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Situational Trauma and Grief Jack Hackett LMHC Senior Mental Health Therapist UnityPoint Employee and Student Assistance
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Awareness of the Neurobiology of trauma and emotions Developing an awareness of PTSD Symptoms See the connection between past traumas and current reactions. Identifying helpful coping tools
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Trauma experiences activate the release of hormones and neuro-transmitters that are associated with flight or fight responses
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First, we try to assess the danger and degree of personal threat Second, we have strong emotional and physical reactions. These reactions help us to take action, yet they can be very distressing to feel and difficult to handle. Third, we take action. ◦ We try to prevent it from happening ◦ try to protect ourselves or other people against harm ◦ ◦ or try to do something to keep it from getting worse
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Dangers become "traumatic" when they threaten serious injury or death. Traumatic experiences also include physical or sexual violation of the body. The witnessing of violence, serious injury, or grotesque death In traumatic situations, we experience immediate threat to ourselves or to others, often followed by serious injury or harm.
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Repeated Exposure to the emotional reactions of others who have experienced and reacted to Trauma Events Family members Law enforcement People in helping professions
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Trauma and Emotional Sensations Trauma may elicit feelings of: Terror Helplessness Confusion Rage Indifference Sadness Grief
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Rapid heartbeat Increased respiration trembling Heighten sensory acuity Stomach dropping A sense of being in a dream Paralysis (Tonic Immobility)
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Brain Regions Impacted by Trauma
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HPA Axis Balances body following stress by releasing of various hormones/ chemicals Brain-Body Regions Impacted by Trauma (Southwick et al., 2005)
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Brain-Body Regions Impacted by Trauma Catecholomines: Fight or flight response Cortisol: Energy available Opiods: Prevent pain Oxytocin: Promotes good feelings (Southwick et al., 2005)
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Hippocampus processes information into memories Encoding = Organizing sensory information Consolidation = Grouping information into memories and storing them Amygdala specializes in the processing of emotional memories (works with the hippocampus) Both structures are VERY sensitive to hormonal fluctuations Memory Processes Impacted by Trauma (Southwick et al., 2005)
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Amygdala Detects Threat Activates Hypothalamus HPA Axis Kicks In Hormonal Flood SOURCE: Banks, 2002; Southwick et al., 2005
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Increased Stress Hormones Impaired Functioning in Hippocampus Memories Fragmented Memory Activation Can Be Unpredictable and Traumatic SOURCE: Koss et al., 1995, 1996; Roozendaal et al., 2009; Rubin et al., 2008 Events CAN Be Recalled Accurately BUT... Alcohol use may prevent encoding, which means there’s nothing to retrieve
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Similar to muscle Memory Trauma experiences cause learned emotional responses to new environmental triggers
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Environmental sensory cues that cause the brain to recall trauma and reactivate (trigger) stress responses Sights Sounds Smells Tastes
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Trigger Emotional/behavioral Thoughts reactions
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The person re-experiences the physical and emotional reactions associated with the original trauma These reactions are involuntary they are triggered by the environmental stimulus The person responds as if the Trauma is reoccurring The person is emotionally “flooded” Critical Thinking is difficult as the brain and body are flooded by stress chemicals
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Fear Anger Rage Guilt Confusion Disassociation
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Anxiety behavioral impulsivity Aggressive Hypervigilance Hyperactivity apathy or depression sleep difficulties tachycardia or hypertension
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Reenactment of trauma through play Loss of interest in previously-enjoyed activities Angry outbursts Irritability Behavioral inhibition Reckless behaviors Regression Self Harming behaviors Suicide attempts
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Feeling as though the event is happening all over again Sleep disturbances Complaints of headaches and stomach aches Difficulties with physical contact
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Feeling as though the trauma is happening again Trouble concentrating in school Negative cognitive development Altered cognitive functioning Increased arousal and hyper-vigilance Jumbled, out of order recollection of the event
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Emotional numbing Sadness Guilt Low self-esteem Inability to trust others Avoidance of memories or situations that trigger memories of the event Flashbacks of the event Intrusive memories of the event Nightmares and night terrors Fears about death Worry
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Escape Avoidance Fighting, acting out Risk Taking Using drugs/alcohol Verbal aggression Indifference – Emotional numbing Shutting Down
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Things to remember The person is overstimulated The person is experiencing confusion Additional sensory stimulation will increase the stress response
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Experience of being under threat puts the body into an activated state It increases chances of survival by mobilizing reserves of physical, mental and emotional energy.
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Survival-oriented activity Relieves tension by acting to reduce threat. An aroused person has increased Energy, Strength, Perception, Emotional toughness
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Tension may be changed into anxiety or fearfulness Anxiety: Undermines a person’s sense of their competence It is a threat in itself, keeps arousal up We revert to early learned patterns of responding to threat
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Tension may be released as Anger or withdrawl: Perception of threat Aggression and anger avoid the disabling effects of anxiety May enhance short term survival by focusing on the threat Anxiety and anger often alternate in distressed people
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Tension is relieved when angry or anxious people feel they are communicating their concerns. The first priority is to reduce the level of emotion by hearing the person out Receiving the information absorbs anxiety, anger and hostility. Creating a safe environment diffuses emotions
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Looking directly at the person speaking to you Responding and nodding so they know you are listening Asking questions to make sure you understand them Avoiding interrupting or being rushed
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Giving orders or commands without explanation Comparing their problem with others’ Talking down to them, not listening, telling them what they should feel Taking their anger or emotions personally Getting emotional or frustrated with them
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Relieve tension by absorbing anger Engage with their concerns Provide information Conclude by offering an outcome
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Recognize behaviors Acknowledge feelings Keep calm Lower the volume Reduce stimulation Refer for help
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Encourage referral to therapist Collaborate with counseling staff/therapist Encourage engagement – healthy activities Help identify “Safe” environments Individualize responses based on student needs
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Psychotherapy Talk therapies teach people helpful ways to react to frightening events that trigger their PTSD symptoms. Based on this general goal, different types of therapy may: Teach about trauma and its effects. Use relaxation and anger control skills. Provide tips for better sleep, diet, and exercise habits. Help people identify and deal with guilt, shame, and other feelings about the event. Focus on changing how people react to their PTSD symptoms. For example, therapy helps people visit places and people that are reminders of the trauma.
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cognitive behavioral therapy, or CBT. Exposure therapy. This therapy helps people face and control their fear. It exposes them to the trauma they experienced in a safe way. It uses mental imagery, writing, or visits to the place where the event happened. The therapist uses these tools to help people with PTSD cope with their feelings. Cognitive restructuring. This therapy helps people make sense of the bad memories. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about what is not their fault. The therapist helps people with PTSD look at what happened in a realistic way. Stress inoculation training. This therapy tries to reduce PTSD symptoms by teaching a person how to reduce anxiety. Like cognitive restructuring, this treatment helps people look at their memories in a healthy way. Post-
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Jack P. Hackett LMHC Senior Mental Health Therapist Unity Point Health Employee and Student Assistance Program 1301 Pennsylvania Ave Suite 305 Des Moines, IA 50316 515-263-4004 fax 515-263-4010 Jack.Hackett@Unitypoint.org
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