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BEST TREATMENT PRACTICES FOR TRAUMA RECOVERY

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Title: BEST TREATMENT PRACTICES FOR TRAUMA RECOVERY


1
BEST TREATMENT PRACTICES FOR TRAUMA RECOVERY
2
TRAUMA DEFINED
  • A traumatic event involves a single experience,
    or an enduring, or repeated events, that
    completely overwhelm the individuals ability to
    cope or integrate ideas and emotions involved in
    that experience.
  • It involves a feeling of COMPLETE HELPESSNESS in
    the face of real or perceived threat to ones
    life, or that of a loved ones, to bodily
    integrity, or sanity.
  • There is frequently a violation of a persons
    familiar ideas about the world and their human
    rights, putting the person in an extreme state of
    confusion, and insecurity.
  • Reactions physiological and psychological.

3
POSSIBLE TRAUMATIC EXPERIENCES
  • Abuse Physical, Emotional, Verbal, Sexual,
    Neglect, Abandonment
  • Violence (murder, rape, robbed, physically
    attacked)
  • The threat of violence or sexual abuse, or
    witnessing violence
  • Catastrophic events (hurricanes, earthquakes,
    volcanic eruptions, war or other mass violence)
  • Car accidents, plane crashes, fires

4
POSSIBLE TRAUMATIC EXPERIENCES
  • Paramedics, fire fighters and rescue teams
    experiences
  • Long-term exposure to conditions like parents who
    are substance abusers, having a parent
    incarcerated, poverty or milder forms of abuse
    such as verbal abuse can be traumatic.
  • Medical Procedures, Being diagnosed with a life
    threatening illness
  • Being Kidnapped, Held hostage
  • Combat
  • Battering Relationships, Being Stalked, Bullied,
    Harassed

5
  • Its not the event that determines whether
    something is traumatic, but the individuals
    experience of the event

6
CHILDHOOD TRAUMA ABUSE
7
ABUSE STATISTICS
  • 1 out of 3 women will experience sexual abuse by
    the time they are 18 years old. (The Publics
    Health)
  • 1 out of 5-7 men will experience sexual abuse by
    the time they are 18 years old. (childhelp.org)
  • 90 of sexual abuse victims know their
    perpetrator and 68 are abused by family members.
    (National Center for Child Abuse)
  • 90 of cases go unreported and untreated, as the
    symptoms of CSA are often misdiagnosed and
    unappreciated. (The Publics Health 2009)
  • Over 3 million cases of child abuse are reported
    each year in US. Those reports can have multiple
    children in them. (NCAS)

8
PYCHOLOGICAL AFFECTS OF ABUSE
  • PTSD Depression
  • Anxiety/Panic Failure to thrive
  • Agoraphobia/Phobias Rage
  • Irritability Mood Disorders
  • Substance Abuse Eating Disorders
  • Personality Changes/ Disorders Suicidal and
    Homicidal Ideation
  • Dissociative Disorders Self-Injury/Cutting
  • Negative Self-concept Abusive Partners
  • Obsessive Compulsive Feelings of Powerlessness

9
RELATIONSHIP ISSUES
  • Trusts too easily or does not trust at all
  • Difficulty communicating
  • Does not set boundaries or sets too many
    boundaries
  • Wants to be rescued
  • Isolation and withdraw
  • Sexual problems/promiscuity
  • Fear of abandonment
  • Fear of Intimacy
  • May be abusive or choose abusive partners
  • People pleasing

10
ACADEMIC ISSUES
  • Inability to concentrate
  • Lower test scores
  • Comprehension problems
  • Memory deficits
  • Peer relational issues
  • Communication problems
  • Attendance issues
  • Teen Pregnancy

