Week 4 Flashcards
(34 cards)
What is trauma?
Trauma is an emotionally painful experience that overwhelms a person’s ability to cope.
- often a single experience
- It is not an event because every person experiences the same event in a different way.
What is complex trauma?
- Trauma that is caused by a series of experiences.
- Multiple or ongoing traumatic events happen over time (years of abuse/neglect)
What is the difference between primary and secondary trauma?
- Primary trauma = When you directly experience something traumatic
- Secondary trauma = You witness of hear about someone else’s trauma (seeing a sibling get hurt) (indirectly)
What is childhood trauma?
Trauma exposure before 18 years of age
Which types of trauma’s are there?
- Abuse and Neglect
- physical abuse
- emotional abuse
- sexual abuse
- physical neglect (not getting food or medical care)
- Emotional neglect (not receiving love/attention) - Household dysfunction
- Parents constantly fighting or divorcing
- Seeing domestic violence
- Living with a parent with mental illness or substance abuse - Community or environmental trauma
- unsafe neighbourhood
- bullying or discrimination
- being in foster care
- Natural disasters or accidents
Describe the prevalence of trauma
- Children in foster care:
- 70% has 3 or more adverse childhood experiences (ACE) - Adolescents:
- 62% has at least 1 ACE
- 18% has 3 or more ACE
It’s based on a person’s memory or report of what happened to them in the past. BUT:
- memory isn’t perfect
- people may underreport due to shame
Children who have experienced any type of trauma are more likely to experience other types of trauma
Describe the development of PTSD
- After trauma exposure, individuals may develop (symptoms of) Post-Traumatic Stress Disorder (PTSD). It is a normal response to an abnormal experience.
- PTSD usually develops within the first 6 months after trauma exposure (when symptoms develop after 6 months: late/delayed onset PTSD)
— Late onset can be caused by a later realisation or late triggered - factors that contribute to PTSD development (risk factors):
— Trauma characteristics (type of trauma, onset, frequency)
— Demographic and personality characteristics (gender, age, resilience)
— secondary stressors (low social support, parental stress)
— comorbid (internalizing) psychopathology
EXTRA SLIDE 12:
When someone experiences trauma, they often develop natural and protective reactions — like fear, anxiety, or avoidance — which can become learned patterns through conditioning.
1. Classical conditioning:
- This is when the brain starts to associate neutral cues (like a sound or a smell) with the trauma.
- Over time, those neutral things become “triggers” that automatically cause fear or distress — even though they’re not dangerous anymore.
- Example: If a child was abused and a loud voice was present, they might later feel fear every time they hear someone raise their voice.
- This process is called generalization — the trauma response spreads to other, similar situations.
2. Operant conditioning
- This explains how avoidant behaviors develop.
- If avoiding certain people or places reduces distress, the person learns to keep avoiding — which gives short-term relief.
- But long-term, this limits growth, relationships, and healing, especially in young people still developing socially and emotionally.
Name and describe the PTSD symptoms:
- Intrusive symptoms:
- Repetitive, unwanted memories of the event
- Flashbacks to the event (re-living of the event)
- Recurrent nightmares about the event
- Severe distress when you’re reminded of the event
- Physical reactions such as increased hart rate, sweating - Avoiding thoughts or feelings of the event:
- Resisting conversations about the event
- Avoiding situations that bring back unwanted memories - Heightened arousal:
- Being easily startled or fearful
- Struggling with irritability or angry outbursts
- Having trouble concentrating, falling or staying asleep
- Being overly aware of your surroundings and potential threats - Changes in thoughts and feelings:
- Struggling to remember important parts of the event
- Ongoing distorted beliefs about yourself or others
- Recurrent feelings of fear, anger, guilt, shame
- Feeling detached from others
Describe the differences between PTSD and Complex PTSD (CPTSD)
According to the ICD-11, which is the World Health Organization’s international diagnostic manual:
- PTSD (Post-Traumatic Stress Disorder) is the “classical” trauma diagnosis most people know — symptoms include flashbacks, avoidance, and hypervigilance.
