Working with Trauma How to understand it Dr Adam
Description: Working with Trauma How to understand it Dr Adam Morgan Dr Stale Rygh Clinical Psychologists Training Outline Intro and session 1 1 hour Break 15 mins Session 2 1 hour Health warning.. Aims of the training Understanding the impact of
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slide1. Working with Trauma How to understand it Dr Adam Morgan & Dr Stale Rygh
Clinical Psychologists<br>
slide2. Training Outline Intro and session 1 1 hour
Break 15 mins
Session 2 1 hour<br>
slide3. Health warning……..<br>
slide4. Aims of the training Understanding the impact of trauma on people’s lives
Understanding formulation and how can it help<br>
slide5. Warm up exercise: What are the biggest challenges you face with your students?
What do you want from today?<br>
slide6. What is trauma? “Trauma refers to harmful emotional, psychological, biological and social human responses to an event(s) or circumstances which are experienced as life threatening to the individual”
Substance abuse and mental health administration SAMHSA 2014
“Being traumatised means continuing to organise your life as if the trauma were still going on – unchanged and immutable – as every new encounter or event is contaminated by the past”
Van Der Kolk, The Body Keeps the Score<br>
slide7. Vignette: Imagine a child grows up in an unpredictable, abusive/neglectful environment. For example, there is domestic violence at home from one of the parents who is a drinker. The other parent is anxious and depressed and is withdrawn and absent as a result (they are a victim of domestic violence after all.
How may they come to think about:
Themselves
Others (people, e.g. caregivers, friends)
The world in general
What might they do to cope?
How might it effect their education, job prospects and their relationships?<br>
slide8. Feedback: I don’t matter
I’m a problem
People are dangerous/don’t care
World isn’t safe
World unpredictable
Child might be combative or withdrawn
Child might try to keep others happy
Might struggle at school, with peers, struggle to concentrate<br>
slide9. ACE Studies -Vincent Felitti: Studies that looked at correlations between Adverse Childhood Events (hence ‘ACE’) and health outcomes in adulthood
ACE score 0 – 10 with one ‘point’ for each adverse event. Adverse events included things such as:
emotional/physical/sexual abuse, misuse of drugs and/or alcohol in family home, family member in prison, parental separation.
Only 1/3 reported no ACEs<br>
slide10. Likelihood of Diagnosis – for children who were sexually abused
Depression: 5.07 times more likely
Phobia: 12.12 times more likely
OCD: 7.01 times more likely
PTSD: 8.23 times more likely
Eating Disorder: 6.53 times more likely
Psychosis: 10.14 times more likely
Sources: 1. jonas, s et al. (2011) sexual abuse and psychiatric disorder in England: results from the 2007 adult psychiatry morbidity survey, psychological medicine; 41: 709-20.<br>
slide11. Personality disorder No maltreatment Childhood maltreatment
Aniti-social 3.5% 19.9%
Borderline/EUPD 3.1% 21.1%
Narcissistic 5.0% 20.3%
Histrionic 1.0% 42.4%
Source: turner et al (2017) the relationship between childhood sexual abuse and mental health outcomes among males: results from a nationally representative United States sample, Child Abuse & Neglect 66: 64-72<br>
slide12. Some ACE Correlations: Suicide attempts: from a score of zero to a score of six or more, 5000% increase
Alcoholism: people with ACE scores of four were 700% more likely to be alcoholic than adults with a score of zero
IV drug use: from a score of zero to a score of 6 or more, 4600% increase<br>
slide13. Breaktime <br>
slide14. Vignette: Dislocation
Loss
Impermanence
Uncertainty
Constant reminders
Guilt
Loss of control
Tanya had to leave her country of origin and move to UK due to war. She has three children one of whom had to be left behind with her grandmother. Husband is fighting. Her English is limited. She is living with and English family but is struggling to communicate and fit in.<br>
slide15. Trauma and the Brain the affect regulation model (CFT, Paul Gilbert) Drive (distract) mode
Incentive/resources focused,
Wanting, pursuing, achieving, consuming.
Activating Safe-Soothing mode
Non Wanting, Affiliative Focused, Safeness, Kindness.
Soothing Threat Mode
Fight-flight-freeze
Protection & Safety seeking.
Emotions: Fear, disgust, anger, hopelessness.
Activating/Inhibiting<br>
slide16. Formulation and diagnosis Formulation: A map/story Diagnosis: A categorisation<br>
slide17. So a formulation is a story that helps us understand and explain things<br>
slide18. Let’s take another look at our Vignette: Imagine a child grows up in an unpredictable, abusive/neglectful environment. For example, there is domestic violence at home from one of the parents who is a drinker. The other parent is anxious and depressed and is withdrawn and absent as a result (they are a victim of domestic violence after all.
How may they come to think about:
Themselves
Others (people, e.g. caregivers, friends)
The world in general
What might they do to cope?
