Download Trauma And First Responders

Trauma And
First Responders
Corey Pavelka
Who are First Responders
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Police
Firefighters
Emergency Medical Techinans
Military
Doctors
Nurses
Correctional officers
Dispatchers
Clergy
Mental Health Professionals
What qualifies as a “traumatic
event?
 According
to the DSM-IV a traumatic
event is one in which we experience a
threat (actual or perceived) of death or
serious injury to self or others , with a
response of “intense fear, helplessness or
horror.”
 Type I
 Type II
What is the normal response to
a traumatic event?
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anxiety,
feeling “revved up;”
emotional instability
fatigue
irritability
hyper-vigilance
trouble sleeping
exaggerated startle
response
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change in appetite
feeling
overwhelmed
impatience
isolation from family
and friends
shock
nightmares
somatic complaints
Quiz
1. What are 2 normal trauma reactions?
2. How many types of traumatic events are
there?
3. Are clergy considered first responders?
Stress disorders
 Acute
stress disorder
 Post traumatic stress disorder
Acute Stress Disorder
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Criterion A: exposed to: death, threatened death, actual
or threatened serious injury, or actual or threatened sexual
violence, as follows by direct exposure, witnessing or
indirectly learning about the trauma
Criterion B: numbing, detachment, a reduction in
awareness of the surroundings, derealization, or
depersonalization; dissociative amnesia
Criterion C: persistently re-experienced in at least one of
the following ways: recurrent images, thoughts, dreams,
illusions, flashback episodes, or a sense of reliving the
experience; or distress on exposure to reminders of the
traumatic event.
Criterion D: marked avoidance of stimuli that arouse
recollections of the trauma.
Symptoms of Acute Stress
Disorders
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Criterion E: marked symptoms of anxiety or increased
arousal.
Criterion F: significant distress or impairment in social,
occupational, or other important areas of
functioning or impairs the individual's ability to pursue
some necessary task
Criterion G: the disturbance lasts for a minimum of 2
days and a maximum of 4 weeks and occurs within 4
weeks of the traumatic event.
The disturbance is not due to the direct physiological
effects of a substance or a general medical
condition, is not better accounted for by Brief
Psychotic Disorder, and is not merely an
exacerbation of a preexisting Axis I or Axis II disorder.
Treatment of Acute Stress
Disorder
 Treatment
for acute stress disorder usually
includes a combination of antidepressant
medications and short-term
psychotherapy.
Medications
 Clonidine
 Propranolol
 Clonazepam
 Fluoxetine
Quiz
4. Name 2 symptoms of acute stress
disorder?
5. What is the timeframe acute stress
disorder must appear in?
6. Does Individual vulnerability and coping
have any influence on the severity of acute
stress disorder?
Post Traumatic Stress Disorder
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Criterion A: exposed to: death, threatened
death, actual or threatened serious injury, or
actual or threatened sexual violence, as
follows by direct exposure, witnessing or
indirectly learning about the trauma
Criterion B: recurrent, involuntary, and
intrusive memories, flashbacks, intense or
prolonged distress after exposure to traumatic
reminders, marked physiologic reactivity after
exposure to trauma-related stimuli
Criterion C: avoidance of distressing traumarelated stimuli
Post Traumatic Stress Disorder
cont.
 Criterion
D: negative alterations in
cognitions and mood
 Criterion E: trauma-related alterations in
arousal and reactivity
 Criterion F: symptoms longer than 1
month
 Criterion G: significant symptom-related
distress or functional impairment
Treatment for PTSD
 Cognitive
therapy
 Exposure therapy
 Eye movement desensitization and
reprocessing (EMDR)
Medication
 Celexa
 Fluoxetine
 Paxil
 Zoloft
Acute Stress Disorder VS PTSD
Acute Stress Disorder
PTSD
Present within 2 days to 4
weeks
Present usually within 3
months
greater emphasis on
dissociative symptoms
not a focus dissociative
symptom cluster
Resolve within 1 month
Persist longer than 1 month
Quiz
7. For PTSD does the trauma have to be
Direct or Indirectly exposure?
8. What is the most effective treatment
modality for PTSD?
9. Does acute stress disorder focus on the
dissociative symptoms?
10. True/False Eye movement
desensitization and reprocessing is a new
therapy used for PTSD?
Vicarious Trauma
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Vicarious trauma is the emotional residue
of exposure that counselors have from
working with people as they are hearing
their trauma stories and become
witnesses to the pain, fear, and terror that
trauma survivors have endured.
Signs of Vicarious Trauma
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having difficulty talking about
their feelings
free floating anger and/or
irritation
startle effect/being jumpy
over-eating or under-eating
difficulty falling asleep and/or
staying asleep
losing sleep over patients
worried that they are not doing
enough for their clients
dreaming about their
clients/their clients’ trauma
experiences
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diminished joy toward
things they once enjoyed
feeling trapped by their
work as a counselor
diminished feelings of
satisfaction and personal
accomplishment
dealing with intrusive
thoughts of clients with
especially severe trauma
histories
feelings of hopelessness
associated with their
work/clients
blaming other
Risk Factors for Vicarious
Trauma
 The
worker
 The situation
 The culture
Video
 https://www.youtube.com/watch?v=G95
7P6w1Xfs
Questions
Resources
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Kessler, R.C., Sonnega, A., Bromet, E. Hughes, M., & Nelson, C.B. (1995). Posttraumatic stress disorder in
the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048-1060.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., & Walters, E. E. (2005a). Lifetime prevalence and age-ofonset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of
General Psychiatry, 62, 593-602.
Kulka, R.A., Schlenger, W.E., Fairbank, J.A. Hough, R.L., Jordan, B.K., Marmar, C.R., & Weiss, D.S. (1990).
Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam Veterans
Readjustment Study, New York: Brunner/Mazel.
Tanielian, T. & Jaycox, L. (Eds.)(2008). Invisible Wounds of War: Psychological and Cognitive Injuries,
Their Consequences, and Services to Assist Recovery. Santa Monica, CA: RAND Corporation.
www.counseling.org
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th
ed., text revision). Washington, DC:
Benner, A. (2000). Cop Docs. Psychology Today Nov/Dec2000, Vol. 33 Issue 6, p36, 4p, 1c
Beutler, L. E., Nussbaum, P., & Meredith, K. (1988). Changing personality patterns of police officers.
Professional Psychology: Research and Practice. Vol. 19 (5), 503-507.
Bisson, J. I., McFarlane, A. C., & Rose, S. (2000). Psychological debriefing. In E. F. Foa, T. M. Keane, & M.
J. Friedman (Eds.) Effective treatments for PTSD (pp. 39-59, 317-319). New York: Guilford.
Bohl, N. (1995). Professionally administered critical incident debriefing for police officers. In M. I. Kurke,
& E. M. Scrivner (Eds.), Police psychology into the 21st century (pp. 169-188). Hillsdale, NJ: Erlbaum.