TRAUMA A lot is Known About Trauma

Unattended Trauma leads to self-defeating,

self-destructive, pathological behavior

Most will need external support to move
Tana Bridge, PhD, LMSW
beyond trauma
Associate Professor ~ Eastern Michigan University
Additive Nature of Trauma
Supervisor/Consultant:
National Institute for Trauma & Loss

Steele (1992), Terr (1979), Pynoos(1988)

Substance Use/Trauma Trauma Defined

 Ability to escape from trauma memory/symptoms
Acute Stress Disorder

may be accomplished through drug use

Post Traumatic Stress Disorder
 Drug use can perpetuate feelings of
powerlessness, fear, etc. brought about by trauma
Disorder of Extreme Stress Not Otherwise
 Drug culture can expose/create victims of trauma Specified ~ Complex Trauma

Differences in Trauma & Grief

Grief
Trauma  Anger is non-destructive,  Anger- can become
 Sadness non-assaultive assaultive
 Terror
 Grief does not disfigure self  Attacks, distorts self image
 stands alone  Include grief
image  Guilt says ”It was my fault, I
 Reactions are known to  Reactions unknown, held could have prevented it
public within  Guilt says ”I wish I
 Dreams of self as potential
 Can usually talk about loss
would/would not have”
 Can’t or don’t want to talk victims
 Pain is acknowledgement of
 -dreams of deceased  Grief reaction and trauma
 Pain triggers terror,
loss powerlessness, loss of safety  No trauma specific reactions specific reactions.

W. Steele
 Complex/Chronic PTSD~ DESNOS Trauma is a Sensory
Experience

Prolonged and Repeated Trauma
 DV woman and children

Enters via the 5 senses
 Victims of ongoing child abuse
 Prisoners
 Hostages
What are some events/situations that
 People held under the control of their perpetrator
might bring about a trauma specific
response?
 Also known as DESNOS-Disorder of Extreme
Stress/Not otherwise specified.

Traumatic Situations
War Suicides
Violence Car Accidents/Plane Crashes
Rape Disasters - earthquake, floods, fires, etc.
Murder Injuries or life
Beatings/Assaults threatening illness
Domestic Violence Dog Bites
Fires Drowning

Exposure to Trauma Symptoms….

What are common symptoms of trauma or PTSD?

Surviving Victim/Survivor

Witness to the Event

Related or Connected to the Victim

Hearing the Details
 Symptoms Symptoms - continued

Physical symptoms: hypervigalence, startle Avoidant symptoms: avoiding specific thoughts,

response, sleep difficulties, concentration or
memory problems, mood problems such as
anger or depression
 Intrusive symptoms: recurrent recollections
(thoughts, memories, dreams, nightmares or
flashbacks), re-enactment (behavior or re-
telling) distress at symbolic events, survivor guilt
or grief
feelings, activities or situations, diminished
interest, emotional numbness, inability to
connect with future (feel they will die at young
age)
Special forms of avoidant symptoms:
dissociation, helplessness, loss of fear

SYMPTOMS -CONTINUED

 Cognitive Struggles: 2+2 ??? 4, Magical

Thinking (E.G. if I touch him he will die),
concentration , recall and problem solving.
Rumination or preoccupation: Continuous
conscious awareness about the event and How the brain receives and processes trauma….
associations that go beyond ordinary thinking. THE BRAIN AND TRAUMA
Characterized by a sense of uncontrolled
repetition.

2 Component of Brain
Response
1. Reaction – “auto” responses
Development: The brain develops
2. Memory sequentially, with “lower” systems
developing first and “higher” systems
developing later.

There are several areas of the brain that are
impacted by trauma.
 Neurochemical basis of PTSD
Brain ~ parts impacted by
trauma

Cortex: reasoning, problem solving, cognitive memory, Trauma changes the levels of 5 major
planning, recognition neurotransmitters: epinephrine, cortisol,

Limbic: emotions, survival related emotions/pleasure, norepinephrine, serotonin and endorphins
emotional memory
The limbic system (involved in strong emotion)

Diencephalon: (includes thalamus and hypothalamus)
“fight, flight or freeze,” stress response, receives, filters can be changed by the presence of excess
and relays sensory inputs – NOT cognitive norepinephrine and produces:

Brainstem: heart rate, body temperature, respiration.
The brainstem also stores anxiety or arousal states
associated with a traumatic event

Neurochemical basis of PTSD

- continued

Continual presence of symptoms/reactions to trauma

Kindling effect - when small amounts of norepinephrine cause a
cascade effect - the person reacts to a small stressor as if a true
emergency has occurred

Prolonged stress creates a dependency on the analgesic effect -
the person seeks intensity to achieve overload and then the National Institute
for Trauma & Loss in Children
calming effects of endorphin release
VIDEO: BILL STEELE

The Process of Working through

Putting together the pieces…
Trauma

What is needed for ‘resolution’ or successful
Safety –Seeking Safety
process in working through a traumatic
situation….
Attachment /Connection
 Connect with trusted adults
 Elicit support of others

Educate about possible reactions

 Gives meaning
 Normalizes
 Promises of Healing

Connect with Details – Nonverbal into Verbal  Reduced frequency of symptoms

 It gives the “why”s  Reduced fear of the symptoms
 Allows for mastery over content
 Reduced fear of insanity
 Allows for experience outside of self
 Removes negative image
 Opportunity to grieve
 Challenge distorted thinking  Change from victim to survivor

Interventions should be psychomotor as experience is
sensory (art sculpting, play, story telling, journaling,
etc.)

Promises of Healing
...continued

 Opportunity to begin enjoying life

 Sense of humor
 Profound empathy for others who suffer Questions???

Trauma and the CBT Process: Example:

Think Person is
Traumatic “People Think
(Cognitions) Sexually Abused
Event by a Relative
I’m:
”

Do Feel Behavior: This Makes me

(Behavior) (Affect) Substance Use Feel