The Many Facets of Trauma Introduction to Trauma by Marina E Hewitt R Psych Early Childhood Experiences by Dr Heather Sheppard R Psych Presented by Dr Megan Grant R Psych PostTrauma Responses ID: 1045120
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1. APNL Presents: All About TraumaThe Many Facets of Trauma
2. Introduction to Trauma by Marina E. Hewitt, R. Psych. Early Childhood Experiences by Dr. Heather Sheppard, R. Psych. Presented by Dr. Megan Grant, R. Psych.Post-Trauma Responses by Dr. Megan Grant, R. Psych.The body remembers: Physiology of Trauma by Dr. Beatriz R. Rodriguez Rubio, R. Psych. Trauma Symptoms and Diagnoses by Curt Hillier, M.Sc., Registered PsychologistPaths to Recovery by Dr. Megan Grant, R. Psych.Pharmacological Management of PTSD by Dr. Cynthia Slade, MD, FRCPCThemes for This Evening:
3. Introduction to Trauma Marina E. Hewlett, R. Psych.
4. What is Trauma?Trauma is caused by negative events that are stored in the brain and body and may affect how we feel, think, and behave. It affects how we see the world..
5. Facets of TraumaTrauma affects how we interact with the world.
6. Facets of TraumaTrauma is not about what is wrong with someone but about what has happened.
7. Facets of TraumaTrauma can result in living the present through the past.
8. Facets of TraumaNegative experiences and unmet developmental needs which undermine sense of:self-worth;safety;ability to assume responsibility for self or others;ability to control choices.
9. Facets of TraumaTrauma comes in many forms and reactions are individualized.
10. Facets of TraumaStored memorythoughts, pictures, sounds, smells, tastes, emotions; andbody sensations.
11. Trauma and the brain’s pathways to healingThe Brain is :oriented towards healthhas a physiological information processing system that normally helps us to process our experiences adaptively.Facets of trauma
12. The Callery Tree , now known as the “Survivor Tree”, was discovered in the rubbles of Ground Zero following the terror attacks on September 11, 2001. The severely damaged tree was nursed back to health and now stands at the 9/11 Memorial as a living reminder of our shared strength in the face of trauma.Facets of Trauma Recovery
13. Early Childhood Experiences Dr. Heather Sheppard, R. Psych.Presented by Dr. Megan Grant, R. Psych.
14. Childhood mattersChildhood trauma can include Abuse Neglect Parental mental illness/substance use Parental incarceration Parental separation Family violence Environmental disasterWar
15. Childhood Trauma is Common 67% of us experience at least one of these traumas 1 in 8 experience 4 or more. Our developing brain is extremely vulnerable to toxic stress.
16. What are the impacts?
17. Our Body Remembers Childhood trauma increases the rates of 7 of the 10 leading causes of death in our country (e.g., heart disease, asthma, cancer) With or without an increase in negative behaviours (e.g., smoking) Changes our DNA Changes brain structure and functionChanges our immune system Alters the impact of adult trauma
18. Our Thinking is changed Our story Safety, intimacy, trust, control Self and other Memory is changed Trauma memory are tied together – neurocognitive,
19. Our emotions are changed Reactions become more automatic We get ‘stuck’ in an emotion FearAnger Numbness Fearful of emotions Dissociation Emotions can become triggers
20. Our coping is changed You survived. Many of the tools and solutions we used to cope and survive become ‘stuck’, They stay, even when we are safe The solution may become the “problem”.
