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The veteran/service member described a sense of emptiness. The veteran/service member displayed a hopeless attitude related to the death of a family member. The veteran’s/service member’s hopeless attitude about life has diminished and he/she has begun to make more hopeful statements about the future. The veteran/service member no longer has a hopeless attitude about life and has demonstrated a normal attitude of hope and planning for the future.

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The service member was reinforced as he/she agreed to follow through with the medication evaluation. The service member strongly opposed being placed on medication to help stabilize his/her mood and anger symptoms; his/her objections were processed. The service member was assessed for psychiatric medication, and a prescription was provided by the prescribing clinician. The service member was assessed for possible medication to assist in controlling his/her more significant mood, anxiety, and sleep disturbance systems, but no medication was prescribed.

A complete psychosocial history was taken, with a focus on the personal and family history of addiction. As therapy has progressed, the veteran/service member has become more open in acknowledging the extent and seriousness of his/her substance abuse problems; this progress has been reinforced. The veteran/service member was asked to identify in writing several key points obtained from each didactic lecture.

The veteran/service member was given ideas about blacking out windows and ceiling door cracks, and wearing a night mask. The veteran/service member has worked to create a light-free sleeping environment, and the benefits of these changes were reviewed. The veteran/service member has not developed a light-free sleeping environment and was redirected to do so. Decrease Noise/Disruption A. The veteran/service member was encouraged to minimize noise and disruptions during sleep times. The veteran/service member has developed a quieter sleeping area, and the benefits of this were reviewed.

The pair have now been married since May 2018, and they have undergone multiple major life changes together.

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Behavioral and cognitive-restructuring techniques were used to help build social and communication skills to manage everyday challenges. The veteran/service member was provided with positive feedback regarding his/her ability to manage common everyday stressors. The veteran/service member continues to struggle with common everyday stressors and was provided with remedial feedback in this area. 39.

The veteran/service member has talked with family members about his/her feelings of sadness and loss, and his/her experience was processed within the session. The veteran/service member has not utilized support from his/her friends and family and was redirected to do so. Explore Anger Feelings A. The veteran’s/service member’s feelings of anger or guilt that surround the loss were explored as to their depth and causes. The veteran/service member was supported as he/she verbalized feelings of anger and guilt focused on himself/herself that surround the grief experience of loss. C. The veteran’s/service member’s feelings of grief are coming more to the surface as he/she faces the loss issue more directly.

Blunted Emotions A. The veteran/service member reported an inability to experience the full range of emotions, including love. The veteran/service member reported beginning to be in touch with his/her feelings again. The veteran/service member is able to experience the full range of emotions. Pessimistic/Fatalistic A. Since the traumatic event occurred, the veteran/service member has had a pessimistic and fatalistic attitude regarding the future. The veteran/service member sees his/her future as foreshortened. The veteran/service member is beginning to experience a somewhat hopeful attitude regarding the future.

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The veteran/service member was determined not to have had any previous psychotic episodes. The nature of the veteran’s/service member’s genetic vulnerability or predisposition to psychosis was investigated and reviewed. The nature of the veteran’s/service member’s environment and life events were reviewed. The interaction of the diathesis and stressors were reviewed and explained.

Such rates of abandonment are not surprising given the state of the platform and the failure of the site operators to offer more features and create a more vibrant community. Educate about Common Triggers Common triggers for the use of tobacco were identified for the veteran/service member. The veteran/service member was assisted in identifying his/her own triggers for tobacco use. The veteran/service member displayed an increased understanding that triggers increase cravings and create risk for tobacco use. Lack of Future Orientation The veteran/service member displays a lack of future orientation.

It was reflected to the veteran/service member that most people would experience the same distress and difficulties, given the same circumstances, thoughts, and feelings. The veteran/service member was noted to accept the validation about his/her level of distress. Orient to DBT A. The veteran/service member was oriented to the process of dialectical behavioral therapy .