Course Description:
Some of the toughest clients presenting for therapy are plagued by issues of co-occurring trauma and addiction. Although the popular 12-step approaches to addiction treatment are still appropriate for clients with posttraumatic stress disorder (PTSD) and other trauma-related diagnoses, rigid application of the disease model and 12-step principles may prove more harmful than helpful for clients in need. In this workshop, participants will learn how to blend traditional knowledge about the disease of addiction and 12-step approaches to recovery with the latest research and practice knowledge on trauma. As a result, participants will find that they will be able to better connect with addicted clients who struggle with trauma, and deliver the help that they so desperately need in a way that honors their experience. In this workshop, participants will learn how to blend traditional knowledge about the disease of addiction and 12-step approaches to recovery with the latest research and practice knowledge on trauma. As a result, participants will find that they will be able to better connect with addicted clients who struggle with trauma, and deliver the help that they so desperately need in a way that honors their experience.
Objectives:
Describe how certain 12-step approaches, slogans, and customs may be counterproductive when working with a traumatized client
Explain how certain features of 12-step recovery are productive for working with addicted survivors of trauma stress and identify how these features can be implemented into treatment
Develop a plan for working 12-step recovery strategies alongside appropriate treatment for the traumatic stress issue(s)
TREATMENT RESISTANT DEPRESSION IS A AREA THAT IS NOT EXPLORED MUCH, BUT IT REALLY NEEDS LOT OF ATTENTION AS IT IS ONE OF THE MOST COMMON OBSTACLE IN ACHIEVING COMPLETE REMISSION IN DEPRESSION
The diagnostic assessment and treatment and treatment planning in psychiatry is a dynamic process that integrates the biological, psychological, social, and behavioral paradigms to develop a plan of action that provides a rational for the types of interventions employed to sustain the therapeutic alliance and relieve suffering.
TREATMENT RESISTANT DEPRESSION IS A AREA THAT IS NOT EXPLORED MUCH, BUT IT REALLY NEEDS LOT OF ATTENTION AS IT IS ONE OF THE MOST COMMON OBSTACLE IN ACHIEVING COMPLETE REMISSION IN DEPRESSION
The diagnostic assessment and treatment and treatment planning in psychiatry is a dynamic process that integrates the biological, psychological, social, and behavioral paradigms to develop a plan of action that provides a rational for the types of interventions employed to sustain the therapeutic alliance and relieve suffering.
Classificatory systems - Advantages & DisadvantagesHemangi Narvekar
Classification of Diseases/Disorders are important to improve treatment and prevention efforts. Two important classification system used in the field of Mental Disorders are DSM -V and ICD -10. Here we will discuss Strengths and Weaknesses of both.
The function of defenses has been modified over the years, from a counter-force against instincts to the protection of self-esteem.
To understand the role of defenses in pathological and normal development, a coding method to use with Thematic Apperception Test (TAT) stories – the Defense Mechanism Manual (Cramer, 1991a) – has been developed
Three broad defenses – Denial, Projection, and Identification – may be coded with this method.
Research has shown that the two ego functions of defense and IQ are not correlated in childhood and adolescence, but are correlated in adulthood defenses and IQ.
Importantly, IQ serves as a moderator for the effect of defense use on variables such as
Psychiatric symptom change,
Level of Ego Development, and
Big Five personality traits
Recovery Through Balance is a Coaching Program for people recovering from addiction where we work together to create a highly personalized plan to ensure sobriety with support for sober behavior and personal responsibility.
The Gurū-Chelā Relationship Revisited: The Contemporary Relevance of the Work...Université de Montréal
The aims of this appreciation of the life and work of Jaswant Singh Neki (1925–2015), a leading Indian psychiatrist and Sikh scholar, are: (1) to revisit Neki's contributions to social psychiatry through his employment of the Indian paradigm of the gurū-chelā relationship; (2) to contrast and compare Neki's gurū-chelā paradigm for psychotherapy with the Western “I-centred paradigm” of psychotherapy; and (3) to examine the impact of Neki's gurū-chelā paradigm in India and the Indian diaspora and to synthesize it with contemporary trends in psychotherapy in Western societies.
Keywords: Gurū-chelā paradigm, Indian psychiatry, Jaswant Singh Neki, psychotherapy
USP Sensory Phenomena Scale-English version - with hypersensitivityAline Sampaio
Dear Colleague
I am glad to let available USP-Sensory Phenomena Scale that can be used for clinical or research purposes. It is a free of use instrument, developed by Prof. Dr. Eurípedes Miguel (USP) and Prof. Dr. Maria do Rosário (UNIFESP). It is useful for evaluation of just right perceptions, sensory phenomena, that are disturbing physical perceptions that preceeds or accompany repetitive behaviors such as tics or compulsions in OCD patients. Please, cite as:
Rosario MC, Prado HS, Borcato S, Diniz JB, Shavitt RG, Hounie AG, Mathis ME, Mastrorosa RS, Velloso P, Perin EA, Fossaluza V, Pereira CA, Geller D, Leckman JF, Miguel EC. Validation of the University of São Paulo Sensory Phenomena Scale: initial psychometric properties. CNS Spectrums. , v.14, p.315 - 323, 2009.),
plus:
Sampaio AS, McCarthy KD, Mancuso E, Stewart SE, Geller DA. Validation of the University of São Paulo's Sensory Phenomena Scale - English version. Compr Psychiatry. 2014 Jul;55(5):1330-6. doi: 10.1016/j.comppsych.2014.02.008. Epub 2014 Feb 25.
