RESPONDING TO TIP TRAUMA VICTIMS Beyond the Obvious
RESPONDING TO TIP TRAUMA VICTIMS Beyond the Obvious
PRESENTATION AGENDA q Differentiate between stress, crisis, trauma q Understand sources of trauma and how trauma (including TIP) affects individuals – individually q Develop strategies for identifying and interviewing victims of trauma
Before we begin… q What are some beliefs pertaining to the effects of trafficking in persons on victims? q How are victims effected by their kidnapping, brainwashing, and imprisonment? q How do our beliefs effect the way we approach and intervene with trauma victims? q What are some bias’ pertaining to TIP victims?
THE SCIENCE OF TRAUMA There is science we need to understand apply to discover the truth…can reduce the fear and prejudice
THE DIFFERENCE BETWEEN STRESS, CRISIS, AND TRAUMA q. A stressor is: q An event that can cause a person physical or emotional tension q Short term or chronic q Followed by physical and emotional effects which are alleviated when the stressor is removed q Examples? Filing you income taxes q Late for a meeting q Receiving a call on a complaint q What type of crimes might you consider stressful on the victim? q
THE DIFFERENCE BETWEEN STRESS, CRISIS, AND TRAUMA q A crisis is: q A threat to homeostasis (Caplan, 1964) q A temporary disruption of coping and problem solving skills – but not necessarily a life threatening experience q Resolved when the crisis event passes and normal functioning returns q Examples? q A traffic accident in which you break a leg q When will the cast come off, how are you going to get to work, how will you walk? You child has an epileptic fit in front of you for the 1 st time q You fail a tax audit q What type of crimes might you consider a crisis for the q
THE DIFFERENCE BETWEEN STRESS, CRISIS, AND TRAUMA q Trauma q More is: extreme versions of stressful events, they are perceived as: life threatening and evoke fear, helplessness and even horror q Have physical and emotional responses that last long after the event is over q Memory of the traumatic event lingers on q Fear and psychological arousal continues and the body may never fully recover q Life changing…
THE DIFFERENCE BETWEEN STRESS, CRISIS, AND TRAUMA q Examples of trauma? q. You kill an intruder in your home q. You find your child dead q. You are told you have cancer q. What type of crimes might you consider traumatic on the victim? q Child abuse q Suicide (friend, co-worker, relative) q Attempted homicide (victim, friend, coworker, relative) q Homicide (friend, co-worker, relative, witness) q Sexual assault
VICTIMIZATION PROCESS q Life Experiences Before The Assault q Common Experiences During The Assault q Common Experiences After The Assault
PRE-TRAUMA EXPERIENCES q Gender Socialization q Lack Of Sufficient Boundaries q Lack Of Self-Parenting q Utopian Approach To The World Vs. Environmental or Situational Awareness q Looking to Others to Keep Them Safe
EXPERIENCES DURING TRAUMATIC ASSAULT q Physical resistance q Verbal resistance q Surprise or confusion q “Frozen fright” q Disassociation q Tend or befriend
POST-ASSAULT EXPERIENCES q Acute Trauma (Stage 1) q Disorganization-Nightmares-Flashbacks q Reliving Event or Re-Enacting Experience q Shock-Disbelief-Loss of Control-Guilt. Shame q Suppressed or Intensified Emotion q Fear-Hyper-vigilance or Calm and Denial q Irritability and Angry Outbursts q Depression-Suicidal Ideations-Self. Destructive q Physical Pain or Fatigue
