Tana Bridge, PhD, LMSWAssociate Professor ~ Eastern Michigan University

Supervisor/Consultant: National Institute for Trauma & Loss

A lot is Known About Trauma Unattended Trauma leads to self-

defeating, self-destructive, pathological behavior

Most will need external support to move beyond trauma

Additive Nature of Trauma

Steele (1992), Terr (1979), Pynoos(1988)

Substance Use/Trauma

Ability to escape from trauma memory/symptoms may be accomplished through drug use

Drug use can perpetuate feelings of powerlessness, fear, etc. brought about by trauma

Drug culture can expose/create victims of trauma

Trauma Defined

Acute Stress Disorder Post Traumatic Stress Disorder Disorder of Extreme Stress Not

Otherwise Specified ~ Complex Trauma

Differences in Trauma & Grief Grief

Sadness stands alone Reactions are known to

public Can usually talk about

loss Pain is

acknowledgement of loss

Trauma Terror Include grief Reactions unknown,

held within Can’t or don’t want to

talk Pain triggers terror,

powerlessness, loss of safety

Anger is non-destructive, non-assaultive

Grief does not disfigure self image

Guilt says ”I wish I would/would not have”

-dreams of deceased No trauma specific

reactions

Anger- can become assaultive

Attacks, distorts self image

Guilt says ”It was my fault, I could have prevented it

Dreams of self as potential victims

Grief reaction and trauma specific reactions.

W. Steele

Complex/Chronic PTSD~ DESNOS Prolonged and Repeated Trauma

DV woman and children Victims of ongoing child abuse Prisoners Hostages People held under the control of their

perpetrator

Also known as DESNOS-Disorder of Extreme Stress/Not otherwise specified.

Trauma is a Sensory Experience

Enters via the 5 senses

What are some events/situations that might bring about a trauma specific response?

Traumatic SituationsWar ViolenceRapeMurderBeatings/AssaultsDomestic ViolenceFires

SuicidesCar Accidents/Plane CrashesDisasters - earthquake, floods, fires, etc.Injuries or life

threatening illnessDog BitesDrowning

Exposure to Trauma

Surviving Victim/Survivor Witness to the Event Related or Connected to the Victim Hearing the Details

What are common symptoms of trauma or PTSD?

Symptoms….

Symptoms

Physical symptoms: hypervigalence, startle response, sleep difficulties, concentration or memory problems, mood problems such as anger or depression

Intrusive symptoms: recurrent recollections (thoughts, memories, dreams, nightmares or flashbacks), re-enactment (behavior or re-telling) distress at symbolic events, survivor guilt or grief

Symptoms - continued

Avoidant symptoms: avoiding specific thoughts, feelings, activities or situations, diminished interest, emotional numbness, inability to connect with future (feel they will die at young age)

Special forms of avoidant symptoms: dissociation, helplessness, loss of fear

Cognitive Struggles: 2+2 ??? 4, Magical Thinking (E.G. if I touch him he will die), concentration , recall and problem solving.Rumination or preoccupation: Continuous conscious awareness about the event and associations that go beyond ordinary thinking. Characterized by a sense of uncontrolled repetition.

How the brain receives and processes trauma….

2 Component of Brain Response1. Reaction – “auto” responses2. Memory

Development: The brain develops sequentially, with “lower” systems developing first and “higher” systems developing later.

There are several areas of the brain that are impacted by trauma.

Brain ~ parts impacted by trauma

Cortex: reasoning, problem solving, cognitive memory, planning, recognition

Limbic: emotions, survival related emotions/pleasure, emotional memory

Diencephalon: (includes thalamus and hypothalamus) “fight, flight or freeze,” stress response, receives, filters and relays sensory inputs – NOT cognitive

Brainstem: heart rate, body temperature, respiration. The brainstem also stores anxiety or arousal states associated with a traumatic event

Neurochemical basis of PTSDTrauma changes the levels of 5 major

neurotransmitters: epinephrine, cortisol, norepinephrine, serotonin and endorphins

The limbic system (involved in strong emotion) can be changed by the presence of excess norepinephrine and produces:

Neurochemical basis of PTSD - continued

Continual presence of symptoms/reactions to trauma

Kindling effect - when small amounts of norepinephrine cause a cascade effect - the person reacts to a small stressor as if a true emergency has occurred

Prolonged stress creates a dependency on the analgesic effect - the person seeks intensity to achieve overload and then the calming effects of endorphin release

National Institute for Trauma & Loss in Children

This audio section is included with the permission of The National Institute for Trauma and Loss in Children (TLC) www.tlcinst.org . - William Steele, PsyD, MSW A Program of Starr Institute for Training- 48255 Garfield Road, Suite. 111, Clinton Twp. MI 48038- Phone: 313-885-0390.   Toll-Free: 877-306-5256 . - On the web: http://www.starrtraining.org/tlc- On Twitter : http://twitter.com/TLCchildtrauma- On Facebook: http://www.facebook.com/pages/The-National-Institute-for-Trauma-and-Loss-in-Children/137750291707    

Putting together the pieces… What is needed for ‘resolution’ or

successful process in working through a traumatic situation….

The Process of Working through Trauma

Safety –Seeking Safety

Attachment /Connection Connect with trusted adults Elicit support of others

Educate about possible reactions Gives meaning Normalizes

Connect with Details – Nonverbal into Verbal It gives the “why”s Allows for mastery over content Allows for experience outside of self Removes negative image Challenge distorted thinking

LEARN HEALTHY coping and thinking!

Trauma and the Cognitive Triangle:

Traumatic Event

(TF-CBT: Tassell & Schmidt)

Promises of Healing

Reduced frequency of symptomsReduced fear of the symptomsReduced fear of insanityOpportunity to grieveChange from victim to survivor

Promises of Healing ...continued

Opportunity to begin enjoying lifeSense of humorProfound empathy for others who

suffer

Questions???