Download Trauma

Case Study
 7th grade boy presents for treatment.
Client has been referred due to
oppositional behaviors, ditching school,
fighting, and failing grades.
Post Traumatic Stress Disorder
LaMarr D. Edgerson MA, LMFT, CHt
Trauma Specialist
Post Traumatic Stress Disorder
Anatomy
Memory
Trauma
Potentially Traumatic Events
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War
Terrorism
Physical Assault
Sexual Assault
Being teased?
Embarrassing
Moments
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Natural Disaster
Death of loved one
Domestic Violence
Child Abuse
Witness of events
Emotional Abuse
PTSD Stats
 Est 5.2 million
Americans dx between
18-54yrs old (3.6%).
 1 million Vietnam Vets
affected. What about
Iraq and Afghanistan ?
 2x number of women
affected vs men.
 Often co-exist with
depression, alcohol or
other substance, or
other anxiety disorders.
Maslow
In what ways can a traumatic event(s) effect your life?
Basic Anatomy
Our brain develops from back to front:
primitive - executive functions arise in that order.
Lymbic System
The oldest part of the brain: This system is most
responsible for our flight or fight system.
It includes structures involved in emotion,
motivation and emotional association with memory.
Hypothalamus
Hippocampus
Amygdala
Corpus Callosum
Each hemisphere of the human brain is a conscious system in its
own right, perceiving, thinking, remembering,reasoning, willing and
emoting. If the two hemispheres are separated, each is able to
produce its own consciousness.
Split brain syndrome
Alien-hand syndrome
The left hand doesn’t know what the right
hand is doing - literally
Thalamus
Not a part of the limbic system
 Major relay station that
monitors and processes
incoming info before it’s
sent to the upper
regions of the brain.
 Receives auditory,
somatosensory and
visual sensory signals
Hypothalamus
Regulates the autonomic nervous system via hormone
production and release. Initiates feelings, actions and
emotions such as hunger, thirst, rage & terror. Affects and
regulates blood pressure, sexual arousal and the sleep/wake
cycle.
Hippocampus
 Involved with recognizing
new experiences and with
learning and memory,
especially short-term
memory and information
relating to recent events.
Amygdala
Stores emotional parts of memory, especially powerful
feelings; also concerned with emotions such as anger and
jealousy, and drives such as hunger, thirst and sexual desire.
Sends msg to hypothalamus for activation of sympathetic
nervous system: increase reflexes, facial expression of fear,
activate dopamine, epinephrine and norepinephrine.
Importance of the fear center
Fight or Flight
Memory
What were you doing when this incident occurred?
Memory
Input From Senses
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Sensory Memory
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Attention Paid
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Short-Term Memory
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Memory Consolidated
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Long-Term Memory
Attention Not Paid
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Information Lost
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 Memories Not Consolidated
Memory trace
Short Term Memory
 Also known as working memory
 Used to manipulate info (mental mapping for directions)
 Used to store small amounts for short periods (30-45
sec)
 Quickly disappears by default - unless needed
Long Term Memory
 Structure: Hippocampus
 Anything from one minute - lifetime
 Needs to be encoded (associated in a
meaningful way)
 Associated in a meaningful way
 Consolidated and stored (permanent neuron
change)
 Believed to occur during dreaming (REM sleep)
Hebb’s Axiom
 From the beginning of life, the brain responds to
experience with the establishment of connections
among neurons. Those pathways activated
simultaneously become associated with one another
and are more likely to be activated together again in
the future.
Dreaming
Why do we dream?
Dreaming
REM sleep is crucial for memory consolidation
and has been suggested to facilitate long-term potentiation
allowing the strengthening of synaptic connections.
Daniel Siegel
Trauma
Children & Trauma
Pre-School
 Cognitive: shorter attention span, confusion
regarding event, location sequencing.
 Physical: loss of appetite, overeating,
bowel/bladder problems, sleep disturbance.
 Emotional: generalized fear, nervousness, anxiety,
irritability, fearful of reminders.