PMID: 24666717
This presentation explores some of the basic principals of CBT-CP. It is based on a treatment outline put out by the VA system. The slide show explores key treatment targets, session overview and some functional data on outcomes.
This presentation discusses the use of cognitive behavioral therapy and mindfulness in treating addiction.
By Tony Pacione, LCSW, CSADC
Harborview Recovery Center
Saint Joseph Hospital
Chicago, IL
Mental health and injury: Trauma, Rehabilitation and RecoveryValerie Lougheed
The Power Point Program presented by Val Lougheed at the Mental Health and Injury conference on April 19th, 2011, in Winnipeg, Manitoba, for the Rehabilitation Return to Work Partnership
EMDR & Mindfulness: Interventions for Trauma, Anxiety, Panic, and Mood Jamie Marich
Course Description (From www.pesi.com):
Attend this seminar and gain a deeper understanding of both Mindfulness and EMDR. Learn how and why they can be powerful tools for healing, and with whom and when it is suitable to use each. Experience various practices of Mindfulness, and leave with skills to teach Mindfulness to your clients. Increase your knowledge of how trauma affects the brain, and how Mindfulness and EMDR can improve patient outcomes. Clinicians not trained in EMDR: gain an overview of EMDR, how and why it works. Clinicians already trained in EMDR: update your skills and enhance your ability to use Mindfulness to deepen your sessions.
Dr. Jamie Marich is not only an EMDR expert, author, speaker and practicing clinician, she is the creator of ‘Dancing Mindfulness’, a powerful community-based practice that teaches people mindfulness principles through creative expression. She is known for her natural way of presenting the “complex” in very relatable terms that translates into your having real-life, effective tools to take back to your offices!
In addition to the seminar, you will take home a manual with dozens of specific strategies along with numerous recent citations from scientific literature attesting to the efficacy of EMDR and Mindfulness.
Classificatory systems - Advantages & DisadvantagesHemangi Narvekar
Classification of Diseases/Disorders are important to improve treatment and prevention efforts. Two important classification system used in the field of Mental Disorders are DSM -V and ICD -10. Here we will discuss Strengths and Weaknesses of both.
The function of defenses has been modified over the years, from a counter-force against instincts to the protection of self-esteem.
To understand the role of defenses in pathological and normal development, a coding method to use with Thematic Apperception Test (TAT) stories – the Defense Mechanism Manual (Cramer, 1991a) – has been developed
Three broad defenses – Denial, Projection, and Identification – may be coded with this method.
Research has shown that the two ego functions of defense and IQ are not correlated in childhood and adolescence, but are correlated in adulthood defenses and IQ.
Importantly, IQ serves as a moderator for the effect of defense use on variables such as
Psychiatric symptom change,
Level of Ego Development, and
Big Five personality traits
Recovery Through Balance is a Coaching Program for people recovering from addiction where we work together to create a highly personalized plan to ensure sobriety with support for sober behavior and personal responsibility.
The Gurū-Chelā Relationship Revisited: The Contemporary Relevance of the Work...Université de Montréal
The aims of this appreciation of the life and work of Jaswant Singh Neki (1925–2015), a leading Indian psychiatrist and Sikh scholar, are: (1) to revisit Neki's contributions to social psychiatry through his employment of the Indian paradigm of the gurū-chelā relationship; (2) to contrast and compare Neki's gurū-chelā paradigm for psychotherapy with the Western “I-centred paradigm” of psychotherapy; and (3) to examine the impact of Neki's gurū-chelā paradigm in India and the Indian diaspora and to synthesize it with contemporary trends in psychotherapy in Western societies.
Keywords: Gurū-chelā paradigm, Indian psychiatry, Jaswant Singh Neki, psychotherapy
USP Sensory Phenomena Scale-English version - with hypersensitivityAline Sampaio
Dear Colleague
I am glad to let available USP-Sensory Phenomena Scale that can be used for clinical or research purposes. It is a free of use instrument, developed by Prof. Dr. Eurípedes Miguel (USP) and Prof. Dr. Maria do Rosário (UNIFESP). It is useful for evaluation of just right perceptions, sensory phenomena, that are disturbing physical perceptions that preceeds or accompany repetitive behaviors such as tics or compulsions in OCD patients. Please, cite as:
Rosario MC, Prado HS, Borcato S, Diniz JB, Shavitt RG, Hounie AG, Mathis ME, Mastrorosa RS, Velloso P, Perin EA, Fossaluza V, Pereira CA, Geller D, Leckman JF, Miguel EC. Validation of the University of São Paulo Sensory Phenomena Scale: initial psychometric properties. CNS Spectrums. , v.14, p.315 - 323, 2009.),
plus:
Sampaio AS, McCarthy KD, Mancuso E, Stewart SE, Geller DA. Validation of the University of São Paulo's Sensory Phenomena Scale - English version. Compr Psychiatry. 2014 Jul;55(5):1330-6. doi: 10.1016/j.comppsych.2014.02.008. Epub 2014 Feb 25.
