Trauma And First RespondersCorey Pavelka

Who are First Responders 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?

anxiety, feeling “revved up;” emotional instability fatigue irritability hyper-vigilance trouble sleeping exaggerated startle

response

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 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

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

Quiz4. 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 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 trauma-related 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 PTSDAcute Stress Disorder PTSDPresent 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

Quiz7. 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

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 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

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=G957P6w1Xfs

Questions

Resources 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-

of-onset 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.