POST-ASSAULT EXPERIENCES q Outward Adjustment (Stage 2) Effort to Deny or Minimize the Impact of the Sexual Assault q Rationalize the Reasons it Happened q Avoid Reminders of the Sexual Assault q Depression, Anxiety and Fear Remain q Fewer Episodes of Reliving the Incident q Return to Crisis q Increased Ability to Express Emotions about Incident q Develops Coping Skills q
POST-ASSAULT EXPERIENCES q Integration (Stage 3) q. Acceptance and Understanding Assault q. Reorganization of Life
q Severity Of Response Does Not Reflect Brutality Of Attack q Stranger Vs. Non-stranger q Re-victimized Victims
SPECIAL ISSUES AFFECTING VICTIMIZATION – COMMON VICTIM BEHAVIORS May try to normalize trauma q May have difficulty understanding the context of the assault q May have difficulty fully realizing and/or appreciating danger posed by offender q May attempt to “forgive” the offender q May believe their higher power will protect them – exclusively q May feel overwhelming guilt and may try to ease their conscience and may blame themselves q
SPECIAL ISSUES AFFECTING VICTIMIZATION – COMMON VICTIM BEHAVIORS May be trying to protect others – physically, psychologically q May feel pressure from the rapist or others q May actually feel safer maintaining the relationship q May have some emotional/physical attachment w/offender q May still be under the influence or manipulation and control of the offender q May be worried about collateral misconduct – perceived or real q
WE CANNOT TRULY UNDERSTAND BEHAVIOR WITHOUT UNDERSTANDING THE EXPERIENCES OF THE PERSON OR CONTEXT IN WHICH THE BEHAVIOR OCCURS
UNDERSTANDING MEMORY & TRAUMA
WHAT IS MEMORY? q a: the power or process of reproducing or recalling what has been learned and retained especially through associative mechanisms q b: the store of things learned and retained from an organisms activity or experience as evidenced by modification of structure or behavior or by recall and recognition Webster We are organisms
Memory… Sense • External • Internal Process • Perceive • Store Act • Survive • Mating
• Abstract thought • Concrete thought • Affiliation • Attachment • Sexual behavior • Emotional reactivity • Motor regulation • “Arousal” • Appetite/Satiety • Sleep • Blood pressure • Heart rate • Body temperature Goldstein, 1995 Cortical Limbic Midbrain Brainstem
MEMORY q q q “We tell ourselves stories in order to live” Joan Didion What we can’t recall, we invent Memory is designed to filter the world and discard what we deem irrelevant We tend to hone in on the details of the event – called weapon focus – we recall the grisly details of the weapon pointed at us, but we may not remember the robbers face or the other people in the store If our brains were perfect video cameras we would be paralyzed by information overload – “Funes, the Memorious”
MEMORY ENCODING q q q Whenever we encode an experience (and we all do) we filter it through our own awareness. If we only remembered the literal words or all the details, we might miss the meaning If I tell you “I’m really tired today because the baby was up all night” - what might you remember about what I told you? An inference would normally be that the baby cried all night People have unfounded confidence in our memories We continually confabulate and we don’t
MEMORY AND RECALL v No one is a human video recorder v When we recall an event – that recall becomes our most recent memory v Like a photograph – when we take a photograph and look at it we most often do not recall most of the details in the original memory v What impact does this information have on how and when we interview?
