1. Trauma, Grief, and Loss Greg Bohall, M.S., C.R.C., CADC-II

2. Nature of Trauma  Experiencing the event  Witnessing in person  Learning that the event(s) occurred to a close relative or close friend; in such cases, the actual or threatened death must have been violent or accidental.  Experiencing repeated or extreme exposure to aversive details of the event(s) (first responders, police officers repeatedly answering child abuse calls);does not apply to exposure through electronic media (television, movies, pictures) unless it’s work related.  (Small, 2011)

3. Posttraumatic Stress Disorder  The essential feature of PTSD is the development of symptoms following exposure to an extreme traumatic stressor.  The response involves intense fear, helplessness, or horror.  Symptoms resulting from exposure to the extreme trauma include persistent re-experiencing of the event.  Persistently avoiding of stimuli associated with the trauma  Persistent symptoms of increased arousal.  Must be present for more than one month.  Must cause significant distress or impairment in social, occupational or other important areas of functioning.  (American Psychiatric Association, 2000)

4. Trauma and PTSD  PTSD is a significant potential negative outcome of trauma exposure.  Not all individuals exposed to trauma develop PTSD.  A growing body of research is showing that the cumulative effects of prior traumas contribute to PTSD symptoms.  Exposure to multiple traumas has been shown to have a stronger effect on subsequent PTSD symptoms than an exposure to one single trauma.  Researchers have also considered the possibility that prior trauma exposure may be a resource for coping with future life stressors.  (Schuster, Park, & Frisman, 2011)

5. Why does PTSD Develop?  Failure to process trauma successfully  Trauma does not fit our understanding of reality.  Causes most people distress and conflict.  An invalidating environment  “It didn’t happen”  Not everyone responds to anxiety the same  Coping mechanisms  (Small, 2011)

6. Posttraumatic Growth  The experience of positive psychological change following highly challenging and traumatic life circumstances.  Relating to others  New possibilities  Personal strength  Spiritual change  Appreciation of life  Posttraumatic Growth tends to help people grow through PTSD.  (Small, 2011)

7. Resiliency  The ability to sustain trauma without developing PTSD  Less likely to see the trauma as a threat to self therefore they are less likely to need to make meaning of a situation.  Many times don’t address the situation.  Tends to be related to certain personal characteristics: optimism, coping, positive affect.  (Small, 2011)

8. Psychological First Aid  Help them decide what type of help they need.  Provide comfort and validation.  Provide information.  Reduce stigma.  Don’t force disclosure.  (Litz, 2004)

9. Discussion Questions  What kind of trauma are you seeing in the homeless population?  What kinds of things can you do on the street that can be helpful to people having symptoms due to a trauma?  How can you improve your personal reactions to hearing some of the trauma people are going through?

10. References American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders- fourth edition- text revision. Arlington, VA: American Psychiatric Association. Litz, B. T. (2004). Early intervention for trauma and traumatic loss. New York, NY: The Guilford Press. Schuster, J., Park, C.L., & Frisman, L. K. (2011). Trauma exposure and ptsd symptoms among homeless mothers: Predicting coping and mental health outcomes. Journal of Social and Clinical Psychology, 30 (8). Small, K. (2011). Cognitive-behavioral approaches to treating ptsd: Empirically based treatment techniques. Brentwood, TN: Cross Country Education.