Post Traumatic 2008


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  • Talk about my background- my work with the VA hospital Maybe my father
  • Post Traumatic 2008

    1. 1. POST TRAUMATIC STRESS DISORDER Working with Trauma Clients in the Shelter System Developed under contractual agreement between New York State Office of Temporary and Disability Assistance and Brookdale Center for Healthy Aging & Longevity of Hunter College 2007
    2. 2. Learning Objectives <ul><li>Upon completion of this workshop, participants will be able to: </li></ul><ul><li>Identify the major causes of PTSD </li></ul><ul><li>Recognize presenting symptoms and triggers of PTSD </li></ul><ul><li>Specify appropriate coping mechanisms </li></ul><ul><li>Describe the differences between simple and complex PTSD </li></ul><ul><li>Demonstrate an understanding of how to work with trauma survivors </li></ul><ul><li>Discuss the effects of secondary traumatization and identify key prevention measures for staff </li></ul>
    3. 3. What is PTSD? <ul><li>Post Traumatic Stress Disorder </li></ul><ul><ul><li>is defined as a psychological disorder that follows an individual’s personal experience with or witnessing of life-threatening events. </li></ul></ul>
    4. 4. How does PTSD affect the population? <ul><li>An estimated 7.8% of Americans will experience PTSD at some point in their lives </li></ul><ul><li>3.6% of the adult population (18-54 yrs.) will have PTSD during the course of a given year </li></ul><ul><li>Women are twice as likely to develop PTSD as men. </li></ul><ul><li>Lifetime prevalence of PTSD for women has been estimated to be as high as 18%. </li></ul><ul><li>About 60% of those who develop PTSD recover (even without treatment.) </li></ul>
    5. 5. Symptoms of PTSD <ul><li>There are three main symptoms of PTSD: </li></ul><ul><li>HYPERAROUSAL </li></ul><ul><li>INTRUSION </li></ul><ul><li>CONSTRICTION </li></ul>
    6. 6. HYPERAROUSAL <ul><li>Chronic arousal of the autonomic nervous system </li></ul><ul><ul><li>Increased startle response </li></ul></ul><ul><ul><li>Hyperalertness </li></ul></ul><ul><ul><li>Elevated baseline of arousal </li></ul></ul><ul><ul><li>Intense reaction to specific stimuli associated with the traumatic event </li></ul></ul>
    7. 7. INTRUSION <ul><li>The reliving or re-experiencing of the traumatic events </li></ul><ul><ul><li>Flashbacks </li></ul></ul><ul><ul><li>Waking states </li></ul></ul><ul><ul><li>Nightmares </li></ul></ul><ul><ul><li>Any reminder that can evoke the original traumatic event </li></ul></ul>
    8. 8. INTRUSION (continued) <ul><li>Most survivors do not consciously seek to relive a trauma. Reliving a traumatic event can provoke such feelings as: </li></ul><ul><ul><li>Fear </li></ul></ul><ul><ul><li>Anger </li></ul></ul><ul><ul><li>Emotional distress </li></ul></ul><ul><ul><li>Isolation </li></ul></ul><ul><ul><li>Avoidance </li></ul></ul>
    9. 9. CONSTRICTION <ul><li>This is caused by situations of inescapable danger that invoke a state of calm in which terror, rage, and pain dissolve. </li></ul><ul><li>Physical Symptoms </li></ul><ul><ul><li>Numbing </li></ul></ul><ul><ul><li>Distorted perceptions </li></ul></ul><ul><ul><li>Loss of particular sensations </li></ul></ul><ul><ul><li>Time sense may be altered (ie: slow motion) </li></ul></ul><ul><ul><li>May feel event is not happening (experience outside of body) </li></ul></ul>
