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PTSD in Partners: A Treatment Approach with Eye Movement

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PTSD in Partners: A Treatment Approach with Eye Movement (Accelerated Resolution Therapy)

Presented at IACSAS in Dalla on May 1,2,3 2014 by Dr. alexis Polles

Published in: Health & Medicine
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PTSD in Partners: A Treatment Approach with Eye Movement

  1. 1. Copyright 2014 Recovery That LastsCopyright 2014 Recovery That Lasts PTSD in Partners: A Treatment Approach with Eye Movements (Accelerated Resolution Therapy) Dallas, May 1,2,3, 2014 Presented by Alexis Polles, MD, PLLC www.RecoveryThatLasts.com agpolles@recoverythatlasts.com 601-255-5485
  2. 2. Copyright 2014 Recovery That Lasts Disclosures  None  No relevant financial issues  If medications are mentioned the generic name will be used and non-FDA approved uses will be stated
  3. 3. Copyright 2014 Recovery That Lasts OUTLINE I. Trauma and its sequelae II. Trauma in partners of sexual compulsives/addicts (focus on women) III. Treatment options IV. Use of special approaches in the treatment of trauma  Eye Movements V. Conclusion
  4. 4. Copyright 2014 Recovery That Lasts
  5. 5. Copyright 2014 Recovery That Lasts Definition of Trauma The diagnostic manual used by mental health providers (DSM-5) defines trauma an event that involves actual or threatened death or serious injury or sexual violation. The Merriam-Webster Dictionary defines it as a)an injury to living tissue caused by an extrinsic agent b)a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury or c)an emotional upset DSM-IV requirement that “The person’s response to the event must involve intense fear, helplessness or horror” has been eliminated in DSM-5.
  6. 6. Copyright 2014 Recovery That Lasts Trauma • May include events that are not beyond the scope of normal human experience, as long as the event has had a trauma-like impact on the person. • DSM-5 moved it from an Anxiety Disorder to Trauma- and Stress-or-Related Disorders • What makes an event traumatic: – The severity of the event – The proximity of the experience – The personal impact of the event – The after-event impact
  7. 7. Copyright 2014 Recovery That Lasts Potential Victims Of A Traumatic Stressor 1 Primary Victims Those individuals most directly affected by the event, e.g., the persons whose houses are blown down in a hurricane. 2 Secondary Victims Those individuals who in some way observe the consequences of the traumatic event on the primary victims, e.g., bystanders, rescuers, and emergency response personnel. (Partners/kids) 3 Tertiary Victims Those individuals who are indirectly affected by the traumatic event as a result of later exposure to the scene of the trauma or to the primary or secondary victims of the trauma.
  8. 8. Copyright 2014 Recovery That Lasts Trauma Spectrum Trauma - + + + + Consequences - -/+ + + +++ Impairment > 30d - - + ++ Re-experience, arousal and avoidant symptoms + ++ Co-occurring syndromes +
  9. 9. Copyright 2014 Recovery That Lasts Types of PTS/PTSD Simple PTS/D  The response to one or more traumatic events that are NOT linked in any way (e.g., one rape, one car accident, one sudden loss). Complex PTS/D  The response to a combination of specific traumatic events that ARE linked to each other in some way or occur repeatedly over time
  10. 10. Copyright 2014 Recovery That Lasts Natural vs. Human Made  Prolonged stressors, deliberately inflicted by people, are far harder to bear than accidents or natural disasters. If this was done deliberately, in the context of an ongoing relationship, the problems are increased. The worst situation is when the injury is caused deliberately in a relationship with a person on whom the victim is dependent – most extreme is parent-child; spouse or partner infidelities/betrayals are high on the list
