Trauma and Crises Intervention

Trauma and Crisis
Intervention in Counseling
Muthoni Njogu (B.A Psychology, M.A MAMFT; (IP)November 17th 2018

This course addresses the impact of trauma induced events on
individuals and communities as well as treatment of trauma
related disorders. Trauma is examined through the impact on
the brain regions, impact on memory, variations of emotional
regulation and somatic responses. This course will offer
empirically based treatments and discuss treatment planning
for trauma survivors with acute as well as complex PTSD.
Muthoni Njogu (B.A Psychology, M.A MAMFT; (IP) November 17th 2018
Psychological trauma is human reactions to trauma-
provoking events or traumatic events (Roberts, 2002).
- accidents
- abuse
- combat
- assault (physical/sexual/emotion)
- torture
- natural disasters
Types of Trauma
- sexual abuse or assault - physical abuse or assault

- emotional abuse or psychological maltreatment
- neglect - serious accident, illness, or medicinal procedure - victim or witness to DV
- victim or witness to community violence - historical violence - school violence
- bullyng - natural or manmade disasters - forced displacement
- war, terrorism or political violence - military trauma
- victim or witness to extreme personal or interpersonal violence
- traumatic grief or separation
- system induced trauma and re-traumatization
Consequences of Trauma
Image from google images

Definition of PTSD
PTSD (post-traumatic stress disorder) is a mental
health problem that some people develop after
experiencing or witnessing a life-threatening event,
like combat, a natural disaster, a car accident, or
sexual assault.
DSM-5 Criteria for PTSD
(Diagnostic and Statistical Manual of Mental Disorders
(DSM-5)
DSM-5 introduced a preschool subtype of PTSD for children six
years and younger. The criteria below are specific to adults,
adolescents, and children older than six years.
All of the criteria are required for the diagnosis of PTSD.
Criterion A: stressor (one required)
• The person was exposed to: death, threatened death, actual or threatened
serious injury, or actual or threatened sexual violence, in the following
way(s):
• Direct exposure
• Witnessing the trauma
• Learning that a relative or close friend was exposed to a trauma
• Indirect exposure to aversive details of the trauma, usually in the course
of professional duties (e.g., first responders, medics)
Criterion B: intrusion symptoms (one required)
• The traumatic event is persistently re-experienced in the following
way(s):
• Unwanted upsetting memories
• Nightmares
• Flashbacks
• Emotional distress after exposure to traumatic reminders
• Physical reactivity after exposure to traumatic reminders
Criterion C: avoidance (one required)
• Avoidance of trauma-related stimuli after the trauma, in the
following way(s):
• Trauma-related thoughts or feelings
• Trauma-related external reminders
Criterion D: negative alterations in cognitions and mood (two required)
• Negative thoughts or feelings that began or worsened after the trauma, in the
following way(s):
• Inability to recall key features of the trauma
• Overly negative thoughts and assumptions about oneself or the world
• Exaggerated blame of self or others for causing the trauma
• Negative affect
• Decreased interest in activities
• Feeling isolated
• Difficulty experiencing positive affect
• Criterion E: alterations in arousal and reactivity
• Trauma-related arousal and reactivity that began or worsened
after the trauma, in the following way(s):
• Irritability or aggression
• Risky or destructive behavior
• Hypervigilance
• Heightened startle reaction
• Difficulty concentrating
• Difficulty sleeping
Criterion F: duration (required)
• Symptoms last for more than 1 month.
Criterion G: functional significance (required)
• Symptoms create distress or functional impairment (e.g.,
social, occupational).
• C-PTSD occurs as a result of exposure to multiple, repeated traumatic
event(s). Complex trauma:
· is usually interpersonal i.e. occurs between people
· involves ‘being or feeling’ trapped
· is often planned, extreme, ongoing and/or repeated
· often has more severe, persistent and cumulative impacts
· involves challenges with shame, trust, self-esteem, identity and regulating
emotions.
· has different coping strategies. These include alcohol and drug use, self-
harm, over- or under-eating, over-work etc.
· affects emotional and physical health, wellbeing, relationships and daily
functioning
Complex trauma commonly occurs with repeated trauma against a child.
Sometimes a parent or caregiver has experienced their own trauma, which
is still affecting them e.g. from mental illness, drugs and alcohol misuse, or
being physically or emotionally unavailable. Many situations can cause
complex trauma in childhood.
Complex childhood trauma can be especially damaging. This is not always
the case. This includes all forms of child abuse, neglect, adverse childhood
experiences, community violence – domestic and family violence, civil
unrest, war trauma or genocide, cultural dislocation, sexual exploitation and
trafficking.
Complex trauma is not always the result of childhood trauma. It can also
occur as a result of adults’ experience of violence in the community e.g.
domestic and family violence, civil unrest, war trauma or genocide, refugee
and asylum seeker trauma, sexual exploitation and trafficking, extreme
medical trauma and/or re-traumatisation.
1. Brain region
2. Memory
3. Emotional regulation
4. Somatic response to trauma
1. BRAIN
Trauma is stored in multiple components of the
brain which becomes deeply embedded in the
behavior and emotional state of the client.
Image from google images.
2. MEMORY
The hippocampus is a part of the limbic system of the brain that is
tasked with the process of storing and retrieving memories. constant
stress may damage the hippocampus. During stressful events, the
body releases cortisol which is helpful in mobilizing the body to
respond to a stressful event.
Researchers have also looked at the size of the hippocampus in people
with and without PTSD. They have found that people who have
severe, chronic cases of PTSD have smaller hippocampi. This
indicates that experiencing ongoing stress as a result of severe and
chronic PTSD may ultimately damage the hippocampus, making it
smaller.
(Conrad, 2008)
3. EMOTIONAL REGULATION SYSTEM
• Our nervous systems cycles through sympathetic (our flight, and
fight response), and parasympathetic nervous system (our rest and
digest response) states as we respond to our environment. This is an
expected and essential part of our survival.
• When facing a potentially stressful event, our bodies provide us with