11
POST TRAUMATIC STRESS DISORDER
12
PTSD SYMPTOMS
  • Intrusive re-experiencing of the trauma
  • ? flashbacks, nightmares, triggers
  • 2) Hyper-arousal
  • ? Problems falling or staying asleep
  • ? Difficulty concentrating or
    completing tasks
  • ? Anger and irritability
  • ? Startle response
  • ? Hyper-vigilant
  • ? Panic attacks, shortness of breath or
    chest pain
  • 3) Avoidance of stimuli and numbing response
  • ? Making efforts to avoid thoughts,
    feelings, conversations, people, or places that
  • remind them of the trauma.
  • ? Restricted range of emotions/Numbing of
    emotions
  • ? Feeling detached from others
  • ? Dissociation
  • ? Substance Abuse
  • ? Loss of interest in activities they
    used to enjoy

13
DISSOCIATION
  • Detachment from immediate surroundings
  • Detachment from physical or emotional experience
  • It is a disconnect between material in the
    conscious mind and material in the unconscious
    mind.
  • Adaptive Survival Skill can become maladaptive
  • Can be done consciously or automatically
  • It can become pathological and interfere with
    daily functioning

14
PTSD SYMPTOMS
  • Survivors Guilt
  • Rage
  • Depression and Grief
  • Anxiety and Panic
  • Shame and Fear
  • Trust Issues
  • Loss of appetite
  • Sexual dysfunction
  • Poor coping skills
  • Feelings of hopelessness

15
RISK FACTORS
  • Previous traumatic experiences, especially in
    early life
  • Family history of PTSD or depression
  • Being Female
  • History of physical or sexual abuse
  • History of substance abuse
  • History of depression, anxiety, or another mental
    illness
  • High level of stress in everyday life
  • Lack of support after the trauma
  • Lack of coping skills
  • Mayo Clinic

16
PTSD TYPES
  • Acute
  • Less than 3 months
  • Chronic
  • Longer than 3 months
  • Delayed onset
  • 6 months later
  • Complex (Disorder of Extreme Stress)
  • Exposed to prolonged traumatic events, especially
    during childhood, such as childhood sexual
    abuse(severe and sustained)
  • Often have a personality disorder.
  • Long-term effect on adult functioning

17
DEVELOPMENTAL TRAUMA
  • ? Trauma that is stressful that occurs
    repeatedly and cumulatively over a period of
    time, within specific relationships and
    context(child abuse)
  • ? Domains of impairment
  • attachment
  • biology
  • affect (emotional) regulation
  • dissociation
  • behavioral control
  • cognitive processes
  • self-concept

18
DISSOCIATIVE DISORDERS
  • Marked by a dissociation from or interruption of
    a person's fundamental aspects of waking
    consciousness (such as one's personal identity,
    one's personal history, etc.)
  • Most dissociative disorders stem from trauma.
  • Coping mechanism the person literally
    dissociates himself from a situation or
    experience too traumatic to integrate with his
    conscious self.
  • Types
  • Dissociative Identity Disorder (Multiple
    Personality Disorder)
  • Dissociative Amnesia
  • Dissociative Fugue
  • Depersonalization Disorder
  • Dissociative Disorder NOS
  • Scales for this Dissociative Experience
    Scale(DES), SCID-D, SDQ-20

19
TRAUMA AND ATTACHMENT
  • Trauma that happens in childhood at the hands of
    a caregiver is doubly destructive because it
    destroys the attachment relationship that the
    child would normally need to depend on to manage
    the trauma of the abuse.
  • The resolution of attachment issues is a central
    component of trauma recovery

20
TYPES OF ATTACHMENT
  • Secure
  • Parent is aligned with the child and in tune with
    the childs emotions, trustworthy, and reliable.
  • Adult is able to create and maintain
    relationships
  • Ambivalent
  • Parent is inconsistent, unpredictable and
    sometimes intrusive parent communication
  • Adult is anxious and insecure, controlling,
    blaming, erratic, unpredictable, and sometimes
    charming
  • Avoidant
  • Parent is unavailable or rejecting, and punitive
  • Adult avoids closeness, or emotional connection,
    distant, superficial relationships, critical,
    rigid or intolerant
  • Reactive
  • Parent is extremely unattached or malfunctioning,
    and abusive
  • Adult cannot establish positive relationships,
    withdrawn, substance abuse
  • Disorganized
  • Parents ignored, or did not see the childs
    needs. Parental behavior was frightening or
    traumatizing. Often sexual, or physical abusive
  • Adult is chaotic, insensitive, explosive,
    abusive, untrusting, while craving security

