psychological trauma: human cognitions & affects tim dunne consultant / chartered clinical...

Psychological Trauma: Psychological Trauma: Human Cognitions & AffectsHuman Cognitions & Affects

Tim DunneTim DunneConsultant / Chartered Clinical Consultant / Chartered Clinical

PsychologistPsychologistDelivered at Webster University, Delivered at Webster University,

GenevaGenevaFebruary 2008 ©February 2008 ©

OutlineOutline Historical overview of TraumaHistorical overview of Trauma Definition of TraumaDefinition of Trauma Risk Factors for PTSDRisk Factors for PTSD Cognitions & PTSDCognitions & PTSD Affects & PTSDAffects & PTSD Individual & Organisational factors Individual & Organisational factors

affecting development of PTSDaffecting development of PTSD Vicarious TraumaVicarious Trauma Future Directions Future Directions

Trauma: Historical Trauma: Historical OverviewOverview

Galen, father of Greek Galen, father of Greek medicine, described medicine, described trauma symptoms trauma symptoms among soldiers in the among soldiers in the Peloponnesian warsPeloponnesian wars

1862 American Civil 1862 American Civil War = “Soldier’s heart”War = “Soldier’s heart”

1891 Boer War = 1891 Boer War = “Disordered action of “Disordered action of the heart” (DAH)the heart” (DAH)

WW1 = “Shell shock”WW1 = “Shell shock” WW2 = “Battle fatigue” WW2 = “Battle fatigue”

or “Lack of moral fibre” or “Lack of moral fibre” LMFLMF

1950 Korean War = “Old 1950 Korean War = “Old Sergeant syndrome”Sergeant syndrome”

1972 “Buffalo Creek 1972 “Buffalo Creek syndrome” in USAsyndrome” in USA

1979 Vietnam War = 1979 Vietnam War = PTSDPTSD

1982 Falklands/ 1982 Falklands/ Malvinas War = Malvinas War = “Battleshock”“Battleshock”

1993 = “Gulf War 1993 = “Gulf War syndrome”syndrome”

1993 ICD-10 WHO 1993 ICD-10 WHO defined clinical criteria defined clinical criteria for diagnosis of PTSD for diagnosis of PTSD

Trauma: DefinitionTrauma: Definition 2 main Definitions – 2 main Definitions –

ICD-10 (1993) WHO, ICD-10 (1993) WHO, & DSM-IV-TR (2000, & DSM-IV-TR (2000, American Psychiatric American Psychiatric Association)Association)

6 Criteria6 Criteria Person is exposed to Person is exposed to

traumatic event or traumatic event or events that involve events that involve actual or threatened actual or threatened death or serious death or serious injury. Response injury. Response involves intense fear, involves intense fear, helplessness or horrorhelplessness or horror

Intrusion - event is Intrusion - event is relived by the personrelived by the person

Avoidance - stimuli Avoidance - stimuli associated with the associated with the event are avoidedevent are avoided

Physical - persistent Physical - persistent physical symptoms of physical symptoms of arousal or arousal or hypervigilancehypervigilance

Social – disruption in Social – disruption in social, occupational or social, occupational or other areas of other areas of functioningfunctioning

Time – above symptoms Time – above symptoms last longer than 1 monthlast longer than 1 month

Trauma Trauma ““There is an interval…..of suspended There is an interval…..of suspended

animation, a kind of psychological shock animation, a kind of psychological shock or paralysis. It is caused by a traumatic or paralysis. It is caused by a traumatic or or sub-traumaticsub-traumatic experience which experience which explodes, as it were, the world that is explodes, as it were, the world that is familiar to the person as well as his familiar to the person as well as his image of himself (sic) within that world.”image of himself (sic) within that world.”