    10. 10. CONSTRICTION (continued) <ul><li>Emotional Symptoms </li></ul><ul><ul><li>Feeling of indifference </li></ul></ul><ul><ul><li>Emotional detachment </li></ul></ul><ul><ul><li>Profound passivity </li></ul></ul><ul><ul><li>Suspension of initial and critical judgment </li></ul></ul><ul><ul><li>Trance states </li></ul></ul>
    11. 11. Signs & Symptoms of PTSD <ul><li>Physical </li></ul><ul><li>Cognitive </li></ul><ul><li>Emotional </li></ul>
    12. 12. Associated Features of a Trauma Client <ul><li>Self Recrimination-shame/guilt </li></ul><ul><li>Shattered Assumptions- negative feelings towards self, world, and others </li></ul><ul><li>Mood Disturbances </li></ul><ul><li>Addictions </li></ul><ul><li>Impulsive behaviors </li></ul><ul><li>Somatic (physical) complaints </li></ul><ul><li>Overcompensation </li></ul><ul><li>Death anxiety </li></ul><ul><li>Repetition compulsion </li></ul><ul><li>Self-mutilation </li></ul><ul><li>Other addictions and self-destructive behavior </li></ul><ul><li>Alexithymia-general shutting down of feelings </li></ul><ul><li>Changes in personality </li></ul>
    13. 13. Recognizing the Triggers of PTSD <ul><li>Recognizing triggers and realizing their power to elicit intrusions are steps toward controlling PTSD symptoms. </li></ul><ul><li>Triggers are defined within 12 categories. </li></ul><ul><li>1.Visual 7. Stressful events </li></ul><ul><li>2. Sound 8. Strong emotions </li></ul><ul><li>3. Smell 9. Thoughts </li></ul><ul><li>4. Taste 10. Behaviors </li></ul><ul><li>5. Physical or Body 11. Out of the blue </li></ul><ul><li>6. Significant dates or seasons 12. Combinations </li></ul>
    14. 14. Trauma Events & Triggers <ul><li>GROUP EXERCISE </li></ul><ul><li>Match the trigger with the original traumatic event </li></ul>Dark clouds; strong winds Asthmatic breathing Male boss criticizes Elevator Seeing a crime on television Firecracker Entering a subway tunnel Campfire/BBQ Physical assault gunfire Abuse by father Fire Hand held over mouth of rape victim Trench warfare Tornado Taken captive
    16. 16. Understanding the difference between Simple and Complex PTSD <ul><li>Simple/Acute PTSD </li></ul><ul><ul><li>Short lived trauma (i.e.: car accidents, natural disasters, rape) </li></ul></ul><ul><li>Complex/Chronic PTSD </li></ul><ul><ul><li>Long term trauma that can continue for months or years </li></ul></ul><ul><ul><li>Victim’s is held in a state of captivity </li></ul></ul>
    17. 17. Understanding the difference between Simple and Complex PTSD (continued) Combat Stress Acute Stress Disorder Acute PTSD Chronic PTSD TRAUMA 2 Days 1 Month 3 Months Acute Stress Disorder- symptoms develop after a few days or weeks after traumatic event Acute PTSD- Symptoms have been present for less than 3 months PTSD - symptoms persist for a period of time or occurs at least 6 months after event occurred ( delayed onset) Chronic PTSD- Symptoms have lasted longer than 6 months
    18. 18. Trauma Bubbles DEFENSE memory EMOTION BEHAVIOR despair shame terror helplessness shame terror helplessness horror rage grief
    19. 19. Chronic PTSD & Disassociation <ul><li>Harmless State </li></ul><ul><li>Harmful State </li></ul><ul><li>Most Severe State </li></ul>
    20. 20. PTSD and Diversity
    21. 21. Trust and the Trauma Client <ul><li>Trust and Safety are interrelated when working with trauma clients. </li></ul>
    22. 22. Understanding Trust and the Trauma Client <ul><li>Many trauma survivors are mistrustful of others in the following areas: </li></ul><ul><ul><li>Giving information about them and the trauma </li></ul></ul><ul><ul><li>Believing in what others say </li></ul></ul><ul><ul><li>Being able to depend or rely on others </li></ul></ul><ul><ul><li>Fear of losing control </li></ul></ul>