21
SECURE ATTACHMENTS HELP US
  • Feel safe
  • Develop meaningful connection with others
  • Explore our world
  • Deal with stress
  • Balance emotion
  • Experience comfort and security
  • Make sense of our lives
  • Create positive memories expectations of
    relationships
  • Ability to rebound from disappointment,
    discouragement and misfortune

22
INSECURE ATTACHMENTS
  • Unavailable or avoidant
  • Self-absorbed
  • Insecure
  • Disorganized
  • Aggressive
  • Angry
  • Distrusting of others
  • Lack of empathy
  • Clinginess
  • Trouble learning/Developmental delays
  • Lack of Self-control
  • Obsession with food

23
ADVERSE CHILDHOOD EXPERIENCE STUDYBY KAISER
PERMENENTE
  • 1995-1997 17,000 middle class insured individuals
    in the primary care setting
  • Confidential Survey for the incidence of
  • Abuse
  • Sexual, physical, verbal abuse
  • Neglect
  • Emotional neglect, physical neglect
  • Household Dysfunction
  • Household substance abuse
  • Parental separation and divorce
  • Incarcerated household member
  • Household member with a mental illness
  • Mother treated violently

24
ADVERSE CHILDHOOD EVENTS(ACE STUDY) (Kaiser
Permanente)
People with 4 or more ACE were at greater risk
for serious health issues
25
ACE STUDY FINDINGS
  • Alcoholism and alcohol abuse Illicit Drug Use
  • Smoking Early Initiation of Smoking
  • Depression Suicide Attempts
  • COPD Ischemic heart disease (IHD)
  • Fetal death Health-related quality of life
  • Liver disease Obesity
  • Autoimmune Disease Increased risk for Cancer
  • Autobiographical Memory Disturbance Hallucinations
  • Risk for intimate partner violence Multiple
    sexual partners
  • Sexually transmitted diseases Unintended
    pregnancies
  • Early initiation of sexual activity Adolescent
    pregnancy

26
MEDICAL RISKS(The Publics Health 2009)
  • Obesity Hypertension
  • Headaches Stomach Problems
  • Lowered Immune System Chronic Fatigue
  • MS, Lupus, Fibromyalgia Early hysterectomies
  • Gynecological issues Diabetes
  • Heart disease Substance Abuse
  • Sexual Disorders STDs
  • Somatic complaints and Body aches MS, Lupus
  • Fibromyalgia Autoimmune Disorders
  • Increased Risk of Cancer Premature Death

27
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28
HOW TRAUMA IMPACTS THE BRAIN
29
EMOTIONAL NERVOUS SYSTEM
  • TWO PARTS OF NERVOUS SYSTEM

Limbic System
Autonomic Nervous System
30
  • Limbic System
  • Primary responsible for our emotional life
  • Helps with formation of memories
  • Arousal and hyper-arousal
  • Fight, Flight, or Freeze
  • It plays a central role in memory processing

31
  • Amygdala
  • Fear center or alarm system/Fight or flight
  • Stores highly charged emotional memories
  • After trauma can overreact(hyper-responsivity)
  • To remember a threat, generalize it to other
    possible threats and carry it out to the future.
    Imprints it
  • Explicit or unconscious memory
  • Hippocampus
  • Plays a role in organizing memories. Explicit or
    Conscious Memory
  • Interacts with the amygdala during the encoding
    of emotional memories.
  • Encoding of context during fear conditioning
  • Stores memory of time and space puts our
    memories into their proper perspective and place
    in our life's time line.
  • After trauma can shrink in size and diminish in
    functioning
  • Gets damaged in child abuse/ high stress (gaps in
    memory_

32
LIMBIC SYSTEM
33
AUTONOMIC NERVOUS SYSTEM 1)PARASYMPATHETIC
2)SYMPATHETIC
RESTRICTED
ACTIVATED
34
  • Medial Prefrontal Cortex
  • Moral center, planning complex cognitive
    behaviors, personality expression, decision
    making, moderating correct social
    behavior-delaying gratification
  • Appears to be volumetrically smaller and is
    hypo-responsive(under) during symptomatic states
  • Corpus Coliseum
  • Facilitates communication between the 2
    hemispheres.
  • During trauma decreased blood flow and
    communication between hemispheres.