PMID: 24666717
This presentation explores some of the basic principals of CBT-CP. It is based on a treatment outline put out by the VA system. The slide show explores key treatment targets, session overview and some functional data on outcomes.
This presentation discusses the use of cognitive behavioral therapy and mindfulness in treating addiction.
By Tony Pacione, LCSW, CSADC
Harborview Recovery Center
Saint Joseph Hospital
Chicago, IL
Mental health and injury: Trauma, Rehabilitation and RecoveryValerie Lougheed
The Power Point Program presented by Val Lougheed at the Mental Health and Injury conference on April 19th, 2011, in Winnipeg, Manitoba, for the Rehabilitation Return to Work Partnership
EMDR & Mindfulness: Interventions for Trauma, Anxiety, Panic, and Mood Jamie Marich
Course Description (From www.pesi.com):
Attend this seminar and gain a deeper understanding of both Mindfulness and EMDR. Learn how and why they can be powerful tools for healing, and with whom and when it is suitable to use each. Experience various practices of Mindfulness, and leave with skills to teach Mindfulness to your clients. Increase your knowledge of how trauma affects the brain, and how Mindfulness and EMDR can improve patient outcomes. Clinicians not trained in EMDR: gain an overview of EMDR, how and why it works. Clinicians already trained in EMDR: update your skills and enhance your ability to use Mindfulness to deepen your sessions.
Dr. Jamie Marich is not only an EMDR expert, author, speaker and practicing clinician, she is the creator of ‘Dancing Mindfulness’, a powerful community-based practice that teaches people mindfulness principles through creative expression. She is known for her natural way of presenting the “complex” in very relatable terms that translates into your having real-life, effective tools to take back to your offices!
In addition to the seminar, you will take home a manual with dozens of specific strategies along with numerous recent citations from scientific literature attesting to the efficacy of EMDR and Mindfulness.
Val Lougheed's Power point Program for her talk, Trauma, Rehabilitation and Recovery, Staying Stronger Together; Brain Injury Association of Canada Conference, Regina SK, Thursday, Sept. 30th, 2010
CHAPTER SIXThe Age of AnxietyThe multiple perspectives we have.docxtiffanyd4
CHAPTER SIX
The Age of Anxiety
The multiple perspectives we have been using in this book are particularly useful in understanding the impact anxiety has on U.S. society. The word “anxiety” comes from a Latin root meaning to “choke or throttle” connoting a troubled state of mind (Tone, 2009). Anxiety disorders are believed to be the most common mental health problem in the United States. Two common measures are lifetime morbid risk (the theoretical risk of getting a disorder at any point in life) and 12-month prevalence (the proportion of the population thought to suffer from the disorder in any 12-month period). Baxter et al. (2013) conducted a meta-analysis of 87 studies from 44 countries between 1980 and 2009. They found that anxiety disorders are common across the globe with an estimated current prevalence of approximately as much as 28% of the global population. The prevalence of anxiety disorders in the United States is estimated for lifetime morbid risk/12-month prevalence as follows: Specific Phobia 18.4%/12.1%, Social Anxiety Disorder 13%/7.4%, Post Traumatic Stress Disorder (PTSD) 10.1%/3.7%, Generalized Anxiety Disorder 9%/2%, Separation Anxiety Disorder 8.7% /1.2%, and Panic Disorder, 6.8%/2.4%, (Kessler, Petukhova, Sampson, Zaslovsky, & Wittchen, 2012). Although anxiety disorders are prominent, it is important to realize that their incidence has remained steady over several decades despite pharmaceutically funded efforts to make the public think there is an epidemic that needs medicated (Baxter et al., 2014).
Although psychotropic medications are available for anxiety disorders, many psychological treatments also have excellent track records. Remember, from an integrative perspective it is not enough to describe anxiety symptoms, posit a biological explanation, then describe how certain drugs act biologically to (at least temporarily) decrease or eliminate these symptoms. With sentient beings, we have to look to the psychological, cultural and social variables that contribute to anxiety.
We recall a client (Elijah) who lived in what could be described as a “toxic environment.” Elijah's urban residence was the regular scene of violence, and he himself had witnessed two shootings in his 23 years. He was court-ordered to receive treatment for an alcohol-related charge (drunk and disorderly conduct). Even after abstaining from all drugs for 60 days, Elijah was what could only be described as “a nervous wreck.” He showed symptoms of both Panic Disorder and PTSD (the latter related to stimuli associated with the shootings he had witnessed). In consultation with a psychiatrist, who prescribed SSRI medication, Elijah asked why he had his symptoms, and the doctor replied, “Some people have a genetic predisposition to such things.” As Charlie Brown would say, “Good grief!” In this client's case, genetic predisposition not withstanding, there were clearly psychological, cultural, and social contributors to his anxiety. His alcohol use was a .
Depression, its true nature: a comprehensive course for mental health practit...Dr. Terry Lynch
Five decades ago, depression was considered to be relatively uncommon. Now, we are told that depression affects up to 1 in 5 people. But what exactly is this thing we now refer to as "depression"?