- CPTSD (Complex PTSD) is recognized as a separate but related diagnosis. It includes the typical PTSD symptoms plus deeper, longer-lasting effects on a person’s emotional and social functioning.
— causes:
—— CPTSD usually comes from early, long-lasting, and deeply personal trauma — especially interpersonal trauma (abuse, neglect, betrayal by caregivers).
—— It’s often associated with childhood trauma, especially repeated experiences over time.
— People with CPTSD often have more severe daily impairments than those with PTSD.
— They might struggle more in relationships, work, and self-care.
KEY DIFFERENCES:
CPTSD adds three major types of disturbance that go beyond PTSD:
1. Emotional Dysregulation
- Difficulty managing emotions
- Symptoms: persistent sadness, suicidal thoughts, sudden anger outbursts
2. Negative Self-Perception
- Feeling worthless, ashamed, or full of guilt
- Often believing “something is wrong with me”
3. Interpersonal Disturbances
- Trouble forming or maintaining close relationships
- Feeling disconnected or mistrustful of others
Describe the impact of trauma on young children:
Trauma doesn’t just cause fear or anxiety — it can disrupt development in many areas:
- Physical health
- Emotions
- Cognition
- Behaviour
- Social skills
Long-term negative effects:
Trauma disrupts development during a critical period of growth, which can lead to lasting health and behavioral issues.
- Adverse health consequences:
1. Physical health problems:
- conditions like obesity and diabetes
- often linked to risky behaviours (poor diet, substance use)
2. Mental health:
- Symptoms of anxiety and depression
- Diagnoses like ADHD
3. Social difficulties
- Feeling less supported by others
- Poorer social skills, trouble forming relationships
4. Behavioural problems
- issues with conduct, acting out, rule-breaking
5. Sleep and academic issues
- Trouble falling or staying asleep
- struggles with school performance and attendance
What is meant with the dose-response relationship
the more trauma someone experiences, the more adverse effects
Describe the goal of interventions for (complex) trauma:
> optimizing children’s and adolescents’ functioning in all domains of life
Help them overcome:
- Traumatic avoidance
- Feelings of shame, sadness, fear, anger
- Cognitive, behavioural, and social difficulties
Explain the background of CCPT
- Anna Freud and Melanie Klein: were the developers of play therapy
- CCPT emerged from the person-centered philosophy of Carl Rogers, which emphasizes empathy, acceptance, and trusting the client’s internal capacity for growth. It has a few key principles:
- Non-directive approach: The therapist follows the child’s lead.
- Belief in self-actualization: Children, when given the right environment, can heal and grow.
- Emphasis on empowerment: Children are seen as capable of solving their own problems.
- Goal: Positive self-growth.
Explain what the intervention Child-Centered Play Therapy (CCPT) is
CCPT is a developmentally appropriate therapy for young children (ages 3–10).
It targets children with emotional, behavioral, social, or relational challenges.
KEY FEATURES OF PLAY-BASED THERAPY:
- Children use play to learn, process emotions, and make meaning of the world
- Children use symbols to communicate their ideas and emotions
- Play therapy allows for the symbolic expression of children’s inner conflict
- Using toys, children can attain mastery by using imagination to modify the story
- This way, children can process and heal from their trauma
- Voorbeelden:
— Meisje die alleen maar alleen wilde spelen
— Kind die een oorlog had meegemaakt, en vaak een fort bouwde en erachter ging verschuilen.
