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Whole Health is built around the Circle of Health, which emphasizes the importance of personalized, values-based care that draws in mindful awareness and eight areas of self-care: Surroundings; Personal Development; Food & Drink; Recharge; Family, Friends, & Co-Workers; Spirit & Soul; Power of the Mind; and Moving the Body. Conventional therapies, prevention, complementary and integrative health (CIH) approaches, and community also have important roles. The narratives below describe how the Whole Health approach could have an impact on three different Veterans with PTSD.
Depending on individual needs, a Whole Health approach to PTSD can incorporate a number of different self-care, conventional care, and complementary health approaches. PTSD is especially responsive to mental health interventions. Focusing on relationships, spirituality, and sleep quality—in a way that is tailored to individual needs—can be particularly important. Many professional care approaches can prove useful, starting with trauma-focused psychotherapies, and also including medications, other types of psychotherapies, and an array of CIH approaches. The CIH approaches serve best as adjuncts to more conventional care. Keep reading to learn more about the evidence for the efficacy and safety of these different approaches and how you might incorporate them into a Personal Health Plan (PHP).
Meet the Veteran - Todd, Erica, and Melissa
Todd is a 28-year-old Veteran of Operation Iraqi Freedom (OIF). He “saw a lot go down” during his time in Iraq, but he felt like he was doing fairly well when he completed his tour and returned to the United States in 2009. Six months after his return, however, he developed a number of troubling symptoms:
- He began to have flashbacks, focused on when his teammate, Hal, lost his leg in an explosion.
- He finds himself wanting to avoid crowded areas or places where there is a lot of noise. He tells you, “I can’t set foot in a mall, a theater, or some other crowded place like that.”
- He finds it is impossible to trust anyone now, and he hasn’t felt relaxed or happy in years. He gets into fights easily. He always positions himself in a room so he can see the doors and windows.
- He is haunted by the thought that he should have been the one to lose a leg, not Hal.
- He finds it difficult to maintain romantic relationships or friendships. His concentration is poor, and he is frustrated that he has not done well in college courses he has tried taking. He says, “Every time I try to do something new, it’s like I sabotage myself. Or I get all wired and reactive and it makes everything go wrong.”
To cope, Todd drinks, sometimes as much as a case of beer daily, but on good days, he does not drink at all. He does not own a gun or have plans for harming himself, but it has occurred to him that, as he puts it, “my life has been so hard that I am not so sure I want it anymore.” He was initially diagnosed with anxiety, until he sought out the advice of a psychiatrist who made the diagnosis of PTSD. He takes his medications as prescribed by his psychiatrist, and wants to do “anything and everything” he can to improve his quality of life.
Erica is a 34-year-old Veteran of Operation Enduring Freedom (OEF). During her deployment, she was sexually assaulted. She did not press charges due to various circumstances, including being threatened by a superior officer when she went to him for help. Since her return to the United States, Erica has had difficulty in finding work, primarily because she wants to minimize direct interactions with men. She tells you, “I just can’t stand to be around other people, especially men, because it all takes me back to when I was raped.” For a year, she worked out of her home. However, she developed worsening depression and attempted suicide via an overdose of one of her sleep medications in 2012. In the wake of the suicide attempt, her worsening concentration, sleep problems, and periodic anxiety attacks, she lost her home-based job. She was evicted and has been homeless for several years. She currently lives in a women’s shelter.
Melissa is a 48-year-old Veteran of both the Gulf War (Operation Desert Storm) and OIF. In her role as a medic, she was often one of the first to respond when explosions or other events generated casualties. While she states she “made it out without a scratch,” she also tells you, “I still feel like something is broken inside me.” Melissa currently works as an EMT. She has some good days and some bad days, but it is increasingly difficult for her to go to work due to the fear that she will be a first responder at a serious trauma and end up “losing it to the point where I can’t do my job well.”
Todd, Erica, and Melissa all receive their care at the same VA facility, where they all registered for “Self-Care for PTSD” resources. Each of them, when given the option, agreed to work with a Whole Health Partner. Their Whole Health Partner, Richard, who was diagnosed with PTSD himself after serving in Vietnam, met with each of them several times to outline their Mission, Aspiration, Purpose (MAP) and to begin some personal health planning.
These are men whose minds the Dead have ravished.
Memory fingers in their hair of murders
Multitudinous murders they once witnessed.
Wading sloughs of flesh these helpless wander,
Treading blood from lungs that had loved laughter.
—Wilfred Owen, English poet and WWI soldier, 1893-1918
PTSD affects 7%-8% of all Americans at some point during their lifetimes, with women being affected twice as often as men (10% versus 5%).The National Vietnam Veterans Readjustment Study estimated the lifetime prevalence of PTSD for male and female Vietnam Veterans as 31% and 27% respectively. Prevalence for Gulf War Veterans is about 12%, and for OEF/OIF Veterans, it is around 14%. The risk of developing PTSD seems to increase for many Veterans over time after they experience trauma, especially in the first three to six months after return from combat.
The etiology of PTSD is complex and arises out of a complex interaction of biological, psychosocial, and cognitive factors.Genetic studies indicate that people with combat-related PTSD may be genetically predisposed to have more inflammatory dysregulation, and this is likely linked to why people with PTSD have a higher risk of inflammatory disorders.
According to a 2015 review of 116 studies, the following can be said about risk factors for PTSD in Veterans:
- It is not clear if overall risk is higher for male or female Veterans.
- Risk is higher for younger people; it is higher for males who are under 40 years of age and females under 30.
- Lower level of education correlates with greater risk.
- Black/African American Marines have been noted to have lower risk.
- Not being in a relationship increases risk.
- Being in the Army or the Marines versus other military branches increases chances of developing PTSD.
- Risk is higher for enlisted personnel compared to officers.
- Risk also goes up based on what one does during deployment; it is higher for health care, service and supply, and combat personnel.
Historically, it was argued by some that PTSD is not an actual diagnosis; however, research indicates that there are a variety of neurological and psychobiological reactions to trauma that occur, many of which are linked to the development of PTSD.
After it is established that a person has experienced trauma, there are four main criteria for a PTSD diagnosis outlined in the Diagnostic and Statistics Manual of Mental Disorders, 5th edition.The four general classes of PTSD symptoms include the following:
- Intrusion symptoms. These can include recurrent, involuntary, or intrusive memories or dreams. Distress may be triggered by events that have something in common with the traumatic experience(s). Flashbacks may occur.
- People with PTSD typically attempt to avoid memories, thoughts, feelings, or external reminders related to traumatic experiences.
- Cognitive and/or mood disturbances tied to the traumatic event(s). A person may experience impaired memory, exaggerated negative beliefs, inappropriate blame, persistent negative emotions, and other similar symptoms.
- Hyperarousal and reactivity. This can manifest as irritable behavior, recklessness, hypervigilance, exaggerated startle responses, and sleep problems, among other symptoms.
Symptoms within each category must be present for more than a month for PTSD to be diagnosed. Otherwise, the diagnosis of Acute Stress Disorder is made instead. For more information about diagnosis (useful to both patients and clinicians), refer to the National Center for PTSD (NCPTSD) website.
An estimated 60% of men and 51% of women in the U.S. experience trauma at some point in their lives; however, only 8% of men and 20% of women develop PTSD.Why do some people develop PTSD and others do not? Genetics, the environment, and adverse childhood experiences all can have a profound impact, as can many other factors. The goal is to stack the odds so as to prevent PTSD from ever even developing, and to focus on healing at all levels if PTSD already has occurred.
Fight or flight, perhaps the most familiar stress response, is linked to activation of the sympathetic nervous system. Polyvagal theory may explain some aspects of the development of PTSD by focusing on the vagus nerve, which is linked with the parasympathetic nervous system. This theory, proposed by Stephen Porges, holds that behavior can be affected differently depending on which part of the vagus nerve is activated. When the ventral vagus is activated, a person feels safe and tends to build connections with others. Conversely, when a person (or other animal) feels that their survival is threatened, the dorsal vagus can be activated. Dorsal vagal activation is associated with withdrawing, even shutting down altogether. This is linked to the avoidance and withdrawal symptoms so commonly observed in PTSD.
Recent research indicates that people with PTSD have significant increases in levels of inflammatory markers, such as interleukins 1β and 6, tumor necrosis factor-α, and C-reactive protein. It is thought that inflammation is not only an effect of having PTSD, but also a causative factor.Neuroinflammation, anxiety, and chronic stress may all contribute to PTSD development.
PTSD is associated with poorer functioning, lower quality of life, and earlier onset of a number of physical and mental health problems.. It is vital to account for these during personal health planning, since they strongly influence overall patient outcomes. PTSD never exists in a vacuum. Just as the Whole Health approach and the Circle of Health can help account for each individual’s unique array of PTSD symptoms, it also can help organize the plan with respect to a person’s multiple comorbid conditions.
Veterans with PTSD have more somatic symptoms, health care visits, and work absenteeism.National Center for PTSD. Risk increases if someone has more distressing trauma memories, poorer impulse control, or a tendency toward a higher level of anger than average. A 2017 study suggested that targeting depression and internal hostility might be particularly beneficial for PTSD patients. There is a link between suicide and combat guilt, and the risk is greater in combat trauma survivors who were wounded more than once or hospitalized as a result of their injuries.Of particular concern, as noted in a 2013 systematic review of 16 studies, Veterans with PTSD are much more likely to be suicidal. In fact, the United States National Comorbidity Study found people with PTSD are six times more likely to attempt suicide than their peers. The reasons for this are complex, as noted in a recent factsheet published by the
Fortunately, a landmark 2013 review by Gradus and colleagues indicated that the reverse is also true; successful treatment of PTSD significantly lowers suicide risk.Researchers are actively exploring which suicide prevention measures are most effective for people with PTSD.
Specific comorbidities related to PTSD include the following:
- Sleep disorders. Sleep problems, including insomnia and nightmares, are reported by 70%-87% of people with PTSD and have a significant impact on quality of life and overall outcome.
- Anxiety. What first may seem to be anxiety could actually be part of the hyperarousal symptom cluster that defines PTSD.
- Depression is four to seven times more likely in people with PTSD, particularly in women.
- Personality disorders. Examples include borderline, bipolar, and narcissistic personality.
- Substance use disorders. Alcohol and other substance use disorders are problematic for many people with PTSD.
- Pain disorders. These include chronic pain, fibromyalgia, chronic musculoskeletal disorders, and osteoarthritis.
- Metabolic syndrome. People with PTSD have higher rates of obesity, hypertension, dyslipidemia, diabetes, and vascular disease. This is thought to be in part due to higher cortisol levels that predispose to inflammation. PTSD may be considered an independent heart disease risk factor (pooled hazard ratio was 1.55 with 95% CI of 1.34-1.79).
- Impaired immunity. This is associated with increased infections, gastric ulcers (H. pylori infection), and risk of HIV positivity.
- Autoimmune disorders. These include thyroid disease and rheumatoid arthritis, among others.
- Grief. Grief and traumatic stress are closely connected. Veterans with PTSD who have unresolved loss from trauma may be limited in their ability to grieve more recent losses, and this can result in challenging emotions or behaviors. They may experience depression, low self-esteem, isolation, and an increase in nightmares. A study of 114 Vietnam-era combat Veterans admitted to a PTSD inpatient rehabilitation unit identified that 70% scored higher (i.e., worse) on standardized measures of grief symptoms related to friends lost in combat 30 years previous than did spouses who were bereaved in the past six months. The investigators ultimately concluded that treating the symptoms of unresolved grief may be as important as treating fear-related symptoms of PTSD.
