Trauma Final Owens

Trauma

• emo response to a terrible event like an accident, rape, or natural disaster

• subjective

• cause intense physical/psychological stress response or distress

  • “T” : news trauma like war and terrorism

  • "t” : everything else; bullying

• exposed to act or threatened death, serious injury, or sexual violation

• Type I versus Typer II

  • One: single vent like flood, fire, hurricane

  • Two: cummalitive, multiple times, like abuse

• symptoms

  • anx, dep, self-injury —> most common

  • often cope mechanism —> what we do for better qual of life

Crisis:

• event exceeds someone's ability to cope

• 4 domains

  • situational

  • evi

  • developmental

  • existential

• Stages of crisis

  • Pre-crisis: prep

    • before event/warning

    • Goal: prep and vigilance; mobilization for intervention

  • Impact: crisis occurs (hours to days)

    • survival is goal FFF and communicate

    • interventionist goal: aid in comm

  • Rescue: assess impact of crisis and unity

    • typical week long; cohesion in community

    • Goal: out of crisis and adjust to recovery

    • interventionist goal: assess need and provide

  • Recovery: plan for future

    • assess damage and plan; last several weeks

    • mental health concerns arise

    • interventionist goal: ID those difficult in processing and faulty narrative; active listening

  • Return to life: “new normal”

    • normal is subjective and rarely occurs post-crisis

      • months to years; stages of grief

    • Goal: reintegrate into life and define new normal

      • anniversary reactions: like 9/11 day of silence

    • devel mental dx: PTSD, GAD, dep, anx

    • intervention goal: alleviate symptoms and increase functioning

  • Reconstruction: “new and improved”

    • crisis is done and community move on to new norm

      • come to terms w events psycho and emo

      • may exper setbacks

    • emo funct and PTG

Trauma-informed care

• realize impact and understand potential for recovery

• recog signs and symptoms in people within the system

• respond by integrating knowledge about trauma into policy, procedures, etc

• actively prevent pretruama pretrauma

SAMHSA TIC Principles (6 Principles)

1. safety

2. trust and transparency

3. peer support

4. collaboration and mutuality

5. empower, voice, and choice

6. cult, history, and gender issues

Historical Trauma/Generational

• multigenerational experience by specific culture, racial, or ethnic group

  • rela major events of oppression of particular groups

  • important for cultural competency

  • EX SLAVERY

Toxic Stress

• Prolonged or chronic stress can cause significant problems with health and development

  • health probs

  • self-regulation

Brain function in trauma

• limbic system highly activated: hippo and amygdala —> FFF

• trauma impacted how info stored in cortex —> stored incorrect; trouble thinking rational

• hippocamp: “librarian”; tags mems w info, time, and store into STM

• Memories

  • implicit:

    • background, sensory and procedural memory

    • Left: lang

    • trauma stored here —> overwhlemed with emo/sensory info

  • Explicit:

    • declarative/narrative; foreground

    • right —> connect to events

• executive functioning

  • PF cortext; 25 years

    • foundation for live and long living; solve and plan

    • build essential life skills —> mem and self- reg, impulse control

Trauma Process

1. Trauma occurs —> often sensory

2. physical reaction to trigger the nervous system (FFF) —> sweat, increase HR

3. body and mind are stuck and process through filter —> widen tolerance and emo reg

4. before trauma vs after trauma

Crisis cycle

GOAL: be more adaptive to triggers and identify them

1. event (devel, envi, sit, ext)

2. subjective exper —> cog process

3. failure to cope: protective factors defend from risks

Post Truamatic Growth

• Tedeschi and Calhoun

  • individ can survive traumatic events but can use it to grow sense of self, new possibilities, relationships, spiritual, and appreciation of life (flip for neg POV)

