Mervin Smucker (2012). Critical factors that affect the course of trauma treatment

1. 1
Smucker, Mervin (2012). Critical factors that affect
course of trauma treatment.

2. 2
3 major factors that affect the course of
trauma treatment
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1. Typology
2. Presence of predominant trauma-related emotions?
primary emotions
• fear, horror, disgust
secondary emotions
• guilt, shame, anger
3. Degree of stabilization

3. 3
Typology of Traumatic Events
Accidental Trauma Man-Made Trauma
Type I Trauma
• single incident
• acute life threat
• unexpected
• traffic accidents
• occupational trauma
(police, fire fighter)
• work-related trauma
• short-lived natural
disaster (hurricane)
• criminal/physical
violence
• sexual or physical
assault
• armed robbery
• domestic violence
Type II Trauma
• repeated
• prolonged
• unpredictable
course
• long-standing natural
disasters (flood)
• technological
catastrophes
(e.g., toxic gas)
• child sexual/physical
abuse, severe neglect
• emotional abuse
• combat/war/torture
• kidnapping/hostage
taking, imprisonment

4. 4
Non-FEAR Emotions often
predominant in PTSD
Anger Self-Blame
Shame
Guilt Helplessness

5. Initial Focus on Stabilization
• Presence of significant stressors in daily life?
• Ongoing traumas?
• Current substance or alcohol abuse?
• Involvement in abusive relationship/situation?
• Presence of self-abusive/injurious behaviors?
• Significant suicidality?
• Diagnosis of DID?
• Repeated dissociation during exposure/emotional
processing?
• Significant sleep disturbance/deprivation?

6. Stabilization Interventions
• Dialectical Behavioral Therapy
– Affective Regulation
– Mindfulness Training
• Sleep-Focused Interventions
– Medication
– CBT
• Self-Calming/Self-Soothing Exercises
• Stabilization Imagery
• Grounding Interventions
– Relaxation Exercises, Music, Dance
– Physical Activity / Exercise
• Medication Management

7. When relative stabilization is
present, proceed with
Trauma Processing
Interventions

8. CBT Trauma-Processing
Models
• Dual Representation Theory
• Cognitive Therapy Model
• Imagery-Based CBT Models