MEMORY AND RECALL When we recall we are reconstructing what we think we remember � When we don’t know something we try to figure it out � If we can’t figure it out we have choices � Say “I don’t know” � Confabulate � Fill in the blanks � What if that memory is less than flattering? �
TO CONFUSE THE ISSUE… q The initial formation of long-term memory requires a chemical called brain-derived neurotrophic factor – while subsequent recall depends on a transcription factor called Zif 268 q These processes are related, but fundamentally different and so researchers conclude that repeated remembering does not create a duplicate
Memory formation CONFABULATION Recall Reconsolidation When the brain strives to re-create an event, it often grafts details of other memories into it q The common wisdom was that once a memory was consolidated into long-term memory – it was stable q Many experts now believe that a memory may return to it’s embryonic state when it’s activated q When a consolidated memory is reactivated through retrieval, it may become particularly q
WE CREATE MEMORIES – EVEN AS THEY CREATE US… Inventive Slippery Malleable Potent Fallible Robust n o i t o m E
BRAINS ARE ELASTIC q Memories change q Patterns change q House breaking a dog… q So what? ? q Our standards for memory are too high…especially when it comes to trauma…and emotions
EMOTIONS ARE AT THE CENTER OF DECISION MAKING… (DAMASIO, 2008) q Brain injury patients (stroke, tumors, accident) whose frontal cortex, somatosensory cortex, or amygdala was damaged Prior to the injury they were successful in their relationships, jobs, and marriages q Following the damage they could still speak perfectly well, deal with the logic of a problem, and could learn new things – but… q Their marriages fell apart, they’re careers were reduced to odd jobs and disability checks q Their emotions were compromised, they were flattened compared to what they used to be an what we expect of people q Patients’ inability to be emotional were getting in the way of their reasoning and decision q
ADDING TRAUMA INTO THE MIX � � The prime “directive” of the brain is survival The brain is “overdetermined” to sense, process, store, perceive, and mobilize in response to the threat (Goldstein, 1995) All areas of the brain are recruited and orchestrated for optimal survival tasks Cognition, emotional, social, behavioral, and physiological residue of trauma may impact an individual for years – even a lifetime (Perry, 1999)
TRAUMA CHANGES THE BRAIN & MEMORY q Trauma response – including rape – is bimodal Hypermnesia –abnormally vivid q Hyper-reactivity to stimuli and traumatic reexperiencing coexist with psychic numbing (Horowitz, 1978) q Avoidance q Amnesia and anhedonia - inability to enjoy pleasure (DMS-R IV) q In many people who have undergone severe stress the post-traumatic response fades over time, while persists in others (von der Kolk, 1994) q Trauma interferes with declarative memory q
BRAIN’S RESPONSE TO THREAT q q In order for any experience to be remembered, traumatic or not, it must 1 st be “sensed” (Perry, 1999) The 1 st “stop” of this sensory input is the lower parts of the brain (brainstem and midbrain) (Perry, 1999) Incoming information is “matched” against previously stored information – if associated with previous threat – an alarm response begins (Aston-Jones , 1986) The fear response will involve a tremendous mobilization and activation of systems – terror involves cortical, limbic, midbrain, and brainstem
USE-DEPENDENT MEMORIES • Learning Names • Phone #’s • Language • Grief • Fear • Joy • • Cognitive Motor Vestibular Emotional - Affect State Riding a bike Typing Dancing Playing piano • Violence • Stress
STATES BECOME TRAITS Sense of Time Extended Days Future Hours Minutes Seconds Loss of Sense of Time Primary Secondary Brain Areas Neocortex Subcortex Limbic Midbrain Brainstem Autonomic Cognition Abstract Concrete “Emotional” Reactive Reflexive Mental State CALM AROUSA L ALARM TERROR FEAR Dr. Bruce Perry
ALTERED REACTIVITY FROM CHRONIC THREAT Terror Fear Alarm Vulnerable Normal Vigilance Calm Dr. Bruce Perry Resilient
STATE MEMORY – 3 YR OLD WITNESS OF A MURDER
DISSOCIATION & FRAGMENTED MEMORIES q q q Trauma overwhelms peoples coping skills – memory is a coping skill Traumatic amnesia is a well documented phenomenon (Kolk & Fisler, 1995) Traumatic amnesia lasts for hours, weeks, or years Dissociation during the trauma (peritraumatic dissociation) is known to cause memory gaps Victimization, helplessness, and betrayal increases the likelihood of peritraumatic dissociation Dissociation refers to a compartmentalization of experience that is stored in memory as isolated fragments (Nemiah. 1998) q q Sensory perceptions Affective states
WHAT DOES THIS MEAN? q When anyone (including you) are under threat – the cortex is shut down q Time to come back to normal state is days, weeks, months, and years… q Intervention q When is state dependent people want to avoid talking – for whatever reason – they use words that conceal rather than reveal “what they can tolerate in the moment” q Just because we are ready for every detail – doesn’t mean the victim is ready or able to fully disclose