- Traumatic brain injury (TBI). PTSD and TBI share a number of characteristics, including sleep disruption and cognitive impairment.
Fortunately, many problems that co-occur with PTSD often resolve or show improvement when PTSD is successfully treated. For additional information on PTSD and comorbidities, along with a helpful list of resources related to various comorbid conditions, refer to the National Center for PTSD website.
The symptoms of PTSD seldom exist in isolation. Always keep comorbidities in mind when working with people with PTSD. Pain, substance use disorders, affective disorders, autoimmune issues, and sleep problems are among the many comorbidities that may be present. Each of these, when present, can make the risk of suicide even greater.
The three “Meet the Veterans” narratives at the beginning of this overview offer a snapshot of the varied ways PTSD can present.A traumatic event can involve an actual or perceived threat to life, personal safety and security, or physical integrity. It can be directly experienced, witnessed in person, or heard about (in cases of family members or close friends). As in the case of Melissa, PTSD can arise after witnessing the details of traumatic events being experienced by others.
Combat trauma, as experienced by Todd, is perhaps the most familiar traumatic precursor to PTSD for most clinicians, but PTSD has different causes— and effects—for each person who suffers with it. Unfortunately, Erica’s situation of PTSD secondary to military sexual trauma (MST) is not uncommon. One in six civilian women experience sexual assault, and for military women the frequency climbs to an estimated one in three.Forty percent of homeless women Veterans report a history of sexual trauma in the military. MST is the main causal factor of PTSD in women, in contrast to combat experience being the strongest predictor in men. Male Veterans (1.1%, versus 21% of women) also experience military sexual trauma. Risk of suicide markedly increases (hazard ratios of 1.7 and 2.3 for men and women respectively) with a history of MST.
The VHA currently mandates routine screening for PTSD in ambulatory settings and supports access to treatment through comprehensive mental health services, including PTSD specialty teams, primary care-mental health integration programs, and behavioral health interdisciplinary program teams located in many general mental health clinics. VA policy set forth in the Uniform Mental Health Services Handbook requires that every Veteran diagnosed with PTSD be offered one of two evidence-based psychotherapies—Prolonged Exposure or Cognitive Processing therapies—when clinically appropriate.These therapies are discussed in greater detail below.
The Veterans Administration/Department of Defense Practice Guideline for the Management of PTSD and Acute Stress Disorder previously emphasized patient education as part of the treatment for all patients with PTSD and their family members, but the latest version has scaled back with this given a paucity of research support. Nevertheless, clinicians can consider offering the following (and these steps are very much in keeping with patient centered and patient-driven care):
- Describe to anyone with PTSD the range of available and effective therapeutic options, emphasizing that PTSD is a highly treatable disorder.
- Inform the patient about evidence-based psychotherapy and/or evidence-based pharmacotherapy as first-line treatments, allowing patient and clinician preferences to drive the selection of therapies. Psychotherapies should be offered by practitioners with adequate training in the preferred treatment methods. These are described more in the conventional approaches section
- Support them with self-care. There are a number of excellent educational products developed by the National Center for PTSD for Veterans and their family members. These include “Understand PTSD” and “Understanding PTSD Treatment,” as well as a broad range of smartphone apps and online products. Clinicians can recommend smartphone apps and online tools that allow Veterans to self-monitor symptoms. These include the following:
Collaborative treatment planning
A collaborative care approach to therapy administration, including care management, may be considered; however, supportive evidence for this specifically for PTSD is currently lacking. Given that the average dropout rate in trials of exposure-based and cognitive interventions for PTSD is 20%-25%, and given that it is often difficult to convince those with PTSD to seek any form of treatment,it is vital that clinicians carefully match individual Veterans with the therapies and practitioners most appropriate for them. This can be accomplished through a collaborative process between Veterans with PTSD and their health care teams that includes the following steps:
- Identify realistic, stepwise functional goals including a list of key activities/domains.
- Choose specific treatment goals and patient centered indicators of progress that include self-care strategies across the Personal Health Inventory (PHI) domains. Treatment preferences and self-care strategies should be specific, promote recovery, and be strength-based.
- Problem-solve around barriers to getting care, such as transportation and availability to attend daytime appointments.
As part of ongoing care, it is important for clinicians and patients to:
- Monitor patient centered progress indicators.
- Adjust the treatment plan accordingly over time based on monitoring.
- Re-evaluate and renegotiate treatment focus and components.
- Provide support surrounding barriers and challenges.
A 2019 article noted a number of new directions being taken for PTSD care, including non–trauma-focused interventions, new medications, personalized medicine, family-based therapies, and enhanced focus on physical health (again, in support of working with PTSD comorbidities).
Self-Care and PTSD
A 2018 review of 1,349 studies (29 met eligibility criteria) concluded that individuals with PTSD are 5% less likely to have healthy diets, 9% less likely to be physically active, 31% more likely to be obese, and 22% more likely to smoke.Self-care strategies can complement treatments specifically aimed at PTSD symptoms. For example the National Center for PTSD recommends that people with PTSD do the following, all of which tie into various self-care circles within the Circle of Health :
- Have more contact with other trauma survivors
- Start exercising
- Change neighborhoods if living in a high-crime area
- Avoid alcohol and drugs
- Invest more in personal relationships
Many of the psychotherapeutic approaches that are beneficial in treating PTSD draw in proactive strategies, such as goal setting, increasing problem-solving or coping skills, clarifying values, and broadening social support. These tie in nicely with the Whole Health approach.
Considerations specifically related to PTSD for each of the eight components of proactive self-care are listed below. These are framed as specific steps a care team member can follow when advising self-care practices for someone with PTSD. Of course, which steps are taken will vary according to each individual’s needs.
A 2018 scoping review concluded that mindfulness-based approaches have medium to large effect sizes and low attrition rates.The review included a number of studies focused on different formal approaches for enhancing mindful awareness, including Mindfulness-Based Stress Reduction (MBSR), Mindfulness-Based Cognitive Therapy (MBCT) and metta Loving-Kindness approaches. The same study noted that neuroimaging research indicates that mindful awareness training targets over- and under-modulation of emotions, which are critical features of PTSD. A 2018 review noted that fear extinction, in particular, may be tied to the benefits of mindful awareness for PTSD. Another meta-analysis from 2017, which included 18 studies of mindfulness training, concluded that longer training periods had stronger effects. These effects were not affected by gender, age, or Veteran status. Another 2017 review of 10 meditation trials (n=643) found that meditation approaches appear to be effective for PTSD symptoms (and noted that more research is needed). Yet another 2017 review emphasized that mindfulness approaches should not be used as first-line treatments but nevertheless do have potential benefit.
Developed in 2014, Trauma Interventions Using Mindfulness-Based Extinction and Reconsolidation (TIMBER) is based on Mindfulness-Based Cognitive Therapy (MBCT), and it combines principles of Mindfulness-Based Exposure Therapy trauma memories work.TIMBER is an example of how various mind-body approaches are being adapted to the care of PTSD.
To cultivate mindful awareness, there are now many ways to weave in new technology. For example, clinicians can recommend smartphone apps that allow Veterans to self-monitor symptoms. Some of these are listed in the “Education” section above. Refer to the resource section at the end of this overview as well.
One review suggested that the mechanisms of action for mindfulness as it relates to PTSD might include the following:
- Mindfulness increases ability to shift attention, so that those with PTSD can reframe how they focus on trauma-related stimuli.
- It allows one to modify maladaptive cognitive styles, allowing one to move away from worry and rumination.
- It enables one to adopt a nonjudgmental stance, changing the way that interpretations and negative attributions are habitually done. This can help to counteract avoidance.
Additional research is needed to confirm these theories.
Power of the Mind
Traumatic events, by definition, overwhelm our ability to cope. When the mind becomes flooded with emotion, a circuit breaker is thrown that allows us to survive the experience fairly intact, that is, without becoming psychotic or frying out one of the brain centers. The cost of this blown circuit is emotion frozen within the body. In other words, we often unconsciously stop feeling our trauma partway into it, like a movie that is still going after the sound has been turned off. We cannot heal until we move fully through that trauma, including all the feelings of the event.
A 2018 review found that, for 15 studies that met inclusion criteria, meditation, mantra repetition, breathing exercises, and yoga combined with breathwork all led to “significant improvements” in symptoms of PTSD.These studies included some post-9/11 Veterans, but 85% were in other conflicts. A 2013 systematic review of the literature found 16 of 92 articles that met review criteria. Studies were usually small, but there was an association between an array of mind-body practices and PTSD symptoms.
When talking about Power of the Mind with Veterans, the following points are worth considering… Explore how the mind-body relationship manifests in daily life, noting what triggers lead to increased tension and hypervigilance.. PTSD is characterized by an altered parasympathetic response to stressors, whereas mind-body approaches typically enhance this response. Teach relaxation techniques to combat hypervigilance and tension. Although evidence is still preliminary, mindfulness-based and other related approaches, such as Acceptance and Commitment Therapy (ACT)and Dialectical Behavioral Therapy (DBT), show promise for helping patients with PTSD. Many mind-body therapies are used frequently enough in the VA that they are most appropriately considered conventional therapies. All of these therapies and the state of the evidence regarding their use are described in the conventional therapies section below.
A 2019 review did not find conclusive evidence that mediation was beneficial for PTSD, but concluded that “…available empirical evidence demonstrates that meditation is associated with overall reduction in PTSD symptoms, and it improves mental and somatic quality of life in PTSD patients.”A 2018 systematic review of 15 studies found benefit for seated or gentle yoga that was accompanied by breathwork and various other types of meditation. A 2017 review of 18 studies indicated a potential benefit of mindfulness training, noting that benefits based on the length of time a person was trained.
Mantram meditation, the repetitive use of a sacred word or phrase throughout the day, was found to be feasible, associated with moderate to high satisfaction, and had a promising effect size in a small cadre of 15 Veterans.A 2012 study by the same lead authors found, in a group of 146 Veterans (66 in the intervention group), that 24% of the intervention group versus 12% of controls showed improvements in PTSD symptom severity. This mind-body approach shows increasing promise as research continues.
This approach has promise for PTSD care, but more research is needed.
A study of 52 people with PTSD had significant symptom improvement with neurofeedback (biofeedback using EEG measurements), and a 2018 systematic review found it showed promise in general for a variety of outcomes measures.In a 2018 study, a group of 20 Veterans were trained using fMRI to up-regulate blood oxygen supply to their amygdalae (a structure in the lower front part of the brain), which markedly improved symptoms in 80% (versus 38% of controls using sham fMRI feedback). Heart rate variability (HRV) biofeedback combined with Cognitive Behavioral Therapy (CBT) was helpful for a small group of people with noncombat-related PTSD. Pre-deployment resilience training that involved HRV biofeedback resulted in lower post-deployment PTSD symptom scores in a group of 342 Army National Guard soldiers.
Research at this point for Guided Imagery is quite limited. Guided Imagery should be used with caution and only by an experienced professional if a person is prone to having flashbacks.
In a 2013 meta-analysis of six studies Writing Therapy was found to have significant benefit for PTSD.
Creative Arts Therapies
A 2018 review noted that evidence for Music, Art, and Drama therapies is not conclusive of clear benefit, and more research is needed.
Mind-body approaches for regulating the autonomic nervous system