THERAPEUTIC RELATIONSHIP:
1. The therapist provides a safe and consistent environment
- Consistency: same day, same hour, same room, same toys
- In which a child can process inner experiences and feelings through play and symbol
- In which a child can experience full acceptance, empathy, and understanding
(even when their behavior requires limits)
- The therapist responds to the child’s defensiveness with openness and empathy
- Allowing the child to learn something new (‘I can trust others’)
- Allowing the child to develop trust and impulse control
- Allowing the child to build identity, self-worth, decision-making skills, coping skills
- > Stimulating adaptive self- and interpersonal functioning
Describe an example of CCPT
In this example the therapist was playing with a boy, kind like a war game, and the child wanted to hide. This is what the therapist did:
- Accepts the child as he is
- Allows him to express himself freely
- Recognizes his feelings and behaviors and reflects those back to him in a way that allows him to gain insight into his own behavior
— “You are protected”
— “You want me to help you and don’t remember it”
- Maintains and communicates a respect for his ability to solve problems
— “You want to hide. I am wondering whether you can tell or show me how to do it. Look at that, you were able to do it. You just knew how to make that work.”
> Show him that he can do things himself and express himself. Fostering positive self-growth. You have a good idea, you are able to solve it.
Original sentence: “In essence, children are able to experience the natural self-actualizing tendency at work and learn to trust themselves in the process, an experience that was taken from them during their adverse experiences.”
1. “Children are able to experience the natural self-actualizing tendency at work…”
- Self-actualization is a core idea from Carl Rogers: it’s the natural drive in every person to grow, heal, and become their best self.
- In a supportive, safe environment, this tendency kicks in — especially in CCPT, where children lead the way.
- So, during therapy, children reconnect with their own inner ability to heal and grow.
2. “…and learn to trust themselves in the process…”
- As they explore emotions through play and are accepted unconditionally, they start to feel more confident in their feelings, choices, and thoughts.
- They rebuild self-trust, something trauma often damages.
3. “…an experience that was taken from them during their adverse experiences.”
- Adverse childhood experiences (like abuse, neglect, or violence) often shatter a child’s sense of safety, control, and self-worth.
- These experiences disconnect them from their natural instincts, making them doubt their feelings or feel powerless.
- CCPT restores what trauma disrupted: their ability to trust themselves and grow from within.
Explain what is meant with the Circle of security
> A powerful framework based on attachment theory (especially the work of John Bowlby). It explains what children need from caregivers to feel secure, explore the world, and return for comfort — and why play therapy must connect back to the child’s home life.
🟢 “Going Out” – Exploring System
- The child moves out into the world — playing, learning, socializing.
- To do this confidently, they need a caregiver to be a “Secure Base”:
— Someone who watches over, delights in them, and is available for help if needed.
— This builds confidence, curiosity, and independence.
⚠️ “Coming In” – Attachment System
- When the child becomes upset, overwhelmed, tired, or frightened, they need to come back to their caregiver.
- They’re seeking a “Safe Haven”:
— Someone who protects, comforts, and validates their feelings.
— This restores emotional safety and helps with regulation.
HOW DOES THIS RELATE TO PLAY THERAPY?
- In Child-Centered Play Therapy (CCPT), the therapist acts as a temporary secure base and safe haven.
— During play, the child can explore (even emotionally difficult material).
— When distressed, the therapist offers empathy, containment, and emotional safety.
- This creates corrective attachment experiences for children who may not have had that security before.
The healing must continue at home, where caregivers also need to offer a secure base and safe haven — otherwise the progress may not last.
Describe the effectiveness and efficacy of CCPT
- A systematic review of 23 clinical studies that compared CCPT with either:
a. waitlist control groups (no treatment yet)
b. alternative treatment approaches
- Results:
Compared to other groups, children who received CCPT showed:
✅ Fewer externalizing behaviors
(like aggression, acting out, hyperactivity)
✅ Fewer internalizing problems
(like anxiety, depression, withdrawal)
✅ Lower parental stress
(Parents felt less overwhelmed or helpless)
✅ Greater parental empathy
(Parents better understood and responded to their child’s emotional needs)
> CCPT helps both the child and the caregiver, improving emotional and behavioral functioning and the parent-child relationship. - A RCT:
- 112 children with complex trauma
- Randomly assigned to either:
a. A CCPT group (16 sessions over 8 weeks)
b. A waitlist group
- results:
Children in the CCPT group showed improved social-emotional functioning:
— better emotion regulation
— increased empathy
— Improved social skills
and displayed fewer behavioural problems
> This study confirms that CCPT significantly helps children with trauma develop better emotional control, stronger relationships, and reduces challenging behavior.