21. Are we doomed?No but…. Often painful and frustrating to acknowledge role of childhood trauma in adult experiences Power in understanding …..Why some things may be hardPersonal vulnerabilities Informs treatment Physical and mental health
22. Post-Trauma Responses Dr. Megan Grant, R. Psych.
23. Post-trauma ResponsesNot everyone who experiences a traumatic event will develop lasting symptomsWhether trauma symptoms develop/persist can be influenced by multiple factors related to theindividual experiencing the trauma traumatic eventsocial context
24. Individual FactorsGreater likelihood of developing trauma impacts/symptoms has been associated with Female genderYounger and older age (vs. middle age)Poverty / low SESPrevious or coexisting psychological disorderLess functional coping stylesFamily dysfunction / family history of psychopathologyPrevious trauma exposureDissociation / “shutting down” at time of traumaGreater distress at time of or immediately after traumatic event
25. Event FactorsGreater likelihood of developing trauma impacts/symptoms has been associated with events thatInvolve intentional acts of violencePresent a life threatCause physical injuryInvolve harming others (e.g.,combat), or witnessing deathLoss of friend/loved one due to traumaLife-threatening illness (especially painful medical procedures/events)Sexual victimizationLonger duration/greater frequency of traumasUnpredictability and uncontrollability
26. Social FactorsSocial factors tend to be some of the most important in determining a person’s response to traumaMore positive outcomes tend to be associated withSupport from family, friends, and safe othersAccepting/non-blaming responses to talking about the traumaCaring and nurturing responses from othersAvailability of helpers/agenciesPublic attitudes / prejudice toward some groups contribute to trauma response
27. Impacts of TraumaFor those who experience symptoms, the impacts can be widespreadMany find that their beliefs are changed by their traumaBeliefs about themselvesBeliefs about others/the worldBeliefs about the future
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29. Impacts of TraumaPeople who are impacted by trauma may find themselves having difficulties withRelationshipsWork, school, daily tasksLeisure / personal interestsSubstance useEven though trauma can dramatically impact one’s life, post-traumatic growth is possible
30. The body remembers:Physiology of Trauma Beatriz R. Rodriguez Rubio, PhD., R. Psych (Dr. Betty)
31. Trauma and the body How does trauma get “stuck” in the body?Part of PTSD is non-verbal it shows up when, at times, seemingly “for no reason” we feel extra jumpy or anxious or angry or numb. This has to do with how our brain works:
32. Frontal Lobe- involved in planning thinking, complex decision making, personality expression, and moderating social behaviour. In charge of language and logic. Thinks things through and can be slowLimbic System: Doesn’t have language it is more concerned with basic survival motivations, kicks in quick, it is not too concerned with logic or reason. Two important parts within the limbic system: Amygdala – Involved with emotions such as anger, fear, pleasureHippocampus – Involved in learning and memory Brain Basics
33. Response to Trauma (Fight, Flight, or Freeze)
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35. Our brain has survival mechanisms that are trying to protect us, it doesn’t know that we are safe now. One of the most important parts in healing is to restore a sense of safety. And to be kind to ourselves, understanding that our limbic system is trying to protect us…. Don’t judge, attack, or “should” at yourself for normal reactions.
36. Trauma Symptomsand DiagnosesCurt Hillier, M.Sc.Registered Psychologist
37. Trauma SymptomsIntrusion and re-experiencing traumaAvoidance of trauma remindersNegative changes in thinking and moodChanges in arousal level
38. Intrusion and Re-experiencing TraumaIntrusive distressing thoughts and memories of the traumaRecurrent distressing dreams related to traumaFlashbacks – feeling or acting like trauma is recurringIntense psychological distress when triggered or cued to traumaMarked physiological reactions when triggered or cued
39. Avoidance of Trauma Cues and TriggersAvoidance of distressing memories, thoughts, or feelings about or closely associated with traumaAvoidance of people, places, conversations, activities, objects, or situations that trigger distressing thoughts, memories, or feelings about trauma
40. Negative Changes in Thinking or MoodInability to remember an important aspect of the traumaExaggerated negative beliefs or expectations about oneself, others, or the worldDistorted thoughts about the cause or consequences of trauma that lead to blame of self or othersNegative emotional state (fear, horror, anger, guilt, shame)Diminished interest or participation in significant activitiesFeelings of detachment or estrangement from othersInability to experience positive emotions
41. Changes in Arousal LevelIrritable behaviour and angry outburstsReckless or self-destructive behaviourHypervigilance – on guard, scanning for threatExaggerated startle response – jumpyProblems with concentrationSleep disturbance
42. DiagnosesAcute Stress ReactionAcute Stress DisorderPost Traumatic Stress Disorder
43. Further ResourcesNational Center for PTSDPTSD Buddies
44. Paths to recoveryThere are many treatment options. Sensorimotor psychotherapy – works with restoring a sense of safety within the body and slowly re-connecting the limbic system with the frontal cortex so that we can work with having less limbic system /amygdala hijacking.