In 2011, the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury published a review of 13 different mind-body techniques.These were classed into the following five categories:
- Body-based tension modulation practices, including yoga
- Mental focused practices, such as mindfulness, meditation, Guided Imagery, and iRest® Yoga Nidra.
- Mind-body programs that offered multiple techniques in the form of taught skills courses
The report concluded that
“…integrative practices designed to regulate the autonomic nervous system and improve mood stress regulation and arousal are promising. However, in order for these and other related practices to achieve greater recognition and be used in the mainstream military health community, there is a need to compare the relative effectiveness of techniques…to each other, as well as to other more mainstream stress and energy management practices, such as exercise, counseling, and psychopharmacology.”73]
These are featured in the “Conventional Care” section, below.
Spirit & Soul
Spirituality may be defined, generally, as what brings meaning, purpose, and connection to a person’s life. Each of us has a unique definition of what matters most. Traumatic experiences affect people deeply; there is a reason people refer to them as “soul wounds.” Spirit and soul are important to explore with people with PTSD. A 2018 review of eight studies of spiritual and religious interventions for PTSD found that seven of them showed significant benefit.Another review noted that being religious either reduced or contributed to PTSD depending on a person’s race and the presence of anxiety or depression. A review of PTSD and spirituality for combat Veterans concluded that their results suggested that “…understanding the possible spiritual context of Veterans’ trauma-related concerns might add prognostic value and equip clinicians to alleviate PTSD symptomatology among those Veterans who possess spiritual resources or are somehow struggling in this domain.”
Of course, care team members should never impose their spiritual and religious perspectives on others; as with all aspects of self-care, Whole Health is tailored to the individual. As you develop a PHP related to Spirit and Soul, keep the following in mind:
Consider Moral Injury
Moral injury is defined as pain and suffering that arise because individuals have been damaged at the level of their moral foundation—the level of their core values.A morally injurious event is one that cannot be justified based on someone’s moral or personal beliefs. People feel compelled, often by an authority figure, to do something that in other circumstances, they never would have done. As one research study puts it,
Moral injury is an emerging construct to more fully capture the many possible psychological, ethical, and spiritual/existential challenges among persons who served in modern wars and other trauma-exposed professional groups.
Moral injury and PTSD have been described as overlapping in terms of many of the symptoms they cause, such as anger, affective disorders, substance misuse, and insomnia. However, they are different in some respects.Moral injury is more commonly associated with feelings of alienation, shame, and regret; PTSD, in contrast, is more likely to be linked to fear, flashbacks, and memory loss. While research related to working with moral injury is in its early stages, it is clear that healing often relies on lessening the pain of these injuries, just as one would ease any other cause of suffering.
Work with Chaplains
If a person has concerns, would like to set a goal related to Spirit and Soul, or is struggling with moral injury (described above), asking for the support of a chaplain or other experienced professional is essential.Passport to Whole Health features more information about chaplains.A 2018 article made a case for contextualizing care, noting that chaplains are especially skilled at providing “nonjudgmental, person-centered, culturally relevant care rooted in communities….” A 2019 review noted that spirituality and religion are closely linked to moral injury and that “…help from chaplains may support healing, self-regulation, and mending of relationships, moral emotions, and social connection.” Chapter 11 of the
Explore How Faith Affects One’s Understanding of Traumatic Experiences
Edward Tick, who among other things has trained over 2,000 Army Chaplains, holds that PTSD is, at its core, a “soul wound” that must be addressed as such. Drawing in chaplains, clergy, and others who can offer spiritual support, based on a patient’s personal beliefs, is appropriate.A 2005 (nonsystematic) review of 11 studies found that typically, religion and spirituality are beneficial to people in the aftermath of trauma and that traumatic experiences often lead to a deepening of religion or spirituality. Spirituality is closely linked to posttraumatic growth, which is described in the “Personal Development” section below.
Focus on Meaning
A 2019 evaluation of data from the National Health and Resilience in Veterans Study concluded that a higher level of “global meaning” reported by Veterans was linked to a significantly lower likelihood of suicide in Veterans who experienced morally injurious experiences related to deployment.Exploring a Veteran’s MAP is fundamental to Whole Health for PTSD.
Family, Friends, & Co-Workers
PTSD has a negative impact on Veterans’ relationship functioning.Conversely, good peer relationships during deployment reduce risk of PTSD. Positive family interactions are linked to a lower risk of PTSD over the following 12 months. A 2019 study, asking why only 6%-10% of people with trauma end up being diagnosed with PTSD, noted that a significant proportion of the risk may be explained by differences in social cognition. People with PTSD are more likely to have deficits in understanding social cues, and particularly cues related to perceiving threats.
Consider the following when collaborating with someone with PTSD who wants to focus on relationships:
A sense of community and community support are extremely important to many Veterans. Often, Veterans with PTSD have a sense that they are best understood by other Veterans. Support groups may be helpful. For more information about PTSD and community, refer to the National Center for PTSD website.
Ascertain How PTSD Symptoms Affect Close Relationships
There is some data supporting family-focused therapies,and the VA is placing more emphasis on therapeutic approaches that include family members. While mores studies are needed, it seems there is benefit to incorporating emotion regulation skills into couple- and family-based treatments for PTSD. Be sure to discuss the extent to which family and friends are knowledgeable of one’s diagnosis and whether or not further disclosure would be beneficial.
Animal-Assisted Therapies May Help
Placement of a PTSD service dog was found to improve physiological and psychosocial indicators of well-being for Veterans with PTSD (the study noted that clinical significance still needs to be explored).“Animal-Assisted Therapy” tool for more information.A study of 141 post-9/11 military members and Veterans concluded that trained service dogs “may confer clinically meaningful improvements” in PTSD symptoms. Yet another 2018 study found that therapeutic horseback riding decreased PTSD scores on different measurement scales. Refer to the
Moving the Body
Take care to explore whether exercise is beneficial for a person’s PTSD symptoms and if so, how. Enhance physical activity as appropriate; refer to the “Moving the Body” overview and Chapter 5 of the Passport to Whole Health. Study findings specific to PTSD and the benefits of physical activity include the following:
- A 2016 review concluded that regular exercise is inversely linked to PTSD and its symptoms. Hyperarousal symptoms, in particular, may improve with physical activity.
- Physical activity may offer benefit in people who are resistant to standard medical treatment.
- In a small group of adults, PTSD symptoms were reduced after 12 exercise sessions of 40 minutes each. Improvements were maintained at one-month follow up.
- An eight-week program that included three 40-minute aerobic exercise sessions each week led to reduced PTSD, anxiety, and depression symptoms in adolescent females with PTSD.
- Ninety percent of adolescents who regularly exercised three times weekly for 60-90 minutes had significant reductions in PTSD symptoms.
- In contrast, Cochrane Review did not find any research that met inclusion criteria addressing whether or not sports and games decreased PTSD symptoms.
- Military-tailored yoga for a small group of 18 Veterans with PTSD was found potentially effective as an adjunctive or stand-alone therapy. However, a 2018 meta-analysis found only “…a weak recommendation for yoga as an adjunctive intervention.” A 2017 review of seven studies found that yoga “contributed to a significant overall reduction in PTSD symptoms.” Another 2017 review concluded that yoga in combination with meditation has promise as complements to conventional PTSD treatment. A 2014 trial involving yoga for 64 women with PTSD did find marked improvement in PTSD symptoms in the yoga group. In fact, 16 of the 31 participants in the yoga group no longer met criteria for PTSD at the end of the study.
- There is limited data supporting the use of tai chi or qi gong for PTSD.
Given that exercise can have overall benefits for anxiety disorders, and given that exercise tends to offer many other health benefits as well, it is reasonable to add it as an adjunct to first-line therapies.There is a growing recognition that running or walking groups can be a helpful component to PTSD specialty clinics’ treatment programs.
Some surroundings-related recommendations specific to PTSD:
- Discuss how surroundings are easing or exacerbating symptoms of avoidance, arousal, or re-experiencing trauma. Surroundings on the VA website might be a helpful tool to use.
- Long-term exposures to green spaces are linked to less anxiety; it is reasonable to assume more time in nature may also benefit certain Veterans with PTSD.
Sleep is often severely compromised in PTSD, with people reporting trauma-related nightmares, insomnia, and other problems.Passport to Whole Health discusses these further.Fear of sleep, decreased parasympathetic activity, abnormal rapid eye movement (REM) sleep, and other factors seem to be involved. Explore the relationship between sleep and PTSD symptoms for each individual. Offer suggestions for improving sleep quality, falling asleep, or enhancing sleep hygiene, as appropriate. The “Recharge” chapter of the
Cognitive Behavioral Therapy for Insomnia (CBT-I), along with new CBT-I smartphone applications can be helpful in improving sleep symptoms in patients with PTSD.Recharge” overview for more information on CBT-I and other psychotherapeutic approaches for improving sleep. Keep medications, such as prazosin, in mind as options, if appropriate.CBT-I can often prove more effective than medications. Refer to the “
Food & Drink
Most of the research related to nutrition and PTSD is focused on comorbidities. Consider the following:
- A review that included nearly 590,000 subjects concluded that the odds ratio for obesity among those with PTSD is 1.55. As noted previously, metabolic syndrome is highly prevalent in people with PTSD (39%), to the point where some are questioning whether PTSD should be considered a cardiovascular disease risk factor itself. Abnormal eating behaviors are linked to PTSD. Working with healthy eating patterns is essential to reduce the elevated risk of vascular disease that plagues people with PTSD.
- Address alcohol use. Excessive alcohol use often is done to try to blunt PTSD symptoms but ultimately worsens symptoms and interferes with treatment.
- Explore whether dietary patterns influence symptoms. Some people are more likely to be emotionally labile if they are hungry.
Personal Development also has a role:
- Discuss whether any activities, hobbies, and/or creative pursuits ease PTSD symptoms and whether or not Veterans have insights about this.
- Explore posttraumatic growth, which is
…the development of positive changes and outlook following trauma, including increased personal strength, identification of new possibilities, increased appreciation of life, improved relationships with others, and positive spiritual changes.120]
A survey of 272 primarily “older” Veterans of Operation Enduring Freedom and Operation Iraqi Freedom found that:
- 72% endorsed a significant degree of posttraumatic growth.
- 52% reported having changed priorities about what is important in life.
- 51% reported a greater appreciation for each day.
- 49% reported being better able to handle difficulties.
Of note, those with higher PTSD scores often score higher for these measures as well; it would seem that posttraumatic stress and posttraumatic growth are not opposite ends of a spectrum, but actually can coexist.Over 50% of people report moderate-to-high posttraumatic growth after a traumatic experience. A 2018 systematic review of 21 studies confirmed that moderate posttraumatic growth, not just PTSD alone, can arise for military service personnel who have experienced trauma. Explore what Veterans need to foster posttraumatic growth as part of their Whole Health care.
In terms of prevention and treatment of PTSD, it is important that evidence-based PTSD therapies be offered to all Veterans. Most research has focused on psychotherapies and pharmaceuticals. The following highlights are based on summary recommendations from the VA/DOD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder, which was recently updated.
General Clinical Management. Engage patients in shared decision-making and focus on collaborative care using evidence-based treatments.
Diagnosis and Assessment. Screen periodically with measures like the Primary Care PTSD Screen or the PTSD Checklist. In people with suspected PTSD, offer an appropriate diagnostic evaluation. In people diagnosed with PTSD, use self-report measures to monitor treatment progress.
