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Flashcards in Final Deck (50):
1

Elements of Crisi (PPEI)

1. PERCIPITATING Event
2. PERCEPTION of the event
3. EMOTIONAL Distress
4. IMPAIRMENT of functioning

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Two Types of Precipitating Events

Developmental and Situational

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" transitional phases and difficulties with adaptation.
" Ex. Relationship between parent and adolescent, parenting style that worked when they were a little kid doesn't work anymore now that the child is a teen. This can lead to a crisis in a family due to escalation ("You can't tell me what to do")

Developmental Precipitating Event

4

" Losses, interpersonal conflict, extreme event, flare-up of symptoms.
" Ex. Break up, losing a pet, an assault, someone kills themselves at school will cause classmates to go into crisis,

Situational Precipitating Event

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Robert's Seven Step Model

1. Crisis and BIOpsychosocial Assessment
2. Rapport, build collaborative relationship
3. Identify Major Problem and Crisis Precipitants
4. Explore feelings and Emotions
5. Generate Alternatives
6. Develop and Implement an Action Plan
7. Agreement and Follow Up

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" Defined as death caused by self-directed injurious behavior with intent to die as a result of the behavior.

Suicide or Completed Suicide

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a non-fatal, self-directed, potentially injurious behavior with intent to die as a result of the behavior.

-May not result in injury

Suicide Attempt

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Refers to thinking about, considering, or planning suicide.

Suicidal Ideation

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Domains of Risk Assessment

- Identifiable precipitants or stressors

- Symptomatic presentation

- Presence of hopelessness

- Nature of suicidal thinking

- Previous suicidal behavior

- Impulsivity and self-control

- Protective factors

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Elements of a Suicide Safety Plan

o Triggers for thoughts of suicide

o Coping skills

o Supportive individuals

o Professional/Community supports

o Ways to keep the environment safe

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o Engaging in pain-enhancing/sustaining behaviors while trying to reduce painful or upsetting memories
Ex. Substance Use
o Related to how we are socialized to address emotional pain
o Message that pain and distress are bad, should be removed, avoided, or medicated
Ex. We don't want pain, take an Advil avoid pain

Pain Paradox

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Assessment Related to Grounding

1. Immediate Concerns, Imminent Danger

2. Assessing Trauma Exposure

3. Evaluating the Effects of Trauma

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In relation to Assessment

- Danger of death, HI, SI, incapacitation, unsafe environment
- Psychological stability & stress tolerance
- Are the able to handle session right now?
- Capacity to discuss traumatic material

Immediate concerns, imminent danger

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In relation to Assessment
- Once you have determined that the client is safe and stable
- Assess client's symptoms or chief complaint to attend therapy before to begin building rapport
- Assessment such as Initial Trauma Review-3 (ITR-3)

Assessing Trauma Exposure

15

In relation to Assessment
- Activation Responses
- Avoidance Responses
- Affect Dysregulation
- Relational Disturbance

Evaluating the Effects of Trauma - CAPS assessment

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o A way of bringing client to the present moment and increase affect regulation
o Used to reduce the client's internal escalation
o Should be used when clearly indicated
- When client is acutely overwhelmed by intrusive symptoms or escalating trauma memories.

Goal of Grounding

17

Use of Language in Trauma Therapy

o Journaling:
Writing to yourself and for
yourself
-Not just the events but also how they felt
o Homework: to share with the therapist
o Talk therapy: the bulk of therapy work
oCommunication and meta-communication
- Changes in tone of voice, level of arousal
- Use breaks, brakes, anchors, exercises for dual awareness

o Narratives
About the event
About ourselves
(autobiographical)

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(taking a risk and safety, past and present)
- Activating a little, then going back
- Feeling activated to feeling safe again

Pendulating

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- Having access to different parts of the self, taking ownership
- Putting words to embodied sensations
- Being truly accepted by others (not just version for "public consumption")

