2. Time Course of Reactions Traumatic event Acute stress reaction (first 48 hrs) Acute stress disorder (up to 4 weeks) Acute PTSD (4-12 weeks) Chronic PTSD (12 wks +)

3. vulnerability trauma Edna Foa, 1994

4. vulnerability trauma With apologies to Edna Foa- Hull, 2004

5. Maslow’s Hierarchy of Needs

6. Resistance, Resilience & Recovery Adapted from NATO, Psychosocial care for people affected by disasters & major incidents, 2008

7. Resistance, Resilience & Recovery Adapted from NATO, Psychosocial care for people affected by disasters & major incidents, 2008. With apologies to NATO 32% 16% 34% 18% Creamer et al, 2007

8. Assessment 1 Ready for treatment YES Trauma Story Support / Monitor NO EMDR Cognitive Therapy Behaviour Therapy Drugs Normalisation Vulnerability Responsibility Appraisal of trauma Survival behaviour Avoidance SSRIs Prazosin Anxiety reduction Exposure Activity schedules Stress inoculation training Relapse prevention Follow-up Assessment 2

9. Arousal zones Hyperarousal zone sympathetic “fight or flight” response Window of tolerance social engagement response Optimal arousal zone (ventral vagal) Hypoarousal zone “immobilisation” response

10. Williams & Kemp (2008) A Strategic Stepped Model of Care Adopted by NATO Mental Health professionals involved in which levels? Clearly L3, L4 Also L1, L2 Input needed at strategic planning level