Prevention. Evidence is limited for psychotherapy or medications in the time immediately after trauma. If someone is diagnosed with acute stress disorder, use Trauma-Focused Psychotherapy that includes exposure and/or cognitive restructuring. (These are described in the next section.) Evidence for medications is insufficient.
Start with individual, manualized, trauma-focused psychotherapy (preferred over drug therapy). Drug therapy or non–trauma-focused psychotherapy can be used if trauma-focused psychotherapy is not available or not preferred by a patient. Certain medications (e.g., serotonin specific reuptake inhibitors, or SSRIs) are preferred, and other drug classes are suggested if those are ineffective.
There is not enough evidence to recommend for or against “…repetitive transcranial magnetic stimulation, electroconvulsive therapy, hyperbaric oxygen therapy, stellate ganglion block, or vagal nerve stimulation.”
Acupuncture and other CIH practices are not recommended as primary treatments.
Psychotherapies, sometimes classed under “Power of the Mind” as well, are being used with increasing frequency in the VA, depending on the availability of clinicians trained to offer them. A 2016 review found large effect sizes for an array of therapies, noting that the number needed to treat was <4.More research comparing the different therapies to one another is still needed.
The 2017 VA/DOD guidelines most strongly recommend the following trauma-focused therapies.
Prolonged Exposure Therapy (PET)is built around the idea that repeated exposure to thoughts, situations, and feelings can reduce their power to cause a person distress. It has four main parts, which include education, breathing retraining, practice in real-world situations, and talking through one’s trauma. A 2013 study of 1931 Veterans found that PET significantly decreased PTSD-related symptoms, as well as depression.
Cognitive Processing Therapy (CPT). The primary goal of CPT is to improve mood and behavior by making efforts to change thoughts, beliefs, and expectations that are irrational or dysfunctional. Its four main parts include learning about symptoms, enhancing awareness about thoughts and feelings, learning skills to help challenge these thoughts and feelings, and understanding how trauma changes beliefs. Through these steps a person is able to deal with trauma in new ways.
Eye Movement Desensitization and Reprocessing (EMDR). This involves an eight-phase approach for addressing experiences that contribute to PTSD. After taking an elaborate history and helping patients identify a target for the therapy, clinicians have them focus on a particular image, thought or sensation while their eyes follow the clinician’s finger through a series of prescribed movements. Other stimuli might also be used.A 2018 review found trauma-focused EMDR and Cognitive-Behavioral Therapy to be equally efficacious (if not slightly better) at reducing PTSD symptoms. An August 2014 meta-analysis concluded that EMDR Therapy significantly reduces PTSD symptoms, anxiety, depression, and overall distress in people with PTSD.
Other recommended therapies include Cognitive Behavioral Therapies (CBT) tailored specifically to PTSD, Brief Eclectic Psychotherapy (BEP), Narrative Exposure Therapy (NET), and Written Narrative Exposure (WET).
Some non–trauma-focused therapies are also recommended:
Stress Inoculation Training (SIT) takes people through three stages.In the first, stressors and responses are identified, as are patterns of self-defeating dialog. The second stage, skill acquisition and rehearsal, allows a person to practice new, more rational thought patterns. In the third stage, they practice applying what they have learned in real-life situations. Present-Centered Therapy (PCT) and Interpersonal Psychotherapy (IPT) are also mentioned. Not mentioned in the guidelines but also used for aspects of PTSD care are Imagery Rehearsal Therapy (IRT) involves reducing nightmares by changing the end of remembered nightmares while awake.
Psychodynamic Therapy (PT) is defined differently in various studies. Also known as insight-oriented therapy, it focuses on gaining insight into unconscious processes and how they manifest in the way a person behaves.GoodTherapy website.It has been used primarily in clinical practice for the treatment of depressive disorders. For more information, refer to
Evidence is insufficient to recommend other psychotherapies for PTSD, including Dialectical Behavior Therapy (DBT), Skills Training in Affect and Interpersonal Regulation (STAIR), Acceptance and Commitment Therapy (ACT), Seeking Safety, and supportive counseling.
For more information about each individual therapy, refer to individual PTSD 101 courses on the National Center for PTSD website. Mental health services have supported the rollout training and dissemination of evidence-based PTSD treatments (CPT and PET) to large numbers of VA clinicians. Additional rollout trainings in the past year in cognitive-behavioral treatments for insomnia and pain, as well as problem-solving skills therapy, assist PTSD patients with recovery. These efforts are supported by didactic lectures in both psychotherapy and pharmacotherapy of PTSD, organized by the National Center for PTSD, as well as a broad array of educational courses and materials available on its website.
The 2017 VA/DOD guideline suggests that sertraline, paroxetine, fluoxetine, or venlafaxine be used as monotherapies for those who choose against or cannot access the preferred psychotherapies. Prazosin, an inexpensive alpha-1 antagonist, is recommended for PTSD-related nightmares.VA/DOD Clinical Practice Guideline the Management of PTSD and Acute Stress Disorder for more specifics. Low-dose ketamine has also been used with increased frequency. More research is needed, but infusing it in a subanesthetic dose seems to be safe and potentially beneficial in Integrative Health approaches. In 2010, 39% of Americans with PTSD reported using complementary approaches (then referred to as complementary and alternative medicine, or CAM) in the past year, with mind-body therapies, relaxation/meditation, exercise, herbal remedies, massage, and chiropractic listed among the most popular. A 2012 survey of 125 Veterans Hospitals revealed that 96% used at least one of a list of 32 CAM therapies in their PTSD treatment programs. The majority of systematic reviews and meta-analyses conclude that “more research is needed” regarding treating PTSD with various complementary medicine modalities. Considerable research to investigate various CIH treatments for PTSD is now underway in the VA.. See the full
For a detailed summary of CIH research in PTSD, refer to the National Center for PTSD website. The information below summarizes many of the key research findings of this and other reviews of the literature.
There is currently no research supporting the use of dietary supplements for PTSD, though there is interest in the use of omega-3 supplements. Many who recommend supplements will try supplements similar to those used for anxiety. For more information, go to the “Anxiety” overview.
Limited research is available to support the use of spinal manipulative therapies for PTSD. A small cross-sectional analysis conducted in 2009 with a group of 130 Veterans with neck or low back pain found that the 21 people with PTSD were much less likely to benefit from chiropractic than those without PTSD.Few studies are available on massage and PTSD.
Energy Medicine (Biofield Therapies)
One small randomized controlled trial (RCT) of Healing Touch that included 123 returning active duty military personnel found statistically significant improvements (p<0.0005) in PTSD and depression symptoms.
Acupuncture has shown increasing promise for PTSD in recent years. A 2018 systematic review and meta-analysis of seven trials with 709 participants found evidence was low-quality evidence but suggested significant benefit.A 2012 systematic review of CIH therapies for PTSD found acupuncture superior to no treatment (being waitlisted) and comparable to group-based Cognitive-Behavioral Therapy (CBT). In that study, which did not focus specifically on Veterans, it was the only therapy found to have a moderate effect size; other approaches seemed to have less of an effect. A frequently cited 2007 study of acupuncture for PTSD found improvement in a cohort of non-Veteran males who received a series of 24 acupuncture sessions (one hour each) over 12 weeks. A separate article on acupuncture’s mechanism of action offers detailed explanations of how acupuncture might affect PTSD at the biochemical level.
Emotional Freedom Technique (EFT) has been classed by some as a form of “energy psychology,” and involves a combination of making specific statements and tapping on various acupuncture points. A 2017 meta-analysis of seven trials, found EFT significantly beneficial for PTSD.In addition, an uncontrolled 2014 trial that included 218 couples (Veterans and their spouses) found significant benefit based on PTSD checklist scores. A very small study suggested that EFT may also help prevent progression from subclinical to clinical PTSD.
Overall, research does not support using complementary approaches as replacements for first-line interventions for PTSD. However, there is room, especially regarding acupuncture and mindfulness-based meditation, to use these approaches adjunctively.
Neuromodulatory therapies are techniques for altering nervous system circuitry using different types of electrical modulation. Examples include deep brain stimulation, transcranial magnetic stimulation (TMS), vagal nerve stimulation, and stellate ganglion block. A 2019 study concluded that, overall, research is insufficient to determine efficacy for these interventions, except perhaps for some benefits seen in small studies for repetitive TMS.
Back to the Veterans
Each of the three patients with PTSD—Todd, Erica, and Melissa—completed a Personal Health Inventory (PHI). In every case, their care team members were careful to assess their suicide risk as a first priority and then to assess for current life stressors. Todd reviewed his PHI with his health psychologist, who coordinated the plan with the Patient-Aligned Care Team (PACT) that had previously been assigned to him. Erica went over hers with her primary care practitioner, who specializes in women’s health. An important member of her was a social worker who could help her with her living situation. Melissa reviewed her PHI with a nurse practitioner she often sees, then followed up on her Personalized Health Plan (PHP) with both her psychologist and her Whole Health Coach. Todd decided that his MAP, his reason for wanting his health, was so that he could go back to school to study to be a counselor because “I want to help people like me, and it will help if they have someone who really knows what all this is like.” He also intends to get into a steady relationship. In the meantime, he plans to train as a Peer Support Specialist at his local VA.
Todd’s health plan outlined the following priorities:
- Continue with his medications, as per his psychiatrist.
- Work with a mental health expert who is skilled at offering trauma-based psychotherapies, which he has not yet tried.
- Begin an MBSR course that is offered at his local VA Hospital.
- Try acupuncture, not only for his PTSD, but also for his chronic low back pain.
- Ramp up his exercise to 150 minutes weekly and develop a plan to ensure it happens. Of course, the physical activity will help him in many other ways, as well. Like many people with PTSD, he is at increased cardiac risk and is working on eating healthy, too.
- Reduce alcohol consumption and explore other healthier ways to ease his stress levels. He was given some Veteran handouts on relaxation approaches he can try even before his MBSR class starts.
Erica received help navigating the system from a clinical social worker recommended by her primary care clinician. Once her basic needs of safety and shelter were more reliably met, she and her health coach worked together on the following:
- Erica was evaluated by a psychiatrist skilled in the management of PTSD (she had not been established in the health care system previously).
- The social worker on her care team ensured she was able to get her medications, including prazosin for her nightmares.
- She began to receive regular psychotherapy. PET was difficult for her but ultimately quite helpful. She also received CBT-I, and her sleep gradually improved.
- Erica found a support group for women victims of sexual trauma and cultivated a support network. She ultimately chose to attend church services with some of her new-found friends/supporters. Spirit and Soul became a high priority for her.
- Erica “isn’t quite ready” to focus on diet and exercise, but says her health mission is “to love my body again and really be in it.” She says she will just take it “day by day” and has plans for follow up with a Whole Health Coach after counseling has been ongoing for a few weeks.
Melissa appreciated the psychotherapy she received for her PTSD, and with time, she was able to return to work. EMDR was especially helpful to her. One thing that completing the PHI brought to her attention was that, as someone who works in health care, she wanted to do much more as far as “practicing what I preach.” For her health mission, she noted, “I want to enhance my ability to be a healer, understanding that it starts with me.”
Her PHP includes several steps:
- She will begin by cutting down to, at most, a 50-hour work week (she was working 60 hours) and go back to school to do pre-med coursework.
- She realized that she wants to be more “reassuring and present” with the people she rides with in the back of the ambulance as an EMT. She understands that starting a mindfulness-based practice (she prefers tai chi or something that allows her to stay active while she focuses her attention) can help with this and may (though more research is needed at this point) also help some of her PTSD symptoms.
- Melissa is actively exercising and paying attention to daily calorie intake as part of her plan to model healthy living.


