final Flashcards
1
Q
aspects in psychological variable
A
emotions, cognition & perception, self-concept (body image, self-esteem), sexuality, self-identity
2
Q
affect regulation
A
- ability to maintain or increase positive feelings and wellbeing states and to minimize or regulate stress feelings & defensive states
3
Q
affect regulation is responsible for
A
monitoring, evaluating & modifying emotional reactions to accomplish one’s goals
- more decision-making
4
Q
affect regulation is considered a
A
type of emotional resilience
5
Q
other words for affect regulation
A
emotion regulation or self-regulation
6
Q
affect regulation may be or involve
A
automatic or involve purposeful cognitive processing
7
Q
affect regulation requires what kind of awareness
A
emotional awareness (ability to distinguish b/w emotions) awareness of social context of emotions (social cognition)
8
Q
ppl may not have affect regulation soooo
A
can teach ppl to think more about their emotional reactions & regulate
9
Q
affect dysregulation
A
impaired ability to regulate or tolerate negative emotional states
ex: personality disorders, mood disorders
10
Q
affect dysregulation following trauma: childhood adversity connected to
A
increased reactivity to stress, and creased capacity for emotional regulation in children, & often these problems are maintained in adulthood
11
Q
both childhood trauma and emotional dysregulation/affect dysregulation are
A
highly correlated with a variety of mental illnesses, including PTSD, mood disorders, and personality disorders, anxiety disorders
12
Q
severity of PTS symptoms correlated
A
with emotional dysregulation/affect dysregulation
13
Q
some studies have identified emotional dysregulation/affect dysregulation as a
A
mediating factor b/w sexual trauma & revictimization
14
Q
trauma survivors often react more
A
intensely to stimuli, and have less ability to calm themselves
15
Q
deficits in self-soothing and affect regulation are
A
often connected to lack of secure attachment in childhood
16
Q
2 indicators of affect dysregulation following trauma
A
hyperarousal & hypoarousal
17
Q
hyperarousal indicators
A
- emotions are easily “triggered”
- hypervigilance
- psychomotor agitation (restless, pacing)
- anxiety
- sensitive to rejection
- overwhelmed emotionally
- positive symptoms
18
Q
hypoarousal indicators
A
- flat affect
- less obvious
- emotional numbing, detachment (difficulty recognizing feelings)
- passive, submissive
- avoidant, withdrawn
- feeling disconnected from body
- negative symptoms (don’t feel emotions until its boiling over)
19
Q
regulation theory - schore & schore “modern attachment theory”
A
- ability to manage emotional states depends upon successful attachment
- considers impact of attachment on brain development & neurobiological systems involved in processing emotions, modulating stress, and self-regulation
20
Q
(schore & schore) affect regulation begins with inter-regulation:
A
- soothing, consistent nurturance from caretakers
- through experience of modeling, neurological imprinting, and learned behaviour, this gets introjected by child & leads to auto-regulation
21
Q
traditional attachment theory shows implications for treatment for affect regulation
A
- attachment itself is relational (b/w infant & caregiver), & that the quality of these early attachment will influence development & future relationships
22
Q
modern attachment theories shows implications for treatment for affect regulation
A
- further understand the influence of attachment on brain development, and that affect regulation is learned in the context of attachment (through modeling)
23
Q
what implications does this (attachment) have for treating affect dysregulation
A
- attachment is disrupted, the relationship b/w victim & professional is IMPORTANT & the victim can learn through us through modeling to help work through their emotions
24
Q
trauma & self-concept
A
- cognitive appraisal of an event, therefore, the meaning one makes of it, is critical to trauma response
25
following a potentially traumatic event,
individual develops beliefs about the event and about themselves in relation to this event (trauma & self-concept)
26
whats common with regards to self-concept & trauma
- traumatized individuals to internalize core beliefs or "negative underlying assumptions" of the self as being "unlovable", "incompetent", which impacts self-perception, self-esteem
27
trauma effects self-concept by
not allowing the process of trauma, gets stored in this way which reinforces the fact that it's their fault
28
an example of trauma and self-concept
a child's belief, "if i make a mistake, I am worthless" may be a consequence of ongoing abuse occurring whenever the child makes a mistake
29
trauma and shame
the intensely painful feeling that we are unworthy of love and belonging
30
scoglio et al (2015) 3 central components of self-compassion
1. self-kindness
2. common humanity
3. mindfulness
31
self compassion is
- a way of internalizing the compassion of an imagined other
- associated with resilience & general wellbeing
32
self-compassion is negatively associated with
