PTSD Exploring the Funcationality of Symptoms
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Transcript of PTSD Exploring the Funcationality of Symptoms
PTSD Exploring the Functional
Nature of Symptoms
Instructor: Dr. Dawn-Elise Snipes LPC-MHSP, LMHC, CCDRC
Executive Director: AllCEUs
Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Podcasts
Objectives
Review PTSD Symptoms and explore their
functional nature
Purpose
By understanding the function of symptoms we
can
Normalize the behavior
Identify alternate ways to meet that same need or
address the issue
Re-Experiencing
Trying to replay it to figure out how to integrate into
your schema (like fitting a puzzle piece)
Reminding the person of similar situations to “protect”
them
Purpose
Avoidance
The system is already over taxed. Avoiding upsetting stimuli
by blocking out most stimuli, memories of the event.
Avoiding unnecessary use of energy by not getting “excited.”
Changes in Beliefs
Protects against future “surprises”
Tries to assimilate the experience into schema
Increased Arousal
Protects the individual
Re-Experiencing
You re-experience things every day
Access schema that guide your actions
When you go to work
When you encounter a particularly volatile client
When you approach a stop light
Re-Experiencing in PTSD
The context is often overgeneralized
The precipitating factors are often unknown
In many cases the resolution was not one of empowerment, resulting in trying to continually figure out how to not be disempowered
Re-Experiencing: Assimilation or Accommodation
Intrusive distressing memories of the traumatic events
In children repetitive play may occur in which themes or aspects of the traumatic events are expressed.
Recurrent distressing dreams in which the content or feeling of the dream is related to the events
In children there may be frightening dreams without recognizable content.
Flashbacks or other dissociative reactions in which the individual feels or acts as if the traumatic events are recurring
In children trauma-specific reenactment may occur in play.
Re-Experiencing
Intense or prolonged psychological or
physiological distress at exposure to internal or
external cues that symbolize or resemble an
aspect of the traumatic events
The event represents a time in which the person
experienced or witnessed something horrifying
The brain is trying to help the client
Avoid future similar situations
Learn how to protect during future similar situations
Avoidance
Purpose: Avoidance of Recurrence of Pain or Arousal of Stress Response System
Emotional numbness and avoidance of places, people, and activities that are reminders of the trauma.
Inability to remember an important aspect of the traumatic events (not due to head injury, alcohol, or drugs)
Purpose: An exhausted system conserves energy in case there is another threat
Markedly diminished interest or participation in significant activities
Feelings of detachment or estrangement from others
Persistent inability to experience positive emotions
Hypocortisolism
Cortisol is the stress chemical
After extreme stress and/or under chronic stress
the brain may reduce the responsiveness of the
stress response system by reducing the cortisol
This is protective, it keeps the organism from
using precious resources by getting “excited”
about anything (including pleasure)
Due to fear conditioning, when a stressor is
detected, the stress response is exaggerated.
Changes in Beliefs
Purpose: The need for order and meaning
(Regaining control, Ability to predict)
Persistent and exaggerated negative beliefs or
expectations about oneself, others, or the world
“I am bad”
“No one can be trusted”
"The world is completely dangerous"
Persistent, distorted blame of self or others about the
cause or consequences of the traumatic events
Changes in Beliefs
Persistent
Fear, horror
Anger
Guilt, shame
Trauma taps in to nearly every basic fear
Loss of Control
The Unknown
Death (Am I going to die? I could have died. I was unable to prevent someone from dying)
Isolation
Failure
Child abuse,
Car accident
Drowning
Bank robbery
Rape
War
Beliefs Interventions
After a trauma people’s lives are changed forever.
It is often necessary to grieve the loss not only of
tangible things like property, but also existential
things like belief in a just world and the goodness
of people.
Identifying the threats and associated thoughts
the person had/is having
Addressing cognitive distortions using Cognitive
Processing Therapy
CPT Challenging Questions
What is the evidence for and against this belief?