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On the Love & Hip Hop Hollywood episode ‘I Want It All,’ Willie, A1, Ray J and Safaree meet at Venice Beach to work out. Ray J says the wedding has been stressing him out. That’s when A1 announces that he and Lyrica eloped. (A1 suggests Ray J and Princess do the same.) Ray J keeps talking about his parents (who he loves dearly) who are “rearranging” how he feels. (That’s code for his mother wanting Princess to sign a pre-nup.) Willie says he would be happy to have any of these problems – he’s not on speaking terms with his wife Shanda.
When the topic turns to Safaree’s love life, Safaree admits that he likes Nikki Baby “a lot.” He says “She has a big heart.” Ray J tells Safaree what he’s heard about Nikki hooking up with Rosa Acosta. Ray J suggests that Safaree tell Nikki and Rosa that he needs to be with both of them. “Normally, Ray J’s advice is a little crazy but right now, I think he might be on to something.” A1 doesn’t know if Safaree should be taking advice from Ray J. “Even if it was a good idea, I don’t think Safaree can pull it off,” says A1. The men then discuss if Safaree is “going to let them give it to him or if he’s going to give it to the both of them.” Safaree declares the latter, of course. Love & Hip Hop Hollywood airs Mondays at 8pm on VH1.

domain: celebrity


text:
ARMYs Fell in Love with Jimin`s Recent Stage Outfit... It Reveals Chimchim`s SKIN!
BTS` [Love Yourself: 轉 Tear] is Now #1 Best Seller On Amazon for Album Pre-Sale
BTS Surprises Fans with the Making Film of Their Latest MV... It`s Beyond Amazing
BTS Won TIME 100 Reader Poll over World`s Big Names
Won at the [2017 Billboard Music Awards], BTS has Once Again Nominated for Top Social Artist
BTS is Rumored to Perform at the [2018 Billboard Music Awards]... Fans Went Seriously Excited for That
Taehyung broke into tears after he heard Jin's explanation about their argument.
During the fourth episode of 'Burn the Stage,' Taehyung and Jin were spotted having a word fight regarding to their stage performance. The environment got intense as both of them started to raise their voice. Being professional, leader RM told them to stop and finish the concert in the first place, before they might continue arguing.
Image Source: Youtube 'DaisyxBTS 07' Screenshot
As the boys going back to their place, everyone sat down together in the living room to discuss what really happened between the two. After the problem got solved one by one, Taehyung and Jin apologized to each other, saying that none of them actually meant to do so. The rest of the members then left the two, giving them chance to have a deeper talk.
Getting into a deeper talk, both Taehyung and Jin slowly explained their perspective and found out why they ended to have an argument. After being clear, Taehyung, who is younger than Jin, could not help but shed tears in front of Jin. Taehyung then said to Jin, "Let's have a drink later on."
Find out more in the video above!
Source: [Youtube] DaisyxBTS 07
Thumbnail Credit: Youtube 'DaisyxBTS 07,' LUVIN_TAETAE
Get Your KStarCoin to fund your own K-Pop concert!

domain: entertainment


Newcastle boss Rafa Benitez opted for the Spaniard to lead the line - despite the club snapping up Salomon Rondon on loan from West Brom and Japan World Cup star Yoshinori Muto from Mainz.
Benitez included no debutants in his starting line-up as Joselu got the nod, with Rondon and Muto both on the bench.
Fellow new boys Fabian Schar and Ki Sung-yueng were also named among the substitutes.
And Newcastle fans were not impressed to see Joselu picked to lead the Toon's attack against Spurs at St James' Park.
One fan wrote on Twitter: "I'd rather Shola start up front than Joselu. I'd rather a training cone start then Joselu."
Another added: "Joselu starting tho? Really?"
"Joselu starting ahaha might as well give them the 3 points now," added a third.
Newcastle signed seven players before Thursday's transfer deadline, but also recorded a net profit of more than £20m, leaving fans bewildered after owner Mike Ashley, whose Sports Direct business agreed a £90m deal to buy House of Fraser on Friday, had promised him "every last penny" the club generated to spend.
Despite the unrest, Benitez has insisted he will not allow the ongoing uncertainty over his contractual situation to disrupt a fresh drive for Premier League safety.
The 58-year-old Spaniard has endured another frustrating transfer window during which his efforts to strengthen his squad were hampered by his decision not to accept the club's offer of an extension to extend his current deal, which is due to expire next summer.
He was in diplomatic mood when asked about the Magpies' summer business at his press conference on Friday afternoon, and later allowed his name to be added to a statement to supporters, along with those of managing director Lee Charnley and captain Jamaal Lascelles, aimed at offsetting mounting discontent within the fanbase.
However, asked if his own situation might disrupt the season, which gets under way against Tottenham on Saturday, he said: "I don't think so.
"We have time to do things and I don't need to explain at every press conference that we have talked. We know now is the time to relax a little bit and concentrate on the games."
The statement said: "Doing good business in a transfer window is about ending the window clearly stronger than when you started and we believe we have done this.
"The view we all share is that we have a better squad now than the one that finished 10th last season and all involved have worked tirelessly to make this happen."
Joselu opened the scoring for Newcastle at St James' Park, cancelling out Jan Vertonghen's opener for the visitors.


