Transcript Surviving Trauma: The Impact on Individuals, Families, and

Jessica Duffel, Psy.D.
Clinical Psychologist
Family Mental Health Program
Oklahoma City VA Medical Center
 Review the signs and symptoms of PTSD
 Identification of risk factors and protective
factors associated with posttraumatic stress
 Examine the principles of recovery and
resilience
 Describe the impact of posttraumatic stress in
the family and school settings
 Exposure to death, threatened death, actual or
threatened serious injury, or actual or
threatened sexual violence
 Direct exposure or witnessing
 Indirect exposure
 Repeated or extreme indirect exposure to gruesome
details of the event(s), usually in the course of
professional duties
 Sexual abuse, physical abuse, domestic
violence
 Violent crimes: assault, mugging, kidnapping
 War
 Natural or man-made disasters
 Community violence
 Transportation accidents
 R e-experiencing
 A voidance
 I ncreased arousal
 N egative thoughts and feelings
 Recurrent, involuntary, and intrusive memories
 Children age 6+ may show repetitive play
 Traumatic nightmares
 Children may have frightening dreams without content
related to the trauma(s)
 Dissociative reactions- flashbacks
 Children may reenact the event in play
 Intense distress after exposure to traumatic
reminders
 Efforts to avoid distressing trauma-related
stimuli associated with the event:
 Trauma-related thoughts or feelings
 Trauma-related external reminders (e.g., people, places,
conversations, activities, objects, or situations)
 Irritable or aggressive behavior
 Self-destructive or reckless behavior
 Hypervigilance
 Exaggerated startle response
 Problems in concentration
 Sleep disturbance
 Negative beliefs and expectations about oneself,
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others, or the world
Blaming self or others for causing the traumatic event
Negative trauma-related emotions (e.g., fear, horror,
anger, guilt, or shame)
Decreased interest in previously enjoyed activities
Feeling alienated from others (e.g., detachment or
estrangement)
Inability to experience positive emotions
 Symptoms persist for at least one month
 Negatively impact important areas of life
 There may be delay in appearance of symptoms
 Fear
 Low self-esteem
 Worry
 Difficulty trusting
 Sadness
 Aggression
 Anger
 Self-harm
 Feeling alone
 Alcohol or drug
use/misuse
 Not everyone who experiences trauma develops
PTSD
 Posttraumatic reactions vary by the individual
and depend on many variables
What variables?
Risk Factor = behavioral, hereditary, and
environmental effects that increase the
likelihood of developing a disorder
Protective Factor = factors that prevent or
reduce vulnerability for developing a
disorder
 Severity of the trauma
 Physical proximity to the trauma
 Trauma involved interpersonal violence
 Repeated traumas
For Children:
 Parents’ reaction to the trauma
 Child has a preexisting mental health condition
 Parent(s) with mental health concerns
 Use of healthy coping skills
 Holding the belief that there is something you can do
to manage your feelings and cope
 Being resourceful and having good problem-solving
skills
 Helping others
 Finding positive meaning in the trauma
 Self-disclosure of the trauma to loved ones
 Having an identity as a survivor as opposed to a victim
 Distance from the trauma
 For children, parents demonstrating resilience after trauma
 Being more likely to seek help
 Availability of social support
 Being connected with others – family,
friends, community
* Consistently cited in research as an
extremely important protective factor
 The process of adapting well in the face of
adversity, trauma, tragedy, threats, or
significant sources of stress
 Research has shown that resilience is ordinary,
not extraordinary
American Psychological Association, 2015
 Self-direction: determine own path to recovery
 Individualized and person-centered: multiple
pathways to recovery based on individuals’ unique
strengths, needs, preferences, experiences, and
cultural backgrounds
 Empowerment: individuals choose among options
and participate in all decisions that affect them
APA, 2015
 Holistic: recovery focuses on people’s entire lives,
including mind, body, spirit, and community
 Nonlinear: recovery isn’t a step-by-step process but
one based on continual growth, occasional setbacks,
and learning from experience
 Strengths-based: recovery builds on people’s
strengths
APA, 2015
 Respect: acceptance and appreciation of the
individual
 Responsibility: responsibility for self-care in
recovery
 Hope: recovery’s central, motivating message is a
better future — that people can and do overcome
obstacles
APA, 2015
 Help child learn what it means for a parent to have
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PTSD
Help the child understand it is not his/her fault
Individual therapy for parent
Individual therapy/supportive counseling for child
Family therapy is a good option
 Caution against parents or others oversharing the details
of the parent’s trauma (depends on age and maturity of
child)
 Be aware of possible violence in the home
 May feel that their parent does not care about or love
them
 May worry their parent cannot take care of them
 May worry about their parent’s well-being
 May show similar symptoms as parent
 May take on the adult role
 May not learn how to manage their feelings
 Adults:
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Prolonged Exposure
Cognitive Processing Therapy
Acceptance and Commitment Therapy
Couples and Family Therapy
Family Education Programs
 Children:
 Trauma-Focused Cognitive Behavioral Therapy
 Play Therapy
 Specialized treatments for behavior problems or substance
use
* Parent involvement in treatments
 Difficulty paying attention
 Slowed processing of information
 Learning and memory difficulties
 Difficulty with problem-solving, planning,
organization
 Negative attitudes toward school
 Extra time on in-class exams or out-of-class
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assignments
Additional reminders for due dates
Allow for audio recording of class lessons/lectures
Give seating options
Alternative seating arrangements
Breaks during class
 Allow to stand in back of class for brief periods
 When possible, use of break out groups
 Tutoring
 Excused absence procedures for medical and/or
mental health appointments
 Communicate directly to educators about student
being a trauma-survivor (if known) and
suggestions for accommodations to help the
student succeed
 Speak calmly and gently, yet firm
 Respectful language
 Even tone of voice, not shouting
 Approach from the front
 Minimize sudden movements
 Avoid touching the individual unless asked or given
permission
 Minimize loud, sudden noises
 Firmly ask the individual to leave the setting if being
disruptive
“Life doesn’t get easier or more
forgiving, we get stronger and
more resilient.”
-Steve Maraboli, Life, the
Truth, and Being Free
 OKC VA Med Center Family Mental Health Program:
405-456-5183
405-456-2392
 National Center for PTSD: http://www.ptsd.va.gov/
 National Child Traumatic Stress Network,
Psychological First Aid, Appendix E:
http://www.nctsn.org/sites/default/files/pfa/english/a
ppendix_e.pdf
 Vet Parenting Toolkit
http://www.ouhsc.edu/VetParenting
 American Psychiatric Association, DSM 5
 American Psychological Association
 Agaibi, C.E., & Wilson, J.P. (2005). Trauma, PTSD, and
resilience: A review of the literature. Trauma, Violence,
and Abuse, 6, 195-216.