maladaptive states & behaviours, as well as psychiatric symptoms
33
self-compassion can enhance
emotional regulation
34
central findings of scoglio et al (2015)
- self-compassion negatively related to PTSD symptom severity & emotion dysregulation, & positively related to resilience
- emotion dysregulation mediated the relationship b/w PTSD symptom severity & self-compassion, & also influence relationship b/w resilience & self-compassion
35
high level of self-compassion=
low level of PTSD symptom severity & emotional dysregulation
36
trauma & impact on attention & consciousness causes
dissociation & depersonalization
37
dissociation is
disruption of integrated functions of consciousness, memory, identity, or perception of environment && occurs on a continuum
38
dissociation results in
losing touch with one's surroundings, losing time
39
dissociation is an
adaptive response to traumatic experiences & their associated memories
40
when can dissociation become maladaptive
when it is triggered by a "false alarm"
41
depersonalization
sense of being detached from one's own mental processes or body & sometimes accompanied by derealization (sense that the environment is unreal) occurs on a continuum
42
depersonalization serves as
means to escape from stressful or traumatic realities
43
recent research suggests about depersonalization that
emotional abuse may be especially linked to depersonalization disorder
44
disorders among children and adolescents who have experienced trauma
- reactive attachment disorders (early age, child will not have an attachment figure)
- disinhibited social engagement disorder (abnormal behaviour from neglect)
- acute stress disorder
- PTSD
- developmental trauma disorder
- oppositional defiant disorder
- ADHD
44
disorders among children and adolescents who have experienced trauma
- reactive attachment disorders (early age, child will not have an attachment figure)
- disinhibited social engagement disorder (abnormal behaviour from neglect)
- acute stress disorder
- PTSD
- developmental trauma disorder
- oppositional defiant disorder
- ADHD
45
common disorders among adults who have experienced past trauma
- PTSD
- adjustment disorder
- major depression (concurrent with PTSD)
- substance-related disorders
- anxiety disorders
- borderline personality disorder (high correlation w/ past trauma)
- eating disorders
- psychotic disorders
46
PTSD was originally categorized as
anxiety disorder
47
DSM-5 moved PTSD to
new category: trauma & stressor-related disorders & symptoms expanded to include changes in thinking and mood
48
DSM-5 4 factor model for PTSD
1. intrusion
2. avoidance
3. alterations in arousal & reactivity
4. negative alterations in cognition and mood
49
what is included in PTSD in DSM5
- inclusion of sexual violence within the core premise of trauma
- indirect exposure to trauma included
50
new subtype in DSM5 PTSD
- dissociative (prominent dissociative symptoms, either depersonalization or derealization)
51
criterion A of PTSD (1 required)
- person was exposed to: death, threatened death, actual/threatened serious injury, actual/threatened sexual violence in the following ways:
1. direct exposure
2. witnessing trauma
3. learning that a relative or close friend was exposed to trauma
4. indirect exposure to aversive details of trauma, usually through professional duties
52
criterion B of PTSD (1 required)
- traumatic event is persistently re-experienced, in ways:
1. intrusive thoughts
2. nightmares
3. flashbacks
4. emotional distress after exposure to traumatic reminders
5. physical reactivity after exposure to traumatic reminders
53
criterion C of PTSD (1 required)
avoidance of trauma-related stimuli after trauma in ways:
1. trauma-related thoughts or feelings
2. trauma-related reminders
54
criterion D of PTSD (2 required)
- negative thoughts/feelings that began or worsened after the trauma, in ways:
1. inability to recall key features of trauma
2. overly negative thoughts and assumptions about oneself or world
3. exaggerated blame of self or others for causing the trauma
4. difficulty experiencing positive affect
5. negative affect
6. decreased interest in activities
7. feeling isolated
55
criterion E (2 required) for PTSD
- trauma-related arousal & reactivity that began or worsened after the trauma, in ways:
1. irritability or aggression
2. risky or destructive behaviour
3. hypervigilance
4. heightened startle reaction
5. difficulty concentrating
6. difficulty sleeping
56
criterion F for ptsd
symptoms last for more than a month
57
criterion G for ptsd
symptoms create distress or functional impairment (social, work)
58
criterion H
symptoms are not due to medication, substance use or other illness
59
2 specifications of ptsd criteria
- dissociative specification: individual experiences high levels of either depersonalization or derealization
- delayed specification: full criteria not met until at least 6 months after trauma although symptoms may occur immediately
60
several other diagnoses have been proposed
complex ptsd, disorders of extreme stress not otherwise specified, post-traumatic personality disorder, developmental trauma
61
