The video for this presentation is available on our Youtube channel: https://youtube.com/allceuseducation A continuing education course for this presentation can be found at https://www.allceus.com/member/cart/index/index?c= From a survival perspective the symptoms of PTSD make a lot of sense. We explore not only how the cognitive symptoms can be understood in terms of helping people make sense of the situation and survive, but also how physical symptoms including hypocortisolism make sense to help the organism survive.

1. PTSD
Exploring the Functional
Nature of Symptoms
Instructor: Dr. Dawn-Elise Snipes LPC-MHSP, LMHC, CCDRC
Executive Director: AllCEUs
Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Podcasts

2. Objectives
 Review PTSD Symptoms and explore their
functional nature

3. Purpose
 By understanding the function of symptoms we
can
 Normalize the behavior
 Identify alternate ways to meet that same need or
address the issue
 Re-Experiencing
 Trying to replay it to figure out how to integrate into
your schema (like fitting a puzzle piece)
 Reminding the person of similar situations to “protect”
them

4. Purpose
 Avoidance
 The system is already over taxed. Avoiding upsetting stimuli
by blocking out most stimuli, memories of the event.
 Avoiding unnecessary use of energy by not getting “excited.”
 Changes in Beliefs
 Protects against future “surprises”
 Tries to assimilate the experience into schema
 Increased Arousal
 Protects the individual

5. Re-Experiencing
 You re-experience things every day
 Access schema that guide your actions
When you go to work
When you encounter a particularly volatile client
When you approach a stop light
 Re-Experiencing in PTSD
 The context is often overgeneralized
 The precipitating factors are often unknown
 In many cases the resolution was not one of
empowerment, resulting in trying to continually figure
out how to not be disempowered

6. Re-Experiencing: Assimilation or Accommodation
 Intrusive distressing memories of the traumatic
events
 In children repetitive play may occur in which themes or
aspects of the traumatic events are expressed.
 Recurrent distressing dreams in which the content or
feeling of the dream is related to the events
 In children there may be frightening dreams without
recognizable content.
 Flashbacks or other dissociative reactions in which
the individual feels or acts as if the traumatic events
are recurring
 In children trauma-specific reenactment may occur in play.

7. Re-Experiencing
 Intense or prolonged psychological or
physiological distress at exposure to internal or
external cues that symbolize or resemble an
aspect of the traumatic events
 The event represents a time in which the person
experienced or witnessed something horrifying
 The brain is trying to help the client
 Avoid future similar situations
 Learn how to protect during future similar situations

8. Avoidance
 Purpose: Avoidance of Recurrence of Pain or Arousal
of Stress Response System
 Emotional numbness and avoidance of places, people, and
activities that are reminders of the trauma.
 Inability to remember an important aspect of the traumatic
events (not due to head injury, alcohol, or drugs)
 Purpose: An exhausted system conserves energy in
case there is another threat
 Markedly diminished interest or participation in significant
activities
 Feelings of detachment or estrangement from others
 Persistent inability to experience positive emotions

9. Hypocortisolism
 Cortisol is the stress chemical
 After extreme stress and/or under chronic stress
the brain may reduce the responsiveness of the
stress response system by reducing the cortisol
 This is protective, it keeps the organism from
using precious resources by getting “excited”
about anything (including pleasure)
 Due to fear conditioning, when a stressor is
detected, the stress response is exaggerated.

10. Changes in Beliefs
 Purpose: The need for order and meaning
(Regaining control, Ability to predict)
 Persistent and exaggerated negative beliefs or
expectations about oneself, others, or the world
“I am bad”
“No one can be trusted”
"The world is completely dangerous"
 Persistent, distorted blame of self or others about the
cause or consequences of the traumatic events

11. Changes in Beliefs
 Persistent
 Fear, horror
 Anger
 Guilt, shame
 Trauma taps in to nearly every basic fear
 Loss of Control
 The Unknown
 Death (Am I going to die? I could have died. I was unable to
prevent someone from dying)
 Isolation
 Failure
Child abuse,
Car accident
Drowning
Bank robbery
Rape
War

12. Beliefs Interventions
 After a trauma people’s lives are changed forever.
 It is often necessary to grieve the loss not only of
tangible things like property, but also existential
things like belief in a just world and the goodness
of people.
 Identifying the threats and associated thoughts
the person had/is having
 Addressing cognitive distortions using Cognitive
Processing Therapy

13. CPT Challenging Questions
 What is the evidence for and against this belief?
 Are the sources of this evidence reliable?
 Is my reasoning based on facts or feelings?
 Is this belief based on habit or facts?
 Habits can be persistent negative interpretations or old
“tapes” that have never been checked.
 Am I basing my belief on the whole picture, or a small
aspect of it?
 Does my belief contain all-or-none terms?
 In what ways is this belief confusing high probability
and low probability events?

