

Chapter 47 of such title, relating to personnel research programs and demonstration projects. Such other authorities as the Under Secretary considers appropriate. Section of title 10, United States Code, is amended—. Use of partnership intermediaries to promote defense research and education. Subject to the approval of the Secretary or the head of the another department or agency of the Federal Government concerned, the Director of a Center may enter into a contract, memorandum of understanding or other transition with a partnership intermediary that provides for the partnership intermediary to perform services for the Department of Defense that increase the likelihood of success in the conduct of cooperative or joint activities of the Center with industry or academic institutions.

In this subsection, the term partnership intermediary means an agency of a State or local government, or a nonprofit entity owned in whole or in part by, chartered by, funded in whole or in part by, or operated in whole or in part by or on behalf of a State or local government, that assists, counsels, advises, evaluates, or otherwise cooperates with industry or academic institutions that need or can make demonstrably productive use of technology-related assistance from a Center. None of the funds authorized to be appropriated or otherwise made available by this Act may be used to exceed a procurement quantity of one Surface Navy Laser Weapon System, also known as the High Energy Laser and Integrated Optical-dazzler with Surveillance HELIOS , per fiscal year, unless the Secretary of the Navy submits to the congressional defense committees a report on such system with the elements set forth in subsection b.

The elements set forth in this subsection are, with respect to the system described in subsection a , the following:. A document setting forth the requirements for the system, including desired performance characteristics. An acquisition plan that includes the following:. A program schedule to accomplish design completion, technology maturation, risk reduction, and other activities, including dates of key design reviews such as Preliminary Design Review and Critical Design Review and program initiation decision such as Milestone B if applicable.

A contracting strategy, including requests for proposals, the extent to which contracts will be competitively awarded, option years, option quantities, option prices, and ceiling prices. The fiscal years of procurement and delivery for each engineering development model, prototype, or similar unit planned to be acquired. A justification for the fiscal years of procurement and delivery for each engineering development model, prototype, or similar unit planned to be acquired.

A test plan and schedule sufficient to achieve operational effectiveness and operational suitability determinations such as Early Operational Capability and Initial Operational Capability related to the requirements set forth in paragraph 1. Associated funding and item quantities, disaggregated by fiscal year and appropriation, requested in the Fiscal Year Future Years Defense Program. An estimate of the acquisition costs, including the total costs for procurement, research, development, test, and evaluation.

Section e of the National Defense Authorization Act for Fiscal Year Public Law —91 is amended by adding at the end the following new paragraph:. The National Security Technology Accelerator. None of the funds authorized by this Act or otherwise made available for the Marine Corps for fiscal year for the development of Amphibious Combat Vehicle 1. The Secretary of Defense shall carry out a quantum information science and technology research and development program. Have you created a personal profile?

Login or create a profile above so that you can save clips, playlists, and searches. Please log in from an authenticated institution or log into your member profile to access the email feature. The connection of psychological trauma to post-traumatic stress disorder PTSD is well established, partly because PTSD is diagnostically conditioned on the experience of a severe trauma.

The role of trauma in suicidality, however, continues to be elusive. Furthermore, there is a dearth of studies that systematically examine the association of PTSD with suicide and suicidality. The therapists will then meet with the subject daily until the period of destabilization has passed. The second option is for the subject to be hospitalized until she or is in a stable condition.

All subjects will be aware of these possibilities when consenting to undergo MDMA-assisted psychotherapy. The therapists are only likely to use these options under extreme conditions, and all other options will be tried prior to requiring the assistance of another or hospitalizing the subject. For all subjects who are eligible for a second session, the follow-up visits between MDMA sessions should include a discussion of their thoughts and feelings about undergoing a second session.

In early and pilot studies, the therapists will contact the subject for a week after each MDMA session. The therapists will use clinical judgment to assess the psychological well-being during this time period. The first integrative follow-up session occurs the day after the MDMA treatment session.

The following section describes three steps involved in conducting the integrative follow-up sessions. The therapists provide a ninety minute follow-up session the day after the MDMA session. These include, but are not limited to, the following:. The protocol for other emergencies is also reviewed at this time. The initial ninety minute Follow-up treatment session is scheduled for the day after the MDMA session and is designed to begin the integration process.

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The therapists and subject begin the process of understanding the lessons and experiences of the previous day. The therapists schedule three to four additional sessions, generally one week apart, before the second MDMA session. The therapists engage in an active dialogue and elicit detailed disclosure as a means to accomplish the following:. In response to distress or upsetting thoughts, memories or feelings lingering after the MDMA session and those which may unfold over the course of time, the subject is reminded to perform the relaxation and centering techniques such as diaphragmatic breathing.

These exercises may be especially important immediately after each MDMA session, as the anxiolytic effects of MDMA decline while some upsetting memories, thoughts or feelings brought forth during the session remain. Information on the utility of bodywork and breathing exercises can be reinforced in this session in preparation for the next MDMA session. The content of the treatment session will cue the therapists to the likelihood of the subject requiring or requesting bodywork to assist in working with the physical areas in which there might be tension and pain.

This work catalyzes the healing process by releasing any emotions that may be contributing to somatic complaints and otherwise keeping emotional energy blocked within the body. Bodywork is only done under the condition of subject permission and is immediately discontinued if the subject requests "Stop.

The bodywork is most appropriate in situations in which emotional or somatic symptoms are not resolving because their full experience and expression appears to be blocked. The therapists must exercise judgment about when body work is indicated to help facilitate the therapeutic process and when it is preferable to allow the process to proceed at its own pace. For the purposes of this manual we will use the term "bodywork" to refer to touch, usually in the form of giving resistance for the subject to push against which is aimed at intensifying and thereby releasing tensions or pains in the body that arise during therapy.

The subject of touch in psychotherapy is complex and is discussed in more detail in Appendix A. The ultimate goal of MDMA-assisted psychotherapy is the elimination of symptoms and the attainment of an improved level of functioning. The integration phase of treatment brings these elements together, in a cohesive, harmonious way. Integration involves the ability to access and apply to daily life the lessons, insights, changes in perception, awareness of bodily sensations, and whatever else was revealed during the treatment experiences.