THE BRAIN RESPONDS TO THREAT q Preparing q Freezing the human for survival – the instantaneous assessment of danger (some people do not leave this state, unable to fight or run away) q Flight – escaping the danger q Fight – trying to defeat, remove or contain the fear q Tend or befriend – the person may survive by a strategy that does not use either of the other approaches but uses interpersonal skills in an attempt to reduce threat
TRAUMATIC RESPONSES CAN ALTER… q Physiology q Heart rate, respirations, dilated pupils, dry mouth, knot in the stomach q Affective (mood and emotion) responses q Fear, helplessness, horror q Cognitive q Memory (thought) processing – fragmented, out of sequence q Time distortion q Increased confabulation q Trauma memory and recall
EFFECTS OF NEUROTRANSMITTERS & TRAUMA Trauma is not only a psychological event but also a physiological event as well… During stress, crisis, and trauma, the human body generally produces higher levels of neurotransmitters such as Norepinephrine Cortisol (stress hormones) Dopamine Serotonin Massive quantities Interaction with alcohol and other drugs unknown May alter memory, reaction, judgment, response High levels received during event may be undetectable
WORKING WITH TRAUMA VICTIMS q q q Memories of personal trauma are particularly durable and accurate (so don’t worry if you don’t get everything in the ER) The content of traumatic memory is usually vivid, detailed and more accurate than that of ordinary dayto-day memories Traumatic events are first organized in memory on a perceptual or sensory level q q This often depends on the way trauma was first received Visual images, smells, pain, taste, body positions, sounds For some people recalling sensations in the only way to describe the traumatic event initially The narrative emerges over time as the individual tries to explain what has happened (Schacter, 1996)
WORKING WITH A TRAUMA VICTIM q While some victims may be able to verbalize and recount what happened, many experience difficulties in: q q q Concentration Sequencing of events, and Memory disturbances Retelling of experiences may contain internal inconsistencies Victim may often re-live the event and re-experience all of the emotional, physiological effects The victim may not even be able to recall experiencing any pain, or location of the pain due to stress induced analgesia q This analgesic effect is caused by the activation of the
THE IMPACT q The assault experience is remembered in fragments but infused with intense emotion and recollections of sensations such as tastes, smells, and sounds. q Some victims may become haunted by feelings and senses they know are related to the trauma, but have difficulty identifying the source of the feeling or sensation
q Appropriate Open-Ended Questions: What did you do next? q Help me understand? q Tell me what you were thinking at that point? q Tell me what you were feeling when he did that? q Tell me more about that? q This type of questioning will provide the victim an opportunity to talk about thoughts, feelings, and experiences during the assault q This will help us understand better the reality of the situation and overcome most, if not all, challenges to credibility q
CONDUCTING A BETTER VICTIM INTERVIEW Begins with a realistic understanding of our role q Law enforcement must focus on developing at least three hypothesis and prove or disprove each one to attempt to remain unbiased q We must use an awareness of societal stereotypes regarding victimization to overcome challenges to the victim’s credibility q Engage in finding new and better ways to understand the victims experiences – q
COGNITIVE INTERVIEW TECHNIQUES ü Cognitive interview ü Free flow narrative ü Third person/object ü Backwards ü Questions üWhat they remember the most üWhat is most important aspect of what happened to them
VICTIM’S EXPERIENCE/PERSPECTIVE Continue to ask questions until you can experience the incident yourself – feelings Explore smell – tastes – sounds – feelings The truth is in the details!
THEREFORE… Sensitivity and empathy are the keys to a successful victim interview q Be patient q Be thorough q Go beyond “He said, She said” q Build a case in depth q Don’t stop asking questions until you can in some ways experience what the victim has experienced q Give the victim time to process and work through the trauma q Provide the victim with a materials to “journal” their experience q
QUESTIONS & ANSWERS q Invite questions from the audience For further information – contact: Russell W. Strand Chief, Family Advocacy Law Enforcement Training Division US Army MP School, 401 MANSCEN Loop, Suite 1721, Ft. Leonard Wood, MO 65401 Email: russell. strand@us. army. mil Phone: (573)563 -8061
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