1. Reactions to Trauma Jason Mitchell, B.S.
University of Colorado at Colorado Springs
University Counseling Center

2. Prevalence 1245 American Adolescents
23% physical/sexual assault occurrence rate
1/5 develop PTSD
Around 1.07 million teens
Elliott & Briere, 1995
- 76% of American adults reported having been exposed to extreme stress
Breslau & Davis, 1992
- 9% of an urban population suffered from PTSD
Kulka et al., 1990
- 15.2% of U.S. Vietnam vets continue to suffer from PTSD
Saxe et al., 1993
- 15 % of psychiatric inpatients meet the diagnosis for PTSD and many more have been found to have sever trauma histories
***All cited in van der Kolk & McFarlane (1996). In van der Kolk, McFarlane, & Weisaeth (Eds.) Truamatic Stress
Kilpatrick, Saunders, Resnick, & Smith, 1995

3. Contrasted Effect “Normal” coping Abnormal coping
Overly preoccupied with the event
Involuntary intrusive thought
Abnormal coping
Failure to integrate
Avoidance and hyperarousal
Normal
- Intrusive memories may allow us to become tolerant to the context (Horowitz, 1978)
Abnormal
- Start to organize life around trauma
van der Kolk & McFarlane, 1996

4. Immediate and Short-Term Responses
Observable Behaviors or Symptoms
Conversion, agitation, stupor
Emotions and Cognitions
Anxiety, panic, numbing, confusion
Mental Processes or Functions
Defenses
These symptoms can be confounded - Dissociation: observable behavior, an experience, and a form of defense against pain, distress, or humiliation
Marmar et al., 1994

5. Psychopathology Acute Stress Response Chronic Response
Adaptations in dealing with chronic response
McFarland & Yehuda, 1996
Acute Stress Response
- Intrusive symptoms
- Variable levels of discomfort, arousal, dissociation, and memories
- Significant self judgment of actions
- May create negative beliefs about oneself and others
- In normal responses these feeling/sensations/behaviors subside in time

6. Development of PTSD Unpredictable and uncontrollable
Vulnerability vs. Resilience
Psycho/Bio/Environmental influences
Social Networks
Coping Self-efficacy
McFarland & Yehuda, 1996
Barlow 1988
- if individuals do not possess adequate coping skills or social support, they will become fearful about the repetition of the stress
- This preoccupation with and anticipation of future stress that is the core of the disorder
**Cited in Brett (1996) In van der Kolk, McFarlane, & Weisaeth (Eds.) Traumatic Stress
Vulnerability
- Psychological/Environmental/Biological individual differences that make an individual more susceptible to developing PTSD symptoms
- Family history of psychological illness
- Individuals of increased risk of reoccurring trauma (firefighters/auto accidents/domestic violence/drug user)
- Neurobiology of an individual’s stress response, the capacity for self-modulation, the ability to tolerate the fear and threat that trauma involves, and the ability to cope with losses
Resilience - factors may minimize individuals level of acute distress or allow more rapid modulation
- Ability to cope with intrusive memory, ability to tolerate suffering
- successful mobilization of social networks
- coping self-efficacy

7. Impact Beliefs and Attitudes Physical Health
Behavioral and Interpersonal Functioning
Disordered Affect and Arousal
Beliefs and Attitudes
- modify vulnerability to subsequent traumatic events
- hypervigiience and erratic driving/ self-medication and drug use
- shift in an individual’s internal perceptual sensitivities
- can be a powerful source of motivation (art and literature), shape culture
Physical Health
- Increased report of physical symptoms but the association can be unclear
- physical symptoms can be the focus of the distress
- physical symptoms can be directly caused by the stressor
- physical symptoms can be a nonspecific response to exposure to a traumatic experience
Behavioral and Interpersonal Functioning
- (Concentration Camp) more frequent change in jobs, housing, and occupation
- less qualified and well-paid work (Eitinger & Strom, 1973)
- (Australian Female Prisoners) - PTSD and history of abuse was ubiquitous
- factors contributed significantly to their criminal histories
- Dysfunctional social groups (drug users) higher rate of PTSD
- High levels of depression, suicide attempts and gestures, and alcohol abuse
Disordered Affect and Arousal
- significant psychological and neurobiological changes - increase vulnerability to other psychiatric disorders
McFarland & Yehuda, 1996

8. Treatment Cognitive Behavior Therapy
Eye Movement Desensitization and Reprocessing
Psychopharmacology
Individuals with PTSD become “stuck” on the trauma - relive the trauma in thoughts, feelings, actions, and images
- Organize lives around the trauma
- Avoidance:
- isolation (situations, people, emotions)
- drug and alcohol use
- dissociation to keep thoughts out of conscious awareness
- Changes in self-concept and world view
Aim of therapy: help move away from the past and move away from interpreting arousal as a return of the trauma
- become fully engaged in the present
- regain control of emotional responses
- take charge of life as a preemptive attempt to avoid future trauma
van der Kolk, McFarlane, & Hart, 1996

9. Questions ? Resources University Counseling Center
Pikes Peak Mental Health