Prevalence of Trauma & Retraumatization 3

Transcript

1. PREVALENCE OF TRAUMA & RETRAUMATIZATION
2. Many Pathways to Depression • There are many pathways to depression; Trauma is only one of them, but it’s a common contributor. • When trauma plays a significant role in the development of depression, we can think in terms of posttraumatic depression. (Allen, J. 2005, Coping with Trauma)
3. The Trauma Spectrum Cumulative adverse experiences since childhood create vulnerability: • Primary trauma-Adverse childhood events • Secondary trauma-Impact of observation • Neglect / Poor Attachment • Out of control high levels of stress • Culturally endorsed trauma
4. The Trauma Spectrum (con’t.) Adult traumatic experiences build on and exacerbate childhood traumatic experiences • Abusive relationships • Assaults • Death of loved ones • Losses, i.e., employment, disease, relationships • War • Accidents • Natural Disasters
5. The Trauma Spectrum (con’t.) Some research suggests that people who experience “normal” stresses like illness, divorce, bereavement, or job loss develop PTSD symptoms at the same rate as those who undergo traumatic stress. A romantic breakup or the anticipated death of a relative may not be traumatic by DSM-IV-TR standards but those who experience them report as much distress as those who suffer a catastrophic trauma. (Harvard Mental Health Letter, Aug 2007)
6. What makes trauma responses more likely, intense, or complicated? The amount and type of post trauma symptoms an individual experiences are a function of at least three domains: 1. Variables specific to the victim 2. Characteristics of the stressor 3. How those around the victim respond to the victim
7. Victim Variables • Female • Younger or Older • African Americans and Hispanics • Lower socioeconomic status • Previous psychological dysfunction • Less functional coping styles • Family dysfunction • Previous history of trauma exposure • Greater distress around the time of the trauma • X-Factor – Resiliency – Untapped Inner Resources (Briere & Scott, 2006, Principles of Trauma Therapy)
8. Characteristics of the Stressor • Intentional acts of violence • Presence of life threat • Physical injury • Extent of combat exposure during war • Witnessing death (esp. when grotesque) • Loss of a friend or loved one • Unpredictably and uncontrollability • Sexual victimization (Briere & Scott, 2006, Principles of Trauma Therapy)
9. Why Trauma Impacts Us Differently Cumulative Adverse Experiences since childhood create vulnerabilities that combine with Traumatic Events of adolescence and adulthood and worsen the The Trauma Lifestyle that generates Stress Pileup = Pathways for Post-Trauma Conditions emotionally and medically.
10. The Trauma Spectrum Creates A Lifestyle that Can Itself be Traumatic Heridity Employment X-Factor Psychosomatic/Medical Problems Psychological Problems/Disorders Level of Social/Emotional Support Substance Abuse Life Circumstances/Environment Trauma/ Stress
11. Stress & Trauma Stress: can be a model of what happens to the brain and body when there is trauma. Trauma: The higher adrenalin level of stress is locked in, causing a perpetual cycle of elevated adrenalin release, with accompanying fight, flight, and freeze response. This continuous increased adrenalin causes a sequence of symptoms and problems often associated with medical referrals.
12. How Trauma Affects the Brain and the Brain Affects Everything Else The brain has three basic parts in a bottom-up design (triune brain): 1. Action: “primitive brain” brain stem (automatic func.) 2. Emotion: “survival brain” limbic system (“emotional brain”) 3. Thought: “higher brain” cerebral cortex § The Primitive & Survival Brain tend to override the Cerebral Cortex. (Prepotency) § HPA Axis = Hypothalmus-Pituitary-Adrenals (Scaer, 2001, The Body Bears the Burden)
13. Stress & Trauma (con’t.) Perpetual High Levels of Adrenalin: Like having a car in drive, with the accelerator and brake to the floor. The major organ systems of the body wear out Chronic fatigue and chronic pain sets in. The survivors long term ability to function is undermined. Depression results from sustained, unresolvable stress.
