Trauma, Self Harm _ Stress Management, a presentation by Dr Leju Benjamin Modi, a South Sudanese Medical Doctor Young people face unique challenges in today's fast-paced and complex world. This masterclass offers valuable insights and practical skills tailored to their specific needs. This session intends to help young individuals gain the necessary tools to foster personal wellbeing, manage self-harm tendencies, cope with stress, and address trauma effectively. Investing in their mental health and well-being is crucial for achieving personal growth, resilience, and overall happiness.

1. TRAUMA, SELF-HARM, &
STRESS M A N A G E M E N T
© Dr Leju Benjamin Modi (MBChB)
(For EFSS Audience on Zoom)
J
uly 16,2023
1

2. DISCLAIMER
The information discussed in this presentation
is entirely for health awareness and
information purposes to the audience and
must notbeused formaking selfdiagnosis
and/or prescriptions!
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3. O U T L I N E
• Background to trauma- and stressor-related disorders
(definition,examples of events)
• Signs & Symptoms ofT
rauma/Stress
• Risk factors for trauma/stress
• Forms of trauma- and stressor-related disorders (PTSD,
Depression,etc.)
• Self-Harm/Suicide
• Management of stress 4

4. B A C K G RO U N D TO T RA U M A &
STRESS
• Stress – a feeling of emotional or physical tension. Can come from
any event or thought that makes you feel frustrated,angry,etc.
✓Usually a reaction to emotional or mental pressure. It is often
related to a feeling like you’re losing control over something.
✓The body’s reaction to harmful situations – whether real or
perceived.
• Trauma – an emotional response to a terrible event like an
accident, rape, or natural disaster
. Reactions such as shock and denial
are typical.
✓Response to a deeply distressing or disturbing event that
overwhelms or numbs an individual’s ability to cope, causes
feelings of helplessness,etc. 5

5. • Psychological, or emotional trauma, is damage or injury to
the psyche after living through an extremely frightening or
distressing event and may result in challenges in functioning
or coping normally after the event.
• Any situation that leaves one feeling alone and completely
overwhelmed can be traumatic – even without physical
harm. It’s important to remember that it’s not the objective
facts of the event alone that determine how traumatic an
event is; it’s also the subjective emotional experience of the
event. 6

6. •A potentially traumatic event is more prone to leave an
individual with longer-lasting emotional and psychological
trauma if:
✓The individual was unprepared for the event;
✓The event occurred out of the blue;
✓The person felt powerless to prevent the event;
✓The event occurred repeatedly (such as child abuse);
✓The event involved extreme cruelty;
✓The event occurred during the childhood years
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7. Examples of events and situations that can lead to the
development of psychological trauma may include:
• Natural disasters such as fires, earthquakes, tornados, and
hurricanes, COVID-19
• Interpersonal violence like rape, child abuse, or the
suicide/death of a loved one or friend
• Involvement in a serious car accident or workplace
accident
• Acts of violence such as an armed robbery, war
,or
terrorism
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8. Commonly overlooked causes of potential emotional
and psychological trauma can also include:
•Breakup or divorce in a significant relationship
•Significantly humiliating experience
•Surgery
•Falls or injuries due to sports
•Sudden,unexpected death of a loved one
•Diagnosis of a life-threatening or disabling condition
•Loss of job
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9. SIG NS & SYMPTOMS
Cognitive (conscious/ unconscious):
•Intrusive thoughts of the event that
may occur out of the blue
•Nightmares
•Visual images ofthe event
•Loss of memory and concentration
abilities
•Disorientation;Confusion
•Mood swings
Behavioral:
•Avoidance of activities or places
that trigger memories of the
event
•Social isolation and withdrawal
•Lack of interest in previously-
enjoyable activities
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10. Physical:
• Easily startled
• T
remendous fatigue and
exhaustion;Vague complaints of
aches and pains throughout the
body
• Tachycardia
• Edginess;Extreme alertness;
always on the lookout for
warnings of potential danger
• Insomnia;Changes in sleeping and
eating patterns
• Sexual dysfunction (esp. men)
Psychological:
• Overwhelming fear;Shame
• Obsessive and compulsive
behaviors
• Detachment from other people
and emotions;Emotional numbing
• Depression;suicide
• Guilt – especially if one lived
while others perished
• Emotional shock;Disbelief
• Irritability;Anger
• Anxiety;Panic attacks
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11. RISK FACTORS FOR T R A U M A - & STRESSOR-
RELATED D I S O R D E R S
• Environmental – serious social neglect; lower
socioeconomic status; war; exposure/severity (directly or
indirectly); war; murder; death of loved one;marital woes;
• Genetic and physiological – female sex; family history of
mental illness
• Temperamental – negative appraisals; inappropriate coping
strategies;prior mental disorder;
• Substance abuse –
• Physical harm – 12