Another 80 million doses are also to be delivered this year but without a clear timetable yet.
- The district attorney has suggested in court filings that the probe is now broader and could focus on potential bank.
Reporting by Steve Holland and Jeff Mason; Editing by Chris ReeseOur Standards: The Thomson Reuters Trust Principles我來回答(da)
（000 votes in the southern state.Biden emphasized the need to reinvigorate U.
Such tweets from political candidates and elected or government officials are instead hidden by a warning and Twitter takes actions to restrict their reach我來回答(da)
還Biden said in a town-hall meeting in October.
- an assertion election officials dispute.我來回答(da)
國Republicans control the Michigan.
- It is typical for the Senate to hold such hearings before inauguration to help assure a smooth transition.我來回答(da)
個Hong Kong Internet Registration Corporation Limited (HKIRC).
- The Trump campaign is still expected to mount a legal challenge to the overall result in Wisconsin.日本无限看免费视频-日本免费无限吗2021芒果我來回答(da)
Lizbeth Diaz4 Min ReadGUATEMALA CITY (Reuters) - As the first groups from Central America reached the Guatemalan border on Thursday as part of a caravan aiming to reach the United States.


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The history of Dents can be traced back to 1777, when John Dent established his accessory company manufacturing fine leather gloves in Worcester, England.
The company continued to grow under the guidance of Dent’s two sons, John and William, and by 1833 Dents was employing 133 craftsmen and craftswomen at its factories in Worcester and London, engaged in hand cutting and stitching, a unique skill still practised today.
From its earliest days the company was an active exporter, successfully selling to the finest shops and stores in Europe, North America, Asia and Australia.
The skill and craftsmanship which underpin Dents’ worldwide reputation are still very much in evidence, and today the company continues to exercise that care and attention to detail which has been its hallmark since 1777.
Although primarily famous for the crafting of fine leather gloves, Dents has always been involved with the design and manufacture of fine accessories. Today the Dents Collection includes gloves, belts, handbags, hats, scarves, and small leather goods for men and women.
Dents was awarded a Royal Warrant in 2016 by His Royal Highness, the Prince of Wales. This has become a mark of quality for the company’s products across the world, and is regarded with enormous pride by everyone at Dents.

domain: history


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Fabric Palette 5 x 18" x 21" Fat Quarter Bundle - City Collection
Each beautifully wrapped bundle comes complete with five colour coordinated fat ¼’s (18” x 21”) ideal for an array of sewing, quilting and home decor projects.
Description & Features+
The City Bundle is a sophisticated collection of soft lavender, bold amethyst mingled in with a little metallic silver and solid black to add drama and flare.
Featuring small to medium sized prints this collection will inspire you for your next home dec or quilting project or it imagine it all sewn up as a trendy handbag.
- 100% Cotton
- 5-piece bundle
- Pre-cut size 18" x 21”
If you buy something online but it's not everything you dreamed it to be, no worries! We're here for you.
You can return this item within 90 days from the day you receive your online order.
You can easily return this item by mail.
From the Manufacturer +
Q & A+

domain: design


translated by Brett Larner
On Feb. 4 it was announced that 64 Tokyo Metropolitan Police Department officers will run in the Feb. 22 Tokyo Marathon, carrying cameras that will transmit pictures and video back to police headquarters in real time as part of a counterterrorism operation. It is the first time such an operation will be carried out within Japan. An official commented, "This is part of our security enhancement program in preparation for the 2020 Tokyo Olympics."
According to the police department, the officers will run in eight pairs, covering roughly 10 km before the next set of officers takes over. The core of the group of officers is made up of male and female riot police in their 20s through 40s, four of whom ran in the Hakone Ekiden and Izumo Ekiden as university students. The officers will carry batons, pepper spray and sound equipment in anticipation of any unforeseen circumstances.
In response to the 2013 Boston Marathon the Tokyo Metropolitan Police Department increased the number of officers on security detail at the Tokyo Marathon to 4500 last year. This year it plans to field roughly the same number.


text: The whole Chandra family had been so careful ever since the pandemic began in order to protect Ethan. Their two kids were taken out of school and attended online. They didn’t eat in a restaurant or go to the store since early 2020. When Ethan had a low fever and some sniffles on July 29, Alison’s birthday, they didn’t think much of it. There was no way he could have been exposed to COVID-19. But when they took him to get tested, it came back positive.

domain: news


Japanese company Elecom has released a unique accessory for Nintendo Switch and Nintendo Switch Lite.
The accessory, called “Large Mirror”, enlarges the Nintendo Switch or Nintendo Switch Lite’s screen.
The company claims the screen size could be magnified by up to 3 times.
The accessory includes a mechanical arm that is attachable to the system itself.
Check out the pictures below:


The agency said on March 5 that the Remote Robotic Oxidizer Transfer Test was held in conjunction with the Robotic Refueling Mission on the International Space Station as NASA plans to hold a ground-based test using a mock satellite client and a robotic servicer system.
“RROxiTT gives NASA, and the satellite community at large, confidence that advanced satellite refueling and maintenance technologies aren’t a wild dream of the future,” said Frank Cepollina, associate director of the satellite servicing capabilities office at NASA’s Goddard Space Flight Center.
The nine-day test focused on the more than 400 satellites in geosynchronous Earth orbit and NASA’s team transferred the oxidizer propellant to the mock satellite tank with technologies such as a propellant transfer system.
A roboticist at Goddard in Maryland remotely-operated an industrial robot based at the Kennedy Space Center in Cape Canaveral, Fla.
NASA says the SSCO has been exploring human and robotic satellite servicing tools and is working to develop technologies for on-orbit spacecraft inspection, component replacement and other activities.
SSCO intends to extend satellites’ functional life, prepare for operational challenges and build up the commercial satellite-servicing market.
The agency wants the technology to eventually be applicable for pre-launch servicing and extend to transferring xenon propellant.
SSCO is preparing for future demonstrations of other satellite servicing tools and testing of new technologies.


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Nigeria vs Libya Live Stream
Upcoming, footy fans can watch Nigeria and Libya live on the internet on 13-10-2018!
Our stream channels can be watched via a mobile or tablet with the html5 and flash feeds.
Around 10 minutes ahead of ko, our team will list the working battle feeds from CAF Africa.
All links are official and feature video streaming and live english radio commentary streaming to listen online.
Today's Nigeria versus Libya national football team contest comes from Confederation of African Football and is listed for 13-10-2018 in Africa. Channels from the internet are down below.
* Regional restrictions
CAF Africa Live » Nigeria v Libya - October 13, 2018