14. Adverse Childhood Experience ACE Study (Felittti, V. ,1998) A strong and consistent relationship between level of exposure of childhood emotional, physical or sexual abuse, and household dysfunction and… Adult health risk behavior and disease in adulthood Multiple categories of trauma exposure create multiple risk factors later in life and lead to early death. Childhood traumas are only of the basic causes of disease and death in adult life.
15. Medical Impact of Trauma • Ten Health Risk Factors Studied (these are the leading contributors to the major causes of death and disease) 1. Smoking 2. Severe Obesity 3. Physical inactivity partners 4. Depressed mood 5. Suicide Attempts 6. Alcoholism 7. Any drug abuse 8. Parental drug abuse 9. High lifetime number of sexual partners (> or = to 50) 10. History of having a sexually transmitted disease
16. Medical Impact of Trauma • Major Causes of Disease and Death 1. Heart disease 2. Cancer 3. Stroke 4. Respiratory Diseases 5. Accidents 6. Pneumonia and Influenza 7. Diabetes 8. Suicide 9. Kidney Disease 10. Liver Disease
17. The Impact of Trauma Like the hub of a wheel, psychological trauma can generate multiple disorders. Depression & Anxiety are primary (80%) when there is PTSD Most clients have multiple disorders:
18. Mood & Anxiety Disorders Disorders of Mental Functioning Physical or Medical Disorders Behavioral Disorders Addictive Behaviors Interpersonal Problems The Impact of Trauma
19. The Cycle of Trauma and Addiction 1. Psychological pain related 2. Self-medication through drugs to trauma. alcohol, food, sex, etc. 6. Life’s complications get deeper 3. Life Problems—trouble more overwhelming, & harder to relationships, work, etc. as a result Solve of trauma & drug use controlling one’s world. 5. Greater craving for larger amounts 4. More psychological pain and of drugs, alcohol, food, or combination weakened personal resources of physical tolerance of drugs and due to drug dependence. Worsening emotional and psychological problems.
20. The Trauma Core can Drive One Addiction after Another § The more you rely on external, addictive substances to manage your inner world, the weaker your inner world becomes, and the fewer resources you have to solve your problems. § If the trauma pain is not resolved and the necessary life skills are not learned, one discovers that one addiction leads to another. When the numbing effect of drugs or alcohol is removed, one is left in raw pain. Food, spending, cigarettes, or some other craving will become the next addiction, until the trauma engine is turned off. This is termed ADDICTION TRANSFER.
21. Why Trauma & Depression Often Co- exist 1. According to DSM-IV, A traumatic event entails a person experiencing or witnessing an event that threatens death or serious injury & the person’s response involves intense fear, helplessness, or horror. Helplessness is a key feature of depression.
22. Helplessness & the Catch-22’s of Depression “If you’d just. . .” Depressive symptoms that interfere Sleep Well Insomnia Eat properly Poor appetite Exercise Lethargy Enjoy yourself Anhedonia Be reasonable Global negative thinking Stop wallowing Tendency to ruminate Stop isolating yourself Social withdrawal Be hopeful Hopelessness
23. Why Trauma & Depression Often Co- exist 2. The defining symptom of PTSD are intrusive experiences: • flashbacks of the traumatic event • nightmares • internal or external cues that trigger the traumatic event. Intrusive experiences reinforce the original helplessness of the traumatic event.
