Trauma Crisis and Prevention Final Study Guide

Trauma Crisis and Prevention Final Study Guide

What is trauma?

Trauma is an emotional, psychological, and physiological response to an event or series of events that overwhelm an individual’s ability to cope

Definition of trauma and its limitations

Trauma is subjective and not defined solely by the event itself but by the individual’s experience of it.

Understand that something that will be traumatic for one person might not for another person.

How trauma impacts the brain

Trauma affects key brain regions: the amygdala (heightened fear response), hippocampus (impaired memory processing), and prefrontal cortex (reduced executive functioning).

Dysregulates stress responses and lead to hypervigilance of dissociation

Types of Trauma

Acute: single event

Chronic: repeated exposure to a SINGLE type of stressor

Complex: prolonged interpersonal trauma (EX: person goes through long term childhood abuse, sexual abuse, and living in a war zone)

Developmental: early-life trauma

Vicarious trauma

Symptoms of Trauma

emotional (anxiety, depression)

cognitive (difficulty concentrating, intrusive thoughts)

behavioral (avoidance, withdrawal)

physiological (hyperarousal, sleep disturbances).

Protective factors of trauma

Strong relationships

Coping skills

access to resources

Risk factors of trauma

Prior trauma

lack of support

systemic oppression

pre-existing mental health concerns

Resiliency

Resilience refers to the ability to recover from trauma

dignity and relationships are key to resilience

Post-traumatic growth

Increased meaning, strength, and connection after traumatic event

Increased appreciation for life, stronger relationships

Impact of trauma

Trauma impacts emotional regulation, cognition, physical health, and relationships

Counseling relationship and trauma

Have mutual trust, connection, empathy.

Conceptualizing crisis

A temporary state of psychological distress, results from an event that overwhelms someone’s regular coping skills.

Characterized by: emotional distress, confusion, impaired functioning

Crisis VS Trauma

Crisis: Immediate, time limited, requires stabilization (EX: job loss)

Trauma: Long term, changes view of world (EX: surviving war)

Risk Assessment

involves systematically evaluating the likelihood that a client may harm themselves or others. This includes examining suicidal or homicidal ideation, intent, plans, means, past behaviors, and protective factors

Needed to determine level of care.

Trauma-informed care

Recognizes widespread impact of trauma and integrates into practice

Emphasizes: safety, trust, peer support, collaboration, empowerment, cultural sensitivity

Avoids retraumatization

PTSD Criteria

4 Clusters

Intrusion

Avoidance

Negative alterations in Cognition and Mood

Negative alterations in Arousal and Activity

EMDR

Eye Movement Desensitization and Reprocessing

Process traumatic memories through bilateral stimulation such as guided eye movements

Mindfulness

Being aware of the present moment with a nonjudgmental stance

Trauma and loss among immigrants, refugees, asylum seekers (Stages)

Pre-migration: Witnessing violence, victim of violence, persecution

Migration: Dangerous journey, loss of life

Post Migration: acculturation, discrimination, loss of life in old country,

Empowerment

 Helping clients regain control, autonomy, and confidence after trauma

Traumatic Countertransference

Counselor’s emotional reaction transferred onto client

Vicarious trauma

Experiencing trauma from cumulative exposure to client’s traumatic events

ACE 4 Fs

Fight, flight, freeze, fawn, survival strategies commonly developed by those with Adverse Childhood Experiences (ACEs)

How a crisis develops

When a situation overwhelms coping mechanisms

Crisis theoretical Models

Internally focused cognitive and coping models

Biopsychosocial and psychosocial transition models

System and ecological models

Grief models

Crisis model: Internally focused cognitive and coping models

Cognitive model: Based on CBT, focuses on how people develop and sustain irrational beliefs

Equilibrium model: Crisis happens due to regular coping being challenged

Crisis Model: Biopsychosocial and Psychosocial transition models

Looks at personal, genetic, and demographic with psychological and social influences

Looks at crisis risk based on these factors

Crisis Model: Systemic and Ecological approaches

Systems theory: Understand reaction, patterns within a group/community/family in crisis

how different parts of a family or community take on different roles during crisis

Models of Grief

Ambiguous losses: loss without definite answer or clear end. Ex: Missing person, loved one w/ SUD goes away for weeks at a time

Disenfranchised losses: not socially sanctioned losses Ex: pet death, miscarriage, death due to drug overdose

Dual process model: adjust to loss while living in new reality

Meaning making: finding new meaning in loss

Stage Theories: Kubler Ross stages of grief

Enhancing safety and trustworthiness

Use Consistency, empathy, transparency

Crisis intervention strategies

Task based approaches- useful due to the chaotic nature of crises, establishes new routines. Includes seven step model and task approach.

Triage and assessment- screen for lethality, assess for safety, used to help refer out to services.