> Across both slides, the evidence is clear: CCPT is an effective intervention for children with trauma, helping them (and their parents) build emotional strength, reduce distress, and improve relationships — all through the healing power of play.
What is efficacy and what effectiveness?
- Efficacy: How well a treatment works under ideal, controlled conditions
— RCT studies - Effectiveness: How well a treatment works in real-world settings, with all the messiness of daily life.
Describe the background of TF-CBT, What TF-CBT is and how it works
What?
- A structured, skill-based therapy model for children aged 3 to 18.
- Designed specifically for those who have experienced or witnessed traumatic events
KEY FEATURES:
1. Trauma-sensitive + CBT-based:
- Combines principles from Cognitive Behavioral Therapy (CBT) and Family-Based Therapy (FBT).
- It’s trauma-sensitive, meaning it’s adapted to be emotionally safe and supportive for trauma survivors.
2. Core components include:
- Psychoeducation – teaching children and families about trauma and its effects.
- Skill-building – learning coping strategies for anxiety, anger, and stress.
- Exposure – helping children gradually face and process trauma memories in a safe way.
- Trauma narrative processing – children tell their trauma story, which helps reduce distress and shame.
- Parental involvement (highlighted): Parents are actively involved in therapy to support healing and improve family functioning.
3. Therapist role:
- Provides a safe, nonjudgmental environment.
- Helps children and caregivers open up, reduce shame, and build trust.
in severe cases:
- If the child is showing extreme acting-out, suicidal behavior, or substance use, TF-CBT may not be the best starting point.
- In those cases, other treatments like DBT-A (Dialectical Behavior Therapy for Adolescents) may be needed first to stabilize behavior.
How does TF-CBT works - treatment program:
TF-CBT is structured into three main phases, often delivered in 8 to 20 sessions:
1. PRAC phase: coping skills phase
This is the foundation-building stage where both children and parents learn skills to manage emotions and prepare for trauma work.
- P: Psychoeducation – learning about trauma and its effects
- P: Parenting Skills – helping caregivers support their child
- R: Relaxation – calming techniques (e.g., breathing)
- A: Affective modulation – recognizing and managing feelings
- C: Cognitive coping – identifying and challenging unhelpful thoughts
- T Phase: Trauma Narrative and Processing Phase
- The child gradually tells and processes their trauma story, with therapeutic support.
- Helps reduce avoidance, fear, and shame. - ICE Phase: Treatment Consolidation and Closure Phase
- I: In vivo mastery – confronting real-life trauma reminders in safe ways
- C: Conjoint sessions – child and parent meet together to share and heal
- E: Enhancing safety – planning for the future and preventing relapse
📌 Note: Parental skills and gradual exposure are woven into all phases.
HOW DOES IT WORK IN PRACTICE:
🔄 Sequential & Progressive
- TF-CBT follows a step-by-step approach:
— Start with PRAC: build coping and safety skills.
— Then TICE: work through trauma and prepare for the future.
- Each step builds on the last, so children are never thrown into trauma work unprepared.
⏳ Flexible Session Count- Children with more severe emotional dysregulation (e.g., foster care, complex trauma) may need more sessions to move through the stages safely.
🌱 Gradual Exposure
- Exposure isn’t forced — it’s carefully and safely structured:
— Children and parents learn to tolerate reminders of trauma instead of avoiding them.
