Advanced Training Trauma

8/7/2019 Advanced Training Trauma

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Advanced Training in theAdvanced Training in thePsychological ManagementPsychological Management

of Trauma and Disastersof Trauma and Disasters

Dr. Kevin BeckerDr. Kevin Beckerandand

Dr. Guy SapirsteinDr. Guy SapirsteinThe course is offered by NISE andThe course is offered by NISE and

Sponsored by IBMSponsored by IBM


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PSYCHOLOGICAL REACTIONS

TO DISASTER


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PHASES OF DISASTER REACTIONPHASES OF DISASTER REACTION

Warning of threatWarning of threat

ImpactImpact Rescue or HeroicRescue or Heroic

Remedy or HoneymoonRemedy or Honeymoon

InventoryInventory DisillusionmentDisillusionment

Reconstruction and RecoveryReconstruction and Recovery


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Key Principles in Disaster workKey Principles in Disaster work SAFETYSAFETY

PREDICTABILITYPREDICTABILITY

CONTROLCONTROL


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Biopsychosocial ModelBiopsychosocial Model BiologicalBiologicalBrain and physiologyBrain and physiology

PsychologicalPsychologicalcognitive andcognitive andemotionalemotional

Social/communitySocial/communityBehavior,Behavior,interpersonal interactions andinterpersonal interactions and

community functioningcommunity functioning


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Behavioral ReactionsBehavioral Reactions

Sleep ProblemsSleep Problems

Crying EasilyCrying Easily Avoiding RemindersAvoiding Reminders

Excessive Activity levelsExcessive Activity levels

Increased conflict with familyIncreased conflict with family Hypervigilance, startle reactionsHypervigilance, startle reactions

Isolation or social withdrawalIsolation or social withdrawal


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COGNITIVE REACTIONSCOGNITIVE REACTIONS

Confusion, disorientationConfusion, disorientation

Recurring dreams or nightmaresRecurring dreams or nightmares Preoccupation with disasterPreoccupation with disaster

Trouble concentrating or remembering thingsTrouble concentrating or remembering things

Difficulty making decisionsDifficulty making decisions Questioning spiritual beliefsQuestioning spiritual beliefs


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EMOTIONAL REACTIONSEMOTIONAL REACTIONS

Depression, sadnessDepression, sadness

Irritability, anger, resentmentIrritability, anger, resentment Anxiety, fearAnxiety, fear

Despair, hopelessnessDespair, hopelessness

Guilt, selfGuilt, self--doubtdoubt Unpredictable mood swingsUnpredictable mood swings


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PHYSICAL REACTIONSPHYSICAL REACTIONS

Fatigue, ExhaustionFatigue, Exhaustion

Gastrointestinal distressGastrointestinal distress Appetite changeAppetite change

Tightening in throat, chest or stomachTightening in throat, chest or stomach

Worsening of chronic conditionsWorsening of chronic conditions Somatic ComplaintsSomatic Complaints


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EFFECTS OF LONGEFFECTS OF LONG--TERM DISASTER STRESSTERM DISASTER STRESS

Anxiety and vigilanceAnxiety and vigilance

Anger, resentment and conflictAnger, resentment and conflict Uncertainty about the futureUncertainty about the future

Prolonged mourning of lossesProlonged mourning of losses

Diminished problemDiminished problem--solvingsolving Isolation and hopelessnessIsolation and hopelessness

Health problemsHealth problems

Physical and mental exhaustionPhysical and mental exhaustion Lifestyle changesLifestyle changes


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Myths About ChildrenMyths About Children

They are better off not knowingThey are better off not knowingThey forget about bad events easilyThey forget about bad events easily

Boys should not express sadnessBoys should not express sadness

Living through tough times makes youLiving through tough times makes you

strongerstronger

Hitting them helps them learn betterHitting them helps them learn better


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Symptoms of PTSDSymptoms of PTSD

Criterion A:Criterion A: Exposure to a traumatic eventExposure to a traumatic event

which included:which included: the person witnessed or was confronted with anthe person witnessed or was confronted with an

event that threatened death or serious injury toevent that threatened death or serious injury toself or othersself or others

and the persons response included intense fear,and the persons response included intense fear,

helplessness or horrorhelplessness or horror


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Traumatic Events include...Traumatic Events include...

Natural DisasterNatural Disaster

Violent/Sudden Death of Loved OneViolent/Sudden Death of Loved One Witness to ViolenceWitness to Violence

Physical AssaultPhysical Assault

RapeRape Child abuse and exploitationChild abuse and exploitation

WarWar

Serious car accidentsSerious car accidents

Other serious life eventsOther serious life events


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Criterion B: ReCriterion B: Re--experiencingexperiencing

Intrusive recollections, images, thoughts orIntrusive recollections, images, thoughts orperceptionsperceptions

Recurrent distressing dreamsRecurrent distressing dreams Flashbacks (not simply remembering)Flashbacks (not simply remembering)

Distress at exposure to remindersDistress at exposure to reminders Physiological reactivity to remindersPhysiological reactivity to reminders


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Criterion C:AvoidanceCriterion C:Avoidance

