TRAUMA

Tana Bridge, PhD, LMSW

Associate 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

Trauma
Trauma
Terror Reactions unknown, held within Cant or dont want to talk Pain triggers terror, powerlessness, loss of safety Anger- can become assaultive Attacks, distorts self image Guilt says It was my fault, I could have prevented it Cognitive Struggles: 2+2 ??? 4, Magical Thinking (E.G. if I touch him he will die)

W. Steele:TLC

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 Situations
War Violence Rape Murder Beatings/Assaults Domestic Violence Fires

Suicides Car Accidents/Plane Crashes Disasters - earthquake, floods, fires, etc. Injuries or life threatening illness Dog Bites Drowning Etc.

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

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 retelling) 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

SYMPTOMS -CONTINUED
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.

THE BRAIN AND TRAUMA

2 Component of Brain Response

1. Reaction processing of trauma 2. Memory how memory is stored

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 PTSD

Trauma 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

VIDEO: BILL STEELE

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 whys Allows for mastery over content Allows for experience outside of self Removes negative image Challenge distorted thinking Interventions should be psychomotor as experience is sensory (art sculpting, play, story telling, journaling, etc.) May need support in working through unhealthy thinking and its connection to behavior.

Promises of Healing
Reduced frequency of symptoms Reduced fear of the symptoms Reduced fear of insanity Opportunity to grieve Change from victim to survivor Opportunity to begin enjoying life Sense of humor Profound empathy for others who suffer