• salutogensis

• growth occurs absed on new cog schemas

• growth varries dep on sit

• Flow of PTG

  • Major life crisis that shatters sense of self

  • prev cope strategies/beliefs challenged and negatively responds

  • cog reprocessing ID new strat that more pos and increase soc support

  • new schema developed and replace what was lost/damages

• Inventory

  • 2 items 5 categories

    • spirit, appre of life, new possible, rela to others, personal strength

    • deter abil cope post exper and reconstruct POV of self/others

Salutogenisis

• sources of health and repsond neg/pos in a sit —> hollistic WB

• sense of coherence

  • comprehend: stim of ext/int envi w life

  • manageable: resources available ot meet stim

  • meaningful: demanding chall and worthy of investment and engagement

• Solu Focus Tech

conceptualization

• personal constructs and behaviors

  • affect, cog, beh, bio, genes

• evi

  • realationships, culture, fam norms

• Time

  • past, pres, and future influences

treatment of trauma

• diagnosis DSM: trauma and stress related disorder

  • reactive disorder; acute stress disorder

  • PTSD; prolong grief disorder

  • adjust disorder

DSM vs ICD-II with trauma

• DSM

  • used to meet mental health dx

• ICD-II

  • used globally medically

  • reg PTSD versus Complex PTSD

• common disorders/dx

  • dep/anx

  • sub related dis

  • disso/sleep disorders

  • personality disorders

Personality disorders

Not identified before 18 years

• Cluster A

  • Paranoid, schizoid, schizotypal

• Cluster B:

  • Antisocial, borderline, histrionic, narcissistic

• Cluster C

  • avoid, dependant, obsessive-compulsive

PTSD Dx

• reexper a traumatic event that exposed to death or threatened death, serious injury, or sexual violence

  • EX: war, rape, SA, evi disaster

• occur by experience or witnessing or learned about event

• criteria

  • not diagnosed before one month

  • 8 dimensions

  • greatest factor is soc support

Acute Stress Disorder Dx

• sim to PTSD but symptoms 3 days to month

• post event and diagnosed beofre PTSD

Reactive attachment Disorder Dx

• childhood disorder: failure to have secure attachment during infancy or childhood

  • result of abuse, neglect, or change in caregivers

• criteria

  • 9 months to 5 years

  • inabil emo bond w caring adults

  • emo withdrawl, lil emo response, not comfortable

Disinhibited Soc Engagement Dx

• experince neglect or abuse and overly friendly w adults

  • no stranger danger

• criteria

  • over verb/phsyical beh, no check in w adults

  • 9 months

Adjustment Dx

• event causes significant distress; most common diagnosis

• criteria

  • dysmorphic mood/anx, criminal act, school probs

  • 3 months of stressors; no longer 6 months

  • common dx for insurance purposes

Anx and dep Disorders Dx

• Both are failure to cope

• ANX: GAD, phobias, soc anx, panic

• Dep: mostly major dep dis

  • serveroty of dep depends on childhood attach

Substance Related Disorders Dx

• ineffective cop w drugs and alc

• experiences increased drug/alcohol use if not able cope properly

Personality Disorders Dx

• 10 specific dis common w crisis/trauma

  • BPD, Anti soc, OC Personal Disorders

• Struggle to dx and treat

• criteria

  • symptoms early in life can increase significantly

  • beh and mood unpredictable

  • seek supervision often

Somatic symptoms and related Dx

• physical symptoms caused by psychological trauma with no medical explanation

Prolonged exposure therapy

• starts small than increases OT

• emo process theory: fear is a memory asso with a stimulus and its response

• 8-15 sessions

• 2 types

  • vivo: live in person

  • imaginary: memory relived in present

Cog Process Theory

• modify maladaptive thoughts and behaviors

  • dissorted to make sense of event

  • “always my fault”

• 12 weeks and challenging distortions

• psychoed impact statement: write how event impacted me

Trauma focused CBT

• caregiver typically; child and adol focused

• 3 phases

  • safety and stable: psyhcoed about trauma and taught cope skills

    • rela between thought emo and beh

  • trauma and narration Processing

    • create narra abt truama

    • 3 goals: overcome avoidance, ID disort, conceptualize child exper into larger framework of whole life —> not a victim

  • treatment

    • chall irrational thoughts and personal empowerment

    • personal safety and assertive; write own story

• cog v beh

• core belifs: “I am ______” —> typ negative

EDMR

• shaprio; Og PTSD treatment in 1987

• use adapt info processing framework

  • process new experiences by connecting w related emos and info into existing mems

  • target unproc mems and reintroduce to decrease symptoms

• 2x week 6-12 sessions

• goals: process info and reassimilate abil reprocess event/exper and assign meaning

