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Transcript
Healing and Modalities of Therapy Bob Campbell, Psy.D., M.Div. MKSN Conference April 20, 2013 Adult Survivors of Childhood Trauma • Every case is unique • Not every person will develop a disorder • The type or severity of trauma does not determine the probability of developing a disorder • Diathesis/Stress Model • Any extreme stressor • Physical, sexual, psychological abuse Symptoms of Traumatic Stress • Stuck between fight and flight and freeze • Flashbacks • Re-experiencing • Avoidance • Hyperarousal • Irritability • Restricted range of affect PTSD – Posttraumatic Stress Disorder • PTSD • Usually related to a specific event or series of discrete events • Car accident, natural disaster, war • Complex PTSD - DESNOS • Disorder of Extreme Stress, NOS • Prolonged, repeated trauma • Additional symptoms • Developmental Trauma Disorder – DESNOS in children Disorders of Extreme Stress, NOS • Long-term trauma • Person held in a state of captivity, physically or emotionally • Unable to get away from the danger • Examples: • • • • • • Concentration camps Prisoner of War camps Prostitution brothels Long-term domestic violence Long-term child physical abuse Long-term child sexual abuse DESNOS – Additional Symptoms • Emotional dysregulation • persistent sadness, suicidal thoughts, anger • Dissociation • Helplessness, shame, guilt, stigma, feelings of isolation • Distorted Perceptions of the Perpetrator • attributing total power, becoming preoccupied with relationship or revenge • Difficulty forming relationships • Loss of meaning • loss of faith or a sense of despair DESNOS in Trafficked Females Symptom Severe rating Recurrent thoughts/memories 75% Feeling the event is reoccuring 52% Recurrent nightmares 54% Feeling detached/withdrawn 60% Unable to feel emotion 44% Jumpy, easily startled 67% Difficulty concentrating 52% Trouble sleeping 67% Feeling as if you don’t have a future 65% Williamson, Dutch, and Clawson, 2010. Other DESNOS issues • Misdiagnosis as PD • Poor assertiveness due to avoidance of topic • Self-medication • Self-mutilation • Lack of understanding from others Neurobiological Etiology of PTSD Memory Hippocampus Amygdala Anterior Cingulate Cortex Evidence-Based Treatments for PTSD • What is “evidence-based”? • Many are based on exposure and response prevention • Exposure • Scary movies • Response prevention • Stay present • These treatments focus on symptom reduction Types of Treatment • CBT – Cognitive Behavioral Therapy • CPT – Cognitive Processing Therapy • Prolonged Exposure • EMDR – Eye Movement Desensitization and Reprocessing • EFT (Tapping) – Emotional Freedom Techniques • ACT – Acceptance and Commitment Therapy CBT • Cognitive • Exposure • Relaxation • Education Thoughts Feelings Behaviors CPT • Cognitive Therapy • Written accounts • Exposure elements Prolonged Exposure • Classical conditioning • antecedents • Operant conditioning • consequences EMDR • Alternating side stimuli • Exposure elements • Potential neurological change EFT • Tapping points • Exposure elements • Acupressure elements • Relaxation elements ACT • Meditation • Acceptance • Willingness • Values • Defusion • Self as context • Increases flexibility Non-Evidence-Based Therapies (that work) • Existential • Psychodynamic • Self-Psychology (Not Do-it-yourself Psychology) • Humanistic • Family therapy • Hypnotherapy • Solution-focused therapy Medications • Anti-depressants • SSRIs - paroxetine (Paxil) and sertaline (Zoloft) • SNRIs - venlafaxine • Atypicals – Wellbutrin, mirtazapine, bupropion • Anti-psychotics • Risperidone • Quetiapine • Avoid benzodiazepines • Not effective for PTSD • Serious side effects Additional DESNOS Treatment • Address interpersonal difficulties • Restoration of control and power • Develop healing relationships which create safety • Remembrance and mourning • Promote reconnection with everyday life Some things to begin today • Self-care • Exercise • Eating right • Enjoying life • Meditation • Finding meaning • Telling your story • Finding the help you need Dr. Bob Campbell [email protected] www.willowwellness.com