How might it effect their education, job prospects and their relationships?<br>
slide19. CFT formulation<br>
slide20. CFT formulation<br>
slide21. CFT formulation<br>
Clinical Psychologists<br>
slide2. Training Outline Intro and session 1 1 hour
Break 15 mins
Session 2 1 hour<br>
slide3. Health warning……..<br>
slide4. Aims of the training Understanding the impact of trauma on people’s lives
Understanding formulation and how can it help<br>
slide5. Warm up exercise: What are the biggest challenges you face with your students?
What do you want from today?<br>
slide6. What is trauma? “Trauma refers to harmful emotional, psychological, biological and social human responses to an event(s) or circumstances which are experienced as life threatening to the individual”
Substance abuse and mental health administration SAMHSA 2014
“Being traumatised means continuing to organise your life as if the trauma were still going on – unchanged and immutable – as every new encounter or event is contaminated by the past”
Van Der Kolk, The Body Keeps the Score<br>
slide7. Vignette: Imagine a child grows up in an unpredictable, abusive/neglectful environment. For example, there is domestic violence at home from one of the parents who is a drinker. The other parent is anxious and depressed and is withdrawn and absent as a result (they are a victim of domestic violence after all.
How may they come to think about:
Themselves
Others (people, e.g. caregivers, friends)
The world in general
What might they do to cope?
How might it effect their education, job prospects and their relationships?<br>
slide8. Feedback: I don’t matter
I’m a problem
People are dangerous/don’t care
World isn’t safe
World unpredictable
Child might be combative or withdrawn
Child might try to keep others happy
Might struggle at school, with peers, struggle to concentrate<br>
slide9. ACE Studies -Vincent Felitti: Studies that looked at correlations between Adverse Childhood Events (hence ‘ACE’) and health outcomes in adulthood
ACE score 0 – 10 with one ‘point’ for each adverse event. Adverse events included things such as:
emotional/physical/sexual abuse, misuse of drugs and/or alcohol in family home, family member in prison, parental separation.
Only 1/3 reported no ACEs<br>
slide10. Likelihood of Diagnosis – for children who were sexually abused
Depression: 5.07 times more likely
Phobia: 12.12 times more likely
OCD: 7.01 times more likely
PTSD: 8.23 times more likely
Eating Disorder: 6.53 times more likely
Psychosis: 10.14 times more likely
Sources: 1. jonas, s et al. (2011) sexual abuse and psychiatric disorder in England: results from the 2007 adult psychiatry morbidity survey, psychological medicine; 41: 709-20.<br>
slide11. Personality disorder No maltreatment Childhood maltreatment
Aniti-social 3.5% 19.9%
Borderline/EUPD 3.1% 21.1%
Narcissistic 5.0% 20.3%
Histrionic 1.0% 42.4%
Source: turner et al (2017) the relationship between childhood sexual abuse and mental health outcomes among males: results from a nationally representative United States sample, Child Abuse & Neglect 66: 64-72<br>
slide12. Some ACE Correlations: Suicide attempts: from a score of zero to a score of six or more, 5000% increase
Alcoholism: people with ACE scores of four were 700% more likely to be alcoholic than adults with a score of zero
IV drug use: from a score of zero to a score of 6 or more, 4600% increase<br>
slide13. Breaktime <br>
slide14. Vignette: Dislocation
Loss
Impermanence
Uncertainty
Constant reminders
Guilt
Loss of control
Tanya had to leave her country of origin and move to UK due to war. She has three children one of whom had to be left behind with her grandmother. Husband is fighting. Her English is limited. She is living with and English family but is struggling to communicate and fit in.<br>
slide15. Trauma and the Brain the affect regulation model (CFT, Paul Gilbert) Drive (distract) mode
Incentive/resources focused,
Wanting, pursuing, achieving, consuming.
Activating Safe-Soothing mode
Non Wanting, Affiliative Focused, Safeness, Kindness.
Soothing Threat Mode
Fight-flight-freeze
Protection & Safety seeking.
Emotions: Fear, disgust, anger, hopelessness.
Activating/Inhibiting<br>
slide16. Formulation and diagnosis Formulation: A map/story Diagnosis: A categorisation<br>
slide17. So a formulation is a story that helps us understand and explain things<br>
slide18. Let’s take another look at our Vignette: Imagine a child grows up in an unpredictable, abusive/neglectful environment. For example, there is domestic violence at home from one of the parents who is a drinker. The other parent is anxious and depressed and is withdrawn and absent as a result (they are a victim of domestic violence after all.
How may they come to think about:
Themselves
Others (people, e.g. caregivers, friends)
The world in general
What might they do to cope?
How might it effect their education, job prospects and their relationships?<br>
slide19. CFT formulation<br>
slide20. CFT formulation<br>
slide21. CFT formulation<br>