Principles of Trauma Therapy z z John Briere

Principles of Trauma Therapy z z John Briere Catherine Scott

z Major Types of Trauma z § Child abuse § Mass interpersonal violence § Natural disasters § Large-scale transportation accidents § Fire and Burns § Motor vehicle accidents § Rape and sexual assault § Stranger physical assault § Intimate partner violence § Sex trafficking § Torture § Combat § Witnessing a homicide or suicide § Life-threatening medical condition § Emergency worker exposure to trauma

The Effects of Trauma z § Victim variables: § § Aspects that are in place prior to trauma (i. e. gender) Stressor Characteristics: In addition to victim variables, the characteristics of the trauma are also linked with posttraumatic outcome. § § Posttraumatic responses § Depression § Anxiety § Stress disorders § Dissociation § Somatic symptoms and related disorders § Somatic symptom disorder § Conversion § Psychosis § Substance use disorder

z Assessments § Structured interview: § The Clinician Administered PTSD scale (CAPS) 17 PTSD items; PTSD impact on occupational and social functioning; items addressing guilt and dissociation. § § The Acute Stress Disorder Interview (ASDI) § § 19 items The structured Interview for Disorders of Extreme Stress (SIDES) § 45 -items test. § Self Assessments: § PDS § DTS § DAPS § TSI-2

z z Central Treatment Principles § Provide and ensure safety § Provide and ensure stability § Positive therapeutic relationship § Tailor therapy to fit the client § Consider gender § Aware and sensitive to sociocultural issues § Monitor and control counteractivation (countertransference) § Ethical practice within the standard of care

Treatments z § Psychoeducation § § Individual or group § Handouts § Books General focus § Prevalence of trauma § Common myths about trauma § Why perpetrators engage in violence § Immediate response to trauma § Posttraumatic response to being victimized § Reframing symptoms as trauma processing § Safety plans

z Distress Reduction, Emotional Regulation and z Mindfulness § Grounding § Relaxation and breath control § Meditation and yoga § § § Meditation helps to decrease activity in the amygdala and increase activity in the mesolimbic dopamine system (Sapolsky, 2017) Increase general emotion regulation capacity § ID and discriminate emotions § ID and countering thoughts that precede intrusive emotions § Trigger awareness and intervention § Delay tension reduction behavior § Urge surfing Mindfulness § Maintain awareness and openness to current internal experiences and external world. § MSRB § MBCT

Cognitive and Emotional Interventions z § Cognitive processing § detailed verbal exploration of the traumatic event and circumstances. § Developing a coherent narrative § § § Creating an integrative narrative of the trauma has a positive effect on recovery. Emotional processing § Within therapeutic window § Intensity control Components of Trauma Processing § Exposure- Prolonged exposure § Systematic desensitization – Recommended by Briere

Medications and Conclusions z § Medications for PTSD include: § Antidepressants (SSRI) § Monoamine Oxidase Inhibitors § Benzodiazepines § Mood Stabilizers Research question: Are mindfulness-based treatments overwhelming for PTSD clients? § Conduct an n-of-1 clinical trial that is staggered with 5 individuals who have been diagnosed with PTSD. Do a pre and post test. Implement the MBSR intervention to the first client and start another a few weeks later. Continue the process with all clients. Monitor weekly anxiety levels with a self report assessment. §

References z § American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5 th ed. ). Arlington, VA: American Psychiatric Publishing. § Blake, D. D. , Weathers, F. W. , Nagy, L. M. , Kaloupek, D. G. , Gusman, F. D. , Charney, D. S. , & Keane, T. M. (1995). The development of a clinicianadministered PTSD Scale. Journal of Traumatic Stress, 8, 75 -90. § Bormann, J. E. , Liu, L. , Thorp, S. R. , & Lang, A. J. (2011). Spiritual wellbeing mediates PTSD change in veterans with military-related PTSD. International Journal of Behavioral Medicine. § Brier, J. N. , & Scott, C. (2015). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment (2 nd ed. ). Los Angeles, CA: Sage. § Courtois, C. A. , & Ford, J. D. (2013). Relational Integrated treatment of complex trauma: A practical guide for therapist. New York, NY: Guilford. § Foa, E. B. , & Rothbaum, B. O. (1998). Treating the trauma of rape: Cognitive behavior therapy for PTSD. New York, NY: Guilford.

z References cont… § Kimerling R. , Street, A. E. , Pavao, J. , Smith, M. W. , Cronkite, R. C. , Holmes, T. H. , & Frayne, S. M. , (2010). Military-sexual trauma among Veterans Health Administration patients returning from Afghanistan and Iraq. American Journal of Public Health, 100, 14091412. § Najavits, L. M. (2002). Seeking safety: A treatment manual for PTSD and substance abuse: New York, NY: Guilford. § Maeda, M. , & Higa, M. 2006). Transportation disasters and posttraumatic responses: A review of studies on major sea, air, and rail accidents. Japanese Journal of Traumatic Studies, 4, 49 -60. § Sapolsky, R. M (2017). Behave: The biology of humans at our best and worst. New York, NY: Penguin Press.