1. Forward-Facing Trauma Therapy: Healing the Moral Wound
J. Eric Gentry, PhD, LMHC
Board-Certified Expert in Traumatic Stress
Vice-President Arizona Trauma Institute

2. International Association of Trauma Professionals

3. SATISFACTION WITH LIFE Ed Dieiner, 1985
  1 = Strongly Disagree / 2 = Disagree / 3 = Slightly Disagree / 4 = Neither Agree nor Disagree / 5 = Slightly Agree / 6 = Agree / 7 = Strongly Agree
_____ 1. In most ways my life is close to ideal.
_____ 2. The conditions of my life are excellent.
_____ 3. I am satisfied with my life.
_____ 4. So far I have gotten the important things I want in life.
_____ 5. If I could live my life over, I would change almost nothing.

4. SATISFACTION WITH LIFE Ed Dieiner, 1985
35-31
Extremely satisfied
26-30
Satisfied
21-25
Slightly satisfied 20
Neutral
15-19
Slightly dissatisfied
10-14
Dissatisfied
5-9
Extremely dissatisfied
OPTIMIZATION
Minimal SX focus
COPING & RESILIENCE
Significant SX reduction
SAFETY & STABILIZATION
Profound SX reduction – Enhanced coping

5. 20th vs 21st Century 20th Century 21st Century Life is stressful
Life is full of perceived threats
Work causes stress
Painful learning at work causes us to perceive threat and have dysreuglated ANS at work
We must address the environment and remove stressors to have QOL [External LOC)
We must develop interoception and self-regulation to have QOL (Internal LOC)
PTSD is psychopathology
PTSD is evidence of optimal development to trauma yet remaining “over adapted” in the present context
You must face your past to heal trauma
Relax the muscles in your body, confront fear, go forward to heal trauma
People who breach their integrity have a lower moral character
People who breach their integrity are trauma survivors.

6. Forward-Facing Trauma Therapy Treating survivors in the 21st Century
Stress (ptSd) – caused by increased perception of threat where there is no danger
Chronic perception of threat (21st Century) = chronic ANS dysregulation
Interoception and acute relaxation is the antidote to SNS dominance
Anyone can learn interoception and self-regulation
Confronting perceived threats with relaxed muscles initiates reciprocal inhibition > desensitization (DTE)
Chronic dysregulation thwarts intention. Reactivity = breach of integrity
With intention made explicit + relaxed muscles anyone can remain intentional.
Increasing intentional behavior via relaxation heals trauma of the past going forward.

7. Reciprocal Inhibition Interoception intentionality
A new path for trauma treatment

8. PERCEIVED THREAT +
RELAXTION =
DESENSITIZATION

9. Reciprocal inhibition
Joseph Wolpe ( )
CS (Anxiety) + Relaxation = Extinguished CR
Engine of ALL effective psychotherapeutic treatments for anxiety/trauma
Most trauma survivors confront perceived threats with ANS arousal (i.e., “brute force”). Treatment proper is teaching them to confront these perceived threats with ANS regulation (left-hand side of Yerkes-Dodson)
BOUDEWYNS promulgated this idea in He was, however, inconsistent with the use of relaxation with exposure.

10. Direct Therapeutic Exposure
Direct Therapeutic Exposure (DTE) is a behavior therapy technique pioneered by Patrick A. Boudewyns, where stressors are vividly and safely confronted to help combat veterans, and patients suffering from posttraumatic stress disorder (PTSD), panic disorder, or phobias. Exposure therapy has supporting evidence with both simple and complex traumas.
BOUDEWYNS, P.A., & HYER, L. (1990). Physiological re­ sponse to combat memories and preliminary treatment out­ come in Vietnam veteran PTSD patients treated with direct therapeutic exposure. Behavior Therapy, 21, 63-87

11. Three stages 1. EDUCTION INTENTIONALITY (vs. REACTIVITY) COACHING
Tools for Hope (Perceived Threat/ANS/Self- regulation/Intentionality)
Skills Development for Self-regulation
INTENTIONALITY (vs. REACTIVITY)
Covenant/Mission Statement
Code of Honor
Vision
COACHING
Confronting Perceived Threats (triggers) with Regulated ANS
Helping client to identify breaches & triggers
Continue confronting triggers with relaxed body

12. Between stimulus and response there is a space
Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.
- Viktor Frankl
ERIC SHOULD EXPLAIN VICTOR FRANKL
JIM 7MIN
Preview of course:
Do any of you know who was Viktor Frankl?
Was an Austrian neurologist and psychiatrist speciailzed in treatment of depress\ion and suicide prevention. HE was also l as a Holocaust survivor. . From he was in Terezín concentration camp where he wrote His best-selling book, Man's Search for Meaning (published under a different title in 1959: From Death-Camp to Existentialism,) chronicles his experiences as a concentration camp inmate
In this quote of Dr. Frankel, There’s both a warning and a prescription in this quote.
What’s the warning? There are some activities of life that are just going to hurt- and I would contend that the work we do is one of those activities.
We’ll deal with the prescription later (self care).

13. Trauma: Thwarting Intention – Breaching Integrity
Impatient
Snarky
Resentful
Reactivity
Covenant
Vision
Trigger
Past painful and/or traumatic learning experiences
Loving & Supportive
See
Hear
Feel
Taste
Smell
Listening
Supporting
Feeling Love
Eric, you should…

14. Healing Trauma With Intentional Living
Impatient
Snarky
Resentful
Reactivity
Self-
Regulation
Covenant
Trigger
Intentionality
Vision
Past painful and/or traumatic learning experiences
Loving & Supportive
Listening
Supporting
Feeling Love
See
Hear
Feel
Taste
Smell
Eric, you should…

15. Practice: Interoception & self-reguLation
Self-regulation vs. relaxation
Body scan
“Wet Noodle”
Figural muscle using Jacobsian relaxation
Pelvic Floor

16. Intention into Words + RELAXATION
Formula for Hope
Intention into Words
RELAXATION
= Comfortable Body
= Maximal Motor & Cognitive Functioning
= Intentional instead of Reactive Eg

17. J. Eric Gentry, PhD,LMHC PO Box 937 Phoenix, AZ 85001