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Mervin Smucker 2012 - Critical Factors Affecting Trauma Treatment


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Mervin Smucker (2012). Critical factors that affect the course of trauma treatment

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Mervin Smucker 2012 - Critical Factors Affecting Trauma Treatment

  1. 1. Smucker, Mervin (2012). Critical factors that affect course of trauma treatment. 1
  2. 2. 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
  3. 3. 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
  4. 4. Non-FEAR Emotions often predominant in PTSDAnger Self-Blame Shame Guilt Helplessness 4
  5. 5. 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?
  6. 6. Stabilization Interventions • Dialectical Behavioral Therapy – Affective Regulation – Mindfulness Training • Sleep-Focused Interventions – Medication – CBT • Self-Calming/Self-Soothing Exercises • Stabilization Imagery • Grounding Interventions – Relaxation Exercises, Music, Dance – Physical Activity / Exercise • Medication Management
  7. 7. When relative stabilization is present, proceed with Trauma Processing Interventions
  8. 8. CBT Trauma-Processing Models• Dual Representation Theory• Cognitive Therapy Model• Imagery-Based CBT Models