35
WHEN TRAUMA OCCURS
  • The brains main function is to get though the
    event.
  • The brain helps us survive by activating
    biological reactions involved in helping us mount
    that fight or flight response.
  • The sympathetic nervous system releases
    adrenaline, increases heart rate, pupils dilated,
    accelerated pulse which readies you to move in
    the fight or flight decision.
  • The brain actually lowers the chemicals released
    to help us with regular functions which means
    your parasympathetic nervous system energy is
    diverted to help you cope with what you need to
    do to survive.
  • Hormones are released to reign in the stress
    response to stop long-term damage to your body.

36
  • During the first 4 years of life 90 of a childs
    brain develops through the experiences of that
    child.
  • The mind and the emotional content of the brain
    are created in the first few years of life
    through the attachment bond between the infant
    and the mother
  • Bruce Perry published a huge number of studies
    showing abnormal brain development following
    neglect and abuse of children including
    significantly smaller brains, decreased activity
    in their prefrontal cortex(the moral center/the
    restraint center/the maturity center.)
  • Depressed and angry mothers regularly produce
    insecurely attached infants who grow up be
    violent adults.
  • The Bomb in the Brain (Freedomain Radio)

37
  • Abusive mothers who are depressed or angry the
    cortisol levels of both elevated in the mother
    and the child. If you are depressed or angry
    your cortisol levels are higher in both you and
    your child. The mother and the child are a system
    particularly for the 1st few years of life
  • Their hippocampus shrinks and they can have
    memory issues
  • The amygdala of insecurely attached children is
    larger and they have a greater surging of fight
    or flight, adrenaline and cortisol.
  • Their prefrontal cortexes are smaller so they are
    less able to control their fears and other
    irrational emotional reactions in interpersonal
    relationships.
  • Physical problem in the brain-fight and flight is
    strong and restraint is weak.
  • The Bomb in the Brain (Freedomain Radio)

38
  • Ainesworth 100 studies over past two decades have
    shown that violence is the result of insecure
    early disorganized attachment
  • Violence and Crime-Bessel Vander Colk concludes
    people with childhood, abuse and neglect make up
    almost the entire criminal justice population in
    the United States. Suffered severe abuse.
  • Poorly integrated cerebral hemispheres- this poor
    integration and underdevelopment of the orbital
    frontal cortex is the basis for such symptoms as
    difficulty regulating emotions, and lack of cause
    and effect thinking
  • The Bomb in the Brain (Freedomain Radio)

39
TRAUMA AND SUBSTANCE ABUSE
40
THE WAY WE USED TO LOOK AT SUBSTANCE ABUSE AND
TRAUMA
  • MENTAL ILLNESS

SUBSTANCE ABUSE
TRAUMA
41
THE RELATIONSHIP BETWEEN TRAUMA SUBSTANCE ABUSE
  • TRAUMA

SUBSTANCE ABUSE
42
THE RELATIONSHIP BETWEEN TRAUMA SUBSTANCE ABUSE
  • Those who have been traumatized are at risk for
    substance abuse and those who use substances are
    at risk for experiencing trauma.
  • 90 of women who are addicted to alcohol were
    physically or sexually abused as children
    (National Trauma Consortium)
  • Victims of trauma are 4-to-5 times more
    vulnerable and therefore likely to experience
    alcohol or substance abuse than the general
    public.
  • 82 of adolescents in residential or inpatient
    programs have been a victim of sexual or physical
    abuse.

