Presentation is loading. Please wait.

Presentation is loading. Please wait.

Trauma Interventions For Survivors of Natural Disasters Kathryn Wetzler, Psy.D Adult Staff Psychologist Consortium Director Kaiser Permanente, Vallejo,

Similar presentations

Presentation on theme: "Trauma Interventions For Survivors of Natural Disasters Kathryn Wetzler, Psy.D Adult Staff Psychologist Consortium Director Kaiser Permanente, Vallejo,"— Presentation transcript:

1 Trauma Interventions For Survivors of Natural Disasters Kathryn Wetzler, Psy.D Adult Staff Psychologist Consortium Director Kaiser Permanente, Vallejo, California

2 Agenda  Three Phases of Intervention  Barriers to Treatment  Provider Issues  Brain Based Biology of Trauma  Evidence Based Treatment  Vallejo Study

3 Topography  Typhoons  Earthquakes  Volcanic Ring of Fire  Need for evidence based or evidence supported responses  Heterogeneity of traumatic events defies specific guidelines (Hobfall, et al.)  1990 MHTFDM

4 Initial Phase - Stabilization  Psychological First Aid (early to mid- phases)  Developed after Hurricane Katrina (National Center for PTSD and the NCTSN)  Focus on non intrusive compassionate attitude of the part of clinicians  Core focus of PFA on the practical needs of trauma survivors

5 Initial Phase – Stabilization (cont’d.)  Consistent with research evidence on risk and resilience following trauma  Applicable and practical in field settings  Appropriate for developmental levels across the lifespan  Culturally informed and delivered in a flexible manner

6 Early to Middle Phase  Five Intervention Principles (Hobfoll, et al.)  Empirical support  Aimed at early to mid- phases  Promotion of a sense of safety  Corrective information to help get a realistic view of the future  Information about friends and relatives

7 Early to Middle Phase (cont’d.)  Safety from rumors and sensationalized media  Leadership must take a role in ensuring accurate information is disseminated and fear is not used for political purposes  Psychological organizations may use their voice to guide media and political strategy

8 Early to Middle Phase (cont’d.)  Exposure to televised images may heighten psychological distress  Children may think the disaster is still occurring

9 Promotion of Calming  High levels of emotionality and arousal may be common especially in the post- trauma period  High levels of arousal may lead to panic symptoms and other non-adaptive responses  Most will return to pre-morbid functioning  Toolbox of skills:  Inoculation training

10 Promotion of Calming (cont’d.)  Grounding  Cognitive re-appraisal  Deep breathing  Diaphragmatic breathing  Deep muscle relaxation  Mindfulness  Normalization of symptoms (i.e. not going crazy)  Sleep hygiene

11 Promotion of Calming (cont’d.)  Delivery of these interventions can be individual, group or community based. Public Health interventions can be directed at large- scale community outreach programs and media used to disseminate information  Technology can also be used to disseminate information  At this point CISD (Critical Incident Stress Debriefing) may actually heighten arousal at a time when you want to dampen it

12 Promotion of Calming (cont’d.)  Studies have shown CISD is not effective in preventing PTSD and may exacerbate some people’s stress after the trauma  Role of positive emotions in coping with stress and trauma including  Joy  Humor  Contentment  love

13 Promotion of Calming (cont’d.)  Problem-focused coping  People may perceive the disaster as one big unmanageable problem  Break it down into manageable chunks, which will help in feeling some sense of control

14 Self and Collective Efficacy  Following a disaster people may be at risk of losing their sense of competency at problem solving which may generalize from the initial trauma to everyday life  Teaching children emotional regulation skills  Community self-efficacy through activities such as  Religious activities  Mourning rituals

15 Self and Collective Efficacy (cont’d.)  Praying  Singing  Bayanihan  Appointment of natural leaders

16 Promotion of Connectedness  Extensive research of the importance of social support and sustained attachments to loved ones - Oxytocin  Salutogenic factors (Antonovsky 1979), such as social support, extend beyond the initial trauma

17 Promotion of Connectedness (cont’d.)  Fundamental importance to children and adolescents  Church  Identify those with minimal social support  Provide formalized support  Organize places for teens to organize under supervised support, etc.