14. Increased Arousal
 Irritable or aggressive behavior
 Anger/threat reaction to continue to self-protect
 Interventions:
Help the person identify and address triggers
Develop skills to address emotional and behavioral
dysregulation (STOP Stop Think Observe Participate)
 Reckless or self-destructive behavior
 Stop the pain (I don’t care if I die, because…)
 Distract (Numb through thrill)
 Regain control (Lightening doesn’t strike twice)

15. Increased Arousal
 Exaggerated startle response (Hypocortisolism)
 Think how exhausting it would be to go from 0 to 100
each time you were startled.
 Because of hypervigilance, people with PTSD are aware of
more things that may startle
 Interventions
Help client understand brain changes that resulted from the
brains “decision” that continuing to use energy to fight was
futile
Develop tools to reduce vulnerabilities and increase energy
reserves

16. Increased Arousal
 Hypervigilance
 Purpose: Protective because the world seems dangerous
and unpredictable
 Other Symptoms
Problems with concentration
 Hypervigilance prevents filtering out extraneous stimuli
 Intervention: Create places that are “peaceful and safe”
Difficulty falling or staying asleep or restless sleep
 You are vulnerable when you are asleep
 Create a safe sleeping space and ability to easily re-ground
 Emotional support dogs can be helpful here

17. Final Thoughts
 Tormenting thoughts and feelings and attempts to
stop or avoid those thoughts and feelings are
central to PTSD
 In the song “Wrong Side of Heaven” by Five Finger
Death Punch the artist speaks of this torment.
 Imagine you have been in a situation in which you
 Had to kill to protect others
 Had to let someone die to protect yourself and be
there for your kids/family

18. Wrong Side of Heaven
 I spoke to God today and she said that she's ashamed.
What have I become. What have I done
 I did some awful things in the spirit of what was right
 I spoke to the devil today and he swears he's not to
blame, and I understood 'cause I feel the same.
 I accept that the devil did not make me do it. I chose it,
but at what cost.
 Arms wide open, I stand alone. I'm no hero and I'm
not made of stone.
 I feel totally isolated. I don’t believe people could
understand. I did not do it to be a hero. I am tormented by
what I felt I had to do for what I felt was right.

19. Wrong Side of Heaven
 Right or wrong, I can hardly tell. I'm on the wrong side of
heaven and the righteous side of hell.
 I know what I did, I did for the right reasons, but I don’t feel
deserving of forgiveness, but I also don’t believe I should be
damned because I was trying to do what was right.
 I heard from God today and she sounded just like me.
What have I done and who have I become.
 Like God, I talk, believe, pray about doing things for the right
reasons
 I saw the devil today and he looked a lot like me
I looked away, I turned away
 Like the devil, I have done a lot of things I don’t know if I can
forgive myself for, and am not sure if I deserve forgiveness. I
can’t stand to see the potential for evil in myself.

20. Summary
 Increased Arousal
 The traumatic threat was unpredictable, ergo future events
are unpredictable.
 Increased arousal keeps people alert to potential threats.
 Using CPT Challenging Questions help the client examine
his/her beliefs about the event and his/her current safety
 Avoidance and numbing helps the person survive since
nobody can be “alert” and agonizing for that long
 Helping the person understand that during a traumatic
event, certain chemicals in the body prevent effective
memory formation. This is protective.
 Numbing helps preserve precious energy.

21. Summary
 Changes in beliefs
 Keeps the person from being vulnerable again
 Helps the person try to make sense of it.
 Re-Experiencing
 Like trying to fit a puzzle piece, the brain is trying to
make sense of how this fits into current schema
 The brain may have to develop new schema based on
likely faulty memories from the trauma, so many
stimuli are overgeneralized and cause “triggers” for
anxiety to be everywhere.