Source: CIA Counter Intelligence Source: CIA Counter Intelligence Interrogation manual Interrogation manual www.gwu.edu/~nsarchivwww.gwu.edu/~nsarchiv

PTSD Risk FactorsPTSD Risk Factors

Not everyone is affectedNot everyone is affected No two people react in the same way to the No two people react in the same way to the

same eventsame event ““One in Ten” rule is a good rule of thumb in One in Ten” rule is a good rule of thumb in

assessing reactions to large scale eventsassessing reactions to large scale events 1.5% of the general population suffering from 1.5% of the general population suffering from

PTSD at any one timePTSD at any one time Previous life experience, life stage, mood & Previous life experience, life stage, mood &

individual perceptions of the event all play a individual perceptions of the event all play a part in how the person responds to a traumatic part in how the person responds to a traumatic eventevent

High Risk Groups %High Risk Groups % Shipwreck survivorsShipwreck survivors Bombing/Terrorist Bombing/Terrorist

survivorssurvivors Rape victimsRape victims Combat veteransCombat veterans Victims of bullyingVictims of bullying Emergency RescuersEmergency Rescuers Car crash survivorsCar crash survivors General PopulationGeneral Population

7575 5050

5050 4040 3535 3030 2020 1.51.5

Cognitions & TraumaCognitions & Trauma

Cognitions refers to any Cognitions refers to any conscious conscious thought, belief, value, idea, image, attitude thought, belief, value, idea, image, attitude in the person’s mindin the person’s mind

Hindsight Bias (Brewin, 2003)Hindsight Bias (Brewin, 2003) Assumptive World Views (Janoff-Assumptive World Views (Janoff-

Bulman1989)Bulman1989) Key Thoughts at moment of dangerKey Thoughts at moment of danger Attribution Theory (Heider,1958)Attribution Theory (Heider,1958) Heuristic Biases (Kahneman & Heuristic Biases (Kahneman &

Tversky,1974)Tversky,1974)

Hindsight Bias (Brewin, Hindsight Bias (Brewin, 2003)2003)

The tendency for someone to assume, once The tendency for someone to assume, once something is known to have happened, that it could something is known to have happened, that it could and should have been anticipatedand should have been anticipated

So pervasive that not only onlookers but also victims So pervasive that not only onlookers but also victims often blame themselves for not acting differentlyoften blame themselves for not acting differently

HB also relates to the tendency to blame victims for HB also relates to the tendency to blame victims for their misfortunes = Maintains Psychological Distance their misfortunes = Maintains Psychological Distance from the trauma in other peoplefrom the trauma in other people

Victims of trauma arouse discomfort in others by Victims of trauma arouse discomfort in others by their mere presence, particularly when the victim their mere presence, particularly when the victim does not make a speedy recoverydoes not make a speedy recovery

Victims of trauma shatter our illusions of Victims of trauma shatter our illusions of invulnerabilityinvulnerability

Assumptive World View Assumptive World View (Janoff-Bulman, 1989)(Janoff-Bulman, 1989)

Awareness of our own mortality carries with it a Awareness of our own mortality carries with it a potential for high levels of anxietypotential for high levels of anxiety

As a protection against this awareness, people hold As a protection against this awareness, people hold cultural worldviews that provide explanations for cultural worldviews that provide explanations for existence, standards for what is valuable and a existence, standards for what is valuable and a promise of immortality to those who live up to these promise of immortality to those who live up to these standardsstandards

When confronted with reminders of our own When confronted with reminders of our own mortality, people either exaggerate their own mortality, people either exaggerate their own invulnerability or deliberately suppress thoughts of invulnerability or deliberately suppress thoughts of deathdeath

When reminders of death become more salient, When reminders of death become more salient, people undergo subtle changes of which they may be people undergo subtle changes of which they may be unaware such as increased liking for those who hold unaware such as increased liking for those who hold similar worldviews and hostility towards those with similar worldviews and hostility towards those with alternative worldviewsalternative worldviews


In the presence of victims, people feel ill at easeIn the presence of victims, people feel ill at ease

Even people who are actively trying to support Even people who are actively trying to support trauma victims are prone to switch the topic of trauma victims are prone to switch the topic of conversation to something more neutral, press their conversation to something more neutral, press their own perspective on the victim or avoid them own perspective on the victim or avoid them altogetheraltogether

Fundamental human difficulty in comprehending and Fundamental human difficulty in comprehending and acknowledging our own vulnerabilityacknowledging our own vulnerability

Historically, the influence of psychoanalytic theories Historically, the influence of psychoanalytic theories that were rooted in internal fantasies rather than that were rooted in internal fantasies rather than external realities, have, paradoxically, supported external realities, have, paradoxically, supported these attitudes to victims these attitudes to victims


The World is Benevolent – positive events are The World is Benevolent – positive events are believed to happen frequently & negative events believed to happen frequently & negative events are thought to be rare & people are viewed as are thought to be rare & people are viewed as generally goodgenerally good

The World is Meaningful – Events make sense and The World is Meaningful – Events make sense and bad outcomes are believed to be justly distributedbad outcomes are believed to be justly distributed

The Self is Worthy – If we see ourselves as good, The Self is Worthy – If we see ourselves as good, we assume we are protected from negative we assume we are protected from negative events. After all, if one is good, then only good events. After all, if one is good, then only good things should happen!things should happen!