advocates of cptsd hoped that the
diagnosis would capture diverse clusters of symptoms observed in survivors of prolonged trauma that outside the current definition of ptsd
62
results of field trial that sought to explore whether victims of chronic interpersonal trauma meet criteria for ptsd
supported the notion that trauma is prolonged, that first occurs at early age & that of an interpersonal nature, can have significant effects on psychological functioning above & beyond ptsd
63
criticisms of cptsd (resick et al 2012)
- lack of clear definition-significant variability in descriptions of the types of traumatic event that contribute & in symptoms
- lack of discriminative validity (overlap b/w other disorders)
- lack of validated measurement/assessment tools
64
symptoms of cptsd include
several defining criteria of ptsd (re-experiencing, avoidance, numbing, and hyperarousal) + disturbances in self-organization
65
3 categories of cptsd
- affect dysregulation
- negative self-concept
- disturbances in relationships
66
compared to ptsd, individuals with cptsd have
higher degree of functional disturbances & tend to experience multiple & persistent traumas
- increased risk of both self-injury & repeated victimization
67
what are the implications of this debate on cptsd treatment
criteria more inclusive so we don't miss ppl who need specific diagoniss & treatments since different from ptsd
68
significant overlap b/w which 2 disorders
BPD & cptsd
69
BPD & cptsd share
impaired interpersonal functioning, impaired sense of self, dissociation, affect dysregulation (impulsivity & self-harm)
70
despite similarities, cptsd is found to be
distinguishable from BPD in several studies
- bpd marked by an unstable self-concept, & cptsd by a more persistent negative self-concept
71
whats more prominent in bpd
mood fluctuations & expressed through unstable social connections, separation anxiety, and emotional reactivity such as self-harming behaviour
72
cptsd mood fluctuations are characterized by
emotional numbing & withdrawal from social relationships
73
treatment implications for ptsd
- diagnostic manual don't consider complexity of human disorders
- stigma
- different diagnosis require different treatments, if misdiagnosed, miss out on that treatment = no recovery
74
how do trauma's impacts on the brain show up in children
- persistent fear response
- hyperarousal
- increased internalizing symptoms
- diminished executive functioning
- delayed developmental milestones
- weakened response to positive feedback
- decreased capacity for self-regulation of emotions and behaviour
- complicated social interactions
75
influences in trauma response to childhood abuse & neglect
- age/developmental stage
- severity of maltreatment
- relationship to abuser
- type of abuse (acts of commission [abusive acts] & acts of omission [neglectful acts]: failure to provide needs)
76
domains of impairment in children exposed to complex trauma (cook et al 2005)
1. attachment
2. biology
3. affect regulaiton
4. dissociation
5. behavioural control
6. cognition
7. self-concept
77
attachment domain of impairment in children exposed to trauma
- problems with boundaries
- distrust & suspiciousness
- social isolation
- interpersonal difficulties
- difficulty attuning to other ppls emotional states
- difficulty with perspective taking
78
biology domain of impairment in children exposed to trauma
- sensorimotor developmental problems
- analgesia (altered perception of pain)
- problems with coordination, balance, body tone
- somatization
- increased medical problems (pelvic pain, asthma)
79
affect regulation domain of impairment in children exposed to trauma
- difficulty with emotional self-regulation
- difficulty labeling and expressing feelings
- problems knowing and describing internal states
- difficulty communicating wishes and needs
80
dissociation domain of impairment in children exposed to trauma
- distinct alterations in states of consciousness
- amnesia (memory loss)
- depersonalization & derealization
- 2 or more distinct states of consciousness
- impaired memory for state-based events
- happens on a continuum
81
behavioural control domain of impairment in children exposed to trauma
- poor modulation of impulses
- self-destructive behaviour
- aggression towards others
- pathological self-soothing behaviours
- sleep disturbances
- eating disorders
- substance abuse
- excessive compliance (be perfect)
- oppositional behaviour
- difficulty understanding and complying with rules
- re-enactment of trauma in behaviour or play
82
cognition domain of impairment in children exposed to trauma
- difficulties in attention regulation and executive functioning
- lack of sustained curiosity
- problems with processing novel information
- difficulty planning and anticipating
- problems understanding responsibility
- problems focusing on and completing tasks
- problems with object constancy
- learning difficulties
- problems with language development
- problems with orientation in time and space
83
self concept domain of impairment in children exposed to trauma
- lack of a continuous, predictable sense of self
- poor sense of separateness