an enormous amount of energy in order to assist us in our flight or
fight response. If this energy is not released, the stressful event
remains unresolved, and the unresolved stress becomes stored in the
body.
EMOTIONAL REGULATION SYSTEM
EMOTIONAL REGULATION
Levine, Ogden, Siegel

Effect of Trauma on Emotional
Regulation
Levine, Ogden, Siegel

4. Somatic Response to Trauma
• Night terrors and insomnia, which lead to fatigue and difficulty concentrating
• Agitation and anxiety, especially in unfamiliar places
• Having an extreme startle reflex, this could result in rage or further withdrawing
• Withdrawing from social situations, or even personal relationships
• Anger, rage, and mood swings
• Feelings of being numb or otherwise disconnected from reality and those around you
• Aches and pains that have no other explanation
• Racing heart, high blood pressure, and diabetics may find their blood sugar levels
difficult to control
• Chronic health conditions related to stress
Google Images
Questions to consider prior to Assessment
• What types of traumas are you most interested in finding out about?
• Do you want to survey a wide range of possible traumas or focus on a
particular group of traumas such as physical and sexual assault?
• Do you want a survey that only screens for traumas included in the DSM-V
diagnostic criteria for PTSD?
• Do you want a survey that simply screens for the presence of PTSD
symptoms or one that also gives you information about frequency and
intensity of symptoms? How much time do you have to assess for trauma,
PTSD symptoms, and associated conditions?
• What is the privacy level of the setting for administering the surveys?
• What is the literacy level of the client being assessed?
• What is the primary language of the client being assessed?
Assessment Tools
The Brief Trauma Questionnaire (BTQ) is a ten-

item self-report trauma exposure screen that can be
quickly administered and is suitable for special
populations such as persons with severe mental
illness as well as for general population groups. The
BTQ is designed to quickly screen for many different
and prevalent types of traumatic experiences,
including war traumas, serious car accidents, natural
disasters, exposure to violent death, life-threatening
illness, and physical or sexual abuse.
Assessment Tools
Traumatic Life Events Questionnaire