Efforts to avoid thoughts, feelings, activities, places, or peopEfforts to avoid thoughts, feelings, activities, places, or peopleleassociated with the traumaassociated with the trauma

Inability to recall important aspectsInability to recall important aspects

Markedly diminished interestsMarkedly diminished interests Restricted range of affectRestricted range of affect

Sense of detachmentSense of detachment

Foreshortened sense of futureForeshortened sense of future


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Criterion D: HyperarousalCriterion D: Hyperarousal

Difficulty falling or staying asleepDifficulty falling or staying asleep Irritability or outbursts of angerIrritability or outbursts of anger

Difficulty concentratingDifficulty concentrating

Hypervigilance (being on guard all the time)Hypervigilance (being on guard all the time)

Exaggerated startle responseExaggerated startle response


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Criterion E:Criterion E:

The duration of symptoms is more than 1 monthThe duration of symptoms is more than 1 month

Criterion F:Criterion F:

Causes significant distress or impairment in social,Causes significant distress or impairment in social,occupational, or other important areas of functioningoccupational, or other important areas of functioning


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Complex PTSDComplex PTSD

in Childrenin Children --AdolescentsAdolescents History of multiple traumasHistory of multiple traumas

Alterations in affect regulationAlterations in affect regulation Alterations in consciousness (Dissociation)Alterations in consciousness (Dissociation)

Alterations in perception of selfAlterations in perception of self Alterations in cognitionAlterations in cognition

Alterations in attachments with othersAlterations in attachments with others

Alterations in behavior controlsAlterations in behavior controls

Alterations in biology/physiologyAlterations in biology/physiology


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Techniques for managing traumaticTechniques for managing traumatic

stressstress GroundingGrounding

Diaphragmatic breathingDiaphragmatic breathing RelaxationRelaxation

Safe place exerciseSafe place exercise


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Coping StrategiesCoping Strategies


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Secondary TraumatizationSecondary Traumatization

There is a cost to caringThere is a cost to caring------Charles Figley, Ph.DCharles Figley, Ph.D..


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Signs and Symptoms:Signs and Symptoms:

Work addictionWork addiction

NightmaresNightmares

Disconnected from loved onesDisconnected from loved ones

Social WithdrawalSocial WithdrawalIncreased sensitivity to violenceIncreased sensitivity to violence

Heightened startle responseHeightened startle response

Sense of hopelessnessSense of hopelessness

Hypervigilance: being on edgeHypervigilance: being on edge


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Secondary Traumatization:Secondary Traumatization:

Interaction basedInteraction based

Traumatic materialTraumatic material

Develops suddenly (often)Develops suddenly (often)

PTSD symptomsPTSD symptoms

Worldview changesWorldview changes


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What makes helping work?What makes helping work?

empathy/identification/safety/trust/intimacy/empathy/identification/safety/trust/intimacy/

controlcontrol

What makes helping hurt?What makes helping hurt?

empathy/identification/safety/trust/intimacy/empathy/identification/safety/trust/intimacy/

controlcontrol


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Addressing VT/STS

AWARENESS

BALANCE

CONNECTION


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SelfSelf--Care StrategiesCare Strategies

Balance your work & personal lifeBalance your work & personal life Seek nonSeek non--victim related activitiesvictim related activities

Respect your personal boundariesRespect your personal boundaries

Develop realistic expectationsDevelop realistic expectations Experience/Address emotionsExperience/Address emotions

Avoid professional isolationAvoid professional isolation

Know your vulnerable areasKnow your vulnerable areas

S ifi i i h hild dS ifi i i h hild d


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Specific issues with children andSpecific issues with children and

adolescents:adolescents: Multiple systemsMultiple systems

Power differentialPower differential Less communicationLess communication

Bias against childrenBias against children

Earlier developmentEarlier development

Stronger rescue fantasiesStronger rescue fantasies

Not enough adequate training in trauma therapyNot enough adequate training in trauma therapywith childrenwith children


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Contributing factorsContributing factorsThe situation:

Nature of the work

Cumulative exposure to trauma

Organizational context Social and cultural context

The individual: Personal history

Personality

Current life context Training and professional history

Supervision


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It takes two to tell the truth: One to say it and the

other to listen.

H.D. Thoreau


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WEB RESOURCES ON TRAUMAWEB RESOURCES ON TRAUMA

www.ncptsd.orgwww.ncptsd.orgNational Center for PTSDNational Center for PTSD

www.traumacenter.orgwww.traumacenter.orgBoston, Trauma CenterBoston, Trauma Center www.traumawww.trauma--pages.compages.com David Baldwins trauma pagesDavid Baldwins trauma pages

www.nctsnet.orgwww.nctsnet.orgNational Child Traumatic StressNational Child Traumatic Stress

NetworkNetwork

www.EMDRIA.orgwww.EMDRIA.orgEMDR InternationalEMDR International

Dr. Kevin BeckerDr. Kevin Becker [email protected]@ORIConsulting.com Dr. Guy SapirsteinDr. Guy Sapirstein [email protected]@ORIConsulting.com

Documents

Advanced Training Trauma