Unit 9 Flashcards
what is the difference between “treatments” for trauma vs “coping strategies”
- Treatments for trauma usually require some processing of the trauma (talking about the traumatic experience)
- Often coping strategies are within the trauma treatment process
- Coping strategies are specific, smaller scale targeting a specific trauma symptom
“treatments” for trauma
typically grounded in a particular therapeutic approach for theory e.g. cognitive theory or psychodynamic theory
- require a professional to “administer”
- requires some processing of trauma
“coping strategies” for trauma
- specific, smaller scale targeting a specific trauma symptom e.g. intrusive thoughts or difficulty sleeping
- building blocks that assist in more direct trauma tx
- useful to develop prior to engaging in more direct trauma tx
- e.g., visualization, deep breathing
therapeutic approaches used with children
straussner & calnan
- play therapy
- expressive arts therapies
- child- parent psychotherapy
- Parents-child interaction therapy (PCIT) = when parent is with child and therapist watches interaction through double mirror and guides parents interaction through headset
- trauma focused CBT
what are the four steps in trauma focused CBT
** must be done in this order
1. psychoeducation (learning about what CBT is)
2. skills building (preparation for discussing the trauma so client has the skills to process it)
3. creating a trauma narrative (telling the trauma story and understanding the meaning the client has attached to it – therapist helps client see it was not their fault & removing maladaptive coping mechanisms)
4. sharing of the narrative with a trusted adult (client feels a new perspective on traumatic experience and is able to see themselves through a more loving light)
ARC framework
** no particular order:
Attachment
Regulation
Competency
- attachment: strengthening the caregiving system, enhancing supports, relational skills
- regulation: strengthening self regulation skills thru psychoeducation
- competency: enhancing resilience, developing identity
what is the ARC framework
- flexible, components based intervention developed for children & adolescents who have experienced complex trauma along w their caregiving systems
- built upon: normative childhood development, traumatic stress, attachment, risk and resilience
- ARC identifies important childhood skills and competencies which are routinely shown to be negatively affected by traumatic stress and by attachment disruptions
ARC framework goals
- Caregiver supports and the caregiver-child relationship are addressed through an emphasis on three primary targets:
(1) Supporting caregivers in recognizing, understanding, accepting, and managing their own emotional and physiological responses, particularly as relates to and impacts parenting or child-care;
(2) Enhancing rhythm and reciprocity in the caregiver-child relationship, and helping caregivers deepen their understanding of child behavior; and
(3) Building effective, trauma-informed responses to child and adolescent behavior - Regulation is addressed through
(1) Supporting youth in developing an awareness and understanding of feelings, body states, and associated thoughts and behaviors;
(2) Helping youth develop increased capacity to tolerate and manage physiological and emotional experience; and
(3) Enhancing tolerance for and skill in building relational connection. - Competency goals include
(1) Increasing opportunity for choice and empowerment, and skill in recognizing choice points and in effective decision-making; and
(2) Identification and exploration of a range of aspects of self and identity, and building coherence through development of narrative around key life experiences, including traumatic exposures.
treatments for adults
straussner & calnan
- CBT
- exposure therapy
- Desensitization and imaginal flooding (– help limbic system/when trauma memories overcome them – helps client cope / tolerate the flooding of trauma memories)
- EMDR
- narrative therapy
- group therapy
- medications (Medications don’t cure trauma but assist with symptoms – that may allow the person to get to a place where they can benefit from the therapeutic relationship)
what is EMDR
- eye movement desensitization reprocessing
- EMDR – “reprograms” the synapse connections in the brain by having the person go back to a snapshot of the memory that’s triggering for the person (doesn’t have to be out loud, can be in their head), clinician uses an object or finger and gets client to focus on it so they can focus on the object (being present) and keeps the client from disassociating
central aims of trauma therapy
van der Kolk
- finding a way to become calm & 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 & engaged with people around you
- not having to keep secrets from yourself including secrets about the ways that you have managed to survive
van der Kolk: body keeps the score
the fundamental issue in resolving traumatic stress is?