Are the sources of this evidence reliable?
Is my reasoning based on facts or feelings?
Is this belief based on habit or facts?
Habits can be persistent negative interpretations or old “tapes” that have never been checked.
Am I basing my belief on the whole picture, or a small aspect of it?
Does my belief contain all-or-none terms?
In what ways is this belief confusing high probability and low probability events?
Increased Arousal
Irritable or aggressive behavior
Anger/threat reaction to continue to self-protect
Interventions:
Help the person identify and address triggers
Develop skills to address emotional and behavioral dysregulation (STOP Stop Think Observe Participate)
Reckless or self-destructive behavior
Stop the pain (I don’t care if I die, because…)
Distract (Numb through thrill)
Regain control (Lightening doesn’t strike twice)
Increased Arousal
Exaggerated startle response (Hypocortisolism)
Think how exhausting it would be to go from 0 to 100
each time you were startled.
Because of hypervigilance, people with PTSD are aware of
more things that may startle
Interventions
Help client understand brain changes that resulted from the
brains “decision” that continuing to use energy to fight was
futile
Develop tools to reduce vulnerabilities and increase energy
reserves
Increased Arousal
Hypervigilance
Purpose: Protective because the world seems dangerous
and unpredictable
Other Symptoms
Problems with concentration
Hypervigilance prevents filtering out extraneous stimuli
Intervention: Create places that are “peaceful and safe”
Difficulty falling or staying asleep or restless sleep
You are vulnerable when you are asleep
Create a safe sleeping space and ability to easily re-ground
Emotional support dogs can be helpful here
Final Thoughts
Tormenting thoughts and feelings and attempts to
stop or avoid those thoughts and feelings are
central to PTSD
In the song “Wrong Side of Heaven” by Five Finger
Death Punch the artist speaks of this torment.
Imagine you have been in a situation in which you
Had to kill to protect others
Had to let someone die to protect yourself and be
there for your kids/family
Wrong Side of Heaven
I spoke to God today and she said that she's ashamed. What have I become. What have I done
I did some awful things in the spirit of what was right
I spoke to the devil today and he swears he's not to blame, and I understood 'cause I feel the same.
I accept that the devil did not make me do it. I chose it, but at what cost.
Arms wide open, I stand alone. I'm no hero and I'm not made of stone.
I feel totally isolated. I don’t believe people could understand. I did not do it to be a hero. I am tormented by what I felt I had to do for what I felt was right.
Wrong Side of Heaven Right or wrong, I can hardly tell. I'm on the wrong side of
heaven and the righteous side of hell.
I know what I did, I did for the right reasons, but I don’t feel deserving of forgiveness, but I also don’t believe I should be damned because I was trying to do what was right.
I heard from God today and she sounded just like me. What have I done and who have I become.
Like God, I talk, believe, pray about doing things for the right reasons
I saw the devil today and he looked a lot like meI looked away, I turned away
Like the devil, I have done a lot of things I don’t know if I can forgive myself for, and am not sure if I deserve forgiveness. I can’t stand to see the potential for evil in myself.
Summary
Increased Arousal
The traumatic threat was unpredictable, ergo future events are unpredictable.
Increased arousal keeps people alert to potential threats.
Using CPT Challenging Questions help the client examine his/her beliefs about the event and his/her current safety
Avoidance and numbing helps the person survive since nobody can be “alert” and agonizing for that long
Helping the person understand that during a traumatic event, certain chemicals in the body prevent effective memory formation. This is protective.
Numbing helps preserve precious energy.
Summary
Changes in beliefs
Keeps the person from being vulnerable again
Helps the person try to make sense of it.
Re-Experiencing
Like trying to fit a puzzle piece, the brain is trying to
make sense of how this fits into current schema
The brain may have to develop new schema based on
likely faulty memories from the trauma, so many
stimuli are overgeneralized and cause “triggers” for
anxiety to be everywhere.