Beruflich Dokumente
Kultur Dokumente
Goal of Workshop
To develop a clearer idea about ways we can make our treatment settings conducive to the treatment of psychological trauma
Workshop Objectives
Review the definition of trauma, PTSD, and Complex PTSD Present and discuss the stages and tasks of trauma recovery Present and discuss Seeking Safety treatment In small groups, discuss how our treatment settings can be more trauma informed
Integrated treatment (treatment for both at the same time) improves outcomes
Trauma
DSM IVR: Experience, threat, or witnessing of physical harm that evoked intense fear, helplessness or horror
Can include: Physical or sexual abuse Domestic violence Assault Severe car accident Life threatening illness Natural disaster/terrorism Combat Prison/torture
Up to 1/3 of people who experience trauma develop PTSD; 2/3 do not What about the 2/3?
PTSD
3 Core Sets of Symptoms
Intrusion
Re-experiencing the trauma over and over again in ones mind
Flashbacks Nightmares Intrusive thoughts
Avoidance
Avoidance of discussion and memories of the trauma Avoidance of activities, people, places linked to the trauma Inability to recall an important aspect of the trauma Diminished interest or participation in activities Feeling of detachment from others Restricted range of affect Sense of foreshortened future
Arousal
Intensely triggered when reminded of the event Hypervigilence Exaggerated startle responses Insomnia Anger Difficulty concentrating
Identifying PTSD
PTSD can go on for years Often under-diagnosed or misdiagnosed Is often interpreted as bad behavior
Complex PTSD
Broad symptoms, more damage to personality Profoundly affects self- and world view Self-harm cutting, burning Relationship problems (too close or distant) Brief psychotic symptoms (paranoia, delusions)
Complex PTSD
Somatic symptoms, the body remembers Dissociation (spacing out) Loss of sense of self (fragmented, empty, split) Traumatic re-enactments
Traumatic Reenactments
Recreating the trauma in new situations with new people Examples: A rape victim repeatedly returns to the area where the incident took place A woman with a history of incest is hypersexual An adolescent who has been physically abused provokes fights
The symptoms of PTSD are the brains way of coping with lifethreatening danger; they are survival mechanisms.
Stage 2: Mourning
Goal: Processing trauma, expressing of grief and pain, transforms story of shame and humiliation to one of dignity and virtue. Approach: Exposure therapy (focus is on past) integration of emotional and cognitive
Stage 3: Reconnection
Goals: to develop a productive, fulfilling life in the present, including stable relationships and career, new identity as survivor and/or person in recovery, often includes helping others with similar problems. Approach: group work, supportive counseling
While there is no way to compensate for an atrocity, there is a way to transcend it, by making it a gift to others. The trauma is redeemed only when it becomes the source of a survivor mission. Judith Herman, Trauma and Recovery, 1992
Treatment
PTSD can be treated just by focusing on the present, e.g., cognitive behavioral treatment. Clients with SUD may not be ready for past-focused treatment. May delay or not do past-focused treatment at all. According to research, past- and presentfocused treatments both work equally well
How do we create a TC that is conducive to the simultaneous treatment of substance use disorders and the healing of trauma?
Seeking Safety
Focuses on first stage of recovery safety vs. danger Teaches coping skills useful to recovery from PTSD and substance use disorders Details of trauma are not processed Trauma may be named, but details are discouraged
Research Support
Found to be effective with: Women Men Adolescents Co-occurring disorders In prison, inpatient and outpatient settings
Psychoeducation
Enhances the clients understanding of how post-traumatic symptoms and substance abuse are an attempt to regain a sense of safety, selfrespect, connectedness, and empowerment Enhances the clients understanding in nonstigmatizing terms of how s/he learned to cope with trauma and why these types of coping made sense for dealing with trauma
Is strength-based
Cognitive Re-structuring
Challenges self-defeating beliefs in a nonconfrontational, non-judgmental way Current beliefs and feelings are validated first Thought-provoking questions, peer feedback, information, and encouragement can replace cognitive distortions with more recovery-oriented thinking
Skills Development
1. Discuss the skill 2. Rehearse the skill in group
Interpersonal topics e.g., role play (talk through) Cognitive topics e.g., think aloud (think through) Behavioral topics 3.
e.g., what would you do? (walk through) Commitments at the end of group practice in real world and report back
Core Principles of a Trauma Informed Approach Safety: How can we ensure physical and emotional safety for clients? Staff? Trustworthiness: How can we maximize trustworthiness? Make tasks clear? Maintain appropriate boundaries? Choice: How can we enhance client
Intrusive monitoring
strip searches body cavity searches urine screens using inappropriate staff or practices
Excessive confrontation Moral inventories that encourage clients to assume more than their share of responsibility for past abuses
References
Bloom, S., Creating Sanctuary: Toward the Evolution of Sane Societies, New York: Rutledge, 1997. Herman, Judith, Trauma and Recovery, New York: Basic Books, 1997 Jaycox, L, Ebener, P., Damesek, L., Becker, K., Trauma Exposure and Retention in Adolescent Substance Abuse Treatment, Journal of Traumatic Stress, Vol. 17, No. 2, April 2004, pp. 113121 Grella, C. E. and Joshi, V. (2003). Treatment processes and outcomes among adolescents with a history of abuse who are in drug treatment. Child Maltreatment: Journal of the American Professional Society on the Abuse of Children, 8(1), 7-18. Griece, D.E., Brady, K., Rustan,L., Malcolm, R., Kilpatrick, D., Sexual and Physical Assault History and PTSD in SubstanceDependent Individuals, American Journal on the Addictions, Vol. 4, Issue 4, pgs. 297-305
References, continued
Harris, M., Fallot, R., Using Trauma Theory to Design Service Systems, San Francisco, CA: Jossey-Bass, 2001. Najavits, L., Seeking Safety: A Treatment Manual for PTSD and Substance Abuse, New York: Guilford Press, 2002. Najavits, L., Implementing Seeking Safety Therapy for PTSD and Substance Abuse: Clinical Guidelines. http://www.bhrm.org/guidelines/PTSD.pdf Najavits, L.M.; Weiss, R.D.; and Shaw, S.R. The link between substance abuse and posttraumatic stress disorder in women: A research review. American Journal on Addictions 6(4):273-283, 1997. www.seekingsafety.org www.sidran.org (resource to find a trained trauma