The Traumatic Life Events Scale captures exposure to 21
traumatic events, proceeding from general (natural
disasters and car accidents) to highly personal (death of a
loved one and sexual abuse). The items include follow-up
probes asking whether respondents felt fear, helplessness,
or horror during any event experienced and whether there
was a physical injury or an immediate emotional response.
For exposure to multiple events, respondents are asked to
indicate which event they perceive as the worst and how
much distress it caused.
Assessment Tools
PCL Checklist
• The Post Traumatic CheckList is a 20-item self-report measure that
assesses the 20 DSM-5 symptoms of PTSD. The PCL-5 has a
variety of purposes, including:
• Monitoring symptom change during and after treatment
• Screening individuals for PTSD
• Making a provisional PTSD diagnosis
• The gold standard for diagnosing PTSD is a structured clinical
interview such as the Clinician-Administered PTSD Scale (CAPS-
5). When necessary, the PCL-5 can be scored to provide a
provisional PTSD diagnosis.
Assessment Tools
The Child Post-traumatic Symptom Scale (CPSS)

has been shown to be reliable and valid as a screening
tool for use with children and adolescents. The CPSS
assesses symptom criteria for PTSD, as well as
whether the respondent is experiencing impairment
in functioning.
Assessment Tools
The UCLA Child/Adolescent PTSD Reaction

Index for DSM-5 is the revision of the UCLA
Child/Adolescent PTSD Reaction Index for DSM-
IV. The new DSM-5 version is a semi-structured
interview that assesses a child's trauma history and
the full range of DSM-5 PTSD diagnostic criteria
among school-age children and adolescents.
Additional Assessment Tool
The Beck Depression Inventory-II is a well-validated

self-report scale for depression that has been used
with a wide range of different populations and
disorders.
While there are numerous therapy approaches, the
purpose of all trauma-focused therapy is to
integrate the traumatic event into the clients’ life, not
subtract it. Trauma treatment research field is still
young, and further difficult to conduct in some cases
Comparisons of different treatments for Trauma are
scarce
• lack of empirical evidence in the literature does not
necessarily signify a lack of treatment efficacy
Questions to Consider
• Type and impact of trauma
• Unique client life challenges
• Side effects and potential negative effects
• Cost
• Length of treatment
• Cultural appropriateness
• Therapist's resources and skills
• Client's resources and stressors
• Comorbidity of other psychiatric symptoms
• Legal, administrative, and forensic concerns
•
Comorbidity /Dual Diagnosis
Associated with increased rates
• affective disorders (MDD, Bipolar Dx)
• anxiety disorders (panic, agoraphobia, OCD, Social, Specific,
GAD)
• substance abuse
They may precede, follow or emerge concurrently with PTSD
• NCS indicates that at least one additional psychiatric disorder is
present in 88.3% of men and 79.0% of women who have a history of
PTSD.
• 59 % of men and 44 % of women who have PTSD meet the criteria

for three or more psychiatric diagnoses.
• Women who have PTSD are 4.1x as likely to develop a major