  11. 11. Copyright 2014 Recovery That Lasts Symptom Clusters (Four in DSM-5) • Re-experiencing (nightmares, intrusive images) • Avoidance • Persistent Negative Alterations in Cognitions and Mood (includes numbing, distorted self-blame, estrangement, inability to remember key aspects of the event) • Arousal (includes fight and flight) Subtypes include kids < 6 and dissociative
  12. 12. Copyright 2014 Recovery That Lasts
  13. 13. Copyright 2014 Recovery That Lasts Trauma is an experience that overwhelms our capacity to have a sense of control over ourselves and our immediate environment, to maintain connection with others and to make meaning of our experience. In Summary:
  14. 14. Copyright 2014 Recovery That Lasts Effects of Trauma on Brain Function Amygdala Sorts for immediate danger (significance) Pre-frontal Cortex (Integration and Planning) Hippocampus Stores longterm memory (cognitive map)
  15. 15. Copyright 2014 Recovery That Lasts Fear Response
  16. 16. Copyright 2014 Recovery That Lasts 16 Trauma Response Visual Cortex Amygdala
  17. 17. Copyright 2014 Recovery That Lasts
  18. 18. Copyright 2014 Recovery That Lasts Hypothalamus-Anterior Pituitary-Adrenal Cortex Axis  Cortisol (stress hormone) elevates blood sugar and increases metabolism  Body is then able to sustain prolonged activity  But immune system activity is decreased  High cortisol levels damage hippocampus  Learning and memory suffer as a result
  19. 19. Copyright 2014 Recovery That Lasts Tend and Befriend (Taylor, Lewis, Gruenwald, Gurung, Klein, & Updegraff, 2000; 2002)  Women developed other stress responses  To protect the child  To galvanize resources  Mediated by oxytocin
  20. 20. Copyright 2014 Recovery That Lasts Partner Trauma Is Financial Social Psychological Emotional Spiritual Sexual Modified from APSATS Multidimensional Trauma Model Training
  21. 21. Copyright 2014 Recovery That Lasts Therapeutic Options Psychosocial PharmacologicalComplementary
  22. 22. Copyright 2014 Recovery That Lasts Healing is Possible Evidence Supported Treatments  Narrative (oral, written, past tense, imaginal)  Cognitive Therapy, Cognitive Processing Therapy (TfCPT)  Exposure Therapy  Stress Inoculation Training (SIT)  Psychoeducation  Eye Movement Desensitization and Reprocessing  DBT Strategies  Mindfulness Based Strategies  Complementary and Integrative Modalities (Yoga, Meditation, Acupuncture)  Pharmacotherapy (alpha 2 ligands, SSRI, SNRI) Avoid Ambien for sleep. Consider B-blockers, and morphine in field or acute injury.
  23. 23. Copyright 2014 Recovery That Lasts
  24. 24. Copyright 2014 Recovery That Lasts How It Works Access relevant memory Stimulate brain with bilateral stimulation Move through channels of association until memory successfully resolved in EMDR or Image Replacement with ART
  25. 25. Copyright 2014 Recovery That Lasts Courtesy Dr. Uri Bergman
  26. 26. Copyright 2014 Recovery That Lasts NEURAL NETWORKS Courtesy Dr. Uri Bergman
  27. 27. Copyright 2014 Recovery That Lasts Yes, this is part of healing!
  28. 28. Copyright 2014 Recovery That Lasts The Conclusion The trauma reactions of partners of sexual addicts who have been terrorized and repetitively assaulted are not due to the person’s “underlying issues,” they are the issue.
  29. 29. Copyright 2014 Recovery That Lasts Core Principles of Partner Trauma  Almost all the behaviors are coping strategies.  Reactions are not character flaws.  Reactions are affected by supports and circumstances.  Behaviors may be effective or ineffective.  Responses will change if safety is established, though all triggers may not be eliminated.  There can be reconnection that is healthier and more deeply satisfying with God, ones self, and others, including the perpetrator.
  30. 30. Copyright 2014 Recovery That Lasts Alexis Polles, MD, PLLC agpolles@recoverythatlasts.com 601-255-5485 www.RecoveryThatLasts.com

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