- disturbances of body image
- low self-esteem
- shame & guilt
84
what makes childhood trauma different from trauma experienced in later life
- affect on developing brain
- lack of coping skills
- attachment
- relational attachment
85
how is childhood trauma different
exposure to multiple or repeated forms of maltreatment & trauma in childhood can lead to outcomes that are simply more severe than the sequelae of single incident trauma, but are qualitatively different in their tendency to affect multiple affective & interpersonal domains
86
behavioural impacts of trauma on adolescents
- increased impulsivity (beyond what is expected)
- difficulty with tasks using higher-level thinking & feeling (poorer critical thinking)
- delayed social skills
- poor school performance
- substance use
87
trauma and older adults (monahan)
- prevalence very high, simply by virtue of opportunity for exposure
- this population neglected in research, less frequently screened for trauma
- age related stressors & transitions may serve as triggers of past trauma
- be aware of potential for elder abuse
- consider reasons they may not disclose trauma
88
aspects of the sociocultural variable
- language & communication patterns
- cultural roles and expectations
- social history: family, education
- relationships/significant others
- health beliefs, habits
- ethnicity & race
89
relational impacts of trauma: general findings
- expectations of harm leading to difficulties developing trust
- confusion about what/who is safe
- avoidance of relationships as a protective strategy
- aggression as a defensive strategy
- difficulty experiencing positive emotions or closeness in relationships
- lack of healthy boundaries (& difficulty interpreting other ppl's boundaries)
- sexual dysfunction
90
marital/romantic relationship impacts of trauma
- trauma symptoms like sleep, dissociation, sexual dysfunction may impact relationship satisfaction for both ppl
- non-traumatized partner may attempt to compensate for trauma by exaggerating their role in the relationship (ex: weakened boundaries)
91
trauma's relational impacts: revictimization
- poor affect regulation may increase risk of involvement in dysfunctional relationships
- victim may identify with relationships that feel "familiar" leading to reenactment of old trauma
- resulting psych pathology may increase vulnerability
- impulsive behaviour, substance abuse
92
trauma's relational impacts: victimizing others
- trauma have negative impacts on parenting behaviours, potentially influencing intergenerational trauma
- not treated/addressed, trauma history has been shown to be a significant predictor of abuse potential, punitiveness, psychological aggression and physical means of discipline
93
trauma's relational impacts: victimizing others (male as abusers)
- widespread belief that males who have been the victim of sexual abuse will go on to become perpetrators themselves is exaggerated
- researchers tended to lump all perpetrators together, irrespective of their experiences as victim, & few studies have been conducted when ppl have not been victims too
- some evidence suggest that male survivors more likely to react to their experience through externalizing behaviours whereas females internalize experience & self-destruct
94
moral of the research of victim to victimizer cycle
most ppl who experience abuse/trauma DO NOT go on to become perpetrators
95
3 aspects of victims perception of their abuser
- idealization of the perpetrator
- trauma bonding
- preoccupation with hurting/harming the perpetrator
96
idealization of the perpetrator
- victims blame themselves or external factors for abuse & idealizes perpetrator allowing relationship maintain/preservation
- certain relationship dynamics b/w victim & abuser enforce this
- intense experiences & extreme feelings tend to bond people in a special (dysfunctional) way
97
trauma bonding definiton
dysfunctional attachments that occur in the presence of danger, shame, or exploitation
98
what are the 2 conditions necessary for trauma bonding
1. severe power imbalance causing the victim to feel helpless & vulnerable
2. intermittent abuse that alternates with positive or neutral interactions
99
modern conceptualizations see trauma bonding as
occurring on a continuum of severity
100
preoccupation with hurting/harming the perpetrator
- can signal an attempt to regain a sense of control/power after being victimized
- a form of fantasizing, putting an end to one's emotional pain, effects of the trauma, creating "new ending"
- occurs on a continuum of intensity
- level of risk for "retaliation" low, assess risk for harm to others
101
what did Rutter et al (1975) report about high-risk environmental factors
- dramatic increase in the probability of children exhibiting a behaviour disorder as a function of multiple family stressors
- experiencing 1 of these family stressors was NOT associated with increased behaviour problems; however when 2 or more stressors were present, risk of behaviour problems was found to increase 2 to 4 fold
102
several studies provided evidence that stessful life events . . ..