In this presentation, Dr. Terry Lynch sets out why he has created a comprehensive online course on the nature of depression for mental health practitioners.
Bottom line; the current prevailing view of depression is seriously flawed. A far more psychologically-oriented approach is required. In this presentation, Terry Lynch provides a glimpse of the comprehensive understanding of depression that is presented in detail in his online course.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Trauma and the Twelve Steps: Clinical Keys to Recovery Enhancement
1. Trauma and the 12 Steps:
Clinical Keys For Enhancing
Recovery Services
Jamie Marich, Ph.D., LPCC-S, LICDC
Counselor, PsyCare, Inc.
Founder, The Ohio Center for Mindful Living (Mindful Ohio)
Author, Trauma and the Twelve Steps
3. About the Presenter
Ohio: LPCC-S, LICDC
Member of the American Academy of Experts on
Traumatic Stress
Twelve years of experience working in social services
and counseling; includes three years of experience in
civilian humanitarian aid in Bosnia-Hercegovina
Specialist in addictions, trauma, abuse, dissociative
disorders, performance enhancement, grief/loss, and
pastoral counseling
Trained in several specialty interventions for trauma,
most extensively in EMDR
Author, qualitative researcher
Creator, Dancing Mindfulness & Founder of the Ohio
Center for Mindful Living
4. Objectives
O Describe how certain 12-step approaches, slogans, and customs
may be counterproductive when working with a traumatized client
O Define trauma in a biopsychosocial/spiritual manner and explain
how honoring this holistic conceptualization of trauma enhances
addiction treatment
O Explain how certain features of 12-step recovery are productive for
working with addicted survivors of trauma stress and identify how
these features can be implemented into treatment
O Develop a plan for working 12-step recovery strategies alongside
appropriate treatment for the traumatic stress issue(s)
O Apply at least three clinical techniques from various psycho-
therapeutic approaches to help clients attain addiction recovery in
a trauma-sensitive fashion
5. Dr. Marich’s Working Definition
O Addiction is continuing to do something
(e.g., drink alcohol, smoke cigarettes,
gamble, engage in sexual activity), even
when the activity causes repeated pain
and consequences.
SOURCE: GWC, Inc. (1993), Human Addiction
6. From Dr. Kevin McCauley
(2009):
O Organ Defect (Cause) Symptoms
7. From Dr. Kevin McCauley
(2009):
O Organ Defect (Cause) Symptoms
O Femur Fracture (e.g., skiing) Pain
O Pancreas No Insulin Blindness,
Numbness, Wounds
8. From Dr. Kevin McCauley
(2009):
O ___________ __________
_____________
9. From Dr. Kevin McCauley
(2009):
O ___________ __________
_____________
O Midbrain Various * Biopsychosocial
Consequences
* Addiction (McCauley): defect in the brain’s ability to
perceive, process, and act upon pleasurable/painful
experiences
10. Models of Addiction
Rigid acceptance of the disease
model, or any alternative model,
is not optimally trauma-sensitive.
14. PTSD: DSM-IV-TR
O Actual or perceived threat of injury or death- response
of hopelessness or horror (Criterion A)
O Re-experiencing of the trauma
O Avoidance of stimuli associated with the trauma
O Heightened arousal symptoms
O Duration of symptoms longer than 1 month
O Functional impairment due to disturbances
15.
16. For the latest updates on DSM-5,
visit the official website at
www.dsm5.org
17. Trauma: small-t
• Although not life-threatening, definitely life-altering
• If it’s traumatic to the person, then it’s
traumatic
• Examples include grief/loss, divorce, verbal
abuse/bullying, and just about everything
else…
18. Etymological Origin
O Trauma comes from the Greek
word meaning wound
O What do we know about physical
wounds and how they heal?
19.
20. A Client’s Perspective:
Lily Burana (2009)
“PTSD means, in ‘talking over beer’ terms, that you’ve
got some crossed wires in your brain due to the
traumatic event. The overload of stress makes your
panic button touchier than most people’s, so certain
things trigger a stress reaction- or more candidly- an
over-reaction. Sometimes, the panic button gets stuck
altogether and you’re in a state of constant alert,
buzzing and twitchy and aggressive.”
21. A Client’s Perspective:
Lily Burana (2009)
““Your amygdala- the instinctive flight, fight, or freeze partYour amygdala- the instinctive flight, fight, or freeze part
of your brain- reacts to a trigger before your rationalof your brain- reacts to a trigger before your rational
mind can deter it. You can tell yourself, ‘it’s okay,’ butmind can deter it. You can tell yourself, ‘it’s okay,’ but
your wily brain is already ten steps ahead of the game,your wily brain is already ten steps ahead of the game,
registering danger and sounding the alarm. So youregistering danger and sounding the alarm. So you
might say once again, in a calm, reasoned cognitive-might say once again, in a calm, reasoned cognitive-
behavioral-therapy kind of way, ‘Brain, it’s okay…’behavioral-therapy kind of way, ‘Brain, it’s okay…’
22. A Client’s Perspective:
Lily Burana (2009)
“But your brain yells back, ‘Bullshit kid, how dumb do you
think I am? I’m not falling for that one again.’ By then,
you’re hiding in the closet, hiding in a bottle, and/or
hiding from life, crying, raging, or ignoring the phone
and watching the counter on the answering machine go
up, up, up, and up. You can’t relax, and you can’t
concentrate because the demons are still pulling at
your strings.”