18 Hope  Instilling hope critical because of shattered worldview (Janoff Bullman, 1992)  Goes beyond the bounds of psychotherapy  Sense of Coherence (Antonovsky 1979)  Meaning  Manageability  Comprehensibility  Clean-up rebuilding

19 Hope (cont’d.)  Housing  Employment  Relocation  Building on strengths, etc.

20 Barriers to Treatment  Somatization  Validate symptoms  Provide education on etiology  Stigma  Ongoing access to services  Fear of letting guard down

21 Provider Issues  Vicarious Trauma  Burnout/Compassion fatigue  Assessing resiliency in providers  Self care  Gaining perspective  Feelings of incompetency/fear of failure  Realistic expectations of what constitutes help

22 Symptoms  What can I expect?  Nightmares  Flashbacks  Avoidance of thought feelings or places  Mild, moderate or extreme detachment  Sleep disturbance  Anger or irritability

23 Symptoms (cont’d.)  Hyper-vigilance  Exaggerated startle response  Feelings of hopelessness  Loss of connection with faith or spirituality  Disruption in the ability to hope trust or care about others

24 Comorbidities  Depression (psychotic)  Panic disorder  GAD General Anxiety Disorder)  Separation anxiety  Somatization  Complicated or Traumatic Grief  Drug and Alcohol Abuse  Specific Phobias

25 Medications  Possible use of medications:  SSRIs (e.g., Celexa, Paxil, Prozac, Zoloft)  Prazosin  Alpha-adrenergic blocker (blocks adrenaline)  Reduces nightmares in PTSD

26 The Brain and PTSD  Amygdala Hyperactivity  Role of the Pre-Frontal Cortex (PFC)  Davidson work on Emotional Styles and PFC  Resilience – PFC and Amygdala  Hippocampal Abnormalities  HPA Axis (Hypothalamic Pituitary, Adrenal)  PTSD and Memory

27 Assessment Measures  Clinical Interview  PCL-CIV (Post-Traumatic Checklist-Civilian)  BDI (Beck Depression Inventory)  Orienting to Life Questionnaire (Resilience)

28 Evidence Based Treatments for PTSD  Cognitive Processing Therapy  Prolonged Exposure (PE)  EMDR  ACT

29 Cognitive Processing Therapy  The gold standard in Veterans Administration clinics  Look at how beliefs in these domains have been impacted by trauma  Common Trauma-Related Cognitive Distortions:  “The world is dangerous”  “Events are unpredictable and uncontrollable”

30 Cognitive Processing Therapy (cont’d.)  “What happened was my fault”  “I am incompetent”  “Other people cannot be trusted”  “Life is meaningless”  Emphasis on Socratic questioning, thought records, confronting avoidance and homework  Highly structured-detailed agenda for each session

31 Cognitive Processing Therapy (cont’d.)  12 weekly sessions; 60-90 mins.; individual and group modality options; PCL every session  Cognitive Restructuring and Exposure  Cognitive restructuring using thought records centered around domains of safety, trust, power/control, intimacy and esteem  Exposure done through writing about the experience, reading it in session and reading it in between sessions

32 Prolonged Exposure  Overall aim is to emotionally process the trauma  Includes the following procedures  Education about most common reactions  Breathe retraining  In vivo exposure to avoided situations or places  Repeated prolonged imaginal exposure to trauma memories

33 EMDR  Eye movement desensitization reprocessing  Assumption of maladaptive information processing  Bi-lateral stimulation aimed at unblocking traumatic memories  Tapping  Some controversy regarding mechanisms of change