— Activities include:
—— Talking, writing, art, role play about difficult feelings and memories
—— Joint parent-child sessions to rebuild safety and trust
Explain PRAC 1: psychoeducation
You provide the child and parents information about:
- The nature of traumatic experiences: their prevalence, causes, common reactions…
- Trauma reminders: any internal/external cues that remind children of their original
trauma and elicit trauma responses
— Identifying the child’s trauma reminders and connecting these to the child’s trauma
responses (making sense of the trauma)
— Understanding that the child’s emotional and/or behavioral problems are trauma-related
- Treatment
To reassure children and parents that they are not alone or abnormal Occurs throughout the treatment (when needed)
Gradual exposure is implemented by:
- The therapist is referring to the child’s traumatic experiences by name (‘car accident’, ‘domestic violence’) rather than using a euphemism (‘the bad things that happened’)
- Directly looking at and facing the child and parents when using words that describe the traumatic experiences
- Not lowering voice tone when talking about the child’s traumatic experiences as it might convey secrecy, shame, or discomfort
The therapist models nonavoidance; The therapist shows (models) through their own behavior how to face difficult emotions or memories, instead of avoiding or escaping them.
Explain PRAC 2. Parenting skills
Parents are considered the primary agent of change in their children; when parents are supported and involved in the healing process, children make more progress.
Key components:
- 🔎 Informed parents:
Parents are educated about what trauma looks like in their child — behaviors, emotional responses, and symptoms.
👉 This helps reduce confusion and blame.
🔁 Parallel interventions:
Parents receive similar tools as their child (e.g., relaxation, emotional regulation skills) so they can model and reinforce these at home.
💬 Emotional support for parents:
Parents also carry emotional burdens from the child’s trauma (e.g., guilt, helplessness).
TF-CBT helps them process their own reactions, so they can offer strength, stability, and empathy to the child.
🧠 Recognizing dysregulation:
Parents learn to spot signs of emotional dysregulation (meltdowns, shut-downs, anxiety) and respond in supportive, not reactive, ways.
👍 Positive parenting:
The program encourages the use of praise, warmth, and attention rather than criticism or punishment. This builds the child’s sense of safety and worth.
💆♀️ Reducing parental stress:
Stressed-out parents can’t always be present or emotionally available. Supporting parental well-being helps the whole system function better.
Explain PRAC 3. Relaxation skills
It focuses on helping children and caregivers manage physiological symptoms of trauma through calming techniques. Traumatized children often live in a constant state of physiological dysregulation — their bodies are stuck in “survival mode.”
Teaching them how to relax and self-soothe is a crucial early step in trauma recovery.
- Physiological dysregulation =
— When the body struggles to manage stress responses.
— Children may be overly tense, jumpy, have trouble sleeping, or react intensely to minor stress.
- Self-soothing =
— The ability to calm oneself down after stress or emotional upset.
— This is often disrupted by trauma, but it can be relearned through practice.
Interventions:
- focused breathing
- yoga or simpel stretching
- progressive muscle relaxation
- Dancing, blowing bubbles, drawing
- Anything that helps children feel calm and in control of their body
> These strategies help both children shift attention away from distress and regulate their nervous system.
Gradual exposure is implemented by helping children and parents develop a variety of relaxation strategies for when they experience trauma reminders in different scenarios/settings . Relaxation techniques are practiced in multiple settings (school, bedtime, social settings)
Explain PRAC 4. Affective modulation
Traumatized children have often learned to suppress their feelings or have learned that the only safe feeling to express is anger
1. First step is affective expression: children learn to identify and express their feelings
via photographs of faces, drawing, or other creative interventions
2. Second step is affective modulation: children learn to manage their difficult feelings via problem solving, role playing, social support seeking…
Parallel parent session(s):
- Parents express their own feelings about the trauma and develop optimal coping ways
- Parents learn to assist their child in expressing feelings and model appropriate affect expression and modulation
intervention:
- Compare emotions to weather: Just as the weather changes, our emotions can change to. For example:
— Sunny = happy
— Rainy = sad
— Stormy = angry
This works because: It normalizes emotional changes, helps kids name their feelings, and reminds them that emotions — like weather — don’t last forever.
- Role-playing:
Illustrate scenarios where affect modulation comes into play
Example: losing a game: The child learns:
1. To recognize feelings of disappointment or frustration
2. To manage the emotion (e.g., deep breaths, positive self-talk)
3. To reflect: “Why was it helpful to stay calm?”
🔹 This builds emotional resilience in real-life scenarios.