23. A Client’s Perspective:
Lily Burana (2009)
“The long-range result is that the peace of mind you
deserve in the present is held hostage by the terror
of your past.”
24. A Client’s Perspective:
from Marich (2010)
Fadalia (pseudonym), a recovering heroin addict with complex
trauma reflected on where she was at before receiving the
integrated treatment that led to her longest sobriety to date
(3 years):
“Before [treatment], my feelings,
thoughts and experiences were all
tangled like a ball of yarn. I needed
something to untangle them.”
28. Putting it Simply…
O Cognitive-behavioral therapies primarily target
the prefrontal regions of the brain (e.g.,
thinking, judgment, and willpower).
However, when a person gets activated or
triggered by traumatic memories or other
visceral experiences, the prefrontal cortex is
likely to shut down and the limbic brain (e.g.,
emotional brain) takes over.
29. Putting it Simply…
O Simply talking about the trauma can trigger this
volatile, limbic region, and if the client has no
skills to regulate these intense emotions, a
client can be re-traumatized.
30. Putting It Simply
O What does not seem to change with traditional talk
therapy is that uncomfortable experience of being
triggered at a visceral level, (bottom of the brain)
when the person is faced with reminiscent features of
the original trauma in the present (Brown, 2003)
31. Putting it Simply
O Thus, our therapeutic interventions must
address the entire brain.
O Another way to look at processing is to
think of these three brains “linking up”
33. How Significant is Trauma When it
Comes to Treating Addictions?
-High comorbidity between PTSD and substance use
disorders: 27.9% of those with PTSD meet criteria for
substance abuse, 34.5% meet criteria for dependence
(Kessler et al., 1995; (Peirce, Kindbom, Waesche,
Yuscavage, & Brooner, 2008)
-Of patients in substance disorder treatment, 12-34%
have PTSD; these numbers can be as high as 33-59% in
women (Najavits,2001; 2005).
34. How Significant is Trauma When it
Comes to Treating Addictions?
Comorbidity between PTSD and
addictions has been established, and
untreated PTSD has been identified as a
factor in relapse
(Miller & Guidry, 2001; Zweben & Yeary, 2006)
35. Ricci and Clayton (2008)
“Trauma may also disintegrate any sense of a
future, thus fostering a propensity for the
pursuit of instant gratification” (p. 42).
36. A Brief Primer on
12-Step Recovery
O Alcoholics Anonymous founded in 1935 by Bill Wilson
and Dr. Bob Smith in Akron, OH
O Both had been members of the Oxford Groups
O Decided to focus on reaching out just to the alcoholic
(a difference from the Oxford Groups), but kept many
of the same principles
37. A Brief Primer on
12-Step Recovery
• Six steps of the Oxford Groups:
1. Admitted hopelessness
2. Got honest with self
3. Got honest with another
4. Made amends
5. Help others
6. Prayed to God as you understand him
38. A Brief Primer on
12-Step Recovery
O The publication of the book Alcoholics Anonymous in
1939 gave the fellowship a name, saw the publication
of the first draft of the 12-steps, and gave the A.A.
fellowship some uniformity
O Although A.A. co-founder Bill Wilson is the primary
author of the first part of the “Big Book,” various edits
of the book were passed back and forth between the
New York and Akron groups.
39. Context: A Brief Primer on
12-Step Recovery
O Bill Wilson (who was the New Yorker) and the
Akron groups wanted to keep the focus on
spirituality.
O The New York groups wanted to keep the focus on
the physical aspects of alcoholism.
O What emerged was a combination of the two
approaches
40. A Brief Primer on
12-Step Recovery
• The groups hoped that the initial publication of the
book in April of 1939 would propel the message of
Alcoholics Anonymous into the mainstream
• To the dismay of the groups, orders for the book only
“trickled” in
• The Rockerfeller foundation assisted with getting the
4,000 non-purchased copies of the book out of
storage
• There was not a need for a second printing of the so-
called “Big Book” until 1941
41. A Brief Primer on
12-Step Recovery
• It was actually The Saturday Evening Post article in
March 1941 that caused the membership of
Alcoholics Anonymous to expand exponentially
throughout the United States.
• Noted writer Jack Alexander had set out to expose A.A.
as a fraud…what emerged was 6 pages of praise about
the A.A. fellowship, necessitating a second printing of
the Big Book.