    23. 23. Personal Control and the Trauma Client <ul><li>Trauma survivors have often had their environments or bodies invaded by either events or other people. </li></ul>
    24. 24. Working with Trauma Clients <ul><li>OARS </li></ul><ul><ul><li>Observe </li></ul></ul><ul><ul><li>Assess </li></ul></ul><ul><ul><li>Refer </li></ul></ul><ul><ul><li>Summarize </li></ul></ul>
    25. 25. Healing and Recovery <ul><li>Healing starts by applying skills to manage PTSD symptoms of: </li></ul><ul><ul><li>Arousal </li></ul></ul><ul><ul><li>Anger </li></ul></ul><ul><ul><li>Intrusion </li></ul></ul><ul><li>Healing occurs when: </li></ul><ul><ul><li>traumatic memory is processed </li></ul></ul><ul><ul><li>Confronting replaces avoidance </li></ul></ul><ul><ul><li>In a climate of safety and pacing </li></ul></ul><ul><ul><li>When boundaries are intact </li></ul></ul>
    26. 26. Stages of Recovery <ul><li>Recovery of the survivor is based upon empowerment and the creation of new connections. </li></ul><ul><ul><li>STAGE ONE </li></ul></ul><ul><ul><li>STAGE TWO </li></ul></ul><ul><ul><li>STAGE THREE </li></ul></ul>
    27. 27. Healing, Recovery, and Growth Traumatic Event PTSD Healing Recovery Growth
    28. 28. Secondary Stress and the Worker <ul><li>A trauma survivor is exposed to the primary trauma while the worker is exposed to the trauma through the survivor. This is called secondary traumatization. </li></ul>
    29. 29. The Emotional Impact of Trauma Work <ul><li>Working with trauma survivors can be emotionally draining especially if the worker can relate through their own experiences. </li></ul>
    30. 30. Stages Leading to Burnout STAGE 1- Early Warning Signs Vague anxiety Fatigue Feelings of depression Apathy Moderate social isolation STAGE 2- Mild Burnout Lowered emotional control Increased anxiety Sleep disturbance Headaches Diffuse physical symptoms irritability STAGE 3- Moderate Burnout Skin rashes Generalized physical weakness Strong feelings of depression Increased blood pressure Emotional outbursts Development of irrational fears Difficulty with relationships Stage 4- Serious Burnout Serious medical conditions Severe withdrawal Accident proneness Severe depression Suicidal thoughts/actions Serious psychiatric disorders
    31. 31. Coping Techniques and the Trauma Worker <ul><li>Education about signs and symptoms of PTSD and secondary stress </li></ul><ul><li>Support Networks </li></ul><ul><li>Healthy Outlets for stress </li></ul><ul><li>Diet </li></ul><ul><li>Exercise </li></ul><ul><li>Personal power and control </li></ul><ul><li>Time Management and goal setting </li></ul>
    32. 32. How to Manage Overwhelming Stress <ul><li>Overall, stress management is a decision making process. When we are feeling the effects of a stressful event there are three basic ways we can approach that stress: </li></ul><ul><li>ALTER IT </li></ul><ul><li>AVOID IT </li></ul><ul><li>ACCEPT IT </li></ul><ul><ul><li>Building Resistance </li></ul></ul><ul><ul><li>Changing One’s Perceptions </li></ul></ul>
    33. 33. PTSD and the Individual <ul><li>Each individual has their own way of making sense of their own experiences and finding meaning in the traumatic event(s) that has occurred. </li></ul>
    34. 34. In Conclusion <ul><li>Remember, stress is not just an event but more importantly one’s perception of and association to the event. </li></ul><ul><li>“ An abnormal reaction to an abnormal situation is normal behavior” </li></ul><ul><ul><li>- Viktor Frankl (1966) </li></ul></ul>