Key CognitionsKey Cognitions

Thoughts which the person has at Thoughts which the person has at the moment of danger have been the moment of danger have been demonstrated to play an important demonstrated to play an important role in the genesis of PTSDrole in the genesis of PTSD

Thoughts such as “I’m going to die”, Thoughts such as “I’m going to die”, “I won’t make it”, “I’ll never see my “I won’t make it”, “I’ll never see my children again” or “I’m tumbling into children again” or “I’m tumbling into the next life” the next life”

Attribution Theory Attribution Theory (Heider, 1989)(Heider, 1989)

AT seeks to understand how people AT seeks to understand how people explain to themselves how events in the explain to themselves how events in the world happenworld happen

People use ad hoc biases, categorization People use ad hoc biases, categorization processes and other moderating influences processes and other moderating influences to explain, or explain away, eventsto explain, or explain away, events

6 Attribution Errors6 Attribution Errors


Fundamental Attribution Error – Observers Fundamental Attribution Error – Observers underestimate the importance of situation underestimate the importance of situation factors and overestimate that of dispositional factors and overestimate that of dispositional factors. In other words, people are seen as factors. In other words, people are seen as causes too often and situations are seen as causes too often and situations are seen as causes too rarelycauses too rarely

This locates the problem within the individual This locates the problem within the individual and relieves the rest of us and organizations and relieves the rest of us and organizations etc of any responsibility for the eventetc of any responsibility for the event

EG= widespread use of medication in EG= widespread use of medication in psychiatry even though there may be little psychiatry even though there may be little evidence for its effectiveness in specific evidence for its effectiveness in specific situations or conditionssituations or conditions


Actor/Observer Divergence – People Actor/Observer Divergence – People attribute their own actions to the attribute their own actions to the situation but attribute the same situation but attribute the same actions by someone else to that actions by someone else to that person’s dispositionperson’s disposition

Let ourselves off the hook with this Let ourselves off the hook with this attribution really & blame the other attribution really & blame the other person who might do the same thing person who might do the same thing as ourselvesas ourselves


Hedonic Relevance – We see actions Hedonic Relevance – We see actions which have more affective consequences which have more affective consequences for ourselves as being more dispositional for ourselves as being more dispositional than other actionsthan other actions

(EG) – car rolling down a hill when the (EG) – car rolling down a hill when the owner forgot to put the handbrake on. If owner forgot to put the handbrake on. If it crashes into my car, I will tend to see it crashes into my car, I will tend to see this as deliberately caused. If its not my this as deliberately caused. If its not my car which is struck, then it is just an car which is struck, then it is just an “accident”“accident”


People are perceived as more responsible People are perceived as more responsible for acts with serious consequences as for acts with serious consequences as opposed to actions with trivial opposed to actions with trivial consequencesconsequences

Attributions follow affective relationships –Attributions follow affective relationships –thus “good” actions by liked people are thus “good” actions by liked people are attributed to the person and “bad” actions attributed to the person and “bad” actions by liked people to the situation. “Good” by liked people to the situation. “Good” actions by disliked people are attributed to actions by disliked people are attributed to the situation and “bad” actions by disliked the situation and “bad” actions by disliked people are attributed to the personpeople are attributed to the person

Heuristic Biases Heuristic Biases (Kahneman & Tversky, (Kahneman & Tversky,

1974)1974) Judgement under UncertaintyJudgement under Uncertainty People pay little attention to base rate probability (ie) People pay little attention to base rate probability (ie)

airplane crashesairplane crashes People tend to end their search for a causal People tend to end their search for a causal

explanation of events at the first reason which explanation of events at the first reason which provides a plausible explanation (eg) power of labels provides a plausible explanation (eg) power of labels such as mental illness or “satisficing” in orgssuch as mental illness or “satisficing” in orgs

Data which conflicts with my worldview is likely to be Data which conflicts with my worldview is likely to be discredited while supporting data is unquestioningly discredited while supporting data is unquestioningly accepted (eg) effects of environmental tobacco smoke accepted (eg) effects of environmental tobacco smoke

Ref: Enstrom,J & Kabat, G (2003) “Environmental Ref: Enstrom,J & Kabat, G (2003) “Environmental Tobacco smoke and tobacco related mortality in a Tobacco smoke and tobacco related mortality in a prospective study of Californians 1960 -98”, prospective study of Californians 1960 -98”, The The LancetLancet, bmjjournals.com, bmjjournals.com

Hierarchy of Negative Hierarchy of Negative Cognitions/Beliefs in PTSDCognitions/Beliefs in PTSD

Responsibility - “It was my fault, I should have done Responsibility - “It was my fault, I should have done something” – victims of CSA often present with this NCsomething” – victims of CSA often present with this NC

Safety - “I am in danger/ I cannot protect myself/ I Safety - “I am in danger/ I cannot protect myself/ I cannot trust my judgement/ I can’t trust anyone” – cannot trust my judgement/ I can’t trust anyone” – resulting in hypervigilance and often following resulting in hypervigilance and often following Rape/RTA/ WarRape/RTA/ War

Choice & Control – “I’m powerless”/ “I’m not in control”Choice & Control – “I’m powerless”/ “I’m not in control”

Self-Defectiveness – “I am a failure/ I am permanently Self-Defectiveness – “I am a failure/ I am permanently damaged / I’m a bad person /I’m a disappointment / I am damaged / I’m a bad person /I’m a disappointment / I am shameful/ I’m good enough”shameful/ I’m good enough”

Affects & PTSDAffects & PTSD Strong emotions/feelings Strong emotions/feelings

experienced by people with experienced by people with PTSDPTSD

Strong physical sensations (eg) Strong physical sensations (eg) heart rate can predict PTSDheart rate can predict PTSD

Strong sensory elements Strong sensory elements associated with PTSD (eg) associated with PTSD (eg) intrusive images of the event intrusive images of the event or flashbacks, auditory or flashbacks, auditory sensations such as ambulance sensations such as ambulance sirens, smell of petrol/burning sirens, smell of petrol/burning fuelfuel

““Emotional” Brain centrally Emotional” Brain centrally activated in PTSD (eg) Limbic activated in PTSD (eg) Limbic system, Amygdala, HAP system system, Amygdala, HAP system (Hypothalamus, Adrenal & (Hypothalamus, Adrenal & Pituitary)Pituitary)

Right Hemisphere of Brain Right Hemisphere of Brain foremost in PTSDforemost in PTSD

Alan Schore (2007) & Van der Alan Schore (2007) & Van der Kolk (2007) both maintain Kolk (2007) both maintain that “mobilization for action” that “mobilization for action” is an automated response to is an automated response to threat in humans and all threat in humans and all animals (eg) flight/fight animals (eg) flight/fight responseresponse

Left hemisphere involved in Left hemisphere involved in executive functions, executive functions, attention, working memory, attention, working memory, self-observation, reflection, self-observation, reflection, morals & values, reasonmorals & values, reason

High Arousal impairs Pre-High Arousal impairs Pre-Frontal Cortex FunctionsFrontal Cortex Functions

Affects & PTSDAffects & PTSD Neuromodulators such as catecholamines are Neuromodulators such as catecholamines are

released into the CNS and Peripheral NSreleased into the CNS and Peripheral NS These chemicals “turn on” heart and muscles These chemicals “turn on” heart and muscles

and “turn off” stomachand “turn off” stomach In the Brain, these chemicals “turn off” the pre-In the Brain, these chemicals “turn off” the pre-

frontal cortex – we cannot deliberately direct our frontal cortex – we cannot deliberately direct our attention, hold values or goals in mind, think attention, hold values or goals in mind, think logically, or imagine alternativeslogically, or imagine alternatives

““Primitive” sub-cortical structures control Primitive” sub-cortical structures control behaviour and implement “hard wired” behaviour and implement “hard wired” responsesresponses

