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

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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.
  • 2. 2 3 major factors that affect the course of trauma treatment # 1. Typology 2. Presence of predominant trauma-related emotions? primary emotions • fear, horror, disgust secondary emotions • guilt, shame, anger 3. Degree of stabilization
  • 3. 3 Typology of Traumatic Events Accidental Trauma Man-Made Trauma Type I Trauma • single incident • acute life threat • unexpected • traffic accidents • occupational trauma (police, fire fighter) • work-related trauma • short-lived natural disaster (hurricane) • criminal/physical violence • sexual or physical assault • armed robbery • domestic violence Type II Trauma • repeated • prolonged • unpredictable course • long-standing natural disasters (flood) • technological catastrophes (e.g., toxic gas) • child sexual/physical abuse, severe neglect • emotional abuse • combat/war/torture • kidnapping/hostage taking, imprisonment
  • 4. 4 Non-FEAR Emotions often predominant in PTSD Anger Self-Blame Shame Guilt Helplessness
  • 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. 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. When relative stabilization is present, proceed with Trauma Processing Interventions
  • 8. CBT Trauma-Processing Models • Dual Representation Theory • Cognitive Therapy Model • Imagery-Based CBT Models