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Finding one surefire approach to dating for people with disabilities is as difficult as nailing down one definition for disability. Dating can be awkward and challenging, if sometimes exciting, for anyone at any age. It can also be thoroughly uncomfortable for young adults to talk to their parents about dating — disability or not. Parents of teens and young adults with disabilities do, however, have a role to play in preparing them to enter the world of dating and relationships. Parents can start by learning about the barriers teens and young adults with disabilities encounter as they seek out romantic relationships. Dating challenges vary by age and disability.
Love Without Barriers
What initially started as an app on all things lifestyle has quickly become a go-to resource for mothers who have children with special needs. Created for women who have at least one atypical kid, the app gives moms who have kids with special needs — including diagnoses from autism to Down syndrome to even giftedness — a place to socialize, engage in mentorships, and even seek out specialists nearby.
I felt like there was nothing out there in the world that felt inclusive and also helpful. After doing more research, Carissa and Gena discovered that what mothers with kids with special needs desire the most is a support system. Parents don’t understand, friends don’t understand, they don’t know how to express themselves, and that topic kept coming up over and over and over again. For mothers like Gena who have two children on the spectrum, having a way to connect with other parents who have similar experiences can be life-changing.
Single parent dating sites can be there for people when they need a you need to find that special person — without charging you anything!
In , two Connecticut moms launched wolfandfriends. Gena Mann says she felt that same sense of isolation years ago when she learned her two sons, now 15 and 16, were on the spectrum. So when her friend Carissa Tozzi reached out with the idea of creating an online community for parents of children with special needs, Mann was completely on board. In , the two Connecticut-based moms launched wolfandfriends.
Alarmed, she began searching through therapy sites, looking for toys to help, but was disappointed in what she found. Drawing on their background in fashion and publishing the two had met while working at CosmoGirl , Tozzi and Mann, 45, dreamed up an online space that would provide a stylishly presented list of products curated with input from experts in the field geared toward kids with special needs — things like adaptive clothing, sensory regulation toys and books to combat anxiety.
But quickly, the two moms saw that these parents needed more than a shopping list. From their Pinterest-worthy visuals to branded clothing boasting motivational messages e. We never would want to prey on this community of moms. View Series. FB Tweet ellipsis More. Image zoom. Get push notifications with news, features and more.
Helping a Young Adult with Special Needs Develop Dating Skills
Abilities ambassadors hale from all corners of the disability community. They are leaders, writers, artists, entrepreneurs, veterans, athletes, celebrities, advocates and parents to special needs kids, and they may have just the answers you are looking for. If you have a story to tell to the disability community, then we want to hear it! It could be an informative article on the range of subjects featured to the left.
Free dating websites for young adults matchups for friendship Unlike most fun, people. However, tinder and physical disabilities. At more obstacles than any other dating services for special needs the needs adults fighting stigma. Why not check out of the message boards. Traditional dating websites Read Full Report provide more obstacles than any other.
However, is the same as anybody else, adults also. From special bridge will benefit adults with learning disabilities, private dating sites, and a need for adults with unique abilities! People with special needs dating site since Through a middle-aged woman looking women get involved.
When you’re the parent of a child with special needs , every aspect of parenting is magnified. Playdates become complex projects requiring diplomacy, support, and vast quantities of time and patience. Trips to the doctor are frequent, expensive, difficult, and fraught with worry. Ordinary shopping excursions are strewn with potential disasters and pitfalls.
This class, developed by special needs parents Donna Maheady and Vicki Silver, will show other families and supporters how playing music can teach.
Young adults with brain injury, autism spectrum disorder ASD , and other developmental disabilities have social needs and experience sexual feelings just like everyone else. When they see their siblings or typically developing peers beginning to date, they may express an interest in dating too, if they have the necessary communication skills. However, they may be uncertain or fearful about how to interact with someone they are attracted to. The following are tips for parents or caregivers who want to help the young men and women they care for learn about dating, healthy relationships, and appropriate sexual behavior.
Have the conversation Start early — before puberty — to talk to young people with special needs about their bodies and how they are or will be changing. Use words they will understand and teach them the proper terminology for body parts. Encourage them to ask questions, and listen to their concerns. Reassure them that it is normal to have sexual thoughts and feelings. Does your library have videos you can check out? What has worked well for other parents who have children with special needs?
Would your child feel more comfortable talking to another family member or close family friend? Build self-esteem, encourage boundary setting Help your child feel good about herself and deserving of respect. People with high self-esteem are much less likely to engage in risky behavior or to put up with abuse from other people.
Can a Single Parent of a Special Needs Child Find Love, too?
The first time someone told me my son has special needs, I smiled proudly. Yes, I remember thinking, he is…. Yes, I remember thinking, he is special: Look at that gorgeous smile—whoa! Special needs? Miss P. I was already aware that my three-year-old was not like the other kids in his class, but I thought of him as unique, a character.
On the flip side, if you are the parent of a child with special needs and you’ve just started dating someone new, be ready to answer questions and share resources.
Since , Support for Families of Children with Disabilities has offered information, education, and parent-to-parent support free of charge to families of children with any kind of disability or special healthcare need and to the professionals who work with them in San Francisco. Everyone is Welcome at Support for Families!
All orders benefit Support for Families of Children with Disabilities. Message to Our Community. The health, safety, and well-being of our community is important to us. No racial, ethnic or cultural group is more at risk. Having said that, our population is vulnerable and we want to be thoughtful as we move forward. We are canceling all in-person activities until further notice:.
Email: info supportforfamilies.
5 Tips to Finding a New Love When You Have Children with Autism
Department of Education. The purpose of this guidance is to assist educators, parents, and state and local educational agencies in implementing the requirements of Part B of the Individuals with Disabilities Education Act IDEA regarding Individualized Education Programs IEPs for children with disabilities, including preschool-aged children. Department of Education July This guide was developed by the U. Heumann, Kenneth Warlick, and Curtis Richards.
Guide · Past Best of the Best Winners · Pregnancy & Baby · Professional Services Directory · Senior Services · Special Needs Now imagine being a single parent on a date. Mott, on the other hand, has officially sworn off of online dating sites. Equally important is helping children understand the needs of the parent.
We have our favorites, and so do you — favorite place to go for a haircut, favorite grocery store, place to shop and even favorite vacation destination. Read More…. Personality clashes are a part of life, and they are not always limited to peer relationships. You think your child’s on track to start kindergarten, but some of your friends are choosing to hold their kids back a year. Now you’re wondering if that might be a smart move for your child, too. It’s difficult to know, and opinions vary.
Youth sports offer a host of emotional and physical benefits, from helping kids stay active to building self-esteem and learning to work with others. Welcome to BirminghamParent.
What it’s really like to be the single mom of a special needs child
Eight ways to man the battle stations of matrimony when a challenging child almost blows it to smithereens. In a country where over 50 percent of couples are doomed to failed marriages, 36 percent of marriages face infidelity, and all of us go through times that are hard, we are up against it! With marriage being such a challenge, throwing kids into the mix is a recipe for disaster in most cases.
We are now in our eighth year of marriage, and it has been mostly happy.
Starting a romantic relationship can seem nearly impossible for many adults with special needs, but special needs dating websites help to.
While the numbers are not confirmed, experts agree that divorce rates among parents with special needs children is far higher than the general population. Kim Thompson, a single mom of two boys, ages 7 and 13, ages who lives in New York City, has struggled with her son’s autism and other diagnoses first as a married mother, and now as a single, divorced mom.
Because of her younger son’s special needs, she has put her career on hold and cares for him full-time at home. Also: Don’t trust google. Because there is so much negative messaging out there when it comes to unmarried moms and romance: Only losers and pedophiles want to date you. You must get married ASAP to be a good role model for your children. I adore him, and my kids adore him too.
We make it work. When you are in a relationship with someone, you accept all the things that come with them. My recommendation would be to put yourself out there in the dating world. And then get out there.
Find it Fast
Having a child start to date can easily be a challenge to both parents and child alike. When a child with cognitive and intellectual disabilities starts to date, it can come with its own set of difficulties. Here are some tips and conversations to help relieve some of the stress associated with this new and unfamiliar territory. Consent is arguably the most important conversation to have when it comes to relationships. You can have them practice telling you when certain touches or actions are comfortable or uncomfortable.
What You Should Say to a Special Needs Parent. After doing more research, Carissa It’s like a dating app in that respect.” ADVERTISEMENT.
Watching your adult child get ready to start dating is an emotional experience for any parent, but for parents of children with special needs, it can be much more stressful. This list of tips will help you get your child ready to use a special needs dating website and prepare him for that first big date or budding romance. One of the great reasons to use a special needs dating website, like Special Bridge, is that there is no stigma attached to revealing the nature of a developmental disability.
Since everyone on the site has similar issues, you and your child can focus on writing a profile that shows off a great personality. He can talk about favorite hobbies, books, or movies that help to show his personality. It should be in his words, not yours, but it is OK to help with difficult parts of the writing. Luckily, a special needs dating website like Special Bridge is designed to help your child find people with similar disabilities and life experiences.
While searching for a potential match, you can look for people with the same type of developmental disorders and ability levels to help improve the odds of finding a successful match.
20 Things for Parents of Kids with Special Needs
Unfortunately for special needs, and emotional needs parent is practical, as dating can even help parents can browse the forefront of teens and staying safe. Militarycupid is to comfortably get to sign up for adults. Let us your thoughts. One of my experience with special needs – join elitesingles for many are raising children with special needs equipment for an adult child’s single parents. Division for love. I’m the best jewish dating app glimmer wants to hide your comfort zone in a dream.
Dare to Date: A Discussion with a Single Special Needs Parent primary way of meeting men has been from several online dating websites.
Dating and friendships just got a whole lot easier and fun for adults with unique abilities! Let us help you discover your brand new social world in a safe and private atmosphere. This site is family owned and operated and was created for people with special needs and disabled adults who are interested in dating, companionship or just looking for friendship. When creating a profile, be honest and genuine. Make sure to add details that uniquely describe you and your personality. This will help others to get to know you so you can connect and grow a special needs friendship or special needs dating relationship.
Start your search for your brand new friends or romance!

domain: psychology


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A meditation app that touches your soul…
Meditopia is the main app that lets you get calm, scale back stress, sleep properly, love, discover peace and begin a deep discovery inside your self. You’ll be able to create an area for your self in life and uncover the happiness inside.
You’ll be able to take heed to 250+ meditation classes with high quality audio in each English and Spanish.
You’ll be able to be taught to meditate, pay attention music to loosen up with nature sounds, use the timer to meditate and give attention to totally different matters with specialised packages.
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domain: hobby


Qualcomm announced its latest high-end processors. The Snapdragon 8 Plus Gen 1 is faster than its predecessor and consumes much less power. In addition to the high-end chipset, the manufacturer also announced a new mid-range Snapdragon 7 Gen 1 processor.
Qualcomm has announced the successor to the Snapdragon 8 Gen 1, found in the Xiaomi 12 and OnePlus 10 Pro, among others. The Snapdragon 8 Plus Gen 1 About 10 percent faster than its predecessor. In addition, chipsets consume 30 percent less power, so smartphones’ battery should last longer. Qualcomm claims that thanks to the new chipset, you can stream videos for 80 minutes longer or play games for an hour longer. You can even listen to music for 17 hours longer or make calls for 5.5 hours longer.
We will see the Snapdragon 8 Plus Gen 1 in the latest flagship smartphones later this year. For example, Samsung will use the processor in a file Galaxy Z Fold 4 And the Z Flip 4. It is expected that these foldable smartphones will be unveiled in August. Brands like Xiaomi and OnePlus will also use the Snapdragon 8 Plus Gen 1.
For mid-range smartphones, Qualcomm has the extension Snapdragon 7 first generation announced. This processor is the successor to the Snapdragon 778G Plus chip. The new processor is up to 20 percent faster and supports three 25-megapixel cameras or one 200-megapixel camera. Snapdragon 7 Gen 1 should be more power efficient than its predecessor. Xiaomi, Oppo and Honor have already indicated that they will use the Snapdragon 7 Gen 1.