24. Why Trauma & Depression Often Co- exist 3. Avoidance of anything associated with the trauma and numbing responsiveness associate the intrusive experiences. Efforts to avoid conversations, activities, places or people associated with the trauma; Diminished interest or participation; Feelings of detachment or alienation from others; Restricted range of affect (i.e., absence of loving feelings); Sense of foreshortened future (e.g. does not expect to have a career, marriage, children, or normal life span). The PTSD avoidance and numbing symptoms are inherent in Major Depression
25. Why Trauma & Depression Often Co- exist 4. In addition to the avoidance and numbing there is an increased arousal manifested in: Difficulty falling asleep or staying asleep Irritability or outbursts of anger, Difficulty concentrating, Hyper-vigilance Heightened startle response The distress and impairment in social, occupational, or other areas of functioning are integral to depression. Sleep is a major element of impairment
26. Self-Defeating Sleep Cycles of PTSD & Depression • Like flashbacks, nightmares may be replicas of traumatic experience • Yet nightmares may express emotional impact of trauma metaphorically • Both nightmares and flashbacks keep trauma memory networks primed escalating in vicious cycles • PTSD anxiety/hyperarousal interferes w/ sleep • Fear of nightmares prevent deep sleep-sleep phobias • Nocturnal panic Improving Sleep a Central Tx Focus (McKenna, P. 2009)
27. Treatment Considerations 1. Intake Assessment should include symptom clusters associated with trauma: somatic, anxiety, depression, anger, sleep problems, addictions, interpersonal issues, thought disorders, bipolar, ADD, intrusive symptoms, dissociation (traumaawareness.org) Also include a non-invasive way to identify childhood and adult traumas. Measure dissociation with Dissociative Experience Scale (DES). (traumaawareness.org)
28. Treatment Considerations 2. Psycho-Education: If trauma is present provide basic information about trauma. Include trauma sources, four elements of PTSD, two categories of trauma- simple & complex, 3 brains. Explain the relationship of trauma and depression. See “trauma brochure” at (traumaawareness.org) Client learns to “normalize” her trauma responses and symptoms
29. Treatment Considerations 3. Client learns to develop and Utilize inner resources and strengths. Goal: Client learns to use the principle: “The same strengths required to survive traumatic experiences can be used to overcome the effects of the trauma”
30. Discovering Personal Strengths As a child I dreamed: My dream now is: My childhood strengths were (artistic ability, sense of humor, sensitivity, etc.) My strengths now are: I felt happy when: I felt strong when: Three things that mattered most to me in the past are: As a child, when I was sad or upset I turned to: A parent, A sibling, A peer, A teacher, A grandparent, A neighbor/Family Friend, Member of my religious faith, Kept to myself, The family pet, A toy or object,T.V., Other Before 16, I felt the most comfort from involvement with: People, Animals, Nature, God, Art, Reading, Dance, Music, Writing, Athletics, Other
31. Treatment Considerations Developing Inner Resources Reasons People Don’t Let Go of Their Pain: Premature forgiveness of offender/ It’s my identity/Shame & Unworthiness/ It’s my punishment/Fear of a new life/Fear of ________. Pain is a source of strength/It’s a friend/ It’s a distraction/A way to avoid responsibility/A way to avoid people/It’s a way of life/It’s an escape/What if I’m whole & still not good enough?/How do I fill the void? Refer to “Why People Don’t Let Go of Pain” traumaawareness.org
32. Treatment Considerations 4. Follow the organization of the brain when resolving trauma. In addition to the general pain removal, the client can resolve significant, specific traumatic events, such as an assault or violent act that requires focused treatment
33. Treatment Considerations Following the Organization of the Brain (con’t.) • Research by Charcot, Janet, and Freud demonstrates the powerful reality that trauma pain is stored in the sub-conscious. Research in recent years indicates trauma pain is stored throughout the body- e.g., “tissue memory.” • The Limbic System interfaces with the sub-conscious. Pain removal is more basic to healing than memory narration. The sub-conscious has many avenues for pain removal. • Research ego states, body memory, energy work.
34. COME TO YOUR SENSES • Bridging is being in the moment and connecting with your senses in a way that quiets the mind. As you bridge, your awareness expands since you are getting away from your busy and distracting mind. • As you learn to bridge you can neutralize your “Identity System” which contains worry, clutter and noise. (Block, S. 2005, “Come to Your Senses”)