Integrated sense of self

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- For clients to understand their own process
- Normalizing
- I'm not the only one
- To reduce self-blame
- Reframe symptoms as trauma processing

Purpose of Psychoeducation

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o merely discussing a traumatic event without some level of emotional memory activation is less likely to allow the client to change the cognitions related to the memory" (Briere & Scott, 2015, p. 155)
o For parts of the brain to change, they need to be activated

CBT AND TRAUMA THERAPY

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- Review and update cognitions and beliefs that were encoded under stressful situations
- More coherent understanding of the traumatic event
- From the present, re-visit
- Foster more positive self-perceptions
- Reconsidering what one could have actually done in the moment of the trauma
-Developing a coherent narrative of the trauma and of self
- Desensitization
- The more you tell the story, the less power you give it

Purpose of CBT in trauma therapy

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am I able to feel this and be okay , the capacity to feel and still be able to function

Affect

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o Help the person increase tolerance for stressful emotions
- Doesn't go to panic, can feel and remain calm
o So the person does not have to rely only on avoidance strategies like dissociation, substance abuse, tension reduction behaviors (TRB) (self-harm, aggression, indiscriminate sexual activity)

- Take control over emotions
- Avoidance is useful and necessary sometimes, but
-It should not be self-destructive (i.e. substance use, self-harm)
- It should not be the only way to deal with painful emotions

Affect Regulation Work

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- Enough activation but not too much
- Highest level of activation should occur in the middle of the session

Therapeutic Window

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5 Steps of Emotional Processing (EADCD)

1. Exposure
2. Activation
3. Disparity
4. CounterConditioning
5. Desensitization/Resolution

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b. Activity to trigger the client's memories of the traumatic event
i. Recalling and talking about them
ii. Writing about them, and then reading the text to the therapist
c. ´The memory of one trauma can bring to mind memories of other traumas
i. Go from the event to the experience (e.g., feeling abandoned, feeling afraid of being hit)

Exposure

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Overshooting

too much activation

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Undershooting

Not enough activation to lead to processing

30

a. Learn that even though it feels unsafe that memory is from the past and right now you are safe
b. Difference between that the client is feeling and the current state of reality
c. This is a safe place, this is a safe relationship
d. CERs are not reinforced so their strength dissipates
e. Ex. I was beaten as a child, I am okay I am healing

Disparity

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a. Including a better association
b. Not only the absence of a negative association, but presence of positive association
c. Ex. I was beaten as a child I did not deserve to be beaten, I did the best to be the best child.

Counterconditioning

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the memories have lost some of the intensity. They might be painful but not overwhelming

Desensitization

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Look back and not have emotional intensity

Triggers do not elicit the same level of emotional response

The story of Teresa and Fernando
Look at her child beyond the trauma

Desensitization/Resolution

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The awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment-to-moment" (Kabat-Zinn, 2003, p. 145).

Attend to the present moment and view yourself non-judgmentally



Mindfulness

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is the union between the individual soul and the universal soul. It is the split between the two that is viewed as the root of all suffering."

Importance of Acceptance

The notion of acceptance involves acknowledgment and openness to:
o current experiences of oneself and one's situation
o without defining it "good" or "bad"

YOGA

36

_____skills can be utilized during trauma-focused psychotherapy.
Settling skills:
decrease hyperarousal or anxiety, engaging the here and now, tending to the breath
Reduce reactivity or avoidance behavior:
increases affect regulation capacity,

Mindfulness and Trauma Work

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o According to the Adaptive Information Processing model (AIP), traumatic memories are dysfunctionally stored and encoded
o _____ allows clients to reprocess the memories with positive information
o Bilateral eye movements stimulate both sides of the brain
o Shapiro (1995, 2001) hypothesizes that ____ therapy facilitates:
" Accessing of the traumatic memory network
" Enhanced Information processing
" New associations forged between the traumatic memory and more adaptive memories or information.
o These new associations are thought to result in:
" complete information processing
" new learning
" elimination of emotional distress
" development of cognitive insights