Supportive Interventions: open ended questions, reflections, psychoeducation, normalizing the situation

Action planning and commitment: Utilizing motivational interviewing, exploring programs and trying out new behaviors

Suicide terminology and myths

Ideation, attempts, plan, suicidal behavior, suicide survivor

Myth: talking about suicide increases risk

Myth: person that says they will commit suicide doesn’t actually mean it

Suicide Assessment

Includes risk factors and lethality assessment

identifying if they have suicidal ideation, the availability and proximity of means to commit suicide, and the specificity of a suicide plan

Creation of a safety plan to remove lethal means, identify supports

Homicide assessment and risk factors

Involves evaluating threats, history of violence, and access to weapons

Domestic Violence Assessment and Risk Factors

Assesses control patterns, escalation, and risk factors like jealousy and substance use

Staying safe

Safety planning: creating a plan to prevent an unwanted event from happening, identifying supports and a plan of action

Diagnosis and treatment of trauma

PTSD is commonly diagnosed in trauma reactions lasting beyond 1 month

PCL-5 self report PTSD checklist

CAPS-5 clinician administered

Treatment options include EMDR, CBT, TF-CBT, NET

Assessment of trauma

evaluates client symptoms, exposure to trauma, type of trauma, coping skills

Trauma Treatment Interventions

CBT, EMDR, Mindfulness, NET, RCT

Should be tailored to the client

A treatment should

1. establish safety and stabilization

2. process traumatic memories

3. integrate and reconnect one’s self

Crisis Intervention and Prevention in Schools

Counselors should be prepared to intervene which can look like formulating a plan, responding both with class-wide interventions and individual interventions, identifying at-risk students.

Warning signs of potential violence

Verbal threats, aggressive behavior, fascination with weapons, past acts of violence. Early identification allows for intervention that may prevent escalation

Bullying implications for counselors

Counselor may work with both victim and perpetrator, working systemically with schools/families to create safer environments. Counselors take an active role in prevention, intervention, and advocacy

Prevention and Intervention in schools

Prevention: education, skill building, psychoeducation, creating inclusive environment

Intervention: responding to incident, providing counseling, coordinating with teachers, admin, families

Community and Disaster trauma

Large scale traumatic events that affect an entire population

Types of community violence/trauma

Pandemics, natural disasters, mass shootings, terrorism, war, systemic violence

Reactions to communal trauma and grief

Disruption to routines, fear, grief, anger.

Shared emotional experiences can strain social system but also make opportunities for collective resilience

Shared trauma, existential trauma, vicarious trauma

Shared trauma - both client and counselor are impacted by the same event

Existential trauma- involves challenges to one’s meaning, purpose, mortality

Vicarious trauma- cumulative trauma on counselor from hearing client’s trauma stories

Communal Trauma Response

Responses include coordinated crisis intervention, dissemination of accurate information, provision of mental health services, and efforts to rebuild community cohesion

What is grief?

Grief is the multifaceted response to loss, including emotional, cognitive, physical, and behavioral reactions.

Bereavement and mourning

Bereavement- Objective state of having lost someone

Mourning- subjective process of expressing and working through grief, influenced by cultural and social factors

Considerations of grief

Cultural expression, age, type of loss, influence of support systems

Characteristics that impact grief

nature of the relationship, circumstances of the loss (e.g., sudden vs. expected), and personal coping style

Bereavement and Culture

Culture influences beliefs about death, acceptable expressions of grief, and mourning practices

Complicated Grief

Complicated grief involves prolonged, intense symptoms that interfere with functioning. It may include persistent yearning, difficulty accepting the loss, and avoidance of reminders

Grief in Children

More likely to express grief through behavior rather than words

varies depending on developmental stage

Disenfranchised grief

This occurs when a loss is not socially recognized or supported (e.g., loss of a pet, stigmatized relationships).

Therapeutic Models for Trauma

CBT, EMDR, Relational Cultural Therapy, and mindfulness-based approaches

Psychoeducation

Teach clients about trauma responses, helps to normalize what they are feeling.

Provide practical coping strategies

Psychopharmacology

Medications such as antidepressants, anxiolytics, and sleep aids

Relational Cultural Therapy

Healing through relationships, emphasizes empathy, connection, growth.

Relationships can be both the cause of the trauma and the healing modality.

Establishing Safety & Trust

established through consistency, transparency, respect ********

Cognitive Processing Therapy

cognitive therapy that helps clients identify and challenge maladaptive beliefs related to trauma, such as guilt or self-blame, and replace them with more balanced thoughts

Challenges “stuck points”

Made for PTSD/trauma

EMDR

bilateral stimulations to processes and integrate trauma, reduce emotional intensity. Usually uses directed eye movements

Mindfulness

nonjudgmental awareness of the present moment

Military Culture

emphasizes hierarchy, discipline, loyalty, and resilience

Deployment Cycle

Pre-deployment

Deployment

Sustainment

Post-deployment

Factors impacting reentry to civilian life

Identity changes, mental health issues, employment difficulties, readjustment problems, relationship strain

Multidimensional model of acculturation for military veterans

Maintenance of military culture: Keeping values and connections from the military.

Acquisition of civilian culture: Adopting the norms and behaviors of the civilian world.

Chameleonic adaptation: Alternating between military and civilian identities depending on the context.

Minority military members

May face discrimination, marginalization, impacts to mental health and access to care

Implications for counselors working with military families

Understand the different cycles of deployment and how it may be impacting the family

address both individual and family dynamics, changes in roles depending on deployment cycle

Migrant vs Refugee vs Asylum Seeker

Migrants - voluntary relocation

Refugee - flee persecution

Asylum Seeker - legal protection in another country

Refugee and immigration procedures

Complex legal processes, limited access to resources/care, resettlement challenges, stress + uncertainty

Trauma events and loss during the pre-migration, migration, and post-migration experience.

Trauma may occur before migration (e.g., war), during migration (e.g., dangerous travel), and after migration (e.g., loss, discrimination, acculturation stress), creating cumulative impact