42. A Brief Primer on
12-Step Recovery
Fruits of Alcoholics Anonymous (A.A.):
Acknowledgment of addiction as a disease by the
American Medical Association in 1952
Influenced the development and rise to popularity of
the Minnesota model of treatment in the 1950’s
Prompted the founding of hundreds of related
fellowships that also use the 12-steps
43. 12 Steps of Alcoholics Anonymous (1939/2001)
Step 1 - We admitted we were powerless over alcohol- that our lives had
become unmanageable
Step 2 - Came to believe that a Power greater than ourselves could restore
us to sanity
Step 3 - Made a decision to turn our will and our lives over to the care of God
as we understood God
Step 4 - Made a searching and fearless moral inventory of ourselves
Step 5 - Admitted to God, to ourselves and to another human being the exact
nature of our wrongs
Step 6 - Were entirely ready to have God remove all these defects of
character
Step 7 - Humbly asked God to remove our shortcomings
Step 8 - Made a list of all persons we had harmed, and became willing to
make amends to them all
Step 9 - Made direct amends to such people wherever possible, except when
to do so would injure them or others
Step 10 - Continued to take personal inventory and when we were wrong
promptly admitted it
Step 11 - Sought through prayer and meditation to improve our conscious
contact with God as we understood God, praying only for knowledge of God's
will for us and the power to carry that out
Step 12 - Having had a spiritual awakening as the result of these steps, we
tried to carry this message to other addicts, and to practice these principles
in all our affairs
44. Let’s Discuss…
O What are your thoughts/feelings on 12-step recovery?
O What limitations have you encountered with 12-step
recovery in certain populations?
O What does it mean for an intervention, such as 12-step
recovery, to be trauma-sensitive?
45. Common Criticisms of
12-Step Recovery
O Too much emphasis on spirituality
O Too one-size fits all
O Emphasis on powerlessness and character defects is
counter-therapeutic
O Certain 12-step groups and treatment centers can get
too fanatic
O Disease model of addiction is not acceptable
46. Common Problems in
Treatment
O Rigid application of 12-step principles
without considering role of trauma
O “They’re just addicts”
O “You’re here to work on your addiction, not
the trauma”
O Tricky scenarios in group work
48. Potentially Problematic
12-Step Slogans
O Just For Today/One Day at a Time
O Take the Cotton Out of Your Ears and Put it
in Your Mouth
O Your Best Thinking Got You Here
O Think, Think, Think
O We Are Only as Sick as Our Secrets
O Any misplaced spirituality slogan…
49. And The Gauntlet…
4th
and 5th
Step Work
4. Made a searching and fearless moral
inventory of ourselves
5. Were entirely ready to have God remove
all these defects of character
What makes these steps nearly impossible
for someone with unresolved trauma
issues?
50. Case Study: Nancy (Marich, 2009)
You can’t put anything in the proper perspective. And you can’t
really get a heads up on what really happened because you were
so traumatized and you had such bad experiences and like in my
case, I had the trauma then I had the- I call it the after-effect of
my ex-husband- pounding over and over and over and over it for
like 14 years after that. I took so much responsibility for it. It
was almost like I victimized myself all over again in my mind.
51. PROBLEM #2
“They’re just addicts…”
-and/or-
“You’re here to work on your
addiction, not your trauma.”
52. Evans & Sullivan (1995):
Living in the Solution
1.) A large portion of clients presenting for treatment in
any setting have a history of childhood trauma.
Respecting this history enhances treatment.
2.) Successful treatment of the trauma must include
working through memories of the trauma in an
experiential way, after the clinician and client have
established a foundation of safety and coping skills
53. Evans & Sullivan (1995):
Living in the Solution
3.) Substance use disorders are a significant part of the
clinical picture for a substantial number of survivors of
childhood abuse, thus:
-Treatment of the abuse issues that does
not address the substance use issues will
be ineffective
- Treating only the addiction in those with
survivor issues will likely be ineffective
54. Evans & Sullivan (1995):
Living in the Solution
4.) The disease model of addiction and conventional 12-
step approaches to treatment are productive in treating
the addicted survivor of trauma
5.) Treatment models for addicted survivors of trauma
must be integrated, and must address the synergism
of trauma and addiction. A two-track approach is
generally ineffective.
55. Practical Tips for
12-Step Facilitation
O Get to know the local meetings in your area that
are known for tolerance
O Encourage gender-specific meetings
O Advise looking for a sponsor who has at least a
basic understanding of trauma and/or someone
who is not strictly “letter of the law”
56. Practical Tips for
12-Step Facilitation
O Encourage clients to bring their concerns about
what they see/hear at 12-step meetings to
counseling
O Work with clients to build a set of practical, body-
based coping skills (e.g., breath work, muscle
relaxation, exercise, music, journaling) especially
before 4th
and 5th
step work
57. Practical Tips for
12-Step Facilitation
O Consider using individual counseling to help clients
identify their roadblocks to successfully completing
4th
and 5th
steps (may also apply to 8th
and 9th
steps)
O Evaluate with a client whether or not the 5th
step will
be best completed with a trained professional…
remember, the step just says another human being
58. Practical Tips for
12-Step Facilitation
O Be prepared to process pejorative slogans or
insults to self that clients may hear in meetings or
from traditional counselors
O Name calling and hot seat strategies, even if done
in a spirit of “tough love” can be incredibly
damaging for the traumatized client
61. Wrap-Up: Best Practices for
Interacting with Clients
O Do not re-traumatize!
O Do be genuine
O Do ask open-ended questions
O Do be non-judgmental
O Do make use of the stop sign when appropriate
O Do assure the client that they may not be alone
in their experiences (if appropriate)
O Have closure strategies ready
O Do consider the role of shame in addiction,
trauma, and grief
62. What is Shame?
Guilt is feeling bad about what
you’ve done,
Shame is feeling bad about who
you are.
