1. Hannah Haskell October 4, 2009 1

2. “Rehabilitation efforts will be for naught if the mental and psycho-social needs of the survivors are not met. We must take care of minds as well as bodies… If the victims are too distressed, they won’t eat, even if they have ample food. All the (rehabilitation) efforts become pointless.” Dr. Virgilio Ludovice Regional Department of Health 2

3. My own traumatic experiences Summer 2002 - Gerona, Tarlac October 14, 2007 - Taytay, Rizal 3

4. What is a traumatic incident? It is a deeply distressing or disturbing experience It is sudden and unexpected It takes one by surprise There was injury There was a threat to limb or life 4

5. It is a catastrophe that results in death, destruction or loss of home and community It is out of one’s control It renders one helpless It is an exposure to violence It is witnessing grotesque death 5

6. Traumatic incidents include (but not limited to) kidnapping serious accidents natural disasters such as floods or earthquakes violent attacks such as a mugging, rape, or torture being held captive witnessing grotesque death 6

7. What happens during and after trauma? When you can’t escape or resist a traumatic incident, your self-defense system (SDS) becomes overwhelmed and disorganized Your SDS tends to persist in an aroused state long after the actual danger is over Your SDS could also become disintegrated Intense fear but no memory of the event Detailed memory but without emotion Constant state of vigilance and irritability without knowing why 7

8. Time seems to freeze at the moment of trauma The moment is encoded in an abnormal form of memory which breaks spontaneously into consciousness The experience lacks words and context, it is encoded in vivid sensations and images Traumatic memory remains a heightened reality 8

9. Normal responses to traumatic event To resist or escape Automatic rush of adrenalin into a state of alert Concentrate attention on the immediate situation disregarding hunger, fatigue or pain Intense feeling of fear and anger Intense bad memories Emotional numbing Feelings of unreality Bodily tension Healthy adults who have been exposed to a single discrete traumatic event usually recover within a few weeks 9

10. When normal responses become acute They are characterized by Panic reactions Mental confusion Dissociation Severe insomnia Suspiciousness Unable to manage self-care Impaired functioning at school or work 10

11. From acute stress to Post-Traumatic Stress Disorder Three main kinds of symptoms 1. Re-experiencing symptoms 2. Avoidant symptoms 3. Symptoms of hyper (increased) arousal 11

12. 1. Re-experiencing Symptoms Intrusive memories of the traumatic event (flashbacks) Recurrent, distressing dreams or nightmares about the traumatic event Acting or feeling as if the traumatic event is reoccurring Mental and physical discomfort when reminded of the traumatic event (e.g. on the anniversary of the traumatic event) Recreating or reenacting the traumatic event (repetitive play in children) 12

13. Traumatic memory is resolved when the survivor can integrate the experience into the pages of the story book of his/her life. 13

14. Different theories why survivors relive or reenact traumatic experience A fantasy of changing the outcome of the traumatic encounter Attempt to integrate the traumatic event into one’s story Attempt to master the overwhelming feelings of traumatic moment Unsuccessful attempts at healing the memory Traumatic experience is stored as “active memory” – the tendency is to repeat the contents 14

15. 2. Avoidant Symptoms Paralysis of the mind (numbing effect) keeps painful memories split off from awareness Avoiding thoughts or feelings, people or situations associated with the traumatic event Not being able to recall an important aspect of the traumatic event 15

16. Reduced interest or participation in significant activities Feeling disconnected from others Showing a limited range of emotion Having a sense of shortened future 16

17. Danger of numbing effect: Prevents integration necessary for healing May use alcohol or narcotics to create the same numbing effect 17

18. 3. Symptoms of Increased Arousal Similar to anxiety or panic attacks Startles easily (the body is always on the alert for danger -hypervigilance) Reacts irritably or outbursts of anger to small provocations Difficulty concentrating Difficulty falling or staying asleep (More sensitive to noise, awaken more frequently) 18

19. Diagnostic-Statistical Manual-IV Criteria (309.81) for PTSD Duration of the symptoms (re-experiencing, avoidant, hyper-arousal) is more than one month There is significant impairment in social, occupational, and other areas of functioning It is acute PTSD if duration of symptoms is less than 3 months It is chronic if duration of symptoms is 3 months or more Onset of symptoms could be 6 months delayed 19

20. The Dialectic of Trauma Herman, J. L. (1997). Trauma & Recovery. NY: Basic Book Constriction Numbing & Avoidant 20 Intrusion Re-living & Re-enactment

21. Debriefing: Caring for Trauma Survivors It helps survivor process the event and store it in long-term memory. It helps decrease symptoms of avoidance, re-experiencing, and increased arousal. Describing everything that happened allows the brain to make some sense of the events. The incident can be placed in the context of the rest of your life, instead of taking over your whole life. 21

22. It enables the survivor to see the trauma as a time-limited event as opposed to a permanent negative effect of your future. Debriefing provides survivor a sense of closure. The event is over, you are no longer under threat, you can start to move on. 22

23. It does not take away the memory of the event, but it can stop the flashbacks. (Flashbacks could be more distressing than normal memories, because you don’t know what has triggered them). Disclosing both the facts and feelings about a stressful event have more physical and psychological health benefits than disclosing just the facts or just the feelings. 23