depression
• Women 4.5x as likely to develop mania as women who do not have

PTSD
Cognitive-Behavioral Therapy
Cognitive-behavioral therapies for trauma are based on the idea that
problems arise as a result of the way people interpret or evaluate
situations, thoughts, and feelings, as well as the problematic ways
these evaluations cause people to act ( eg avoidance,
disassociation ) Examples of cognitive-behavioral therapies for
PTSD are exposure therapy, stress inoculation training, cognitive
processing therapy, behavioral activation, acceptance and
commitment therapy. Cognitive-behavioral therapy has been
found to be successful in reducing the symptoms of PTSD.
Psychodynamic Psychotherapy
Psychodynamic psychotherapy places a large emphasis
on the unconscious mind where upsetting feelings,
urges, and thoughts that are too painful for us to
directly look at are housed. getting in touch with and
"working through" those painful unconscious feelings.
EMDR - Eye Movement Desensitization & Reprocessing
• EMDR) is a relatively new treatment that's been found to reduce
the symptoms of PTSD.
• It involves making side-to-side eye movements, usually by
following the movement of your therapist's finger, while
recalling the traumatic incident.
• Other methods may include the therapist tapping their finger or
playing a tone.
• It's not clear exactly how EMDR works, but it may help you
change the negative way you think about a traumatic experience.
• Pharmacology
Several types of medications can help improve symptoms of PTSD:
• Antidepressants. These medications can help symptoms of
depression and anxiety. They can also help improve sleep
problems and concentration. The selective serotonin reuptake
inhibitor (SSRI) medications include sertraline (Zoloft) and
paroxetine (Paxil).
• Anti-anxiety medications. These drugs can relieve severe
anxiety and related problems. Some anti-anxiety medications
have the potential for abuse, so they are generally used only for a
short time.
For associated depression, the SSRI antidepressant
medications, again, are the treatment of choice. For those
who do not have a positive response to these medications,
there are the MAOI (monoamine oxidase inhibitor)
antidepressant medications, which require maintaining a
strict diet of foods that do not include the pressor amine,
Tyramine, such as cheese, alcohol, or yeast products. If
these foods are eaten while a person is taking an MAOI
they run the risk of having a hypertensive crisis, which can
lead to a stroke or heart attack. Because of the dietary
restrictions with MAOIs, they are not commonly
prescribed
Somatic Experiencing (SE) Trauma Therapy
Key element is to process stuckness as a result of trauma/traumatic
experiences. Dr. Levine describes in his books Waking the Tiger and In an
Unspoken Voice, SE focuses on the physiological responses that occur when
someone experiences or remembers an overwhelming or traumatic event, in
his or her body, rather than only through the thoughts or emotions connected
to it.
The reason to do this is to restore the nervous system’s normal cycling between
alertness and rest.
• The excitation is when we’re stimulated in some way, whether to feel pleasure
or to respond to danger.
• The settling is to allow for the relatively quiet states necessary for digestion,
rest, and recharging. This settling also permits us to prepare for the next time
we need to react, with yet a new demand for energy.
• This cycle continues smoothly, up and down, when we’re functioning well.
• When any part of this normal cycle is interrupted, the charge of
energy gets ‘stuck’ in our bodies. We can then fail to fluctuate
easily between states of different intensity. And the charge stuck
in our systems will likely be triggered when in the future we
encounter events, people, or things that remind us of the earlier
experience that was never completed.
• Thus, our present lives are colored by our past, often in a negative way, and
when the past intrudes, we can’t fully be present in the present.
•
Somatic Experiencing (SE) Trauma Therapy
Image from Google

STEP 1 Create a safe zone ( focus on available resources)
STEP 2 Identify & Explore effects of the event. Questions like WHERE
in my body do I feel uncomfortable
STEP 3 Exploration of HOW the body needs to respond. Question to
pose is WHAT
Do I need to do NOW that I COULD NOT do then.
STEP 4 Natural and safe release of stuck energy (experiential )
STEP 5 Integration of the traumatic experience. ( Resilience)
Possible outcome: sense of success | restored ability to explore,
identify and integrate feelings | sense of wellbeing | relaxation |
peace
END
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Trauma and Crisis

Muthoni Njogu (B.A Psychology, M.A MAMFT; (IP)November 17th 2018

- sexual abuse or assault - physical abuse or assault

Image from google images

All of the criteria are required for the diagnosis of PTSD.

• When facing a potentially stressful event, our bodies provide us with

Levine, Ogden, Siegel

Levine, Ogden, Siegel

The Brief Trauma Questionnaire (BTQ) is a ten-

Traumatic Life Events Questionnaire

The Child Post-traumatic Symptom Scale (CPSS)

The UCLA Child/Adolescent PTSD Reaction

The Beck Depression Inventory-II is a well-validated

They may precede, follow or emerge concurrently with PTSD

• 59 % of men and 44 % of women who have PTSD meet the criteria

• Women who have PTSD are 4.1x as likely to develop a major

• Women 4.5x as likely to develop mania as women who do not have

Image from Google

THANK YOU FOR

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