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PTSD and ASD

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NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at …

NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at http://www.allceus.com

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  • 1. PTSD AND ASD Dr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 2. PREVALENCE 50 to 90% of the population have been exposed to  traumatic events during their life  Most individuals do not develop PTSD  Resilience is the ability to negotiate psychosocial and emotional changes after trauma exposure Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 3. INITIAL ASSESSMENT Screen for  Recent and remote exposure   Availability of basic resources For each exposure  Proximity   Similarity  Helplessness  Social Support  6-month stressors  Hx of mental illness Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 4. INITIAL INTERVENTIONS Stabilizing   Supportive medical care  Supportive psychiatric care  Ensure availability of basic resources Provide information verbally and in writing to the patient  and support persons Assessment  Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 5. DIAGNOSTIC EVALUATION Waits until patient is stable   Premature evaluation can overwhelm  Clinical evaluation requires assessment of reexperiencing, avoidance/numbing, hyperarousal  ASD occurs within four weeks and must last for a minimum of 2 days  PTSD occurs 1 month or more after exposure Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 6. DISSOCIATIVE SYMPTOMS a subjective sense of numbing, detachment, or  absence of emotional responsiveness  a reduction in awareness of his or her surroundings  derealization  depersonalization  dissociative amnesia Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 7. REEXPERIENCING SYMPTOMS recurrent and intrusive distressing recollections   recurrent distressing dreams of the events  acting or feeling as if event were recurring  intense psychological or physiological distress at exposure discriminitive stimuli Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 8. AVOIDANT SYMPTOMS avoid thoughts, feelings, or conversations  associated with the trauma  avoid activities, places, or people that arouse recollections of the trauma  inability to recall an important aspect of the trauma  feeling of detachment or estrangement from others Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 9. HYPERVIGILENCE SYMPTOMS difficulty falling asleep or staying asleep   irritability or outbursts of anger  difficulty concentrating  hypervigilence  exaggerated startle response Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 10. GRIEF Grief Stages  Denial  Anger  Bargaining  Depression  Acceptance  During the first 48 to 72 hours after a traumatic  event, some individuals may be very aroused, anxious, or angry while others may appear minimally affected or numb Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 11. ONGOING TREATMENT establishing a therapeutic alliance   Increasing understanding of and coping with the psychosocial effects of the trauma  evaluating and managing physical health and functional impairments  coordination of care Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 12. EFFECTS OF A TRAUMA Emotional   Mental  Physical  Social  Spiritual  Environmental  Financial  Occupational Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 13. EFFECTIVE TREATMENTS Supportive Interventions   Psychoeducation  Case management  Psychopharmacology SSRIs   Benzodiazepines  Opiates for physical complaints Preventative: CBT beginning 2-3 weeks post-  exposure Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 14. SSRIS Ameliorate all three PTSD symptom clusters   Are effective treatments for comorbid disorders  May reduce clinical symptoms  Have relatively few side effects Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 15. CHOOSING TREATMENTS The patient’s age and gender   Presence of comorbid medical and psychiatric illnesses  Propensity for aggression or self-injurious behavior  Recency of the precipitating traumatic event  Severity and pattern of symptoms  Presence of distressing target symptoms  Development of problems in psychosocial functioning  Preexisting developmental or psychological issues Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 16. DEBRIEFING Psychological debriefing or single session  techniques are not recommended   may increase symptoms in some settings  appear to be ineffective in treating individuals with ASD and PTSD Triage assessments in a group setting may identify  those in need of intervention, but should avoid detailed discussion of distressing memories and events Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 17. SUPPORTIVE INTERVENTIONS Encourage acutely patients to rely on  their inherent strengths   their existing support networks  their own judgments of the need for further intervention Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 18. TREATMENT GOALS Reducing the severity of symptoms   Preventing or treating related comorbid conditions  Improving adaptive functioning  Restoring a sense of safety and trust  Protecting against relapse  Restore normal developmental progression  Integrate the trauma into a constructive schema of risk, safety, prevention, and protection Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 19. TREATMENT PLAN Observable, measurable goals and objectives   Interventions and their rationale Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 20. CBT Targets the distorted threat appraisal process in  order to desensitize the patient to trauma related triggers  Stress inoculation training involves breathing exercises   relaxation training  thought stopping  cognitive restructuring Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 21. PSYCHODYNAMIC PSYCHOTHERAPY Focus on the meaning of the trauma in terms of  prior psychological conflicts and development  Address developmental, inter and intrapersonal issues that relate to Nature   Severity  Symptoms Assure patients that they will decide how deeply to  explore the difficult events/feelings  Normalize their distress Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 22. COUNTERTRANSFERENCE The therapists reaction can make ongoing attention  to countertransference of particular importance Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 23. PSYCHOEDUCATION the expected physiological and emotional  responses  strategies for decreasing secondary or continuous exposure to the trauma  stress reduction techniques  the importance of remaining mentally active  the need to concentrate on self-care tasks  recommendations for early referral Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 24. TREATMENT PLACEMENT Considerations  symptom severity  comorbidity  suicidal or homicidal ideation or behavior  level of functioning  available support systems  Internet based therapies show some effectiveness  Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 25. OTHER INFORMATION Patients with serious mental illness have higher  rates of abuse  Depression, substance abuse, panic attacks and severe anxiety are associated with increased risk for suicide  PTSD has demonstrated the strongest association with suicidal behaviors  Family members of victims are not only secondary victims but also one of the major buffers  Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 26. AGGRESSION aggressive behavior in patients with PTSD results  from the anticipatory bias caused by the trauma  Occurs in the context of reexperiencing symptoms  Techniques targeting symptoms may reduce aggression Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 27. PERSONALITY DISORDERS Childhood trauma associated with development of  PD  Features of PTSD and PDs overlap  PTSD may be masked by PD symptoms Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 28. OTHER RELATED DISORDERS Traumatic Grief  Sudden unanticipated loss   Patient requires stabilization  Distressing thoughts, longing  Duration at least 2 months Adjustment Disorder  Identifiable stressor within 3 months   Depression, anxiety, conduct Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  • 29. SUMMARY There are many causes for PTSD   Early intervention may be key to preventing later developmental issues in children  Strengths-based, supportive interventions are the best first-line treatments Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC