Transcript Understanding More About Psychological Trauma Reactions

Understanding More About
Psychological Trauma Reactions
Working with people with PTSD
Whilst Awaiting a Specialist
Therapy
Mike Scanlan
The Problems with Diagnosis
• Strict adherence is unhelpful within a
recovery oriented stepped care service
• Lifetime prevalence of about 8%
• We need the person to have had
symptoms for over 1 month and often a
diagnosis cant be made until 6 months
post incident.
The Harry Potter approach
• We often get GP’s referring on people with
a cluster of symptoms.
• Hypervigilance
• Avoidance
• Cued anxiety
• Social withdrawal
• What else might cause these symptoms?
What else?
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Early onset dementia (trauma?)
Adjustment reaction
Panic
OCD
Acute Stress Disorder.
A mnemonic can help
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TRAUMA = PTSD
• Traumatic event - the person experienced, witnessed, or was
confronted by actual or threatened serious injury, death, or threat to
the physical integrity of self or other and, as a response to such
trauma, the person experienced intense helplessness, fear, and
horror
• Re experiences such traumatic events by intrusive thoughts,
nightmares, flashbacks, or recollection of traumatic memories and
images.
• Avoidance and emotional numbing emerge, expressed as
detachment from others; flattening of affect; loss of interest; lack of
motivation; and persistent avoidance of activity, places, persons, or
events associated with the traumatic experience
• Unable to function Symptoms are distressing and cause significant
impairment in social, occupational, and interpersonal functioning
• Month These symptoms last more than 1 Month
• Arousal is increased, usually manifested by startle reaction, poor
concentration, irritable mood, insomnia, and hypervigilance
22 Question -IES
• 24 + PTSD is a clinical concern. Those
with scores this high who do not have full
PTSD will have partial PTSD or at least
some of the symptoms.
• 33 and above represents the best cut off
for a probable diagnosis of PTSD.
• 37or more This is high enough to
suppress your immune system's
functioning (even 10 years after an
impact event).
More than just a score
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Intrusion
Hyper arousal
Avoidance
Adds to the MDS
Remember it is subjective – REF?
Care planning tool
Indicator of strengths
Shattered Assumptions, Betrayal, Fear
Indicates a need for CBT / EMDR
So we know they are troubled by
psychological trauma – What now?
There’s a lot we can do while waiting for CBT/EMDR
• Normalise – Shared understanding (3 or 5)
• Assess for risks, strengths and give hope
• Be an advocate – (solicitors)
• Bibliotherapy (de stigmatisng, hope of recovery, Stories
• Sleep w’shop (People with PTSD become afraid of
sleep)
• Medication?
• Exercise
• Watch out for substance misuse
• Safe Place
• Centering exercise
• Cognitive -restructuring
A word about debriefing
• NICE guidance (2005) makes it clear that
debriefing should not be routine practice.
Wesselly et al (2000) actually states that
'Debriefing may paradoxically induce that
distress in those who would otherwise not
have developed it'
And Another
• A primary care patient feeling confused, angry
and isolated may need to be listened to and to
be reassured. They may need to tell their story
and ask to be able to do so. Suggest using the
3rd person. This is not debriefing. This is natural
empathic caring and is an important function of
good stepped care. In these days of protocol
driven care it is worth perhaps reflecting on the
therapeutic value of just listening (Cox et al
1987) re-framing and normalising.
The Safe Place
• Not restricted to EMDR
• Link with relaxation
• Think of a place where you have felt
comfortable and safe
• Are the people your with OK?
• Build it – use olfactory links, visual cues
and sounds
• Lets have a go – put in a test
Disassociation
• A common adaptation is spontaneous
disassociation when confronted with
painful pictures or memories.
• This again limits choice – but is a coping
mechanism – Be careful not to omit the
behaviour.
• As a stepped care practitioner we can
offer the choice of being more centred
Centering
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Think about something you would rather
forget – choose wisely
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5 Things you can See
4 things you can hear
3 things you can touch
2 things you can smell
1 thing you can taste
Preventative Cognitive
Restructuring
• ASD – you are attempting to prevent
PTSD from developing. (Foa 1995)
• Partial PTSD – you are helping the patient
to limit the damaging impact of self critical
cognitions. Needs to be here and now and
focussed on the traumatic event and the
persons (usually self critical) interpretation
of their role in the event.
• Guided Self Help – Needs research
Post Traumatic Growth
• PTG research shows changes in 3 areas:
• Ones’ philosophy of life. A greater appreciation
of life and small joys.
• Enhanced spirituality. The perception of self:
Through existential reevaluation and
reconstruction of the challenged or shattered
assumptive world
• One’s relationship to others: Perception of
others is transformed, intimacy and compassion
is deepened.