PTSD in Partners: A Treatment Approach with Eye Movement
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Transcript of PTSD in Partners: A Treatment Approach with Eye Movement
Copyright 2014 Recovery That LastsCopyright 2014 Recovery That Lasts
PTSD in Partners: A Treatment Approach with Eye Movements(Accelerated Resolution Therapy)
Dallas, May 1,2,3, 2014Presented by Alexis Polles, MD, PLLC
m601-255-5485
Copyright 2014 Recovery That Lasts
DisclosuresNone
No relevant financial issues
If medications are mentioned the generic name will be used and non-FDA approved uses will be stated
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OUTLINEI. Trauma and its sequelae
II. Trauma in partners of sexual compulsives/addicts (focus on women)
III. Treatment options
IV. Use of special approaches in the treatment of trauma Eye Movements
V. Conclusion
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Copyright 2014 Recovery That Lasts
Definition of TraumaThe diagnostic manual used by mental health providers
(DSM-5) defines trauma an event that involves actual or threatened death or serious injury or sexual violation.
The Merriam-Webster Dictionary defines it as
a)an injury to living tissue caused by an extrinsic agent
b)a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury or
c)an emotional upset DSM-IV requirement that “The person’s response to the event must involve intense fear,
helplessness or horror” has been eliminated in DSM-5.
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Trauma• May include events that are not beyond the scope of normal
human experience, as long as the event has had a trauma-like impact on the person.
• DSM-5 moved it from an Anxiety Disorder to Trauma- and Stress-or-Related Disorders
• What makes an event traumatic:– The severity of the event– The proximity of the experience– The personal impact of the event– The after-event impact
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Potential Victims Of A Traumatic Stressor
1 Primary Victims
Those individuals most directly affected by the event, e.g., the persons whose houses are blown down in a hurricane.
2 Secondary Victims
Those individuals who in some way observe the consequences of the traumatic event on the primary victims, e.g., bystanders, rescuers, and emergency response personnel. (Partners/kids)
3 Tertiary Victims
Those individuals who are indirectly affected by the traumatic event as a result of later exposure to the scene of the trauma or to the primary or secondary victims of the trauma.
Stress Management and Disasters
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Trauma Spectrum
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Types of PTS/PTSD
Simple PTS/D
The response to one or more traumatic events that are NOT linked in any way (e.g., one rape, one car accident, one sudden loss).
Complex PTS/D
The response to a combination of specific traumatic events that ARE linked to each other in some way or occur repeatedly over time
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Natural vs. Human Made Prolonged stressors, deliberately inflicted by people, are far
harder to bear than accidents or natural disasters. If this was done deliberately, in the context of an ongoing relationship, the problems are increased. The worst situation is when the injury is caused deliberately in a relationship with a person on whom the victim is dependent –
most extreme is parent-child; spouse or partner infidelities/betrayals are high on the list
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Symptom Clusters(Four in DSM-5)
• Re-experiencing (nightmares, intrusive images)
• Avoidance
• Persistent Negative Alterations in Cognitions and Mood (includes numbing, distorted self-blame, estrangement, inability to remember key aspects of the event)
• Arousal (includes fight and flight)
Subtypes include kids < 6 and dissociative
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Copyright 2014 Recovery That Lasts
Trauma is an experience that overwhelms our capacity to have a sense of control over ourselves and our immediate environment, to maintain connection with others and to make meaning of our experience.
In Summary:
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Effects of Trauma on Brain Function
AmygdalaSorts for immediate
danger
(significance)
Pre-frontal Cortex(Integration and Planning)
Hippocampus Stores longterm memory
(cognitive map)
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Fear Response
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Trauma Response
Visual Cortex
Amygdala
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Copyright 2014 Recovery That Lasts
Hypothalamus-Anterior Pituitary-Adrenal Cortex Axis
Cortisol (stress hormone) elevates blood sugar and increases metabolism
Body is then able to sustain prolonged activity
But immune system activity is decreased
High cortisol levels damage hippocampus Learning and memory suffer
as a result
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Tend and Befriend(Taylor, Lewis, Gruenwald, Gurung, Klein, & Updegraff, 2000; 2002)
Women developed other stress responses
To protect the child
To galvanize resources
Mediated by oxytocin
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Partner Trauma Is
Modified from APSATS Multidimensional Trauma Model Training
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Therapeutic OptionsPsychosocial
PharmacologicalComplementary
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Healing is PossibleEvidence Supported Treatments
Narrative (oral, written, past tense, imaginal) Cognitive Therapy, Cognitive Processing Therapy (TfCPT) Exposure Therapy Stress Inoculation Training (SIT) Psychoeducation Eye Movement Desensitization and Reprocessing DBT Strategies Mindfulness Based Strategies Complementary and Integrative Modalities (Yoga, Meditation, Acupuncture) Pharmacotherapy (alpha 2 ligands, SSRI, SNRI) Avoid Ambien for sleep.
Consider B-blockers, and morphine in field or acute injury.
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Copyright 2014 Recovery That Lasts
How It Works
Access relevant memoryStimulate brain with bilateral
stimulationMove through channels of association
until memory successfully resolved in EMDR or Image Replacement with ART
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Courtesy Dr. Uri Bergman
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NEURAL NETWORKS
Courtesy Dr. Uri Bergman
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Yes, this is part of healing!
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The ConclusionThe trauma reactions of partners of
sexual addicts who have been terrorized and repetitively assaulted are not due to the person’s “underlying issues,” they are the issue.
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Core Principles of Partner TraumaAlmost all the behaviors are coping strategies.
Reactions are not character flaws.
Reactions are affected by supports and circumstances.
Behaviors may be effective or ineffective.
Responses will change if safety is established, though all triggers may not be eliminated.
There can be reconnection that is healthier and more deeply satisfying with God, ones self, and others, including the perpetrator.