Transcript Impact on Family Systems - Missionary Kids Safety Net

Healing and Modalities of
Therapy
Bob Campbell, Psy.D., M.Div.
MKSN Conference
April 20, 2013
Adult Survivors of Childhood Trauma
• Every case is unique
• Not every person will develop a disorder
• The type or severity of trauma does not determine the probability of
developing a disorder
• Diathesis/Stress Model
• Any extreme stressor
• Physical, sexual, psychological abuse
Symptoms of Traumatic Stress
• Stuck between fight and
flight and freeze
• Flashbacks
• Re-experiencing
• Avoidance
• Hyperarousal
• Irritability
• Restricted range of affect
PTSD – Posttraumatic Stress Disorder
• PTSD
• Usually related to a specific event or series of discrete events
• Car accident, natural disaster, war
• Complex PTSD - DESNOS
• Disorder of Extreme Stress, NOS
• Prolonged, repeated trauma
• Additional symptoms
• Developmental Trauma Disorder – DESNOS in children
Disorders of Extreme Stress, NOS
• Long-term trauma
• Person held in a state of captivity, physically or emotionally
• Unable to get away from the danger
• Examples:
•
•
•
•
•
•
Concentration camps
Prisoner of War camps
Prostitution brothels
Long-term domestic violence
Long-term child physical abuse
Long-term child sexual abuse
DESNOS – Additional Symptoms
• Emotional dysregulation
• persistent sadness, suicidal thoughts, anger
• Dissociation
• Helplessness, shame, guilt, stigma, feelings of isolation
• Distorted Perceptions of the Perpetrator
• attributing total power, becoming preoccupied with relationship or revenge
• Difficulty forming relationships
• Loss of meaning
• loss of faith or a sense of despair
DESNOS in Trafficked Females
Symptom
Severe rating
Recurrent thoughts/memories
75%
Feeling the event is reoccuring
52%
Recurrent nightmares
54%
Feeling detached/withdrawn
60%
Unable to feel emotion
44%
Jumpy, easily startled
67%
Difficulty concentrating
52%
Trouble sleeping
67%
Feeling as if you don’t have a future
65%
Williamson, Dutch, and Clawson, 2010.
Other DESNOS issues
• Misdiagnosis as PD
• Poor assertiveness due to avoidance of topic
• Self-medication
• Self-mutilation
• Lack of understanding from others
Neurobiological Etiology of PTSD
Memory
Hippocampus
Amygdala
Anterior Cingulate Cortex
Evidence-Based Treatments for PTSD
• What is “evidence-based”?
• Many are based on exposure and response
prevention
• Exposure
• Scary movies
• Response prevention
• Stay present
• These treatments focus on symptom
reduction
Types of Treatment
• CBT – Cognitive Behavioral Therapy
• CPT – Cognitive Processing Therapy
• Prolonged Exposure
• EMDR – Eye Movement Desensitization and Reprocessing
• EFT (Tapping) – Emotional Freedom Techniques
• ACT – Acceptance and Commitment Therapy
CBT
• Cognitive
• Exposure
• Relaxation
• Education
Thoughts
Feelings
Behaviors
CPT
• Cognitive Therapy
• Written accounts
• Exposure elements
Prolonged Exposure
• Classical conditioning
• antecedents
• Operant conditioning
• consequences
EMDR
• Alternating side stimuli
• Exposure elements
• Potential neurological change
EFT
• Tapping points
• Exposure elements
• Acupressure elements
• Relaxation elements
ACT
• Meditation
• Acceptance
• Willingness
• Values
• Defusion
• Self as context
• Increases flexibility
Non-Evidence-Based Therapies (that work)
• Existential
• Psychodynamic
• Self-Psychology (Not Do-it-yourself Psychology)
• Humanistic
• Family therapy
• Hypnotherapy
• Solution-focused therapy
Medications
• Anti-depressants
• SSRIs - paroxetine (Paxil) and
sertaline (Zoloft)
• SNRIs - venlafaxine
• Atypicals – Wellbutrin, mirtazapine,
bupropion
• Anti-psychotics
• Risperidone
• Quetiapine
• Avoid benzodiazepines
• Not effective for PTSD
• Serious side effects
Additional DESNOS Treatment
• Address interpersonal difficulties
• Restoration of control and power
• Develop healing relationships which create safety
• Remembrance and mourning
• Promote reconnection with everyday life
Some things to begin today
• Self-care
• Exercise
• Eating right
• Enjoying life
• Meditation
• Finding meaning
• Telling your story
• Finding the help you need
Dr. Bob Campbell
[email protected]
www.willowwellness.com