Evolutionary origins = “Stop to think and you're Evolutionary origins = “Stop to think and you're lunch”lunch”

Affects & PTSDAffects & PTSD The result is that traumatic, angry experiences are The result is that traumatic, angry experiences are

“burned in” – this is why the bad experiences from our “burned in” – this is why the bad experiences from our childhood are often more vivid than the good childhood are often more vivid than the good experiences about growing upexperiences about growing up

Defensive responses inconsistent with our values and Defensive responses inconsistent with our values and ideal self are reinforced (eg) irritability and angerideal self are reinforced (eg) irritability and anger

Feelings of Regret, Shame, Guilt, fervent resolutions Feelings of Regret, Shame, Guilt, fervent resolutions about the “next time” all have little effect on the about the “next time” all have little effect on the Brain’s conditioning, including vulnerability to losing Brain’s conditioning, including vulnerability to losing executive functions in similar situations in the futureexecutive functions in similar situations in the future

““Primacy of Affect” – Alan Schore (2007) – “the locus of Primacy of Affect” – Alan Schore (2007) – “the locus of the emotional brain represents the biological substrata the emotional brain represents the biological substrata of the Unconscious as described by Freud”of the Unconscious as described by Freud”

““The Body keeps the Score” – van der Kolk (2007)The Body keeps the Score” – van der Kolk (2007)

Affects & PTSDAffects & PTSD RH = location of “corporeal self” and is centrally RH = location of “corporeal self” and is centrally

involved in bodily-based emotional processes, involved in bodily-based emotional processes, empathy, processing of non-conscious self images, empathy, processing of non-conscious self images, threat detection, regulation of endocrinological and threat detection, regulation of endocrinological and physiological functions, the human stress response physiological functions, the human stress response and survivaland survival

Emotions represent reactions to fundamental Emotions represent reactions to fundamental relational meanings that have adaptive significance relational meanings that have adaptive significance (Lazarus, 1991)(Lazarus, 1991)

From an evolutionary perspective, emotions function From an evolutionary perspective, emotions function to signal safety or imminent danger & motivate the to signal safety or imminent danger & motivate the person for either approach or avoidance behaviourperson for either approach or avoidance behaviour

Affect amplifies and extends the duration and impact Affect amplifies and extends the duration and impact of whatever activates itof whatever activates it

Affects & PTSDAffects & PTSD In summary, emotions are dominant in trauma In summary, emotions are dominant in trauma

reactions, not reasonreactions, not reason RH is dominant in all forms of affect RH is dominant in all forms of affect

stimulationstimulation Historically, psychotherapy has relied on LH, Historically, psychotherapy has relied on LH,

verbal, rational executive Brainverbal, rational executive Brain Psychotherapy is not the “talking cure” Psychotherapy is not the “talking cure”

anymore but the “affect regulating cure”anymore but the “affect regulating cure” All therapies of whatever school, are now All therapies of whatever school, are now

beginning to focus on affect regulation as the beginning to focus on affect regulation as the primary goal of psychotherapy in treating primary goal of psychotherapy in treating PTSDPTSD

Individual Factors in Individual Factors in PTSDPTSD

Individual factors – Individual factors – Life Stage Development of the person Life Stage Development of the person

at time of Traumaat time of Trauma 3 key phases – Early Adulthood (18 - 3 key phases – Early Adulthood (18 -

25yrs “Who will I be?”), Mid-Life (35 - 25yrs “Who will I be?”), Mid-Life (35 - 50 yrs “Who am I?”), Late Adulthood 50 yrs “Who am I?”), Late Adulthood (60+ “Who was I?”)(60+ “Who was I?”)