“Shame is the lie that someone
told you about yourself.”
-Anais Nin
63. “When we honestly ask ourselves which
person in our lives means the most to us,
we often find that it is those who, instead
of giving advice, solutions, or cures, have
chosen rather to share our pain and
touch our wounds with a warm and
tender hand.”
-Henri Nouwen
65. From Dr. Bessel Van Der Kolk
“The purpose of trauma treatment
is to help a person feel safe in his
or her own body.”
-from a the new documentary
Trauma Treatment for the 21st
Century (Premier, 2012)
66. General Consensus Model of
Trauma Treatment
OPHASE I: Stabilization
OPHASE II: Processing of Trauma
OPHASE III: Reintegration
67. Incorporating into Addiction Treatment
O Research is continuing to demonstrate that any of
these past-oriented treatments can be
appropriately applied to an integrated addiction
treatment program when proper precautions are
taken (Marich, 2010)
68. Tying it All Together…
O Before any clinician can engage in past-
oriented trauma treatments focused on
resolution, a set of coping skills must be in
place.
69. Phase I Treatment Planning
-A set of coping skills must be in place
before heavier trauma resolution
therapies can take place.
-Initial treatment is a valuable time to
help with coping skills training and
installation.
70. What Types of Coping
Skills Work Best???
O Breath work
O Muscle relaxation/pressure points
O Yoga
O Imagery/multisensory soothing
O Resources & Recovery Capital
O Spiritual principles
O Anything that incorporates the body in a
positive, adaptive way!!!
72. Breathing Basics
"Practicing regular, mindful breathing can be
calming and energizing and can even help with
stress-related health problems ranging from panic
attacks to digestive disorders.“
Andrew Weil, M.D.
73. Breathing Basics
“Teaching breathing exercises to your client is like
teaching a teenager when to accelerate and when
to brake the car.”
Amy Weintraub
75. Breathing Basics
O Clients who are easily activated may not feel
comfortable closing their eyes during breath work..
O Start slowly…if a client is not used to breathing
deliberately, don’t overwhelm him. Starting with a
few simple breaths, and encouraging repetition as a
homework assignment, is fine.
O If a client has a history of medical difficulties, make
sure to obtain a release to speak with her medical
provider before proceeding.
78. Yoga: Hype or Hope?
O Dr. Bessel Van Der Kolk is a leading research
proponent of using yoga as a primary and
adjunctive treatment for PTSD
O Yoga, if integrated safely and appropriately, is at
very least, an ideal coping skill technique in
traumatized individuals
O Many addiction treatment centers throughout the
world offer yoga
83. Strategy #5: Mindfulness
Mindfulness means paying attention in a
particular way: on purpose, in the presence
of the moment, and non-judgmentally.
-Jon Kabat-Zinn (1994)
84. Strategy #6: Acceptance
- acceptance as Buddhist principle
- 12-step recovery (Alcoholics Anonymous, 2001;
p. 417)
-”radical acceptance” (from dialectical behavioral
therapy)
-acceptance and commitment therapy
85. Strategy #7: Empowerment
O Encourage that change is possible, no matter how
chronic the relapser… be sincere about it (Marich,
2010).
O Foster identification as a survivor, not a victim
(Hantman & Solomon, 2007)
87. Factors to Consider Before
Going Farther …
O Does the client have a reasonable amount of
coping skills to access?
O Is there a sufficient amount of positive material
(e.g., recovery capital) in the client’s life?
O Is the client willing (and ready) to look at past
issues? In 12-step terms, this is best done between
steps 1-3 and 4-5.
O Have you assessed for secondary gains and other
related issues?
O Have you considered number of sessions available?
90. The Common Factors
O Client and extratherapeutic factors
O Models and techniques that work to engage
and inspire the participants
O The therapeutic relationship/alliance
O Therapist factors
Source: Duncan, B.L., Miller, S.D., Wampold, B.E., Hubble,
M.E. (2009). The heart and soul of change: Delivering what
works in psychotherapy. (2nd
ed.) Washington, D.C.:
American Psychological Association.
91. Some Reprocessing
Approaches You May
Already Incorporate…
O Narrative Therapy
O Trauma-Focused CBT
O Gestalt Elements
O Mindfulness-Based Cognitive Therapy
O Somatic experiencing
93. Intense Affect & Abreaction
O “The therapeutic process of bringing forgotten or
inhibited material (i.e., experiences, memories) from
the unconscious into consciousness, with
concurrent emotional release and discharge of
tension and anxiety.”
APA Dictionary of Psychology; VandenBos (2007)
94. For Continued Development
O What are my personal barriers with addiction and
trauma?
O How do I handle intense affect and abreaction?
O What factors may inhibit me from being effective
with a traumatized addict?
O When is the best time to use collaborative
referrals?
95. Why it Matters…
O The literature in general traumatic stress
studies suggests that the therapeutic alliance
between client and clinician is an important
mechanism in facilitating meaningful change
for clients with complex PTSD (Fosha, 2000;
Fosha & Slowiaczek, 1997; Courtois &
Pearlman, 2005)
96. Tips for Collaborative Referral
O Know your limits. If a client is triggering you too
much, don’t be afraid to refer.