43
THE RELATIONSHIP BETWEEN TRAUMA SUBSTANCE ABUSE
  • Escape
  • Numbing
  • Control
  • Distraction
  • Self-destructive
  • Feel powerful
  • Diminish shame and guilt
  • Protection
  • Acceptance
  • Increase or decrease hyper-vigilance/anxiety

44
BEST TREATMENT PRACTICES
  • Psycho-education(normalization of symptoms)
  • About Effects of Trauma, PTSD
  • 2) Regulation
  • Trigger Recognition
  • Grounding,
  • Containment Distancing
  • Guided Imagery/Calm Place
  • Breathing
  • Meditation
  • Yoga
  • Mindfulness
  • Journaling
  • Music
  • Developing a Support System

45
  • 3) Processing the Trauma
  • ? Trauma Focused Cognitive Behavior Therapy
    (TF-CBT by J.A Kohen)
  • ? Somatic Experiencing/Body Psychotherapy(SE
    , Peter Levine, Pat Odgen)
  • ? Acceptance and Commitment Therapy(ACT by
    Steve Hayes, Kelly Wilson)
  • ? Eye Movement Desensitization and
    Reprocessing(EMDR, Francine Shapiro)
  • ? Emotional Freedom Technique(EFT, Gary Craig,
    Nick Ortner)

46
EYE MOVEMENT DESENSITIZATION AND REPROCESSING
  • Created by Francine Shapiro in 1987.
  • Bilateral stimulation through eye movements
  • Natural way brain processes information and heals
    self(REM Sleep)
  • Treats PTSD and a wide range of mental health
    issues.
  • Trauma overloads the brains natural coping
    mechanism.
  • Unprocessed memories and feelings are stored in
    limbic system of your brain in a raw and
    emotional form, rather than in a verbal story
    mode. These memories can be continually triggered
    when a person experiences event similar to past
    traumatic events.
  • EMDR helps create connections between memories,
    enabling the brain to process the traumatic
    memory in a very natural way.

47
TREATING TRAUMATIC MEMORIES
  • Normal Event

PROCESSING
MEMORY STORED
NORMAL EVENT
48
PROCESSING TRAUMATIC EXPERIENES

Distress (No Processing)
Traumatic Event
49
PROCESSING TRAUMATIC EXPERIENES

Exposure/EMDR
Traumatic Event
Grading
Memories/Less Distress
50
EMDR PROCESS
  • Sudden Units of Distress(0-10)
  • Emotions Experienced
  • Negative Belief About Self
  • Validity of Cognition/Positive Belief(0-7)
  • Body Scan
  • Future Templates

51
POST TRAUMATIC GROWTH
  • It is the positive change experienced as a result
    of the struggle with a major life crisis or a
    traumatic event
  • New opportunities have emerged from the struggle,
    opening up possibilities that were not present
    before
  • Change in relationships with others including
    increased compassion or connectedness
  • Change in an increased sense of ones own
    strength
  • Greater appreciation for life
  • Deeping of Spirituality or Change in Beliefs
  • It can also increase their resiliency to
    subsequent adversity
  • Dr. Richard Tedeschi

52
REFERENCES
  • Books
  • Opening Up the Healing Expressing of Emotions by
    J. Pennebaker
  • Outgrowing the Pain by Elaina Gill
  • Trauma and Addiction by Tian Dayton, Ph.D.
  • Trauma Recovery by Judith Herman
  • Diagnostic Statistical Manual of Mental Disorders
  • Eye Movement Desensitization and Reprocessing
    Basic Principles, Protocols, and Procedures by
    Francine Shapiro
  • EMDR The Breakthrough Therapy by Francine
    Shapiro, PHD
  • Trauma Model Colin Ross
  • The Developing Mind Daniel Seigal
  • Waking the Tiger Peter Levine
  • Trust After Trauma Matskis
  • Articles
  • Crandall, Mark (2007) Post Traumatic Stress
    Disorder What Happens to the Brain.
  • Website
  • http//acestudy.org/
  • Presentations

53
  • Websites
  • Darkness to Light(d2l.org) 
  • National Institute of Mental Illness (nih.gov) 
  • ISSDT (isst-d.org)
  • National Child Abuse Statistics (childhelp.org)
  • Sidran.org
  • National Alliance on Mental Illness (nami.org)
  • Giftfromwithin.org
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