 Behavioral: bed wetting, thumb sucking,
nightmares, repetitive play, anxious attachment,
clinging, aggression, disobedience.
Children & Trauma
3rd - 5th Grade
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Preoccupation with their own actions during the
event, specific fears, retelling and replaying the
event, impaired concentration and learning, sleep
disturbance, concerns about safety(theirs & others),
inconsistent bx, somatic complaints, confusion,
fearful, concerns for other victims and their family,
close monitoring of parent response & recovery.
Children & Trauma
Adolescents
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Detachment, shame, guilt, self consciousness about
their fear, vulnerability & other emotional responses,
acting out, need for revenge, radical change in world
views, life threatening reenactment
Children & Trauma
Thoughts
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Can a traumatic childhood result in learning
disabilities?
Studies in Beirut confirm that traumatized adolescents
with PTSD, as compared to non-traumatized adolescent
lagged behind in academic achievement.
Lasting Effects
Trauma doesn’t just affect the person who
was exposed. It also affects all the people with
whom that person interacts.
The more dependent a person is on a trauma
survivor, the more deeply he or she will be
affected.
Post-traumatic Stress Disorder
Post-traumatic Stress Disorder
Defined
 Re-experiencing distressing images, unwanted
memories, nightmares or flashbacks & physical
symptoms.
 Avoidance of reminders of the event, including
people, places or things.
 Hyperarousal, reflected in physiological symptoms:
insomnia, irritability, impaired concentration,
hypervigilience and increased startle response.
Post-traumatic Stress Disorder
Evidenced-Based
 PET Scans reveal that Vets with PTSD show
increased right amygdala activity when exposed to
combat movies.
 MRI studies show that both male combat vets and
women survivors of childhood sexual abuse have
shrunken hippocampal volumes.
Therapy
Cognitive Behavior Therapy
Cognitive Restructuring
 CBT helps the client first identify the traumatic
memory - evaluate their validity, challenge
defeating or destructive thoughts, then replace
them with a healthy emotional state.
Reframing
Cognitive Behavior Therapy
Cognitive Restructuring
Stops dysfunctional thoughts
 Benefit: Allows integration of trauma memory into
conscious memory; associated thoughts are altered
to reflect current life space & memories can
become manageable (to an extent).
Victim to survivor thinking
Mind/Body Connection
Trauma is experienced at a sensory level and stored
as an implicit memory. Implicit memory (sensations of trauma)
must be linked with explicit memory (facts or reality of incident)
in order for the victim to be able to reorder the experience in
a way that is manageable.
William Steele, PhD
Exposure Therapy
 Derived from the learning theory.
 Fear is maintained through operant conditioning
& the effort to avoid or escape these responses.
 Avoidance supports the fear
Exposure Therapy
 In order modify the trauma - the memory must be
fully reactivated.
 The client’s ability to decrease fear or anxiety is
dependent on the “controlled” reliving of that fear
in a safe environment.
 The client is helped to form a new narrative that
places the traumatic memory in the past as
opposed to the here and now.
Exposure Therapy
Art Therapy
Play Therapy
Stress Inoculation
Systematic
Desensitization
 Virtual Reality
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 EMDR
 Emotional Focused
Therapy
 Tapas Acupressure
Therapy
Challenges with trauma work
 Avoidance
 **Disassociation**
 Increased drug &
alcohol usage
 Secondary Gain
 Blocking
 Flooding
Lessons I have learned
 Patience
 Think outside the box
 Consider client factors
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Stressors
Health
Relationships
Finances
 Only speak when necessary
 Cognitive interweave
 Follow the client
 It’s the client’s therapy
 Don’t push
Action Plan
 A: assess for risk (self harm)
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L:
G:
E:
E:
listen non-judgmentally
give reassurance and info.
encourage professional help
encourage self care
The End
Post Traumatic Stress Disorder
LaMarr D. Edgerson MA, LMFT, CHt
Trauma Specialist