O Network in your local community—get to know who
offers what and who seems to be most
knowledgeable in trauma and addiction.
O The Internet is a treasure trove of resources. Many
of the major websites in trauma therapies have
data bases listing clinicians around the country
who have gone through extra training.
97. Tips for Collaborative Referral
O In making psychiatric referral, get to know the doctors
(or nurse practitioners) in your area who have a
prudent, balanced approach to medication.
O It is not wise to send a client who struggles with
addiction and trauma issues to a psychiatrist who
relies heavily on benzodiazepine prescribing (or use
of other controlled substances)
99. References
O Alcoholics Anonymous World Services. (2001). Alcoholics anonymous. (4th
ed.) New York: Author.
O American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. (4th
ed.-text revision) Washington, D.C.: Author.
O Brown, S. (2003). The missing piece: The case for EMDR-based treatment for posttraumatic stress
disorder and co-occurring substance use disorder. LifeForce Trauma Solutions. Retrieved June 4,
2008, from http://www.lifeforceservices.com/ article_detail.php?recordid=5
O Burana, L. I love a man in uniform: A memoir of love, war, and other battles. New York: Weinstein
Books.
O Courtois, C.A., & Pearlman, L.A. (2005). Clinical applications of the attachment framework: Relational
treatment of complex trauma. Journal of Traumatic Stress, 18(5), 449-459.
O Cunningham, A. (2010). Healing addiction with yoga: A yoga program for people in 12-step recovery.
Forres, Scotland, UK: Findhorn Press.
O Duncan, B.L., Miller, S.D., Wampold, B.E., Hubble, M.E. (2009). The heart and soul of change:
Delivering what works in psychotherapy. (2nd
ed.) Washington, D.C.: American Psychological
Association.
O Evans, K., & Sullivan, J.M. (1995). Treating addicted survivors of trauma. New York: The Guilford
Press.
O Fosha, D. (2000). The transforming power of affect: A model for accelerated change. New York:
Basic Books.
O Fosha, D., & Slowiaczek, M.I. (1997). Techniques to accelerate dynamic psychotherapy. American
Journal of Psychotherapy, 51(2), 229-251.
O GWC, Inc. (1993). Human addiction [VHS Tape]. Cahokia, IL: Author.
O Hantman, S., & Solomon, Z. (2007). Recurrent trauma: Holocaust survivors cope with aging and
cancer. Social Psychiatry & Psychiatric Epidemiology, 42, 396-402.
O Kabat-Zinn, J. (1994). Full catastrophe living: Using the wisdom of your body and mind to face
stress, pain, and illness. New York: Dell Publishing.
O Kessler, R.C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C.B. (1995). Posttraumatic stress
disorder in the national comorbidity survey. Archives of General Psychiatry, 52, 1048-1060.
100. References
O Marich, J. (2009). EMDR in addiction continuing care: Case study of a cross-addicted female’s
treatment and recovery. Journal of EMDR Practice and Research, 3(2), 98-106.
O Marich, J. (2010). EMDR in addiction continuing care: A phenomenological study of women in early
recovery. Psychology of Addictive Behaviors, 24(3), 498-507. McCauley, K. (2009). Pleasure
unwoven. [DVD]. Salt Lake City, UT: Institute for Addiction Study.
O Miller, D. & Guidry, L. (2001). Addictions and trauma recovery: Healing the body, mind, and spirit.
New York: W.W. Norton.
O Najavits, L. (2001). Seeking safety: A treatment manual for PTSD and substance abuse. New York:
The Guilford Press.
O
O Najavits, L. (2005). Handouts for training on PTSD and Seeking Safety. ODADAS Women’s
Symposium, May 16-19, 2006.
O Peirce, J.M., Kindbom, K.A., Waesche, M.C., Yuscavage, A.S., & Brooner, R.K. (2008). Post-traumatic
stress disorder, gender and problem profiles in substance dependent patients. Substance Use and
Misuse, 43, 596-611.
O Premiere Education & Media. (2012). Trauma treatment: Psychotherapy for the 21st
century [DVD].
Eau Claire, WI: Author.
O Ricci, R.J., & Clayton, C.A. (2008). Trauma resolution treatment as an adjunct to standard treatment
for child molesters. Journal of EMDR Practice and Research, 2(1), 41-50.
O VandenBos, G.R. (Ed.) (2007). APA dictionary of psychology. Washington, DC: The American
Psychological Association.
O Weintraub, A. (2012). Yoga skills for therapists. New York: W.W. Norton.
O Zweben, J., & Yeary, J. (2006). EMDR in the treatment of addiction. Journal of Chemical Dependency
Treatment, 8(2), 115-127.
101. To contact today’s presenter:
Jamie Marich, Ph.D., LPCC-S, LICDC
The Ohio Center for Mindful Living
jamie@jamiemarich.com
www.jamiemarich.com
www.drjamiemarich.com
www.TraumaTwelve.com
www.DancingMindfulness.com
Phone: 330-881-2944
Editor's Notes
Apply at least three clinical techniques from various psychotherapeutic approaches to help a client through addiction and trauma interaction
(in longer version)
NOTE TO SELF….Address this in terms of the shame piece