45. Paths to RecoveryDr. Megan Grant, R. Psych.
46. Paths to RecoveryThe type of treatment received will depend on Type of trauma and specific symptoms experiencedIndividual needsAvailability and appropriateness of trauma-specific servicesIn general, treatment that addresses trauma will occur in phasesPhase 1: Education, Safety, CopingPhase 2: Processing MemoriesPhase 3: Engagement / Reconnection
47. Phase 1Client and therapist discuss consent, treatment and what is involved, education provided around rationale for treatmentTherapist assists client in developing an understanding of their symptomsCoping skills and strategies are taught and practiced to promote safety between sessions and prepare for next phase of treatment
48. Phase 2The exact method used to process memories will vary depending on the orientation of the therapist, the service being provided, and on client needsThis is often the most “intense” phase of treatment, but can also be one of the most meaningful for clients Focus of this phase is to discuss memories in a way that will encourageNormalizing client’s response to what happened to themDeveloping new ways of understanding their traumaDecreasing the intensity of emotion associated with the trauma memoriesDecreasing avoidance of thoughts/memories related to the trauma
49. Phase 3This phase focuses on getting clients back to the life they want to be livingTreatment may focus onRepairing relationships or forming new onesReturning to work, hobbies, interestsPotentially developing a new sense of selfEnsuring clients have the knowledge/skills they need to maintain their health/well-being once treatment has endedSupporting post-traumatic growth
50. Paths to RecoveryA client’s journey through these three phases is not always linearThe course that treatment is taking can be impacted by triggers, life events, new traumas, etc.Finding a fit between client needs and a treatment approach that can be consistent yet flexible is key
51. Pharmacological Management of PTSDDr. Cynthia Slade, MD, FRCPCMarch 13, 2018
52. Canadian Psychiatric Association: Clinical Practice Guidelines for Managing PTSD (2006)“Comprehensive management of PTSD should incorporate both psychoeducational and pharmacologic components.”
53. Recommendations for Pharmacotherapy for PTSDFirst lineFluoxetine, paroxetine, sertraline, venlafaxine XRSecond lineFluvoxamine, mirtazapine, moclobemide, phenelzine.Adjunctive: risperidone, olanzapineThird lineAmitriptyline, imipramine, escitalopramAdjunctive: carbamazepine, gabapentin, lamotrigine, valproate, tiagabine, topiramate, quetiapine, clonidine, trazodone, buspirone, buproprion, prazosin, citalopram, fluphenazine, naltrexone.Not recommendedDesipramine, cyproheptadine.Monotherapy: alprazolam, clonazepam, olanzapine.
54. Response to an SSRI should be apparent within 2-4 weeks.Adequate trial length is up to 8 weeks at maximal, tolerated dose.
55. Combination therapy with multiple agents early on is often seen to preserve and build upon gains made in treatment.
56. Long-Term Management (LTM)LTM is often needed.Approximately 25% of patients with PTSD who responded to treatment relapsed within 6 months of discontinuing medications.It is suggested that those patients with chronic PTSD continue medications for at least one year.Benefits have been shown to accrue with LTM.Improvement in psychosocial functioning tends to lag behind symptomatic improvement, highlighting the need to continue medication well after symptoms remit.Many patients will require LTM to prevent relapse.
57. Thank you! Questions? If you would like to seek treatment please go to:http://www.apnl.ca/find-a-psychologist/