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A gigantic Farmer’s Market-style salad with a variety of fresh seasonal produce and fresh herbs, such as fresh baby arugula and radicchio, and red wine vinegar sassed up with a little horseradish. Enjoy visiting your local Farmer’s Market every week and asking the vendors, “What’s new and tasty this week? What would make great ingredients for my salad?”
As a result of all your planning and preparation, all you have to do is toss your meals together when you’re ready to eat! Do you know what else I absolutely love about this 30-day weight loss meal plan? All of the recipes are completely delicious! Every single day is packed full of flavor and you get to enjoy foods like pizza and creamy sauces in addition to an optional snack and dessert each day.
I'm not telling you that it's easy, but it really is pretty simple. In an age where people don't even have to go outside to grill a steak, it's tempting to spend a few dollars on a quick fix. Human anatomy hasn't changed much throughout history, however. If you adopt your grandparents' work ethic and apply it to your every day life, you will achieve your greatest results.
“Under normal conditions, humans absorb only about 80% of the nutrients from the food they eat,” says A. Roberto Frisancho, Ph.D., a weight-loss researcher at the University of Michigan. But, he says, when the body is deprived of nourishment, it becomes a super-efficient machine, pulling what nutrients it can from whatever food is consumed. Start eating again normally and your body may not catch up; instead it will continue to store food as fat.
Instead of satisfying your sweet tooth with some refined sugar, turn to berries and enjoy a slimmer waistline in no time without exercise. Berries are loaded with antioxidants, which can help reduce inflammation throughout the body, and research from the University of Michigan reveals that rats given a cherry-rich diet shaved off a significant proportion of their belly fat when compared to a control group. Berries like strawberries, raspberries, blueberries, and blackberries are also loaded with resveratrol, an antioxidant pigment that has been linked to reductions in belly fat and a reduced risk of dementia, to boot.
This is another light and nourishing soup, full of vitamins and minerals. It’s just the perfect recipe to drive away your diet boredom, as it is spicy and can invigorate your taste buds in the best way possible. Carrots are also rich in beta-carotene, which is converted into vitamin A in the liver. Vitamin A is great for maintaining your vision. Bell peppers are full of beta-carotene, which lavishes you with antioxidant and anti-inflammatory benefits. The capsaicin in bell peppers also has a multitude of health benefits.
Charushila Biswas is a Senior Content Writer and an ISSA Certified Fitness Nutritionist. She is an alumni of VIT University, Vellore and has worked on transgenic wheat as a part of her Masters dissertation from NRCPB (IARI), New Delhi. After completing her Masters, she developed a passion for nutrition and fitness, which are closely related to human psychology. And that prompted her to author a review article in 2015. She has written over 200 articles on Fitness and Nutrition. In her leisure time, Charushila loves to cook and enjoys mobile photography.
So I’m thinking about doing this diet. My daily diet for several years has consisted of eating every 3 hours, no more than 200 calories per meal, and about 100 calories for snacks. I eat very little as it is and hesitant to this diet being a success. Please help with some positive feedback. If I lose 15 to 20 pounds, I will have reached my wit loss goal.
Ultimately, long-term weight loss requires some short-term behavior change and healthier habit formation. That's why we created our Good Housekeeping Nutritionist Approved Emblem, which exists to help turn smart food choices into healthier eating habits. All GHNA foods and drinks make it easier to find — and eat — good-for-you foods without additional time, effort, and cost. We target the lifestyle-related factors that make healthier eating hard, and find simple but creative solutions that actually work! Look for the emblem on labels wherever you shop for food.

domain: food


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Webinar on Role of Regulatory Authorities in Protection of Consumers
Consumer Assisto is going to organize a Webinar on Role of Regulatory Authorities in Protection of Consumers.
Date: 26th July, 2020 (5:00 P.M.)
About the Webinar:
To protect oneself from any illegal mishap, the first and last hope is the regulatory authorities. Authorities hold a very vital position in maintaining the law and order and to make sure that every problem of the person is resolved. They fight for the rights, protect people from any sort of malpractices and take decisions which are beneficial for all and long-lasting. This webinar aims to provide knowledge to all the attendees about the functions which are necessary for the regulatory authorities to follow and their role in protecting the consumers from such disturbing practices.
About the Speaker:
Mr. Bhagyodaya Mishra
Mr. Bhagyodaya Mishra is an advocate in Gujrat High Court & Supreme Court of India. Mr. Mishra is an enforcement Department Special Public Prosecutor, Government of India and Anti-Corruption Special Public Prosecutor, Government of Gujarat. He has appeared in number of landmark judgments and has been standing council in matters of RBI, ONGC, IRTC, BIS, Allahabad Bank, The National Small Industries Corporation Ltd., The Centre of Entrepreneurship Development, etc.
- No Registration Fees.
- Limited number of Seats available.
The last date for registration is 25th July, 2020
Ms. Harshita Agarwal

domain: law


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(Bloomberg) Oil fell to a two-week low as the International Energy Agency warned of a looming supply glut.Futures in New York ended the week 3% lower after four straight days of declines. Sentiment continues to be dominated by an International Energy Agency report highlighting the challenge facing OPEC and its allies in balancing the market as production surges from their competitors. U.S. crude production is set to grow 1.3 million barrels a day next year at current prices, IEA’s executive director Fatih Birol said at an event in Washington D.C. Friday.
Also fueling oversupply concerns, U.S. President Donald Trump was said to weigh easing sanctions on Iran, a move that RBC Capital Markets estimated could bring back around 700,000 barrels a day to the market. Meanwhile, the U.S. and China showed signs of rapprochement in their trade war and Saudi Arabia’s new energy minister downplayed oil-demand concerns, leaving any talk of deeper output cuts to OPEC’s next ministerial meeting in December.
“Lackluster investor positioning, potential thawing of the trade war and concerns of an Iran deal have clouded both investor appetite as well as the fundamental market outlook,” said Michael Tran, a commodity strategist at RBC Capital Markets. “Oil prices are caught in a cycle of trendless volatility.”
West Texas Intermediate crude for October delivery declined 24 cents, or 0.4%, to settle at $54.85 a barrel on the New York Mercantile Exchange.
Brent for November fell 16 cents to $60.22 a barrel on the ICE Futures Europe Exchange, and traded at a $5.42 premium to WTI for the same month. The contract declined 2% for the week.
Other oil-market news:
Gasoline futures rose 1 cent to settle at $1.5531/gallon
Oil exploration in the world’s biggest shale field shrank the most since the worst days of the 2014-2016 market crash, when crude teetered on the verge of a 12-year low and tens of thousands of roughnecks were cast out of work.
A fire on at a vessel at Equinor ASA’s Sture oil terminal in Norway has been put out.
Scott Sheffield, one of the earliest executives to recognize the Permian Basin’s potential, is scaling back his expectations for the world’s largest shale field.
The storm system that’s spent the last two days raining down on the Bahamas, slowing its recovery from Hurricane Dorian, is likely to track along or near Florida’s coast on the weekend, then veer out to sea.
EnergyNow is an online energy news and data media service dedicated to providing essential up to-date information on the United States energy industry.
We provide live feeds designed to help energy professionals, field personnel, business owners, and senior business leaders get the latest energy news and data, energy industry press releases and energy job and event listings.
Help us to improve EnergyNow, Give us your feedback


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In addition to Johnson, Clinton and Trump, only one other U.S. president has faced formal impeachment inquiries in the House of Representatives: Richard Nixon.
Andrew Johnson (in 1868) and Bill Clinton (in 1998) were the only two US presidents to be impeached. Neither one was convicted , so both finished their terms.
Preliminary steps had begun in the House to impeach Richard Nixon when he resigned as President in 1974.
I meant Us Presidents Sorry Answers Gliched Out
No US presidents have been impeached and convicted and so removed from office.
There have been TWO US Presidents that have been impeached- Andrew Johnson and William Clinton.
Clinton and Andrew Johnson.
Andrew Johnson and William Jefferson Clinton
Two US Presidents have been impeached, but neitherwas removed from office.Both Presidents Andrew Johnson and Bill Clinton were impeached by the US House of Representatives, but acquitted (found not guilty of the charges) at trial in the Senate.President Nixon was on the verge of being impeached, but chose to resign rather than face charges.
Andrew Johnson and Bill Clinton were the two presidents to be impeached. Neither was convicted.
The two presidents impeached were Andrew Johnson and Bill Clinton. ( If you are wondering, President Nixon resigned before he could be impeached.)
Only two US Presidents have been impeached: Andrew Johnson (1868) and Bill Clinton (1998). Both were acquitted at their Senate trials.
2 US presidents were impeached in our lifetime: Andrew Johnson and Bill Clinton. Neither was removed from office. Bummer because they both sucked. Richard Nixon was threatened with impeachment, but resigned before he was impeached. That's cheating!
Historically, only two presidents have been impeached. They were Andrew Johnson in 1868 and Bill Clinton in 1998. Richard Nixon would have been impeached in 1974 had he not resigned.
Technically no American president has been impeached and subsequently removed from office. Andrew Johnson was impeached, but acquitted. Richard Nixon resigned before his likely impeachment. Bill Clinton was impeached, but not removed from office. Presidents impeached: * Andrew Johnson: impeached by the House but acquitted by the Senate * William (Bill) Clinton: also impeached but acquitted. Therefore, there have been two impeached, none removed.
No. The only US presidents to have been impeached were Andrew Johnson and Bill Clinton; neither was convicted.
Two have been impeached; neither was removed from office.
Andrew Jackson and Bill Clinton. Richard Nixon faced certain impeachment, but resigned before he could be impeached. my answer is: Clinton was NOT impeached. the Senate voted NO
Andrew Johnson and Bill Clinton were impeached.
Andrew Johnson and Clinton.
no- other federal officers such as judges can be impeached.
Presidents Andrew Johnson and Bill Clinton were impeached and both were later acquitted. Richard Nixon almost got impeached but resigned before.
Andrew Johnson was the first of the two US presidents to be impeached, in 1868. The other was Bill Clinton. Neither one was convicted.
Two have been impeached, Andrew Johnson and Bill Clinton, but none have been convicted. Richard Nixon resigned before he could be impeached.
No Us President has been removed from office via the impeachment process. There have been two presidents who have been impeached. In 1868, Andrew Johnson was impeached by the House for violating certain statutes related to government processes; in 1998, Bill Clinton was impeached for perjury and obstruction of justice. However, neither of these presidents was convicted by the Senate, so neither of them was removed from office.
Two presidents have been impeached- Andrew Johnson and Bill Clinton. Neither was convicted.