Smucker, Mervin (2012). Critical factors that affect course of trauma treatment. 1
3 major factors that affect the course of trauma treatment #1. Typology2. Presence of predominant trauma-related emotions? primary emotions • fear, horror, disgust secondary emotions • guilt, shame, anger3. Degree of stabilization 2
Typology of Traumatic Events Accidental Trauma Man-Made TraumaType I Trauma • traffic accidents • criminal/physical • occupational trauma violence• single incident (police, fire fighter) • sexual or physical• acute life threat assault • work-related trauma• unexpected • armed robbery • short-lived natural disaster (hurricane) • domestic violenceType II Trauma • child sexual/physical • long-standing natural abuse, severe neglect• repeated disasters (flood) • emotional abuse• prolonged • technological • combat/war/torture• unpredictable catastrophes • kidnapping/hostage course (e.g., toxic gas) 3 taking, imprisonment
Non-FEAR Emotions often predominant in PTSDAnger Self-Blame Shame Guilt Helplessness 4
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?