play a significant role in the development of depression, suicide & psychosis in adulthood
103
rutter's indicators of adversity
1. severe marital discord
2. low social economic status
3. overcrowding or large family size
4. parental criminality
5. maternal mental disorder
6. placement outside the child's home
104
homelessness and trauma
- 97% homeless women have experienced physical & sexual abuse, 87% experienced this abuse in childhood & adulthood
- 51% homeless ppl reported childhood sexual abuse, 55% reported physical abuse, 60% reported neglect. 58% reported emotional abuse, 57% met criteria for PTSD
105
contributing factors to high stats of homelessness and trauma
- many individuals become homeless as a result of fleeing trauma
- the experience of homelessness itself can be traumatic
- being homeless increases the risk of further victimization & retraumatization
106
intergenerational trauma is
ways in which trauma experienced in one generation is transmitted, or impacts the health & well-being of subsequent generations
107
negative effects of intergenerational trauma
- mental health symptoms/disorders
- greater vulnerability to stress
- reduced coping abilities
108
intergenerational trauma: why does it occur
- child-parent attachment (parent unable to provide sense of stability)
- parental engagement problems; detachment from children
- family communication problems
- overprotectiveness or parent-child role reversal
- greater family conflict; less family cohesion
- intergenerational conflict rooted in cultural differences b/w parents & children
- transmission of trauma burden
109
historical trauma
- experience of communities and ethnic groups exposed to large scale or repeated traumatic events and accompanying stresses
110
the term historical trauma captures the way that . . . .
collective experiences are perpetuated into the future of a cultural group & can persist across generations
111
the collective distress experienced in historical trauma distress is both
psychological & social, affecting multiple levels of the individual, family, and community
112
historical trauma response includes
depression, anxiety, low self-esteem, anger, alexithymia, difficulty with affect regulation, somatic symptoms, death wishes, suicidal behaviours, substance misuse, victim identity, survivor guilt
113
colonialism
practice of domination, which involves the subjugation of one poeple to another
114
colonialism usually involves
the transfer of a population to a new territory, where the arrivals lived as permanent settlers while maintaining political allegiance to their country of origin
115
what are some of the long-term impacts of colonialism
race-based trauma
116
race-based trauma
mental and emotional injury caused by encounters with racial bias and ethnic discrimination, racism, and hate crimes
117
race-based traumatic stress addresses
the unique psychological and emotional distress that black, indigenous, and people of colour suffer as a result of racism and discrimination
118
root causes of race-based traumatic stress
individual, systemic, direct, vicarious, intergenerational or historically based
119
cultural safety
outcome based on respectful engagement that recognizes and strives to address power imbalances inherent in the healthcare system, results in an environment free of racism and discrimination, where people feel safe when receiving health care
120
cultural humility
process of self-reflection to understand personal and systemic biases and to develop and maintain respectful processes and relationships based on mutual trust.