12. F O R MS OF T R A U M A - & STRESSOR-
RELATED D I S O R D E R S
Disorders (disturbance of normal functioning of mind/body) following
exposure to trauma or a stressful event.Theyinclude:
•Reactiveattachmentdisorder(childhood)–
•Disinhibitedsocialengagementdisorder(childhood)–
•Adjustmentdisorder–
•Acutestressdisorder–
•Post-traumaticstressdisorder(PTSD)
•Depression/Majordepressivedisorder(MDD)
•Self-harm/Suicide
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13. •Posttraumatic stress disorder (PTSD) – the
development of characteristic symptoms following
exposure to one or more traumatic events, such as
oWar, physical assault (e.g., physical attack, robbery, mugging,
childhood physical abuse),
oSexual violence (e.g.,forced sexualpenetration, alcohol/drug-
facilitated sexual penetration,abusivesexualcontact, noncontact
sexual abuse, sexual trafficking),
oBeing kidnapped, being taken hostage,
oTerrorist attack, torture, incarceration, disasters, and
severe motor vehicle accidents. 14

14. PTSD Cont’d:
✓The traumatic event can be reexperienced in various ways. A
common reexperiencing symptom is distressing dreams that
replay the event itself or that are representative or thematically
related to the major threats involved in the traumatic event.
Symptoms usually set in the 1st three months of
experience.
✓These episodes, often referred to as "flashbacks”, typically
brief but can be associated with prolonged distress and
heightened arousal
✓Half adult patients recover in three months, others continue to
a year or more. 15

15. •Depression aka Major Depressive Disorder
(MDD) – a period of at least 2 weeks during which
there is either depressed mood or the loss of
interest or pleasure in nearly all activities; the mood
may be irritable rather than sad.
✓The individual must also experience at least four
additional symptoms drawn from a list that includes
changes in appetite or weight, sleep, and psychomotor
activity; decreased energy; feelings of worthlessness or
guilt; difficulty thinking, concentrating, or making
decisions; or recurrent thoughts of death or suicidal
ideation or suicide plans or attempts. 16

16. Depression Cont’d
✓Individuals may report feeling less interested in
hobbies, "not caring anymore," or not feeling any
enjoyment in activities that were previously considered
pleasurable. Family members often notice social
withdrawal or neglect of pleasurable avocations. In some
individuals, there is a significant reduction from previous
levels of sexual interest or desire.
✓Sleep disturbance may take the form of either difficulty
sleeping or sleeping excessively
✓Decreased energy, tiredness, and fatigue (without
physical activity) are common. 17

17. DELIBERATE SELF-HARM (SUICIDE)
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18. Deliberate Self-Harm (Suicide)
•Intentional taking of one’
s own
life
•Views on suicide:
✓Offense towards God? Thou
shalt no kill!
✓Atone for mistakes, failure;
form of protest?
✓Expression of despair;wish
to escape, rather than
genuine intention to die?
• Associated psychological factors;
✓Mentalhealth concern
(mood disorders,
substance abuse,etc.)
✓Cry for help/attention
✓Crime?
• Most peoplewho attempt
suicide do notcomplete it on
the first attempt
✓ Personal right to die? 21

19. • Attempted suicide – “Every act of self injury consciously
aimed at attempts to kill themselves. But it acknowledges the
gravity of the situation”
• Completed suicide – fatal self harm/injury; more common in
men than women
• Murder suicide – to facilitate murder; escape punishment;
as self-punishment; or to avoid children becoming orphans (to
be together in the afterlife),kill them first then self.
✓Joint suicide (suicide pact)
✓Committing suicide in a method that kills others (e.g.,
crushing an airplane) 22

