TRAUMA Tana Bridge, PhD, LMSW Supervisor/Consultant: National Institute for Trauma & Loss

A lot is Known About Trauma Unattended Trauma leads to self-defeating, self-destructive, pathological behavior Most will need external support to move beyond trauma Additive Nature of Trauma Steele (1992), Terr (1979), Pynoos(1988)

Unattended Trauma leads to self-defeating, self-destructive, pathological behavior

Most will need external support to move beyond trauma

Additive Nature of Trauma

Substance Use/Trauma Ability to escape from trauma can be accomplished through drug use~ Drug use can perpetuate feelings of powerlessness, fear, etc. brought about by trauma~ Drug culture can expose/create victims of trauma`

Ability to escape from trauma can be accomplished through drug use~

Drug use can perpetuate feelings of powerlessness, fear, etc. brought about by trauma~

Drug culture can expose/create victims of trauma`

Trauma is a Sensory Experience

Traumatic Situations War Violence Rape Murder Beatings/Assaults Domestic Violence Fires

War

Violence

Rape

Murder

Beatings/Assaults

Domestic Violence

Fires

Suicides Car Accidents/Plane Crashes Disasters - earthquake, floods, fires, etc. Injuries or life threatening illness Divorce Drowning

Suicides

Car Accidents/Plane Crashes

Disasters - earthquake, floods, fires, etc.

Injuries or life threatening illness

Divorce

Drowning

Exposure to Trauma Surviving Victim/Survivor Witness to the Event Related or Connected to the Victim Hearing the Details

Surviving Victim/Survivor

Witness to the Event

Related or Connected to the Victim

Hearing the Details

Differences in Trauma & Grief Grief Sadness stands alone Reactions are known to public Can usually talk about loss Pain is acknowledgement of loss Trauma Terror Include grief Reactions unknown, held within Can’t or don’t want to talk Pain triggers terror, powerlessness, loss of safety

Grief

Sadness

stands alone

Reactions are known to public

Can usually talk about loss

Pain is acknowledgement of loss

Trauma

Terror

Include grief

Reactions unknown, held within

Can’t or don’t want to talk

Pain triggers terror, powerlessness, loss of safety

Anger is non-destructive, non-assaultive Grief does not disfigure self image Guilt says ”I wish I would/would not have” -dreams of deceased No trauma specific reactions Anger- can become assaultive Attacks, distorts self image Guilt says ”It was my fault, I could have prevented it Dreams of self as potential victims Grief reaction and trauma specific reactions. W. Steele

Anger is non-destructive, non-assaultive

Grief does not disfigure self image

Guilt says ”I wish I would/would not have”

-dreams of deceased

No trauma specific reactions

Anger- can become assaultive

Attacks, distorts self image

Guilt says ”It was my fault, I could have prevented it

Dreams of self as potential victims

Grief reaction and trauma specific reactions.

Neurochemical basis of PTSD Trauma changes the levels of 5 major neurotransmitters: epinephrine, cortisol, norepinephrine, serotonin and endorphins The limbic system (involved in strong emotion) can be changed by the presence of excess norepinephrine and produces:

Trauma changes the levels of 5 major neurotransmitters: epinephrine, cortisol, norepinephrine, serotonin and endorphins

The limbic system (involved in strong emotion) can be changed by the presence of excess norepinephrine and produces:

Neurochemical basis of PTSD - continued Kindling effect - when small amounts of norepinephrine cause a cascade effect - the person reacts to a small stressor as if a true emergency has occurred Prolonged stress creates a dependency on the analgesic effect - the person seeks intensity to achieve overload and then the calming effects of endorphin release

Kindling effect - when small amounts of norepinephrine cause a cascade effect - the person reacts to a small stressor as if a true emergency has occurred

Prolonged stress creates a dependency on the analgesic effect - the person seeks intensity to achieve overload and then the calming effects of endorphin release

Video: Bill Steele National Institute for Trauma & Loss in Children

Neurochemical basis of PTSD - continued The extreme effects of trauma change brain chemistry thereby changing normal emotion, perception, and sensation

Symptoms Physical symptoms : hypervigalence, startle response, sleep difficulties, concentration or memory problems, mood problems such as anger or depression Intrusive symptoms : recurrent recollections (thoughts, memories, dreams, nightmares or flashbacks), re-enactment (behavior or re-telling) distress at symbolic events, survivor guilt or grief

Physical symptoms : hypervigalence, startle response, sleep difficulties, concentration or memory problems, mood problems such as anger or depression

Intrusive symptoms : recurrent recollections (thoughts, memories, dreams, nightmares or flashbacks), re-enactment (behavior or re-telling) distress at symbolic events, survivor guilt or grief

Symptoms - continued Avoidant symptoms : avoiding specific thoughts, feelings, activities or situations, diminished interest, emotional numbness, inability to connect with future (feel they will die at young age) Special forms of avoidant symptoms: dissociation, learned helplessness, loss of fear

Avoidant symptoms : avoiding specific thoughts, feelings, activities or situations, diminished interest, emotional numbness, inability to connect with future (feel they will die at young age)

Special forms of avoidant symptoms: dissociation, learned helplessness, loss of fear

Symptoms -continued Cognitive Struggles: 2+2 ??? 4, Magical Thinking (E.G. if I touch him he will die ) Rumination or preoccupation: Continuous conscious awareness about the event and associations that go beyond ordinary thinking. Characterized by a sense of uncontrolled repetition.

Cognitive Struggles: 2+2 ??? 4, Magical Thinking (E.G. if I touch him he will die )

Rumination or preoccupation: Continuous conscious awareness about the event and associations that go beyond ordinary thinking. Characterized by a sense of uncontrolled repetition.

Putting together the pieces… What is needed for ‘resolution’ or successful process in working through a traumatic situation….

What is needed for ‘resolution’ or successful process in working through a traumatic situation….

The Process of Working through Trauma Safety Attachment /Connection Connect with trusted adult Elicit support of others Educate about possible reactions Gives meaning Normalizes

Safety

Attachment /Connection

Connect with trusted adult

Elicit support of others

Educate about possible reactions

Gives meaning

Normalizes

Connect with Details – Nonverbal into Verbal It gives the “why”s Allows for mastery over content Allows for experience outside of self Removes negative image Interventions should be psychomotor as experience is sensory (art sculpting, play, story telling, journaling, etc.)

Connect with Details – Nonverbal into Verbal

It gives the “why”s

Allows for mastery over content

Allows for experience outside of self

Removes negative image

Interventions should be psychomotor as experience is sensory (art sculpting, play, story telling, journaling, etc.)

Promises of Healing Reduced frequency of symptoms Reduced fear of the symptoms Reduced fear of insanity Opportunity to grieve Change from victim to survivor

Reduced frequency of symptoms

Reduced fear of the symptoms

Reduced fear of insanity

Opportunity to grieve

Change from victim to survivor

Promises of Healing ...continued Opportunity to begin enjoying life Sense of humor Profound empathy for others who suffer

Opportunity to begin enjoying life

Sense of humor

Profound empathy for others who suffer

Questions???

Questions???