EMDR

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o Refers both to:
- The effects on current generations of traumas of past generations (e.g., children of holocaust survivors)
- The repetition of traumas from generation to generation (e.g., _______ transmission of physical abuse, _______ experience of racism)

Intergenerational Trauma

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Adaptations to Work with Couples and Families

o Keep in mind that emotions are an issue (flooding, numbing, dissociation, constricted range of affect and dysregulation)
o Many more sessions
o SSSSLLLLOOOOWWWW process
o Work on staying within the therapeutic window
o Grounding and prep work
o EFT worked better for CSA survivors who had a year of therapy prior to couples therapy
o Do a good assessment with BOTH PARTNERS:
" Do partners have PTSD symptoms and a sufficient degree of emotional regulation? Maybe OK to start EFT
" Do partners have symptoms of complex trauma and issues with emotional regulation? Maybe work on affect regulation before or instead of EFT.
o More repetitions to disconfirm trauma laden IWM
o Continuously monitor for signs of flooding, dissociation, numbing
o Maybe it is easier to use EFT with people who have suffered trauma that is not interpersonal in nature

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o A family member or loved one may be physically absent but psychologically present or may be physically present but psychologically absent
Ex. Deployment, deportation, incarceration, when kids move out

Ambiguous Loss

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Therapeutic Methods of Meaning Making

Narrative
Dialectical
Systemic

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- Cognitive concept
- Shatters your assumptions, it is an event so meaningful and emotionally hurtful it shattered what you use to believe
- Rebuild myself after the experience
Ex. Broken house, we have to rebuild, maybe when we rebuild the house we will use stronger materials to prevent hurt in the future

Ex. Wildfire, can change my view on nature, my idea of safety

This was too much pressure for my inner strength

Post Traumatic Growth

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- We can take all this pressure and then when pressure is gone we are still here
Ex. Palm trees in the wind
- Difference between bending and breaking
- Built in strengths that even in pressure I can bounce back

Resilience

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FIVE DOMAINS OF PTG

1. Greater appreciation for life and changes sense of priorities
2. Enhanced interpersonal relationships
3. Sense of increased personal strengths, recognition of strengths
4. New possibilities or paths in life
5. Enhanced spirituality (existentialism)

45

o Person has assumptive world (adolescents and adults)
o Psychological seismic event: traumatic event, crisis, loss. Highly distressing (otherwise people just cope)
" Highly distressing = emotions are involved
" Usual cooing won't work
o Shattering of fundamental schemas and emotional distress
o Rebuilding: cognitive processing and affective engagement
" After this experience I can't think about the world the same way I can't think about myself in the same way
o Questioning and letting go of previous assumptions, goals
" But we also get new ones taking into account the traumatic event occurred.
o New schemas, new narratives, new functioning, newfound wisdom
" I won't do this anymore because I've been traumatized

PTG Process

46

Is PTG a direct result of trauma?

PTG is NOT a direct result of trauma. It is the individual's struggle with the new reality in the aftermath of trauma that is crucial in the development of PTG
o How after the traumatic event, how am I making sense of the world, reevaluating a bunch of stuff, we arrived to a new place, we rebuild a new house

47

cognitive, emotional, and behavioral changes resulting from knowing about traumatic events experienced by a significant other, and the stress that comes from wanting to help. It mirrors the symptoms of PTSD

Listening to client's traumatic experiences and experience of wanting to help

Vicarious trauma / secondary traumatic stress:

48

ways in which helping professionals can be positively influenced by the exposure to the resilience displayed by the people they help.

Effected by client's resilience, when we see our client's growing,

We are witnessing and being empathic, part our job is to allow these stories to

Vicarious resilience:

49

What determines the length of the therapeutic windown

the persons affect regulation resources

50

The therapeutic window is based on . . .

intensity NOT time