20. RISK FAC TORS FOR SUICIDE – “SAD PERSONS”
• S ex (female)
• A ge (10 – 24/39;≥ 60)
• D epression
• P rior history (likelier to repeat suicide attempt)
• E thanol abuse (excessive use of alcohol)
• R ational thinking loss (“end of thinking capacity!”)
• S upport system loss (breadwinner loss)
• O ragnised plan (suicide pact,murder suicide)
• N o spouse/no significant other (“life worthlessness”)
• S ickness (chronic) 23

21. Suicidal ideation, planning, and attempts among
adolescents in 59 LMICs (2019 study)
• 229,129 adolescents studied across 6WHO regions in theWorld
• Overall prevalence of suicidal ideation = 16.9%, planning = 17.0%,
and attempt = 17.0% in the 12 months preceding the survey
• Africa region had the highest rates of suicidal ideation and
planning at 20.4% and 23.7% respectively.The Pacific region had
the highest suicide attempt rates at 20.5%. Southeast Asia had the
lowest rates of all three at 8.0, 9.9, and 9.2%, respectively
• Girls had higher prevalence of suicidal ideation, planning and
attempts than boys. So, too, did adolescents aged 15 – 17, than 13
– 14 years old 24

22. Methods of Suicide (2018 findings)
• A study of the epidemiology of suicides and
the psychiatric perspective found that
• Most common method of suicide is hanging,
followed by poisoning using pesticides, and
use of firearms
• Majority suicides related to psychiatric
diseases: commonly depression, substance
use, and psychosis
• https://www.mdpi.com/1660-4601/15/7/1425
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23. IMPACT OF SUICIDE?
• Affects others – spouse, parents, children, siblings,
neighbors, friends,relatives,everybody else!
• Future occurrence by others
• Economic importance on family
,nation,health system
• Legal implications
• ??
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24. SUICIDE ASSESSMENT & MANAGEMENT
• Ask patients about suicidal ideations – does not make them suicidal!
• Assess for cause of suicidal ideation/attempt;assess future risk
• T
reat the cause;most times patient is admitted
• Discharged only when:no longer suicidal;medically stable;not
intoxicated;promises to return for help if suicidal thoughts return
• Continued psychosocial support (family
, friends, psychologist, etc.)
watch out for red flags!
• Stress management techniques;keep harmful objects away!
• Engagement ineconomic activities –give a reason for reaching
tomorrow
• Regulation of and keeping away from suicidal items/methods 27

25. 28

26. STRESS M A N A G E M E N T STRATEGIES
(EXERCISES)
1. Progressive muscle relaxation (PMR)
2. ΑutogenicTraining (AT)
3. Relaxation Response (RR)
4. Biofeedback
5. Guided Imagery (GI)
6. Diaphragmatic Breathing
7. Transcendental Meditation (TM)
8. Cognitive BehavioralTherapy (CBT)
9. Mindfulness-Based Stress Reduction (MBSR)
10.Emotional Freedom Technique (EFT)
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27. • Progressive muscle relaxation (PMR) – a technique for
reducing stress and anxiety by alternately tensing (10 s) and
relaxing (20s) the muscles groups over the legs, abdomen, chest,
arms and face in a sequential order with eyes closed.
✓Individual focuses on the distinction between the feelings of
the tension and relaxation (over pain or pain perception;
creating a pleasant mental state; reducing anxiety in response
to stress).
✓With practice, the patient learns how to effectively relax in a
short period of time
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28. • Αutogenic Training (AT) – aself-relaxation procedure by
which apsychophysiological determined relaxation
response is elicited. individual learns a set of directions/
exercises that command the body to relax and control
breathing, blood pressure, heartbeat, and body temperature.
Find a quiet place,lie flat and exercise.
✓Consists of six standard exercises that – with the use of visual
imagination and verbal cues – make the body feelwarm, heavy
,and
relaxed.
✓Useful in arange of diverse disorders including tension
headache/migraine, mild-to-moderate essential hypertension,
coronary heart disease,asthma,etc.
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29. 1.T
akeafewslow breaths. Quietly say to yourself, “I amcompletely
calm”.
2.Focus attention on your arms. Quietly and slowly repeat to yourself
six times, “My arms are very heavy”.Then quietly say to yourself, “I
am completely calm”.
3.Refocus attention on your arms. Quietly and slowly repeat to yourself
six times, “My arms are very warm”. Then quietly say to yourself, “I am
completely calm”.
4.Focus attention on your legs.Quietly and slowly repeat to yourself six
times, “My legs are very heavy”.Then quietly say to yourself, “I am
completely calm”.
5.Refocus attention on your legs.Quietly and slowly repeat to yourself
six times, “My legs are very warm”.Then quietly say to yourself, “I am
completely calm”. 32