34 Acceptance and Commitment Therapy  Origins in functional contextualism and Relational Frame Theory  FC – focuses on the function that a behavior serves as opposed to the actual behavior and how effective that behavior is in moving toward an identified goal  RFT – the building of associations; thoughts and feelings can assume meaning and qualities by being associated with one another  ACT works on the assumption that a certain amount of pain is part of being human and is unavoidable  “Pain is inevitable but suffering is optional”  Why do we suffer?  Experiential avoidance + cognitive fusion

35 Acceptance and Commitment Therapy (cont’d.)  Experiential Avoidance:  Misapplied control of internal events  Paradoxical effect of control for internal events: the intensity of thoughts and feelings tend to increase (e.g., don’t think of a yellow jeep)  Cognitive Fusion:  Thoughts and feelings becomes truths  “I am worthless” is only problematic if you believe it to be true and you allow it to stop you from living a valued life (Walser & Westrup 2007)

36 Acceptance and Commitment Therapy (cont’d.)  Emphasis on living a valued life even with a trauma history  Counters belief that life cannot move forward until unwanted thoughts and feelings are gone  Immediate use of value-based actions in goal setting  The goal is not to change the thoughts and feelings but to change your relationship to those thoughts and feelings  Core Components of Acceptance and Commitment Therapy (ACT)

37 Acceptance and Commitment Therapy (cont’d.)  Values  The blueprint for what we want our life to stand for  Process is not a destination, i.e. like the North star  Mindfulness/Present Moment  Being in the present moment without judgment  Humans tend to spend most of their time in the past or the future

38 Acceptance and Commitment Therapy (cont’d.)  Cognitive Defusion  Incorporates mindfulness  “I notice that I’m having the thought that…”  Programming: Two Computers Metaphor  Techniques: Taking your mind for a walk  Acceptance/Willingness  Letting go of the struggle (Tug-Of-War exercise)  Willingness to have unwanted thoughts or feelings (Eyes On exercise)  What Willingness is not

39 Acceptance and Commitment Therapy (cont’d.)  Self as Context  If I am not my thoughts and feelings then who am I?  Self as content versus self as context  I am my thoughts and feelings versus  I am a context upon which thoughts and feelings occur  Chess Board metaphor

40 Acceptance and Commitment Therapy (cont’d.)  Committed Action  Larger and larger patterns of effective action  Motivated by values  Barriers to Committed Action

41 Acceptance and Commitment Therapy (cont’d.)  ACT, the trauma program at Vallejo, is an eight-week closed group  Each week a new process is introduced  Patients commit to attend all 8 sessions  Facilitated by 2 therapists  Group guidelines include an agreement to not discuss the details of their trauma (different to CPT, et al.)  Exposure not directly addressed but inherent part of the process

42 Strengths and Weaknesses: Cognitive Processing Therapy Strengths  Both individual and group  Belief systems addressed  Trauma-related guilt/atroccities  Strong empirical support Weaknesses  Labor Intensive  Cognitive/Educatio n requirements

43 Strengths and Weaknesses: Prolonged Exposure Strengths  Strong empirical support  Significant reductions in PTSD symptoms  Re-experiencing and hyperarousal symptoms-fear based  Acute PTSD Weaknesses  Treatment attrition  Only individual modality  Cardiovascular risks  Therapist reactions  Numerous Traumas  Not for atrocities  Not feasible with Kaiser (weekly, 90 min., intensive training/supervision)

44 Strength and Weaknesses: Acceptance and Commitment Therapy  Strengths  Both individual and group  Patients don’t have to talk (less attrition)  Complex Trauma  Lifestyle Changes  Present and future oriented  More accessibility to training  Addresses all painful emotions-comorbid conditions  Weaknesses  Less empirical support  Flashbacks, nightmares and startle-response not addressed  Cognitive/Education requirements  Initially confusing to patients

45 Acceptance and Commitment Therapy (cont’d.)  Vallejo study of the Effectiveness of ACT

Download ppt "Trauma Interventions For Survivors of Natural Disasters Kathryn Wetzler, Psy.D Adult Staff Psychologist Consortium Director Kaiser Permanente, Vallejo,"

Similar presentations

Ads by Google