- to restore the proper balance between the rational and emotional brains so that you can feel in charge of how you respond and how you conduct your life
- as long as ppl are either hyperaroused or shut down, they cannot learn from their experience
van der Kolk: body keeps the score
the fundamental issue in resolving traumatic stress is?
- to restore the proper balance between the rational and emotional brains so that you can feel in charge of how you respond and how you conduct your life
- as long as ppl are either hyperaroused or shut down, they cannot learn from their experience
brain-based approaches to help clients after trauma: bottom up approaches
- help clients cope with their raw emotions and defence reactions
- using the limbic system and hippocampus
- Yoga, EMDR (EMDR uses trauma so mid-section on scale)
- Becoming present in your body
- Somatic therapies
brain-based approaches to help clients after trauma: top down approaches
- help clients think differently
- working with the upper part of brain / cortex
- Thinking about trauma
- CBT
- Works for more logical thinking people
somatic therapies
- body based
- work on the premise that emotions are registered/stored in the body due to body-brain connection
- focus on restoring nervous system “bottom up”
- promote body awareness
- enhance insight & movement towards processing trauma
- seen as a “prerequisite” for safe processing and release of aspects of trauma the person may be holding onto
- can be done w/o direct or intense exposure to trauma material
Psychoeducation & Trauma: THE RPNS ROLE
- providing info & education to individuals receiving tx for MI issues &/or family/loved ones
- goal is increased understanding, self awareness, awareness of loved ones regarding persons MI & effective coping abilities and/or tx
- can assist to reduce stigma, enable ppl to feel more empowered & involved in their own care & enable more successful coping abilities
- can be offered individually as part of tx approach or in group format
Psychoeducation & Trauma: calming the limbic system
- essential oils
- deep breathing
- grounding
- containment strategies
- visualization
- cognitive practices (“green thoughts”)
- exercise
- mindfulness practice
grounding
- useful for hyperarousal, flashbacks, dissociation
- promotes refocus on the here & now, present moment, thru the senses
- e.g. touch objects around you and describe them
why are Essential oils effective
– hippocampus is involved in olfaction & it’s been shown smells trigger memories
- May be one of the fastest ways to help anxiety, fatigue, being more present
the importance of the TR when working with trauma survivors
- multiple studies find supportive relationships are the most powerful predictor of protection against traumas impacts
- VAN DER KOLK: “traumatized human beings recover in the context of relationships”
- safety is at the centre of a healing relationship
ways we can create safety in the context of a TR
- confidentiality & what it means
- asking patients preferred name and pronouns
- creating patient privacy
- validating their truth
- having cultural awareness / addressing that/ the limits / self-awareness of biases
- normalization
- asking for permission to come in & letting them know what will happen in the interview & asking them if they’re okay going through the questions
Straussner & Calnan definition of “LARGE-T TRAUMAS”
- Large-T traumas can impact individuals, families, groups and communities
- include natural disasters, such as hurricanes, floods, wildfires, or nuclear disasters, as well as human-caused disasters, such as deadly car accidents, individual and mass violence, and other one-time traumatic events.
- Large-T traumas can also include ‘‘complex traumas,’’ and Disorders of Extreme Stress (DESNOS- disorders of extreme stress not otherwise specified)
—traumas that involve events of pro- longed duration or multiple traumatic events - Examples include on-going interpersonal violence, child physical or sexual abuse spanning several years, never-ending wars, or constant acts of terrorism.
Straussner & Calnan definition of “SMALL-T TRAUMAS”
- Small-t / micro-traumas are the more common traumas encountered by many of us.
- e.g, being bullied in school or in the workplace, being stalked by someone, living in severe poverty, experiencing ongoing discrimination
- often go unrecog- nized and unacknowledged
- these micro-traumas may still cause much psychic pain and life-long damage