30. • Relaxation Response (RR) – a simple practice that
once learned takes 10 to 20 minutes a day to achieve
relaxation. The important characteristics of a relaxation
program are:
a)Repetition of a word, sound, prayer
, thought, phrase or
muscular movement,through which concentration is achieved
b)Passive return to the repetition when other thoughts intrude.
✓During RR, the body moves from a state of physiological
arousal to a state of physiological relaxation
✓RR can reduce systolic hypertension, improve cardiac
rehabilitation and relieve medical symptoms 34

31. •Diaphragmatic Breathing – or abdominal or belly
or deep breathing is marked by expansion of the
abdomen rather than the chest when breathing.
✓ A manipulation of breath movement, contributing to a
physiologic response characterized by the presence of
decreased oxygen consumption, decreased heart rate
and blood pressure, and increased relaxation
(parasympathetic) activity
.
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32. Diaphragmatic breathing – lying on the back or seated
upright.
• Lie on your back on a flat surface or in bed, with your knees bent and
your head supported. You can use a pillow under your knees to
support your legs.
• Place one hand on your upper chest and the other just below your rib
cage.This will allow you to feel your diaphragm move as you breathe.
• Breathe in slowly through your nose so that your stomach moves out,
causing your hand to rise. The hand on your chest should remain as
still as possible.
• Tighten your stomach muscles, so that your stomach moves in,
causing your hand to lower as you breathe out. The hand on your
upper chest should remain as still as possible.
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33. •Transcendental Meditation (TM) – simple and
easily learned, requiring to be practiced for 20 minutes
twice daily while sitting with eyes closed and
repeating a ‘mantra’,a meaningless sequence of
sounds specific to each individual, to promote a
natural shift of awareness to a wakeful but deeply
restful state.
✓This experience is deemed responsible for the restoration
of normal function of various bodily systems, especially
those involved in adapting to environmental ―stressors or
challenges. 37

34. 38

35. •Mindfulness-Based Stress Reduction (MBSR) –
exercises that link thinking and its resulting impact on
feeling – astructured 8-week group program
employing mindfulness meditation in order to alleviate
mental and physical suffering, associated with physical,
and psychiatric disorders – yoga exercise!
✓Technique assumes that greater awareness of the here-and-
now will provide clearer and more accurate perception,
reduce negative affect and improve energy and coping.
✓Skills are cultivated, emotional regulation is developed, and
rumination and worry are significantly reduced. 40

36. https://www.yogabasics.com/practice/yoga-for-beginners/how-to-learn-
yoga-poses/
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37. • Emotional Freedom Technique (EFT) – works by aperson tapping
on some body points (nineofacupoints),while speakingaloud aspecific,
meaningfulshort phrase;resulting in changes leading to reduction of pain,
slowing of the heart rate,decreased anxiety
,shutting offthe arousal
response, andregulation of the nervous system,as well as to the creation
of a sense of calm.
✓Identify anissue that is bothering you; create astatement that describes
your issue,followed by a statement of self-acceptance.
✓For example, you could say
,"Even though I feelanxious about work
tomorrow, I deeply and completely accept myself." Or you could say
,
"Even though my partner broke up with me,I deeply and completely
accept myself.”Saythisstatementoutthreetimesforeachacupointyoutap.
✓Leads to reduced pain perception, increased acceptance, coping ability
and health-related quality of life 42

38. 44

39. • Other stress management strategies:
✓Address the cause of stress – basic needs availability;
✓Seek social company/support/care – meetyourdoctor
,DO
NOT Google it!
✓Counseling
✓Indulge in job/work/training (vocational)
✓Identify recovery goals and build hope of reaching them – you/I
can do it!
✓Reestablish relationships (intimate,etc.)
✓Monitor symptoms
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40. Q&A……..
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