At each Life phase, individual is At each Life phase, individual is particularly vulnerable to stress/traumaparticularly vulnerable to stress/trauma

Individual Factors in Individual Factors in PTSDPTSD

Previous exposure to trauma experiences Previous exposure to trauma experiences over the life cycle (eg) CSA, RTA, Assault, over the life cycle (eg) CSA, RTA, Assault, Losses, Neglect/ Abandonment Losses, Neglect/ Abandonment

Witnessing trauma to othersWitnessing trauma to others Personality – introverted personality Personality – introverted personality

appears to be more vulnerable to PSD. appears to be more vulnerable to PSD. “Hardy” personality less so“Hardy” personality less so

Cumulative effects of prolonged exposure to Cumulative effects of prolonged exposure to stressful and traumatic experiences (eg) stressful and traumatic experiences (eg) police/rescue workerspolice/rescue workers

““Emotional Intelligence” – those with good Emotional Intelligence” – those with good EI are thought to be more resilient to EI are thought to be more resilient to developing trauma reactionsdeveloping trauma reactions

Organizational Factors & Organizational Factors & PTSDPTSD

Orgl Culture – macho culture, bullying style of Orgl Culture – macho culture, bullying style of Mgt/ Peers, Long working day, Lack of supportive Mgt/ Peers, Long working day, Lack of supportive atmosphere, Crisis & Fire Fighting as normal atmosphere, Crisis & Fire Fighting as normal working day, Tyranny of the Urgent V the working day, Tyranny of the Urgent V the Important in work, Excess of Critical Incidents at Important in work, Excess of Critical Incidents at work, Micromanagement from Senior figureswork, Micromanagement from Senior figures

Orgl “Defensive Routines” (eg) Denial of problems, Orgl “Defensive Routines” (eg) Denial of problems, Reactions to Whistleblowers,Reactions to Whistleblowers,

Persecutory Leadership/Mgt stylePersecutory Leadership/Mgt style Emotions are “contagious” hence importance of Emotions are “contagious” hence importance of

social processes in development of anxietysocial processes in development of anxiety Management V LeadershipManagement V Leadership Breaking of the “Psychological Contract” Breaking of the “Psychological Contract”

Secondary TraumaSecondary Trauma

Recently recognized phenomena among Recently recognized phenomena among workers exposed to others’ trauma (eg) workers exposed to others’ trauma (eg) therapists/lawyers/aid workerstherapists/lawyers/aid workers

These professionals can experience range of These professionals can experience range of symptoms secondary to their exposure to symptoms secondary to their exposure to clients’ traumaclients’ trauma

Historically, seen as “burn-out” or “counter-Historically, seen as “burn-out” or “counter-transference”transference”

ST provides more complex and sophisticated ST provides more complex and sophisticated explanation of professionals’ reactionsexplanation of professionals’ reactions


ST can involve profound changes in ST can involve profound changes in the profl’s self including:the profl’s self including:

Disruptions in cognitive schemasDisruptions in cognitive schemas Memory functioningMemory functioning Team workingTeam working Interpersonal relationshipsInterpersonal relationships Concerns for safetyConcerns for safety Intrusive imagesIntrusive images


ST is hypothesized to be rooted in ST is hypothesized to be rooted in the profls’ “empathic engagement” the profls’ “empathic engagement” with the client’s traumatic storywith the client’s traumatic story

Therapist treating torture victimsTherapist treating torture victims Lawyer listening to client’s story of Lawyer listening to client’s story of

raperape Aid worker interviewing refugeesAid worker interviewing refugees

Similarities between Burn-Similarities between Burn-out & STout & ST

Both involve physical reactions (eg) digestive Both involve physical reactions (eg) digestive problems, headaches, increased heart rateproblems, headaches, increased heart rate

Both involve emotional reactions (eg) anxiety, Both involve emotional reactions (eg) anxiety, withdrawal, feelings of helplessness or hopelessnesswithdrawal, feelings of helplessness or hopelessness

Both involve behavioural reactions (eg) sleep Both involve behavioural reactions (eg) sleep disturbance, increased use of drugs or alcoholdisturbance, increased use of drugs or alcohol

Both involve work related issues (eg) team working Both involve work related issues (eg) team working difficulties, conflictsdifficulties, conflicts

Both involve interpersonal relations (eg) arguments, Both involve interpersonal relations (eg) arguments, irritability with othersirritability with others

Both can result in decreased concern for clients/org Both can result in decreased concern for clients/org and lead to decline in performance at workand lead to decline in performance at work

Differences between Burn-Differences between Burn-out & STout & ST

Burn-out more associated with Burn-out more associated with stress in the workplace in stress in the workplace in generalgeneral

Burn-out can happen in any Burn-out can happen in any workplace workplace

Burn-out relates to feelings of Burn-out relates to feelings of overload secondary to work overload secondary to work related issues & complexityrelated issues & complexity