• 8 phases —> see notes

Clinical Emo Freedom Technique (EFT) aka tapping

• 1990s; combo cog and exposure techniques

• 5-10 sessions

• 5 steps

  • ID prob

  • rate level of distress

  • set up statement

  • tap seq

  • rerate stress

• form of acupuncture to ID pressure points

Psychopharma

treatment w meds; limited long term effects

Dialectical Behavior Therapy

• specific to BPD

• multiple solutions to one prob

• thera always availible

• assumptions

  • cant fail

  • 2 things true at same time

  • available

  • accept present and past for good of future

  • truth is subjective

• accept and change skills

  • distress tol and mindfulness

  • emo reg and interper effect

Cul considerations in Assessment

4 Qs counselor ask for understanding

1. traumatic event and understand from other significant stressors

2. immediate short/long term response: cog, somatic, affect, spirit, interper

3. diff responses with best/worst case scenarios from symptoms

4. treatment options and effectiveness: local resources, meds, healing pract

Truage assessment form

assess the crisis and immediacy of need

• abil control reaction, intensity of reaction, and stability of reactions

• ID severity of crisis and magnitude

• threat self and other

Self Harm (NSSH) SEE ASSESSMENT IN NOTES CHAP 4

• cutting, burns, hitting etc —> negative cope strategy directed at skin

• Increase OT and severity increases as well

• typ 13-15 years —> onset of puberty bc lack of support

• considerations

  • intense feels —> anger

  • escape; typically the popular kid

  • peer disclousre lead to discovery

  • ID where and how much damage —> patterns?

• treatment

  • CBT/ beh theory

suicide SEE ASSESSMENT IN NOTES CHAP 4

• stats

  • 25 attmpts to 1 completion; ¼ cli; 51% firearms; 93% of school couns impacted

• assessment includes

  • info rela risk factors, protect factors, and warn signs

  • ID ideation, plan, beh, disire and intent

  • clinical formulation of risk based on data and intervention plan

• protective factors

  • abil cop and soc support decrease attempt

  • ex: clin care for ment health, sub disorders

• risk factors

  • increase risk of suicide; int and ext fatcors; ment/sub probs

  • assist prob solving skills and increase abil cope

  • need thera alliance and ID sit factors

• codes

  • 201 —> vol hospital check in and can check out

  • 302 —> invol hosp check in; legal standard is threat to self/others; 72 hours

  • 303-305 —> post 302; go to court post 72 hours to stay versus leave

• Biopsychosocial vs. Environmental vs. Sociocultural

  • B: ment disorders, alc/sub, history of trauma, hopelessness

  • E: job/$ loss, easy access lethal means (guns), local clusters of sucide

  • S: no soc support, stigma w help, barriers in health care

• warning signs

  • diff dep on age

  • General:

    • talk/write about death ; “I wish I was dead” ; hygenie neglect

  • Elderly:

    • stockpile meds, give $/things away, withdrawal, no daily routine

  • Adol/Preteens

    • mood swings, unexplained injuries/bruises, self-mutilation, gender ID issues

• interventions

  • 3 I’s (inespace, intolerable, and interminable)

  • immed safety, ID target and risk factors and develop coping skills

    • develop safety plan

    • initial safety in short term (resources)

  • CBT, DBT, SFT

    • no perfect fit

  • GOALS:

    • confront beh/resolu of emos

    • develop problem solve/rational thinking

    • engage in pos ID

Homicide

• static factors

  • history of violence, impulse, male gender, military weapon use

• dynamic factors

  • delusions, hallu, no treatment, impulsive, depression, feasible plan

• instruments

  • short term: asses risk and treatability (START)

• Interventions

  • violence cant be treated

  • chall/ ID disorted thinking

  • work on impulse ocntorl, anger, and emo inabil

  • ETHICS

History of crisis intervention

• typ volunteer basis and respond to specific needs

  • OT developed into groups w policy

• Crisis int and counseling

  • CACREP standards

• Crisis standards

  • impact trauma and crisis on invid

  • Violence prevents higher edu

  • SC role and response to school emergency plans

STOPPED B4 CHAP 3