- involves humbly acknowledging onself as a learner when it comes to understanding another's experience
121
aspects of the spiritual variable
- purpose and meaning
- interconnectedness
- faith
- religion
- forgiveness
- creativity
- transcendence
122
define spirituality
- no standardized definition
- often linked to and overlaps with religion
- culturally bound concept
- beliefs about purpose & meaning
123
research supports that spirituality is correlated to
reduced substance us, suicide attempts, depression, hospitalizations, and mortality rates, as well as being an important factor in coping will illness
124
several studies cite engagement in spiritual practices as
contributing to reduced pain, healing time, and enhanced quality of life
125
whatever the event, trauma can be explained as a
disruption in and disconnection from core beliefs about life and the self
126
trauma and meaning causes a disruption of core beliefs about
the world, one's purpose & meaning, religious beliefs
127
spiritual beliefs play an important role in how
humans make sense of life events and cope with challenging situations
128
positive religious/spiritual coping methods
reflect a secure connection with the divine, oneself, and otherss
- post-traumatic growth
129
5 aspects of positive religious/spiritual coping methods
1. finding meaning
2. gaining mastery and control
3. increasing comfort and closeness to god
4. enhancing intimacy with others and closeness to god
5. achieving life transformation
130
negative religious/spiritual coping methods
referred to struggles
- associated with conflicts with the divine, oneself, and others about sacred matters
131
difficulty in the 5 realms has been shown to
lead to intensified problems and greater negative post-traumatic outcomes
132
positive & negative religious coping methods are not
mutually exclusive, they can occur simultaneously and in varying degrees over the course of the recovery process
133
the pathway of healing is
unique to each person, influenced by a variety of personal and situational factors
134
implications for RPN practice with spiritual variable
- attaching positive meaning to suffering helps navigate reoccurring stressors & influence post-traumatic growth
- consider hopelessness, loss of purpose = risk assessment
- consider how spirituality may be "untapped tool" for traumatized individual
135
resilience is the
process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress, it means "bouncing back" from difficult experiences
136
in the context of exposure to significant adversity, resilience is both the
capacity of individuals to navigate their way to the psychological, social, cultural, and physical resources that sustain their well-being, and their capacity individually and collectively to negotiate for these resources to be provided in culturally meaningful ways
137
resilience is not a
trait that ppl either have or not
- exists on a continuum & involves behaviours, thoughts and actions that can be learned and developed in anyone
- doesn't mean person doesn't experience stress
- universal
138
post-traumatic growth
positive psychological change on the part of the client following a traumatic event
- positive changes in self-perception, interpersonal relationships, and life philosophy have been noted
- vicariously experienced by nurses too
139
a treatment for trauma
grounded in particular therapeutic approach (cognitive theory)
140
treatment for trauma usually requires
professional to "administer" & require extra education beyond PNUR
- some processing of traumatic experience
141
examples of trauma treatment
trauma focused CBT, exposure therapy, EMDR
142
coping strategies
specific, small scale, learned by average person
- building blocks that assist with coping and healing from trauma
- usseful to develop prior to engaging in more direct treatments
143
RPN's are well-equipped to assist clients in
acquiring coping strategies via PSYCHOEDUCATION
144
examples of coping strategies
visualization, deep breathing
145
trauma treatments: therapeutic approaches used with children (straussner & calnan)
- play therapy
- expressive arts therapies
- parent-child psychotherapy
- trauma-focused CBT
146
trauma-focused CBT (4) steps
1. psychoeducation
2. skills building
3. creating a trauma narrative (trauma processing -> often become dysregulated, need GOOD coping skills)
4. sharing of the new narrative with a trusted adult ("new", self-loving, positive experience)
147
treatment for complex trauma in children: arc framework
- attachment: strengthening the caregiving system, enhancing supports, relational skills
- regulation: strengthening self-regulation skills through psychoeducation
- competency: enhancing resilience, developing identity
148
treatment for adults (straussner & calnan)
- CBT
- exposure therapy
- desensitization & imaginal flooding
- EMDR
- narrative therapy
- group therapy
- medications
149
central aims of trauma therapy
- finding a way to become calm and focused
- learning to maintain that calm in response to images, thoughts, sounds, or physical sensations that remind you of the past
- finding a way to be fully alive in the present and engaged with people around you
- not having to keep secrets from yourself, including secrets about the ways that you have managed to survived
150
somatic (body based) therapies
- work on the premise that emotions are registered/stored in the body due to the body brain connection