Burn-out progresses gradually Burn-out progresses gradually as a result of emotional as a result of emotional exhaustionexhaustion

Burn-out does not result in Burn-out does not result in similar feelings as STsimilar feelings as ST

ST = traumatic reaction to ST = traumatic reaction to specific client presented specific client presented informationinformation

ST only occurs in those who work ST only occurs in those who work with trauma survivorswith trauma survivors

ST related to specific client ST related to specific client trauma experiencestrauma experiences

ST often has sudden onset of ST often has sudden onset of symptoms not detectable at an symptoms not detectable at an early stageearly stage

At personal level, ST leads to At personal level, ST leads to feelings of hypervigilance, trust feelings of hypervigilance, trust issues, feelings of being out of issues, feelings of being out of control, intimacy issues, esteem control, intimacy issues, esteem needs, safety concerns and needs, safety concerns and intrusive imageryintrusive imagery

Conclusion & Future Conclusion & Future DirectionsDirections

““The Body never lies” – van der The Body never lies” – van der Kolk (2007)Kolk (2007)

Psychotherapy for PTSD will Psychotherapy for PTSD will become more Body focused & become more Body focused & oriented because that is where oriented because that is where the trauma is remembered and the trauma is remembered and felt felt

Treatments with major focus on Treatments with major focus on the Body likely to become the the Body likely to become the “treatment of choice” in PTSD “treatment of choice” in PTSD such as EMDR (Shapiro, 1989) & such as EMDR (Shapiro, 1989) & possibly Sensory-Motor therapy possibly Sensory-Motor therapy (Ogden, 2006)(Ogden, 2006)

More growth experiences from More growth experiences from PTSD recorded & researchedPTSD recorded & researched

Affect Regulation likely to Affect Regulation likely to become the goal of become the goal of Psychotherapy treatment in Psychotherapy treatment in PTSD and related disorders such PTSD and related disorders such as Anxiety/ Panic/ Phobic as Anxiety/ Panic/ Phobic DisordersDisorders

EMDR = well validated in the EMDR = well validated in the literature. Already accepted as literature. Already accepted as the “treatment of choice” by the “treatment of choice” by Govt bodies in USA, NICE Govt bodies in USA, NICE (UK), France, Sweden, Holland (UK), France, Sweden, Holland

Positive Psychology (Seligman, Positive Psychology (Seligman, 2000 address to APA) likely to 2000 address to APA) likely to be major influence (eg) be major influence (eg) “Broaden & Build” approach of “Broaden & Build” approach of Frederickson (2003)Frederickson (2003)

Macro-environment likely to Macro-environment likely to be more competitive following be more competitive following disasters (ie) for-profit orgs disasters (ie) for-profit orgs such as Bechtel & Blackwater such as Bechtel & Blackwater now in the market for now in the market for provision of relief & provision of relief & reconstruction following reconstruction following disastersdisasters

ReferencesReferences ““Post Traumatic Stress Disorder – Malady or Post Traumatic Stress Disorder – Malady or

Myth?” Chris Brewin (2003) Myth?” Chris Brewin (2003) London: Yale UPLondon: Yale UP ““A Guide to Psychological Debriefing: Managing A Guide to Psychological Debriefing: Managing

Emotional Decompression & PTSD” David Emotional Decompression & PTSD” David Kinchin (2007) Kinchin (2007) London: Jessica Kingsley London: Jessica Kingsley Pubs Pubs

““A Randomized Clinical Trial of EMDR, A Randomized Clinical Trial of EMDR, Fluoxetine and Pill Placebo in the treatment of Fluoxetine and Pill Placebo in the treatment of PTSD: Treatment Effects and Long Term PTSD: Treatment Effects and Long Term Maintenance” (2007) van der Kolk, B. et al., Maintenance” (2007) van der Kolk, B. et al., Journal of Clinical Psychiatry, Journal of Clinical Psychiatry, Vol. 68, Vol. 68, No.1, pp 37-46No.1, pp 37-46

““The Shock Doctrine: The Rise of Disaster The Shock Doctrine: The Rise of Disaster Capitalism” Naomi Klein (2007) Capitalism” Naomi Klein (2007) London: London: Penguin booksPenguin books

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