Transcript The art and science of treating trauma survivors

The art and science
of
treating trauma survivors
Tovah Means, MS, LMFT
Watch Hill Therapy
Chicago, IL
www.watchhilltherapy.com
Art & Science of Treating
Trauma Survivors
Dilemma - What little we know, what we still don’t
know, and the limits of current research & EBT’s
Core Elements of Traumatic Response
Top Down vs Bottom Up Processing
Trauma Spectrum & Unique Factors
Current Research
Evidence Based Treatments (EBT or EVT)
Polyvagal Syndrome (Dr. Stephen Porges, Ph.D)
PTSD vs. Stress Disorder (Rachel Yehuda, Ph.D)
EMDR vs. Prozac (van der Kolk et al)
Current Research
Brain Regions Impacted & Sensitive Periods (Martin Teicher,
MD)
Trauma Sensitive Yoga (Bessel Van der Kolk, MD)
Impacts on Play: Rhesus Monkeys (Stephen Suomi, Ph.D) and
Rats with Cat Hair (JP Panksepp)
Core Elements of Traumatic Response
Traumatic Memory - Time
Core Elements of Traumatic Response
Somatization - Bodily Response
Core Elements of Traumatic Response
Cognition - Thinking
Core Elements of Traumatic Response
Neuroscience - The way we’re wired
Core Elements of Traumatic Response
Ego States - We are Multiple
Core Elements of Traumatic Response
Affective States - Emotional Distress
Core Elements of Traumatic Response
Defense Mechanisms - Fight, Flight, & Freeze
Core Elements of Traumatic Response
Relationships & Attachment
Top Down vs. Bottom Up
Models & Interventions
Sensorimotor Psychotherapy (Pat Ogden)
SMART: Sensory Motor Arousal Regulation Treatment
(Elizabeth Warner, Psy.D)
Somatic Experiencing (Peter Levine)
The Body Remembers (Babette Rothschild)
EMDR (Francine Shapiro)
Models & Interventions
Integrative Treatment of Complex Trauma for Children (Cheryl
Lanktree, Ph.D. and John Briere, Ph.D.)
Trauma Sensitive Yoga & The Body Keeps Score (Bessel Van
der Kolk)
Interpersonal Neurobiology, Mindsight (Dr. Dan Siegel)
Neurosequential Model (Dr. Bruce Perry)
DBT, FAP, ACT (Marsha Linehan, Steven Hayes)
TRAUMA SPECTRUM
Multiple
Event (R) Late Onset
One
Event
One Event
(R)
R=Relational
Multiple
Event (R) Early Onset
Trauma Spectrum
The farther down the spectrum you get the more drastic
the effects of the traumatic experience.
More influence the trauma has in shaping what you
know about the world and relationships.
Greater impact on the brain and development.
What your brain and body have to do to survive
becomes more damaging in the long run. Ex.
dissociation.
Less ability to use language to process the
experience.
TRAUMA SPECTRUM
One
Event
Examples:
- Car accident
- Loss of stability ex. house fire, job loss, bankruptcy
- Being diagnosed with a life threatening illness
- Public shame or humiliation
TRAUMA SPECTRUM
One Event
(R)
Examples:
- Physical or sexual assault
- Witnessing violence
- Sudden or tragic death
- Natural disaster
- Highly conflictual divorce
“Big T” trauma
TRAUMA SPECTRUM
Multiple Event
(R) - Late
Onset (Age 3
and up)
Examples:
- On-going physical or sexual abuse
- On-going neglect or emotional abuse
- On-going abuse (above) by a loved one
- On-going witnessing of violence
- Torture, war
- Chronic homelessness or community violence
TRAUMA SPECTRUM
Multiple
Event (R) Early Onset
(Before age
3)
“Small t” trauma
“The traumatic stress field has adopted the term
“complex trauma” to describe the experience of
multiple, chronic, and prolonged,
developmentally adverse traumatic events,
most often of an interpersonal nature (eg,
sexual or physical abuse, war, community
violence) and early-life onset.” - Bessel Van Der
Kolk
Biology
Early Relational Experience
Age
Duration
Severity
Response of Others
Cultural Beliefs &
Practices
Meaning Making
Inventories and
Assessment Measures
Posttraumatic Cognitions Inventory (Foa, E. B., A. Ehlers, et
al)
Trauma Symptoms Check List & Trauma Symptom Inventory
(John Briere)
Aces Study (Center for Disease Control & Kaiser
Permanente)
Beck Depression Inventory (Aaron T. Beck)
Multidimensional Inventory of Dissociation (Paul Dell, PhD)
Dissociative Experiences Scale (Eve Bernstein Carlson,
Ph.D. and Frank W. Putnam, M.D)
Other Resources
Other Resources: Assessment and Screening Tools
for Trauma in Children and Adolescents: A Review
(Virginia C. Strand, Teresa L. Sarmiento, Lina E.
Pasquale, Trauma Violence Abuse, January 2005 6:
55-78)
National Child Traumatic Stress Network (NCTSN)
Consultation - [email protected]