Crisis and Trauma Flashcards
(23 cards)
Roberts’ 7 Stages of Crisis Intervention
- Biopsychosocial assessment of lethality/imminent danger
- Make Contact and establish collborative rapport
- Identify the major problems, including precipitating events
- Encourage exploration of feelings/emotions and convey empathy/validation
- Generate and explore alternatives and new coping strategies
- Restore functioning through use of action plan
- Plan follow up/booster sessions and/or referrals for aftercare maintenance/relapse prevention
The Empowerment Model
ABC
A- Achieving Contact
Attending Behaviors- Eye contact and engaged body posture, Mirroring culturally determined communication styles, Validation and empathy.
B- Boiling Down the Problem (breaking it into more than manageable tasks- assessing immediate needs)
Identifying the problem- sort through to identify what is relevant and immediate, Identify any barriers to coping effectively or accessing care. Psychoeducate re: common trauma responses, Supportive and empowering statements, Reframing w/o patronizing or minimizing
C- Coping - Assessing previous and current coping skills, identifying new coping skills to introduce
Active their strengths
Re-establish a sense of agency and empowerment
Prefrontal Cortex
Rational thinking- regulates emotions such as fear responses from the amygdala- with PTSD this has a reduced volume
Manages thoughts, behaviors, and helps us control our emotional responses to events. Normally, this area of the brain helps us decide if a situation is “ok”. Trauma can weaken the signals from this area, allowing negative emotions from the trauma memory take over the prefrontal cortex’s reasoning ability.
Amygdala
The Amygdala operates as an alarm signal for stressful events, triggering cortisol and adrenaline production. This reaction prepares our fight/flight/freeze response, characterized by increased heart rate, rapid breathing and hyper vigilance. Body/Brain can recover quickly from this state of arousal if danger passes. If danger does not pass or recovery from arousal is blocked the body remains in fight/flight/freeze state during which the amygdala remains overactive. This leads to hyper vigilance and anxiety. Traumatized brains that are hypervigilant, which increases the risk of misinterpreting future stimuli as dangerous. When the amygdala is in overdrive, you may become chronically scared that people hate you or that people are out to get you.
Hippocampus
Assists w/ Learning and memory storage, including how to remember what is safe and dangerous. It helps calm the amygdala. Trauma causes the hippocampus to shrink. Cues to calm the amygdala are weakened which can lead to flashbacks or confusion around the trauma memory.
Autonomic Nervous System (ANS)
Regulates all bodily functions. There are two branches of the ANS: Sympathetic Nervous System & Parasympathetic Nervous System
Sympathetic Nervous System
The Accelerator, Responsible for arousal, including fight or flight responses.
Parasympathetic Nervous System
The Brake, responsible for self preservative functions. In trauma this cold look like a freeze response (dorsal vagal) or in safety it looks like calmness (ventral vagal)
How does Trauma impact the immune system?
Chronic overactivity of the sympathetic nervous system or the dorsal vagal state of the parasympathetic nervous system leads to the immune system being overworked, chronic inflammation and development of autoimmune disease. Similarly, the digestive system can be negative affected via the gut brain-axis which is connected to the brain an modulated in large part by the vagus nerve
Relational Effects of Trauma
Difficulty connecting w/ others
Negative views of self, others, the world
Caregiver, secondary, or vicarious trauma
Insecure, avoidant, or disorganized attachment
Expectations of danger, betrayal, or harm in current or future relationships
Difficulty determining safe situations of relationships, driven by fear of retraumatization
Feelings of anger, helplessness, loss of control, aggresion
Lost sense of sense
Isolation stemming from feeling the need to be hypervigilant around others
Difficulty identifying feelings or expressing feelings to others
Physical intimacy impairments
Common Trauma Treatments
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Internal Family Systems (IFS)
Eye Movement Desensitization & Reprocessing (EMDR)
Emotionally Focused Couples Therapy for Trauma (EFCT-T)
Exposure Therapy
Narrative Exposure Therapy
Prolonged Exposure Therapy
Behavioral Couple and Family Therapy
Strategic Approach Therapy
Psychedelic Assisted Talk Therapy
Animal-Assisted Therapy
Trauma Focused Cognitive Behavioral Therapy (TF-CBT)- PRACTICE
P- Psychoeducation and parenting skills
R- Relaxation Skills
A- Affective expression and regulation
C- Cognitive Coping
T- Trauma Narrative Development and processing
I- In Vivo gradual exposure
C- Conjoint parent-child sessions
E- Enhancing safety and future development
As Part of A-PRACTICE
A- Assessment and Engagement
Goal: Identify history of trauma exposure.
A-PRACTICE
P-
Pschoeducation
Goals: Normalize exposure to trauma “You are not alone/not the only one.
Explain and normalize PTS Symptoms/PTSD and avoidance: You are not crazy
Establish social norms regarding child responsibility for trauma and trauma coping: It is not your fault and you did the best you could.
A-PRACTICE
The P can also be
The P can also be Parenting Skills
Goal: Improve the Relationship (Eg: enhance closeness, warmth and support)
Teach/reinforce use of skills:
Support child use of PRAC skills in the home.
Apply positive paretning (eg praise, selective attention/ignoring, instructions, rewards and consequences.
Prepare for conjoint TN
The R in Practice is
R:
Relaxation
Goal: Create awareness of capacity to change from state of tense/distressed state to state of relaxation.
Teach specific skills from calming/reducing distress in the moment.
the A in PRACTICE
A:
Affective Modulation
Goal: Increase capacity to identify range of feelings, have a feelings vocabulary, and link to appropriate expression.
Teach the Cognitive Triangle: Relationship between Thoughts, Feelings and Behavior.
Learn to rate feeling at different intensities.
Methods: Feelings brainstorm, books about feelings, feelings game (bingo, jenga, pickup things)
the C in PRACTICE
C:
C: Cognitive Coping
Goal: Teach (or revisit) the CBT Triangle
Help the client learn to identify automatic unhelpful or inaccurate thoughts that the client may not immediately be aware of, but which are causing distress.
Methods: Practice CBT Triangle, for non trauma related real life scenarios.
Yaloms Therapeutic Forces in Group
- Instillation of Hope: Encouragement that recovery is possible by sharing stories and information. Seeing others cope with problems similiar to yours, overcome obstacles, that may be overwhelming, and achieve goals of recovery can inspire new members of the group.
Yaloms Therapeutic Forces in Group
- Universality: Recognition of a shared experience and knowing a persons problem are not unique. Members of a group therapy setting find relief in the fact that they can feel understood and similar to others, rather than being an outsider among their peers.
Yaloms Therapeutic Forces in Group
- Imparting Information
Yaloms Therapeutic Forces in Group
- Altruism