- promote body awareness, opening up possibility for enhanced insight and movement towards processing of trauma
- seen as "prerequisite" for safe processing and releasing of aspects of trauma the person may be hanging onto
151
somatic (body based) therapies focus on
restoring the nervous system from the "bottom up"
152
somatic (body based) therapies can be done
without direct or intense exposure to trauma material
153
examples of somatic therapies
breathwork, sensory awareness training, yoga
154
the goal of psychoeducation is
increased understanding and self-awareness and/or awareness of loved ones regarding an individuals mental health issues and effective coping strategies and treatments
155
psychoeducation can assist to
reduce stigma, enable individuals to feel more empowered and involved in their own care, and more enable more successful coping abilities
156
psychoeducation & trauma: calming the limbic system
- essential oils
- deep breathing
- grounding
- containment strategies
- visualization
- cognitive practices
- exercise
- mindfulness practice
157
grounding is
useful for hyperarousal, flashbacks, dissociation
158
importance of the therapeutic relationship when working with trauma survivors
- multiple studies find that supportive relationships are the most powerful predictor of protection against trauma impacts
- safety at the center of a healing relationship
159
TIP & the role of nurses (individual practice)
- maintaining clear & appropriate boundaries, honoring confidentiality policies, clarity, consistency, and predictability are keys to creating a trauma-informed system of care
160
nurses focuses in individual practice
- question coercive activities - focus on rules, search procedures, locked doors, and the use of seclusion and restraint that are potentially retraumatizing
161
interprofessional collaboration occurs when
multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, caregivers & communities to deliver the highest quality of care across settings
162
effective interprofessional collaboration involves
1. role clarity
2. trust & confidence
3. the ability to overcome adversity
4. ability to overcome personal differences
5. collective leadership
163
trauma informed organizations
- realizes widespread impact of trauma & understands potential paths for recovery
- recognizes signs & symptoms of trauma in clients, families, staff, and others in system
- responds by fully integrating knowledge about trauma into policies, procedures, and practices
- seeks to actively resist re-traumatization
164
translating TIP principles into action
- universal screening
- strengths-based assessment
- staff education, training & clinical supervision
- client education
- service partnerships
- policies to reduce traumatization, re-traumatization
165
6 prinicples associated with successful integration of TIC (trauma-informed care)
1. active leadership support, role modeling, and engagement in trauma-informed principles
2. data collection
3. debriefing & prevention-focused analysis of events
4. trauma-informed education & skill development
5. use of a range of assessment tools
6. involvement of individuals with lived experience at all levels of care
166
TIC implemented at an organizational level: what is being done in BC
- staff education at all levels
- shift in hiring practices
- development of supporting policies & procedures
- environmental restructuring
- reduced use of restraint & seclusion
167
conducting screening as well as more in-depth assessment in a trauma-informed manner involves
1. understanding that clients may be uncomfortable answering qts because of distrust, a history of having their boundaries violated or fear that the information could be used against them
2. the interviewer has the need to know the information being requested & the right to ask the qts given the client's goal
3. balancing the usefulness of information for client against use of clients time & emotional impact of qts when designing intake forms & training intake workers
4. clearly communicating the client's right not to answer any qt
5. clearly communicating reasons for asking ats that are not related to problem at hand
6. use of psychometric measures
168
asking about trauma appendix 4
- use normalization & explain why you're asking
- ask qts in a non-threatening way
- ensure the client doesn't feel forced to disclose; provide choice
169
things to avoid when asking about trauma
- asking for details
- confronting
- minimizing or ignoring
- dwelling in the negative, expressing shock/horror
- making assumptions
- making promises you can't keep
170
responding to disclosure
- address confidentiality
- during screening/assessment: maintain safety, validate experience
- acknowledge information & express empathy
- normalize, give context without minimizing
- validate experience as traumatic & validate the disclosure itself
- offer hope
- promote self care
- address & respond to safety concerns
- develop a follow-up plan
171
risk for mental health professional
- secondary traumatization
- compassion fatigue
- vicarious trauma
- secondary traumatic stress
- countertransference
- burnout
- ptsd
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vicarious post-traumatic growth
- positive psychological change in the healthcare worker
- improved relationship skills
- appreciation for resilience in ppl
- satisfaction from witnessing growth in clients & being part of healing process
- expanded worldview
- gratitude
- increased personal strength
